Nodules: rounded lesions

SKIN BACTERIAL INFECTIONS

Urticaria: seen in patients with allergic reaction

- May overlap; has elevation

Bleeding under the Skin

Petechiae: pin-point skin lesions; head of the needle

- Dengue

Purpura: bleeding is greater than 3 mm

Ecchymosis: greater than 3 mm; bruises, blood

clots, black eye

STAPHYLOCOCCUS AUREUS
- Gram-positive round-shaped bacterium
- Usually arranged in grapelike clusters
- A usual member of the microbiota of the body,
frequently found in the upper respiratory tract
Vesicle: small fluid-filled blister on the skin less than
and on the skin
5 mm in diameter
- Most dangerous of all of the many common
- Formation of fluid under the skin
staphylococcal bacteria
- Chicken pox; has water on the lesion
- Produces enzymes and toxins for its
pathogenicity and through direct invasion and
Bulla: more than 5 mm; fluid-filled sac/lesion
destruction of tissues
- Burns

Mode of Transmission – Skin infections are

Macule: flat skin lesion; small patch of skin altered in
transmitted through
color
1. Direct contact with a person having purulent
- Rashes not elevated; discoloration
lesions
2. From the hands of healthcare hospital workers
Papule: skin elevation; small bumps on the skin; no
3. From fomites, like bed linens, and contaminated
pus; can have discoloration
equipment
- Solid; palpable; less than 5mm in diameter
- Solitary (isa lang) or maramihan
Clinical Findings
- Warts, nunal (elevated), pimple without pus
- Folliculitis
- Furuncle
Pustule: small bumps on the skin that contain pus
- Carbuncle
- Pimple with pus
- Sty or Hordeolum
- Impetigo
- Staphylococcal Scalded Skin Syndrome
(SSSS / Ritter’s disease)

Plaque: flat but elevated

 Folliculitis
- A pyogenic (pus-producing) infection involving
the hair follicles
- A common skin condition
Characterized by:
- Localized painful inflammation
- Heals rapidly after draining the pus
Furuncle (Boils)
- An infection of several hair follicles that has a
small collection of pus (called an abscess)
under the skin
- An extension of folliculitis
Characterized by:
- Larger and painful nodules with the underlying
collection of dead and necrotic tissue
Carbuncle
- A red, swollen, and painful cluster of boils that
are connected to each other under the skin
- Represents a coalesce of furuncles that
extends into the subcutaneous tissue with
multiple sinus tracts
- ‘Coalase’ = nagdidikit-dikit
Sty of Hordeolum (Kuliti)
- Involves one or more of the small glands near
the base of the eyelids
- It is red and painful, often filled with pus
Pyoderma (Impetigo)
- Infection common in young children and
primarily involves the face and limbs
- Starts as macule which later becomes a
pus-filled vesicle that ruptures and forms
honey-colored crust
- There maybe enlargement of the regional
lymph nodes but no sign of systemic infection
- Can also be caused by Staphylococcus
pyogens
- A purulent skin infection that is localized and
commonly involves the face, the upper and
lower extremities
- Starts as vesicles then progress to pustules
- The lesion ruptures and forms honey-colored
crusts
Staphylococcal Scalded Skin Syndrome
- Also known as SSSS / Ritter’s Disease
- Primarily found in newborns and young
children
- ‘Scalded’ = parang napaso
Manifestations:
- Exfoliative toxin: responsible for the
manifestations of the disease
- Only the outer layer of the skin is affected,
hence there will be no scarring
1. Sudden onset of periodical erythema or bullous
(redness) that covers the whole within 2 days
2. (+) Nikolsky sign: when pressure is applied to
the skin, it causes displacement of the skin
(wrinkles and tissue paper-like appearance)
3. Bullae and cutaneous blister
4. Desquamation
Laboratory Diagnosis
a. Microscopic examination of Gram-stained
specimen (gram-positive cocci)
b. Culture: gray to golden colonies
c. Qualities of the microorganism
○ Catalase Positive: aerobic bacteria
○ Coagulase Positive: clots plasma
Streptococcus Pyogens
- Gram-positive cocci arranged in pairs or
chains
- Belongs to Groups A beta-hemolytic
- Major virulence factor is M protein which is
anti-phagocytosis (prevents the attack of
phagocytes)
- Produces enzymes and toxins responsible for
the pathogenicity
- Some strains are encapsulated
- Maybe associated with severe systemic
infections
Erysipelas (St. Anthony’s Fire)
- Superficial form of cellulitis
- Follows a respiratory or skin infection
- Affects the upper dermis and extended into
the superficial cutaneous lymphatics

