Microbiology

AN INTRODUCTION

B.E Pruitt & Jane J. Stein

Chapter 21
Microbial Diseases of the Skin and Eyes
 Structure & function of the skin

• Epidermis
• Dermis
• Keratin
• Hair follicles
• Oil glands &
sebum
• Sweat glands
• Mucous
membranes
 Skin

• Salt inhibits
microbes
• Lysozyme
hydrolyzes
peptidoglycan
• Fatty acids
inhibit some
pathogens
 Normal Skin Flora
• Propionibacterium acnes
• Corynebacterium sp.
• Staphylococci
• Staphylococcus epidermidis
• Staphylococcus aureus
• Streptococci sp.
• Candida albicans (yeast)
• Many others
 Mucous Membranes

• Line body cavities

• Epithelial cells attached to
an extracellular matrix
• Cells secrete mucus
• Some have cilia

Stomach section
Skin Lesions
 Vesicle

• Small, fluid-filled lesions

 Bulla

• Vesicles larger than 1 cm dia.

 Macule

• Flat, reddened lesions

 Pustule/Furuncle

• Raised lesions = papules

• Containing pus = pustule
 Carbuncle

• Extensive infection of a group of contagious

follicles

• Painful, hard lump

• Necrosis of intervening skin

• Large deep ulcer

 Staphylococcal skin infections
I. Direct infection of skin and adjuscent tissues
a. Folliculitis: Infections of the hair follicles
b. Furuncle: Abscess; pus surrounded by inflamed tissue
c. Carbuncle: Inflammation of tissue under the skin
d. Ecthyma: bulla on inflamed tissue
e. Impetigo: crusting (nonbullous) sores, spread by
autoinoculation

II. Cutaneous disease due to effect of bacterial

toxin
a. Staphylococcal scalded skin syndrome
b. Toxic shock syndrome
 Staphylococcus aureus
• Most pathogenic of the genus.
• One of the most common pathogens in
hospitals.
• Produces:
• coagulase– causes blood clotting.
• Alpha & delta toxin – lyses human cells.
• Leukocidin – destroys leukocytes.
• Exfoliative toxin – skin separates & peels.
• Toxic shock syndrome toxin – produces TSS.
• Enterotoxin – food poisoning.
 Staphylococcus aureus
• Transmission: close contact, fomites, foreign
body in wound
• Symptoms: range from superficial lesions to
systemic infections
• Treatment: vancomycin or methicillin
(penicillenase)
• Problem: methicillin- resistant strains have
emerged and more strains becoming resistant to
multiple antibiotics
 Ecthyma
• Common in children
• Small bullae or pustules on
erythematous base
• Formation of adherent dry crusts
• Beneath which ulcer present
• Heals with scar and pigmentation
• Buttocks, thighs and legs, commonly
affected
Furunculosis (Boils)

Causative agent:
Staphylococcus aureus
 Furunculosis
• Bacterium invades hair follicle
• Generally originates from nasal cavity
• Infected follicle of eyelash is a sty
• Serious infection of follicle is boil … type of
abscess ( region of pus surrounded by
inflamed tissue)
Scalded Skin Syndrome
Causative agent:
strains of Staphylococcus
aureus
 Scalded Skin Syndrome
• S. aureus lysogenized by phage produces
exotoxin….
• Causes necrosis of epidermal layer
• Within 2 days, epidermal layer peels off in
sheets
• Starts at nose & mouth, then spreads
• Penicillin-resistant
• Effects esp. newborns as complication of
staph infection
 Scalded Skin Syndrome/TSS

• Characteristic of late stage of

Toxic Shock Syndrome
• Known from use of absorbent
tampon
• Toxin enters bloodstream from
around tampon
• Other TSS from nasal surgery,
surgical incisions, following
birth
Streptococcal skin infections
• Streptococcus
pyogenes
• Group A beta-hemolytic
streptococci
• Hemolysins
• Hyaluronidase
• Stretolysins
• M proteins
 Impetigo

Causative agent:
Streptococcus pyogenes
 Impetigo

• Mostly the very young

• Spreads largely thru contact … hands, fomites….
Highly contagious
• Enters thru abrasion/wound
• Lesions blister, break, crust over (brown sugar)
• Seldom serious
 Impetigo
• Problem in schools, hospitals, camps, nurseries
• Drug of choice: penicillin & erythromycin
Necrotizing faciitis

Causative agent:
Streptococcus pyogenes
Necrotizing Fasciitis“Flesh Eating Strep”

Streptococcus pyogenes (Group A Strep)

• Tissue digesting enzymes
• Hyaluronidase
• Streptokinase
• Streptolysins
• Rapidly spreading
cellulitis may lead
to loss of limb
 Necrotizing Fasciitis
• Disease starts as localized infection
• Pain in area, flu-like symptoms
• Invasive and spreading
• May lead to toxic shock (drop in blood
pressure)
• Incidence 1-20/100,000
• 30-70% mortality
• Surgical removal, antibiotics
Infections by Pseudomonads

The model of opportunistic

pathogens:

Pseudomonas aeruginosa
 Pseudomonas aeruginosa
•Gram-negative, aerobic rod
•Pyocyanin produces a blue-green pus
•Has pili for adherence
•Slime layer interferes with phagocytosis
•Rarely a problem for the healthy
 Pseudomonas aeruginosa
• Burn patients esp. high risk:
• 80% of burn fatalities due to infections
(P.aeruginosa most commonly)
• Burn wounds may exude blue-green pus
• If infection becomes blood-borne, patient may die
from shock
• Prevention: scrupulous cleanliness, proper burn
debridement
 Pseudomonas aeruginosa

