Bacterial Infection

Cellulitis
- It is an infection of the skin and subcutaneous
tissue by streptococcal pyogenes.
- The legs are the common site for cellulitis, but
other parts of the body including the face
may be affected.
- The organism gain entry into the skin via
minor abrasions.
Clinical picture:
The affected area becomes erythematous,
hot, and swollen.

- Cellulitis is not spread from person to

another
Risk factors
- Injury, cut, burn.
- Weak immune system as DM, HIV
- History of cellulitis
- Overweight
Treatment

- Strict bed rest and analgesic.

- Parenteral penicillin, cephalosporin,
erythromycin, or ciprofloxacin for
10-14 days.
Pharmacotherapy considerations

1- Penicillins, cephalosporins and erythromycin

are safe in pregnancy, however ciprofloxacin
are contraindicated (cartilage erosion).
2- Drugs require dose adjustment in renal failure:
*All penicillins except nafcillin and oxacillin
*All cephalosporins except cephoperazone and
cephotriaxone.
*All floroquinolones.
3- Erythromycins can be taken safely in renal
failure but it's contraindicated in liver disease.
Complication if untreated
-Bacteremia
-Endocarditis
-Osteomyelitis
Prevention
-Wash hands
-Clean and care of wounds
-Cover the wound with bandage and change it
at least daily
-People with DM or poor circulation should
take extra-precautions by:
-Moisturizing skin regularly
-Inspection foot daily for any signs of injury
-Trimming fingernails and toenails carefully
 Folliculitis

- It is an infection of the superficial part of the

hair follicle with Staph. aureus.
Clinical picture:
- It produce small pustule on an erythematous
base, centered on the follicle.
Treatment
It can be treated with topical antibacterial agent,
but a systemic antibiotic may be required.
When to see a doctor
if the condition is widespread or the symptoms
don't go away after a week or two of self-care
measures.
Risk factors
- Causing damage to hair follicles through shaving,
waxing, wearing tight clothes or hair styling practices
such as wigs.
-Regularly wearing clothing that traps heat and
sweat, such as rubber gloves or high boots.
-Soaking in a hot tub, or public pool that's not
maintained well.
-Excessive sweating (hyperhidrosis)
- Weak immune system as Diabetes, HIV/AIDS or
another condition that lowers your resistance to
infections
Complication
- Recurrent or spreading the infection
- Destruction the hair follicle and permanent
hair loss
▪ Prevention
▪ Wash skin regularly.
▪ Do laundry regularly. Use hot, soapy water to
wash towels, washcloths
▪ Avoid friction or pressure on skin caused by
backpacks, helmets and tight clothes.
▪ Dry out rubber gloves between uses. after each
use turn them inside out, wash with soap, rinse
and dry well.
▪ Avoid shaving, if possible For people with facial
folliculitis, growing a beard may be a good option
▪ Shave with care or Shaving less often
 Impetigo
- It is a superficial infection of the skin caused
by staph. aureus (bullous) or streptococci
(non-bullous).

Clinical picture:
Bullous impetigo:
- It appears as vesicles and bulla on normal
skin, commonly on trunk, face, hands and
intertriginous area.
Non- Bullous impetigo:
- It occur on the face, arms, legs and scalp
as erythematous lesion which develop
pustule that rupture to leave exudating
surface which dried to form golden yellow
crust.
- It may occur secondary to scabies, head -
louse infestation or insect bite.
-Impetigo is a common contagious skin
infection by touching the sores of a person
with impetigo or items like towels, clothes, or
sheets that the person used.
Risk factors of impetigo
close contact with someone who already has
the infection is the most common risk factor.
Impetigo spreads more easily in:
households
schools
prisons
military training facilities
Treatment:
1- Removal of the crust by warm compressor
using antiseptic solution as potassium
permanganate solution.
2- Topical antibacterial agent as sodium fusidate
or tetracycline.
3- Systemic
Ampicillin, amoxicillin (250 -500 mg/6hr/10 days
Erythromycin (250 mg/6 hr/ 10 days)
Cephalexin (250 -500 mg/6hr/ 10 days)
Or Cefotax 0.5 gm vial 2x/day for 10 days
 Leprosy
- It is bacterial infection caused by :
mycobacterium leprae.
- It is a disease of peripheral nerves, but it also
affects the skin, and sometimes other tissues as
the eyes, the mucosa of the respiratory tract, the
bones and the testes.
- The incubation period is lengthy (several years)
and it likely that most patients acquire the
infection in childhood.
- The disease is acquired as a result of close
prolonged contact with an infected person.
- The clinical pattern of the disease is
determined by the host's cell-mediated
immune response to the organism.