Treatment of Choice – Beta-Lactam antibiotics

Manifestations:
- Develops resistance to penicillin derivatives
- Localized raised areas associated with pain
like methicillin and nafcillin
- Erythema
- Oxacillin: the only penicillin derivative
- Warmth
antibiotic that has remained active
- Lymphadenopathy
- Incision and drainage (I & D)
- Systemic manifestations

Prevention
- Use Standard Precautions for skin, burn, and
wound infections if they are minor
- Contact Precaution if major SSSS
- Standard Precautions for infections caused by
methicillin-resistant S. aureus (MRSA); add
Contact Precautions if wounds cannot be
contained by dressing
Cellulitis
- Involves the skin and the SC tissue
- The infected skin and the normal skin are not
clearly differentiated
- Local inflammation with systemic signs

Staphylococcus Epidermis
- Part of the normal flora of the skin
- Associated with “stitch abscess”, UTI, and
endocarditis
- Causes infection in individuals with prosthetic
devices, cardiac devices, CNS shunts

Necrotizing Fascitis
- Also known as “Flesh-eating” Infection /
Streptococcal Gangrene
- Involves deep SC tissue
- Starts as cellulitis then becomes bullous and
gangrenous
- It spreads to the fascia then the muscle and
fat
- May become systemic and cause multi-organ
failure to death
Complications of Streptococcal Infection
1. Acute Glumerolous Nephritis
- Commonly associated with skin infections
2. Rheumatic Fever
- Associated with throat infections
- Non-supporative, immune-mediated
complications
3. Scarlet Fever / Scarlatina
- Develop in some people who have strep
throat
- Manifested by the strawberry tongue, bright
red rash that covers most of the body, sore
throat, and fever
Laboratory Diagnosis
a. Microscopy: gram stain of samples of infected
tissue will show gram-positive cocci in pairs and
chains associated with leukocytes
b. Culture: positive beta hemolysis in blood agar
c. Bacitracin test: antibiotic susceptibility test
with (+) zone of inhibition of growth around the
Bacitracin disc
Treatment of Choice: Penicillin
- In case of penicillin allergy, macrolides
(erythromycin, azithromycin) or
cephalosporins are alternate drugs
- The drainage of pus and thorough
debridement of infected tissues
Pseudomonas Aeruginosa
- An opportunistic aerobic gram-negative
bacillus that is frequent and common cause of
nosocomial infection (hospital-acquired)
- Capable of water-soluble pigments
(pyocyanin-blue)
- Resistant to most antibiotics
- Virulence is attributed to adhesins (flagella,
pili, LPS), toxins (exotoxin A, pigments) and
enzyme
- Infects extensive skin burns, which can be a
source of sepsis
- Has been cultured from washbasins,
respirator tubing, nursery cribs, and even
antiseptic-containing bottles
- Causes corneal keratitis in wearers of contact
lenses, endocarditis, and osteomyelitis in
intravenous drug abusers, external otitis
(swimmer’s ear) in healthy individuals, and
severe external otitis is diabetics
Mode of Transmission
- Colonization or previously injured skin
Clinical Findings
1. Blue-green pus hat exudes a sweet grape-like
odor
- Blue-green due to water-soluble pigments
2. Other skin infections are folliculitis and
secondary infections in individuals with acne
and nail infections resulting from immersion in
contaminated water
3. Osteochondritis: most common cause of
inflammation of the bone and cartilage of the
foot following a penetrating injury
Laboratory Diagnosis
a. Gram stain: gram-negative bacilli arrange
individually and in pairs
b. Culture: flat colonies with green pigmentation
 c. Oxidase test is positive: aerobic and can use
oxygen as a terminal electron acceptor in
respiration
Treatment & Prevention
- P.aerogenosa: resistant to most antibiotics
hence C & S must be done
- Preventive measures must be done and
focused on preventing contamination of sterile
hospital equipment and instruments and
cross-contamination of patients by hospital
personnel
Mode of Transmission
Pseudomonas Aeruginosa
A Aerobic
Clinical Findings
E Exotoxin A
R Rod / Resistance
U UTI, burns, injuries
G Green-blue dressing
I Iron-containing lesions
N Negative grams
O Odor of grapes
S Slime capsule sometimes
A Adherin pili
Clinical Findings of Pseudomonas Aeruginosa
- Ocular keratitis contact lens wearers,
endocarditis, and osteomyelitis in IV drug
users
- External otitis (swimmer’s ear) in healthy
people, and severe external otitis in diabetics
- Many persons with cystic fibrosis die of
respiratory failure caused by P. aeruginosa
infection
- P. aeruginosa frequently infects extensive skin
burns, which can lead to sepsis
Laboratory Diagnosis
Clostridium Perfringes
- Formerly known as C. welchii, or Bacillus
welchii
- Gram-positive bacteria
- Anaerobic and rarely produce endospores
- Produces 4 lethal toxin: alpha (most lethal),
beta, iota, epsilon toxin
- Toxins: cause massive hemolysis, bleeding,
and tissue destruction
- Associated with soil and water, and also feces
- Colonization of the skin following physical
trauma and surgery
1. Cellulitis
- Common bacterial skin infections that cause
redness, swelling, and pain in the infected
area of the skin
2. Suppurative Myositis
- An acute intramuscular infection that develops
secondary to hematogenous microorganisms
spread into the body of skeletal muscle,
manifested by abscess formation of large
muscle groups
3. Myonecrosis or gas gangrene
Clostridial Myonecrosis (Gas Gangrene)
- A life-threatening infection following trauma or
surgery
- Characterized by massive tissue necrosis with
gas formation, shock, renal failure, and death
within 2 days of onset
- Gangrenous tissue
- Brutal killer
a. Microscopic detection of gram-positive bacilli
and culture under an anaerobic conditions
Treatment & Prevention 3 Forms of Anthrax Disease
- Surgical wound debridement
- High-dose penicillin therapy
Patient Care
- Use Standard Precautions