• Also causes: 10-20% of nosocomial infections

• Transmission: fomites
• Symptoms: range from superficial rash to fatal
systemic infections
 And, in addition……
• Pseudomonas dermatitis….
• Rash lasting about 2 weeks
• Associated with pools, hot tubs, etc
• Bacteria enter hair follicles
• Otitis externa – “swimmer’s ear”
• Infection of external ear canal
 Acne

• Propionibacterium
acnes: Gram + rod
• Digests sebum
• Attracts neutrophils
• Neutrophil digestive
enzymes cause lesions,
Microscopy “pus pockets”
 Acne

• Most common
skin disease in
humans
• Oil-based
cosmetics worsen
disease
• No effects of diet
 Acne Treatments

• Benzoyl peroxide dries plugged

follicles, kills microbes
• Tetracycline (antibiotic)
• Accutane – inhibits sebum
formation
• Blue light – kills P. acnes
Viral Diseases of the Skin
 Warts (Papillomas)
• Papillomaviruses (50 known types)
• Treatment:
• Removal
• Cryotherapy
• Electrodesiccation
• Burn with acid
• Topical application of prescription drugs
• Imiquimod (stimulate interferon production)
• Interferon
 Virus Infections of the Skin: Vesicles

Vesicular or pustular rash

(elevated lesions filled with fluid)

Smallpox (Human Pox virus)

Chickenpox/Shingles (Human Herpesvirus-3)
Cold Sores (Human simplex 1 and 2)
Varicella (chickenpox)
Causative agent:

Varicella-zoster virus
(Human herpesvirus 3)
 Chickenpox
• Humans only known host
• Transmitted via inhalation or direct contact
• Acquired via respiratory system
• Multiplies in respir. epithelium, travels by blood to
skin of trunk and face
• Infection localizes in skin cells after about 2 weeks
 Chickenpox
• Infected skin is
vesicular for 3-4 days
(vesicles fill w/pus,
rupture, & scab before
healing)
• Accompanied by fever,
intense itching, &
malaise
• Secondary bacterial
infections may occur
due to scratching
• Confers lifelong
immunity, usually
 Chickenpox

• More serious in adults – high mortality rate

• Is the 3rd most common reportable inf. disease in
U.S. (after gonorrhea & chlamydia infections)
• Virus persists as latent infection in nerve ganglia
• Reactivation may occur as herpes zoster
(shingles)
Initial infection, chickenpox (varicella)
Recurrence of infection, shingles
(herpes zoster)
herpes zoster - Shingles
 Herpes simplex 1
Human herpesvirus 1 (HSV-1)
and
Herpes simplex 2
Human herpesvirus 2 (HSV-2)
 Herpes Simplex 1
• Human herpesvirus 1
• Cold sores or fever
blisters (vesicles on
lips)
• Herpes gladiatorum
(vesicles on skin) -
wrestlers
• Herpes whitlow
(vesicles on fingers) -
health care
• HSV-1 can remain
latent in trigeminal
nerve ganglia
 Herpes Simplex 2

• Human herpesvirus 2
• Genital herpes
• HSV 1 & 2 can cause
Herpes encephalitis
(HSV-2 has up to a
70% fatality rate)
• HSV-2 can remain
latent in sacral nerve
ganglia
• Acyclovir may lessen
symptoms
 Virus Infections of the Skin: Rashes
Maculo-papular rashes
(flat to slightly raised colored bump)
Measles virus (Rubeola)
Rubella virus (German Measles)
Roseola (Human Herpesvirus-6)
Fifth Disease (Human Parvovirus B19)
Rubeola (measles)
Causative agent:

Rubeola virus
 Measles

• Transmission via
respiratory system.
• Droplets, person-person.
• Incubation 10-12 days.
• Multiplies in respiratory
mucosa….
• Moves via blood to skin.
 Measles

• Infection begins in
upper resp. sys. (sore
throat, headache,
cough).
• Fever, malaise.
• Then macular rash
appears on skin
(beginning on face,
spreading to trunk &
extremities) .
• Rash lasts 4-5 days.
 Measles

• Extremely contagious
disease
• Humans only reservoir
• Can result in encephalitis &
pneumonia
• More severe in infants and
adults than in children
• Confers lifelong immun.
• Immunization part of MMR
(mumps-measles-rubella)
at 12-15 mo. age.
 Measles World Wide
• Measles is the leading cause of vaccine-preventable
death among children
• In developed, measles death rates range from 1-5%,
but among malnourished children, the death rate
reaches 10-30%
• Over 500,000 children under the age of five die each
year.
• Measles causes health complications, including
pneumonia, diarrhea, encephalitis, and corneal
scarring.
• The primary reason for ongoing high childhood
deaths is the failure to deliver at least one dose of
measles vaccine to all infants.
Measles (Rubeola)

Figure 21.13
Rubella (German measles)
Causative agent:

Rubella virus
 Rubella
• Portal of entry –
respiratory system
• Respiratory droplets
person-person
• Incubation: 12-23 days
• Much milder than
measles – often goes
undetected
• Usual symptoms –
macular rash of small
red spots & light fever
• Complications rare
 Rubella

• Connection between serious birth defects &

maternal infection during first trimester (virus
crosses placenta)
• Congenital rubella syndrome:
• Deafness
• Eye cataracts
• Heart defects
• Mental retardation
• Death (15% of CRS die 1st yr)
 The Eye

• Normal flora
sparse
• Similar to skin flora
• Tears have
lysozyme, IgA
• Most infections
from contact lens
solutions or eye
make up
Bacterial eye infection resulting from injury
is a medical emergency!
 Infections of the Eye

Viral: Herpesvirus Keratitis (Human simplex 1)

Bacterial infections of the eye

Chlamydia trachomatis causes trachoma and can lead to
blindness.
Neissaria gonorrhea is passed from infected mother to child
during birth (opthalmia neonatorum).