CHAPTER 17:

MAJOR VIRAL,
BACTERIAL, AND
FUNGAL
DISEASES OF
HUMANS
 LEARNING OBJECTIVES

 Classify a particular infectious disease as a viral,

bacterial, or fungal infection

 Categorize various infectious diseases by body

system

 Correlate a particular infectious disease with its

major characteristics, causative agent, reservoir(s),
mode(s) of transmission, and diagnostic laboratory
procedure
 INTRODUCTION

 This chapter summarizes the major viral, bacterial,

and fungal infectious diseases of humans.

 Divided into sections that describes’ infectious

diseases of various anatomical sites including skin,
ears, eyes, respiratory system, the oral region,
gastrointestinal (GI) tract, GU system, circulatory
system, and central nervous system (CNS).
 INFECTIOUS DISEASES OF THE SKIN

 Intact skin is a type of nonspecific host defense

mechanism, serving as a physical barrier.
 It is part of the body’s first line of defense. Very few
pathogens can penetrate intact skin.
 The indigenous microflora of the skin, a low pH, and
the presence of chemical substances like lysozyme
and sebum also serve to prevent colonization of the
skin by pathogens.
 Some infectious diseases affect more than one
anatomical site, and some pathogens move from
one body site to another during the course of a
disease.
 GENERAL INFORMATION

Terms relating to skin and infectious diseases of the

skin are as follows:
 Epidermis – the superficial epithelial portion of the
skin.
 Dermis – the layer of skin containing blood and
lymphatic vessels, nerves, and nerve endings, glans,
and hair follicles.
 Dermatitis – inflammation of the skin.
 Sebaceous glands – glands in the dermis that
usually open into hair follicles and secrete and oily
substance known as sebum.
 GENERAL INFORMATION

 Folliculitis – inflammation of a hair follicle, the sac

that contains a hair shaft.

 Sty (stye) – inflammation of the sebaceous gland

that opens into a follicle of an eyelash.

 Furuncle (boil) – a localize pyogenic (pus

producing) infection of the skin, usually resulting
from folliculitis.
 TYPES OF SURFACE LESIONS

 Macule. A surface lesion that is neither raised nor

depressed, such as the lesions of measles

 Papule. A surface lesion that is firm and raised,

such as the lesions of chickenpox

 Vesicle. A blister or small fluid-filled sac, such as is

seen in chickenpox and shingles

 Pustule. A pus-filled surface lesion

TYPES OF SURFACE LESIONS
 VIRAL INFECTION OF THE SKIN

 CHICKENPOX –(also known as varicella) is an

acute, generalized viral infection, with fever and a
skin rash.
 SHINGLES (also known as herpes zoster) is a
reactivation of the varicella virus, often the result of
immunosuppression. Shingles involves inflammation
of sensory ganglia of cutaneous sensory nerves,
producing fluid-filled blisters, pain, and paresthesia
(numbness and tingling). Shingles may occur at any
age, but is most common after age 50.
 CHICKENPOX AND SHINGLES

 Pathogen. Chickenpox and shingles are caused by

varicella-zoster virus (VZV); a herpes virus (family
Herpesviridae) that is also known as human
herpesvirus 3; a DNA virus.
 Reservoirs and Mode of Transmission.
Infected humans serve as reservoirs. Transmission is
from person to person by direct contact or droplet or
airborne spread of vesicle fluid or secretions of the
respiratory system of persons with chickenpox.
 Patient Care. Use Airborne and Contact
Precautions for hospitalized patients until their
lesions become dry and crusted.
CHICKENPOX AND SHINGLES
 GERMAN MEASLES (RUBELLA)

 German measles is a mild, febrile viral disease. A

fine, pinkish, flat rash begins 1 or 2 days after the
onset of symptoms. The rash starts on the face and
neck and spreads to the trunk, arms, and legs.

 Rubella is a milder disease than hard measles with

fewer complications. If acquired during the first
trimester of pregnancy, rubella may cause congenital
rubella syndrome in the fetus. This can lead to
intrauterine death, spontaneous abortion, or
congenital malformations of major organ systems.
 GERMAN MEASLES (RUBELLA)

 Pathogen. Rubella is caused by rubella virus, an

RNA virus in the family Togaviridae.

 Reservoirs and Mode of Transmission.

Infected humans serve as reservoirs. Transmission
occurs by droplet spread or direct contact with
nasopharyngeal secretions of infected people.

 Patient Care. Use Droplet Precautions for

hospitalized patients until 7 days after the onset of
rash.
GERMAN MEASLES (RUBELLA)
 MEASLES, HARD MEASLES (RUBEOLA)

 Is an acute, highly communicable viral disease with

fever, conjunctivitis, cough, photosensitivity (light
sensitivity).