Ingested the infected meat of the infected animal

Bacillus Anthracis
- A gram-positive bacterium
- Spore-forming rod: bamboo rod or medusa
head appearance
- Produces anthrax toxin resulting in an ulcer
with a black eschar
- Deadly disease to livestock and, occasionally,
to humans
Involvement of the skin
- The only permanent (obligate) pathogen
within the genus Bacillus
- Grows slowly in soil types that meet specific
moisture conditions
- Endospores survive in soil tests for up to 60
years

Virulence Factors – 2 exotoxins

1. Edema Toxin
- Local edema (swelling) and interferes with Spores of anthrax is inhaled by the patient;
phagocytosis by macrophages dangerous
2. Lethal Toxin
- Targets and kills macrophages, which
disables an essential defense of the host
Protective Agent
- A cell receptor-binding protein that binds the
toxins to target cells and permits their entry

Anthrax Disease
- Bacterial disease caused by bacillus anthracis
that can affect skin, and lungs, or
gastrointestinal tract depending on the portal
of entry of the etiologic agent
- Disease of Herbivores: strikes primarily
grazing mammals, such as cattle and sheep
- People at risk are those who handle animals, Mode of Transmission
hides wool, and other animal products - Inoculation into the open skin from either the
soil or infected animal products
 - Ingestion of infected meat or milk - Common during the summer season
- Inhalation of aerosolized spores
Laboratory Diagnosis Pathogens
a. Blood test detects both inhalation and - Common are Haemophilus influenzae
cutaneous cases of anthrax within an hour subspecie aegyptius (most common),
b. The peripheral blood contains a large number Streptococcus pneumoniae and other bacteria
of B. anthracis which is easily seen on gram Patient Care
stain - Standard Precaution
c. Spores can be done using Dorner stain or Wirtz Reservoirs
Conklin - Infected humans
Mode of Transmission
- Human-to-human transmission occurs via
contact