*When it's well-developed (high cell-mediated

immunity); the pattern of the disease is
tuberculoid leprosy, in which: TL
*the skin and peripheral nerves are affected.
*Skin lesions are single or few in number (1-3).
*They are macules or plaques which are hypo-
pigmented in dark skin.
*The lesions are anesthetic.
*The peripheral nerves are thickened and
cord-like with loss of sensation.
*Lepromin test is strongly positive.
*Histology shows well-defined tuberculoid
granulomas and bacilli are not seen on
staining.
When the cell-mediated immune response to
the bacilli is poor, the pattern of the disease
is lepromatous leprosy, in which:
*It involves not only the skin but also, the eyes,
the mucosa of the respiratory tract, the
bones and the testes.
*The skin lesions are multiple and nodular, and
symmetrically distributed.
*If it is on the face, it give lionine face
(characteristic features)
*Lepromin test is negative.
*Histology shows diffuse granulomas and
bacilli are present in large numbers.
N.B
Lepromin test is not diagnostic test, it’s used
to differentiate between LL and TL.
(Intradermal injection of lipromin (heat-sterilized
mycobact. Leprae)
→ palpable nodule in 8-10 days (tuber. Leprosy)
→ no reaction (lepromat. Leprosy)
Borderline leprosy
*It has a combined feature of both polar types (LL
and TL), so the immunity of the patient, number
of lesions, and anesthesia is intermediate
between LL and TL.
Treatment:
Multidrug therapy (to avoid resistance):
Dapsone 100mg/day
(antibacterial)
Dapsone is administered orally as a 100 mg tablet or
alternatively as 25 mg tablets.
To deal with dapsone-resistant leprosy cases, dapsone
is administered along with rifampin and clofazimine
(inhibit bacterial proliferation) or other antileprotic
drugs.
Side effects include: hepatitis and cholestatic jaundice
-Rifampicine:
Side effects: hepatitis and enzyme inducer (metabolic
Viral Skin Diseases
 Herpes simplex infection

- There are two antigenic types:

Type 1 is responsible for the common cold sore
on the lips and face.
Type 2 is associated with genital herpes.

Mode of transmission:
-Droplet infection.
-Direct contact.
 Primary herpes simplex

- Initial contact with the herpes simplex virus

usually occurs in childhood.
- Following a primary infection, the virus
establishes itself in sensory ganglia and may
be triggered to produce recurrent lesions by
a variety of stimuli.
Recurrent herpes simplex:
- It occurs due to activation of the virus by fever,
physical or mental stress, trauma, or menses.
- Recurrent cold sores on the lips are a common
problem.
- The eruption of a group of small vesicles is
preceded by a sensation of tingling or burning
and itching at the affected site.
- The vesicles burst, and become crusted, then the
crust fall within one week leaving normal skin.
-The frequency of episodes usually gradually
declines with advancing years (the body
produce Ab for the virus→ less frequency,
less severe symptoms)

Complication
- Herpes keratitis (if touch the sores then
touch the eye)
Clinical Forms:
- Gingivostomatitis
- Keratoconjunctivitis
- Primary herpes genitals.

-
-Risk factors
-Immunocompromised patients
(children or diseases as DM, HIV)
Treatment:
1- Topical antiviral:
Docosanol 10% cream, approved by FDA. It prevent
the fusion between virus particle and cell
membrane, so reduce cell injury and prevent
replication of virus so rapidly shorten the infection
duration
2-Topical analgesics: Lidocaine, menthol, benzocaine
for controlling pain
3-Drying agents as gentian violet 1% or aluminium
acetate solution 5% (not preferable)
4- Topical protectant: zinc oxide, panthenol, cacao
butter for softening skin preventing cracking and
dryness
- Acyclovir locally or systemically (may be used) in
dose 200 mg five times daily for five days (acyclovir
block viral replication but not viricidal).
Prevention

- Avoid acidic food (citrus or tomato) irritate

skin
- Do not rupture the blister to avoid infection
spread
- Avoid contacting infected hand with eye
- Avoid kissing
- Avoid drinking glasses