 The rash begins on the face between days 3 and 7

and then becomes generalized. Complications
include bronchitis, pneumonia, otitis media, and
encephalitis.
 MEASLES, HARD MEASLES (RUBEOLA)

 Pathogen. Measles is caused by measles virus (also

known as rubeola virus). It is an RNA virus in the
family Paramyxoviridae.
 Reservoirs and Mode of Transmission.
Infected humans serve as reservoirs. Airborne
transmission occurs by droplet spread, direct contact
with nasal or throat secretions of infected persons, or
with articles freshly soiled with nose and throat
secretions.
 Patient Care. Use Airborne Precautions for
hospitalized patients until 4 days after the onset of
rash.
MEASLES, HARD MEASLES (RUBEOLA)
 MONKEYPOX

 Is a rare viral disease that causes fever, headache,

muscle aches, backache, lymphadenitis, malaise
(fatigue), and a rash.

 A milder disease than smallpox, monkeypox occurs

primarily in central and western Africa, although
several people in the United States became ill in
2003 after handling infected prairie dogs. Unlike
smallpox, monkeypox is rarely fatal.
 MONKEYPOX

 Pathogen. Monkeypox is caused by monkeypox

virus, which is in the same group of viruses
(orthopoxviruses) as smallpox virus (variola virus)
and the virus used in the smallpox vaccine (vaccinia
virus).

 Reservoirs and Mode of Transmission.

Infected animals serve as reservoirs. Transmission
occurs via animal bite or contact with an infected
animal’s blood, body fluids, or rash. Person-to-
person transmission does occur.
 MONKEYPOX

 Patient Care. Use Airborne and Contact

Precautions for hospitalized patients; Airborne
Precautions until monkeypox is confirmed and
smallpox is excluded; Contact Precautions until
lesions become crusted.
MONKEYPOX
 SMALLPOX

 a systemic viral infection with fever, malaise,

headache, prostration, severe backache, a
characteristic skin rash and occasional abdominal
pain and vomiting.
 The rash is similar to, and must be distinguished
from, the rash of chickenpox. Smallpox can become
severe, with bleeding into the skin and mucous
membranes, followed by death.
 Patient Care. Use Airborne and Contact
Precautions for hospitalized patients until all scabs
have crusted and separated (3–4 weeks). Use N95 or
higher respiratory protection.
 SMALLPOX

 Pathogen. Smallpox is caused by two strains of variola virus:

variola minor (with a fatality rate of 1%), and variola major
(with a fatality rate of 20%–40% or higher). Variola virus is a
double-stranded DNA virus in the genus Orthopoxvirus,
family Poxviridae. Smallpox virus is a potential biological
warfare and bioterrorism agent.

 Reservoirs and Mode of Transmission. Before smallpox

was eradicated, infected humans were the only source of the
virus. There are no known animal or environmental
reservoirs. Person-to-person transmission is via the
respiratory tract (droplet spread) or skin inoculation. Patients
are most contagious before eruption of the rash, by aerosol
droplets from oropharyngeal lesions.
SMALLPOX
 WARTS

 Consist of many varieties of skin and mucous

membrane lesions, including common warts
(verrucae vulgaris), venereal warts, and plantar
warts. Most are harmless, but some can become
cancerous.
 WARTS

 Pathogens. Warts are caused by at least 70 types of

human papillomaviruses (HPV). They are classified
in the genus Papillomavirus within the family
Papovaviridae. They are DNA viruses.

 Reservoirs and Mode of Transmission.

Infected humans serve as reservoirs. Transmission
usually occurs by direct contact. Genital warts are
sexually transmitted. They are easily spread from
one area of the body to another, but most are not
very contagious from person to person (genital warts
are an exception).
WARTS
 BACTERIAL INFECTIONS OF THE SKIN

 ACNE – a common condition in which pores

become clogged with dried sebum, flaked skin, and
bacteria; leads to the formation of blackheads and
whiteheads (collectively known as acne pimples) and
inflamed, infected abscesses, more common among
teenagers.
 Etiologic Agent – Propionibacterium acnes and
other Propionibacterium spp. (all are anaerobic,
gram-positive bacilli)
 Reservoir and Mode of Transmission –
infected humans, probably not transmissible.
ACNE
 ANTHRAX, WOOLSORTER’S DISEASE

 Can affect skin (cutaneous anthrax), the lungs,

(inhalation or pulmonary anthrax), or the GI tract
(gastrointestinal anthrax), depending on the portal of
entry of the causative agent.
 Etiologic Agent – Bacillus anthracis, a spore-forming,
gram-positive bacillus
 Reservoirs and Mode of Transmission – anthrax –
infected animals; spores may be present in soil, animal
hair, wool, animal skins and hides, and products made
from them. Transmission is by entry of endospores
through breaks in skin, inhalation of spores, or ingestion
of bacteria in contaminated meat.
 Patient Care – standard precautions for hospitalized
patients
ANTHRAX, WOOLSORTER’S DISEASE
 GAS GANGRENE (MYONECROSIS)

 Necrosis (tissue death ) caused by ischemia (lack of

oxygen) is called gangrene. Gangrene may or may
not involve pathogens.

 Gas gangrene always involves pathogen and it is not

a communicable disease.