Wirtz Conklin Staining Method

Treatment & Prevention

- Antibiotics, like penicillin or doxycycline, are
the drugs of choice
- Vaccination of livestock in endemic areas;
single dose of live, attenuated vaccine is
used, which is unsafe for use in humans Haemophilus Influenzae Biogroup Aegyptius
- Vaccine approved for humans: contains - Known as the Koch-Weeks bacillus
inactivated form of antigen toxin to prevent - Gram-negative bacterium
entry of 2 toxins into the host’s cells - Rod-shape (coccobacillus)
- For people who have been exposed to B. - Causative agents of acute and often purulent
anthracis: 3 doses of the vaccine over 4 conjunctivitis
weeks, along with antibiotic treatment, are - Caused worldwide seasonal epidemics
recommended (summer)
- Virulence: pili
Patient Care - Transmission: mechanical
- Standard Precautions - Sulfunamide and gentamycin effective
- Add Contact Precautions for cutaneous
anthrax patient if there is a large amount of
uncontaminated drainage Streptococcus Pneumoniae
- Use soap and water for handwashing; alcohol - Gram-positive, facultatively anaerobic
does not have a specific activity pathogen, in pairs, encaptsulated
- Aerobic = alpha hemolytic; Anaerobic = beta
hemolytic
OCULAR BACTERIAL INFECTIONS
- Lancet shaped
- Virulence: adhesin, capsule, toxin,
Bacterial Conjunctivitis (Pink Eye) pneumolysin, and IgA
- Inflammation / infection of conjuctiva
- Involves irritation, reddening of conjunctiva; Chlamydia Trachomatis
edema of eyelids, mucopurulent discharge, - A small gram-negative bacterium and obligate
sensitivity to light; highly contagious intracellular pathogen; cell with high lipid
 - Susceptible to sufonamides - Corneal vascularization
- associated with eye infections such as
conjunctivitis, and trachoma
- Chlamydia trachomatis bacterium = most
commonly spread through vaginal, oral, and
anal sex

2 Forms:
a. Elementary body: non-replicating infectious
particle
Chlamydia Keratoconjunctivitis
b. Reticulate body: replication and growth
- Also known as Trachoma / Chronic
Keratoconjtivitis
- Caused by serotypes A, B, and C

Transmission
- Eye-to-eye by droplets
- Fomites
- Eye-seeking flies (in poor living conditions)

Signs & Symptoms

- Follicular conjunctivitis with diffuse
inflammation involving entire conjuctiva
Conjunctivitis due to C. Trachomatis
○ Progress to conjunctiva scarring
- Also known as “swimming pool conjunctivitis” producing in-turned eyelids → ulceration
- Adults: occur with non-gonococcal urethritis or → scarring → invasion of vessels into
cervicitis (genital to eyes transfer) cornea → loss of vision (frequent cause
- There is mucopurulent eye discharge that of blindness)
occurs with pneumonia or chlamydial
nasopharyngitis
Neisseria Gonorrheae (Gonococcus)
Transmission - A kidney bean-shaped, gram-negative
- Acquired in non/poor chlorinated swimming diplococcus
pool - Common cause of STI in
neonates–”Opthalmia Neonatorum”
- Adults: transmitted through finger-to-eye
contact, involving infectious genital secretions

Signs & Symptoms

- Redness and swelling of conjunctiva
Chlamydial Conjunctivitis - With purulent eye discharge
- If untreated = leads to corneal ulceration,
- Also known as Inclusion conjunctivitis / perforation and blindness
Paratrachoma
- Caused by serotypes D to K Prevention
- Adults: associated with genital infection - Neonate: 1% silver nitrate (Crede’s
- Newborn: acquired upon the passage in birth prophylaxis) after birth, or;
canal ○ Silver nitrate: not available:
- 1% tetracycline eye ointments, or;
Signs & Symptoms - 0.5% erythromycin eye ointments
- Swelling of eyelids with mucopurulent keratitis ○ Erythromycin (most used)
- Corneal infiltrates
 FOODBORNE DISEASES
A. Gastritis
- Inflammation of the gastric lining - Loss of haustra (fold of the large intestine),
B. Enteritis damages the lining, and produces false
- Inflammation of the small intestine pseudopolyp
C. Colitis
- Inflammation of the inner lining of the colon
D. Gastroenteritis
- Involves the stomach and intestines
E. Hepatitis
- inflammation of the liver
F. Dysentery
- inflammation of the intestines that causes
bloody or mucoidal diarrhea

Gastritis & Gastric Ulcers

Signs & Symptoms
- Sharp or burning pain emanating from the
abdomen
- Severe ulcers can be accompanied by bloody
stools, vomiting, or both
- Worst at night, after eating, or under
psychological stress

Causative Agent
- Helicobacter Pylori: has the ability to survive
acidic environment
Establishment of Infectious Disease in the Digestive System
○ Bores hole in the GI lining and hides
○ Ulceration 1. Pharmacologic Action
- Some bacteria may alter normal intestinal
function without causing lasting damage to
their cells
Ex. vibrio cholerae – produces voluminous, watery
diarrhea due to its ability to induce increased
electrolytes into the intestine

2. Local Inflammation
- Invasion of the alimentary tract by microbes
can lead to inflammation
- Invasion is usually limited to the epithelial
layer but may spread to the deeper tissues
- Mouth: the gums are usually affected,
causing periodontitis
 - Intestines: infections can cause inflammation
that can result to dysentery 8. Bacillus anthracis
9. Mycobacterium tuberculosis
3. Deep Tissue Invasion 10. Clostridium botulinum
- Certain organisms are able to spread to
adjacent tissues and enter the bloodstream
- The parasite is often colonized by GUT
bacteria, and as a result, infection by this
worm can lead to polymicrobial septicemia
Ex. parasite Strongyloides – capable of burrowing
through the intestinal wall
4. Perforation
- When the mucosal epithelium is perforated,
the normal flora spills into sterile areas, and
invades deep tissues, often with serious
consequences
Ex. perforation of an inflamed appendix can lead to
peritonitis
BACTERIAL INFECTIONS of the GIT
A. Bacterial Enterocolitis (food poisoning)
- An illness caused by the consumption of food
contaminated with bacteria of bacterial toxins
Causes
- Bacillus cereus, Staphylococcus aureus,
Clostridium perfringes, Vibrio parahemolyticus
3 Mechanisms of Food Poisoning
1. Ingestion of preformed toxin
- Present in contaminated food
- Signs & Symptoms – developed in few
hours, consisting of explosive diarrhea;
abdominal pain
- Casues: Staphylococcus aureus, Vibrio
cholerae, Clostridium Botulinum
2. Infection by toxigenic organisms
- Involve secretory enterotoxin, dysentery
3. Infection by enteroinvasive organisms
- Proliferate, invade, destroy epithelial cells –
dysentery
B. Gastroenteritis (Diarrhea)
- An inflammation of the lining of the intestines
Causes
1. Escherichia coli
2. Salmonella sp Signs & Symptoms
3. Shigella sp
4. Yersinia enterocolitica
5. Vibrio cholera
6. Clostridium perfringes
7. Clostridium difficile
Clostridium Perfringes
- Common source: beef, poultry, gravies, and
dried or pre-cooked foods
- Occurs when foods are prepared in large
quantities and kept warm for a long time
before serving
- Develop diarrhea and abdominal cramps
within 6~24 hours (typically 8~12 hours)
- Usually begins suddenly and lasts for less
than 24 hours
- People infected with C. perfringes usually do
not have fever or vomiting
Clostridium Difficile
- Gram-postive species of spore-forming
bacteria
- Clostridioides spp. are anaerobic, motile
bacteria, ubiquitous in nature and especially
prevalent in soil
- Its vegetative cells are rod-shaped,
pleomorphic, occur in pairs or short chains
Salmonella
- A genus of rod-shaped gram-negative
flagellated facultatively anaerobic bacilli of the
family Enterobacteriaceae
- Most frequently reported cause of
food-related illness
- Salmonella bacteria typically live in animal
and human intestines and are shed through
feces
Salmonellosis (Salmonella Poisoning)
- Humans become infected most frequently
through contaminated water or food
- Typhoid Fever & Gastroenteritis: most
severe manifestation of Salmonella genus
- Incubation Period: ½ ~ 48 hours
- Abrupt onset of severe diarrhea and
abdominal cramps
- Stools are offensive and putrefactive at first,
later becoming watery, greenish and bloody
 - Tenesmus (straining at stool)
Vibrio Cholerae
- Concurrent nausea and vomiting
- Abdominal tenderness - Curved (comma-shaped), facultative
- Slight fever anaerobe, gram-negative bacilli
- It is widely distributed in aquatic
Management & Prevention environments, where it is a natura, free-living
- Proper canning, preservation and refrigeration organism
of foods - Naturally lives in brackish or saltwater where
they attach themselves easily to the
Treatment chitin-containing shells of crabs, shrimps, and
- Medical care: fluid and electrolytes other shellfish
- Potassium replacement is a life-saving
measure Cholera (El Tor)
- Treatment of shock if present
- An acute diarrheal infection caused by
- Antibiotics
ingestion of food or water contaminated with
- Nursing care: CBR and comfort measures
the bacterium Vibrio cholerae
- Causes severe watery diarrhea, which can
Shigella Dysenteriae lead to dehydration and even death if
- A species of the rod-shaped bacterial genus untreated
Shigella
- Gram-negative, non-spore-forming, Signs & Symptoms
facultatively anaerobic, nonmotile bacteria - Starts with acute colicky pains in the
- Release toxins that irritate the intestines abdomen, a profuse watery diarrhea,
- Invades villus of large intestine–can perforate yellowish becoming grayish-white sometimes
intestine or invade blood described as “rice-water stools,” vomiting
- Enters Peyer’s patches and instigates - Rapid heart rate
inflammatory response–endotoxin and - Low blood pressure
exotoxins - Loss of skin elasticity
- Dry mucous membranes
- Marked mental depression
Shigellosis (Bacillary Dysentery / Bloody Flux)
- Headache
- Infectious disease caused by a group of - Vomiting
bacteria called Shigella - Fever may or may not be present
- Most severe form of dysentery - Extreme thrist, thickly furred tongue, severe or
violent cramps in the legs and feet
Signs & Symptoms - Face appears shrivered
- Ushered in by chills followed by fever - Eyes sunken
- Nausea and vomiting, abdominal pain - Skin: ash-gray color
- Tenesmus - Washerwoman’s hand – because of rapid
- Severe diarrhea at first, mucoid and later dehydration
bloody, alternating with constipation
○ There is stomach cramps starting a day Management
or two after exposure to the bacteria - Antibiotics
- Bowel movements may be 30~40 times or
more in 24 hours
Clostridium Botulinum
- Extreme thirst and rapid dehydration
- Management: antibiotics and fluid, and - Anaerobic, rod-shape, endospore-forming
electrolytes replacement bacterium that produces a protein with
characteristic neurotoxicity
- Under certain conditions like low oxygen
conditions these organisms may grow in
 foods producing dangerous toxin–botulinum Cause
toxin - Streptococcus mutans