 Rapid and intensive tissue damage may necessitate

amputation of the infected extremity.
 GAS GANGRENE (MYONECROSIS)

 Etiologic Agent – various anaerobic bacteria in the

genus Clostridium especially Clostridium
perfringens. After the clostridium spores germinate
in the wound, the vegetative pathogens produce
necrotizing enzymes and toxins, which rapidly
destroy tissue, especially muscle tissue.
 Reservoirs and Mode of Transmission – soil,
humans become infected when soil containing
clostridial spores enters an open wound.
 Patient Care - standard precautions for
hospitalized patients
GAS GANGRENE (MYONECROSIS)
 LEPROSY (HANSEN OR HANSEN’S DISEASE)

 Numerous nodules in skin; there may be involvement of

the nasal mucosa and eyes

 Names for G.A. Hansen who, in 1873 discovered the

bacillus that causes leprosy

 Occurs primarily in warm, wet areas of tropic and

subtropics

 Patient Care – contact precautions for hospitalized

patient with lepromatous leprosy. Standard cautions for
patients with tuberculoid leprosy
LEPROSY (HANSEN OR HANSEN’S DISEASE)

 Etiologic Agent – Mycobacterium leprae; an acid-fast

bacillus

 Reservoirs and Mode of Transmission – Infected

humans (in nasal discharges and shed from cutaneous
lesions); the exact mode of transmission has not been
clearly established. The organisms may gain entrance
through the respiratory system or broken skin. Does not
appear to be easily transmitted from person to person.
Prolonged, close contact with an infected individual
appears to be necessary.
LEPROSY (HANSEN OR HANSEN’S DISEASE)
 STAPHYLOCCOCAL SKIN INFECTIONS

 Follicilitis, Furuncles, Carbuncles, Abscesses,

Impetigo, Impetigo of the newborn, Scalded Skin
Syndrome

 Virtually all infected coccus.

 Impetigo may also be caused by Streptococcus hair

follicles, boils (furuncles), carbuncles, and stys
pyogenes, which is another Gram-positive coccus.
involve Staphylococcus aureus.
 STAPHYLOCCOCAL SKIN INFECTIONS

 The majority of common S. aureus spreads through

skin by producing skin lesions are localized, discrete,
and uncomplicated.

 Patient Care – contact precautions for hospitalized

patients with major staphylococcal skin, wound, or
burn infections.
 STAPHYLOCCOCAL SKIN INFECTIONS

 Etiologic Agent – Staphyloccocus aureus, a gram-

positive coccus. Impetigo may also caused by
streptococcus pygenes, another gram-positive coccus.
SSSS is produced by aureus strains of S. aureus that
produce exfoliative (or epidermolytic) toxin, which cause
the epidermis to split from the rest of the skin
 Reservoirs and Mode of Transmission – infected
humans, persons with draining lesion or any purulent
discharge are the most common sources of epidemic
spread. Transmission is via direct contact with a person
having a purulent lesion. In hospitals, spread by hands of
healthcare workers.
STAPHYLOCCOCAL SKIN INFECTIONS
 STREPTOCOCCAL SKIN INFECTIONS

 Scarlet fever, Erysipelas, Necrotizing Fasciilitis

 Scarlet Fever (scarlatina) widespread, pink-red

rash, most obvious in the abdomen, sides of the
chest, and in skin folds; severe causes maybe
accompanied by high fever, nausea, and vomiting.

 Erysipelas an acute cellulitis, with fever,

constitutional symptoms, and hot, tender, red
eruptions, (sometimes referred to as St. Anthony’s
fire)
 STREPTOCOCCAL SKIN INFECTIONS

 Necrotizing fascilitis is the name disease caused

by the so-called flesh-eating bacteria

 Fascilitis is the inflammation of the fascia (fibrous

tissue that envelops the body beneath the skin; also
encloses muscles and group of muscles)

 Patient Care – contact precaution for hospitalized

patients with major group a streptococcal skin,
wound, burn infections
STREPTOCOCCAL SKIN INFECTIONS
 FUNGAL INFECTIONS OF THE SKIN

 Dermatophytoses are also known as tinea

(ringworm) infections and dermatomycoses.

 Diseases. Some of the dermatomycoses cause only

limited irritation, scaling, and redness. Others cause
itching, swelling, blisters, and severe scaling.

 Patient Care. Use Standard Precautions.

 FUNGAL INFECTIONS OF THE SKIN

 Pathogens. Dermatomycoses are caused by various

filamentous fungi (moulds), collectively referred to
as dermatophytes. Examples include species of
Microsporum, Epidermophyton, and Trichophyton.

 Reservoirs and Mode of Transmission.

Infected humans and animals and soil serve as
reservoirs. Transmission is by direct or indirect
contact with lesions of humans or animals; or
contact with contaminated floors, shower stalls, or
locker room benches; barbers’ clippers, combs, and
hairbrushes; or clothing.
FUNGAL INFECTIONS OF THE SKIN