Botulinum Toxins
- Are one of the most lethal substances known
- Block nerve functions and can lead to
respiratory and muscular paralysis
- Grow in inadequately streilized canned foods
- Produces only under anaerobic conditions
and in alkaline or neutral nonacid foods
- Easily destroyed by boiling
Periodontitis / Gingivitis
- Inflammation of the gums or gingiva
Botulism
- Commonly occurs because a film of plaque or
- A paralytic illness caused by a nerve toxin bacteria accumulates on the teeth
that is produced by the bacterium Clostridium - Treponema denticola and Porphyromonas
botulinim gingivalis
- Severe form of food poisoning when the toxin
containing food are ingested

Sign & Symptoms

- Extreme weakness
- Dizziness
- Difficulty in breathing, swallowing, and
speaking
- Marked vertigo
- Disturbances of vision
Treatment
- Antitoxin

MOUTH INFECTIONS
A. Dental carries
- Tooth decay

B. Peridontal disease Acute Necrotizing Ulcerative Gingivitis

- Inflammation of structures that support teeth
- Also known as Vincent’s disease or Trench
Mouth
C. Gingivitis
- Has a sudden onset with gingiva, showing
- Mild form of gum disease
punched-out crater-like ulcerations, covered
with a whitish pseudomembrane, surrounded
D. Periodontitis
by a demarcated zone of erythema
- Chronic gum disease can cause bone
- Any area of the mouth can be affected
destruction and tooth loss
- There is spontaneous bleeding and breath
has fetid odor
E. Acute necrotizing ulcerative gingivitis

Causative Agent
Dental Carries - Prevotell intermedia
- Involves the dissolution of solid tooth surface Treatment
due to the metabolic action of bacteria - Metronidazole