Bacterial infections Bacterial infections Zora Dubská Zora Dubská Department of Department of Dermatovenereology of 3rd Faculty of Medicine and Dermatovenereology of 3rd Faculty of Medicine and Faculty Hospital Kralovske Vinohrady in Prague Faculty Hospital Kralovske Vinohrady in Prague Head: Prof. Petr Arenberger, MD, MBA Head: Prof. Petr Arenberger, MD, MBA
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Bacterial infections Zora Dubská Department of Dermatovenereology of 3rd Faculty of Medicine and Faculty Hospital Kralovske Vinohrady in Prague Head: Prof.
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Department of Department of Dermatovenereology of 3rd Faculty of Medicine and Faculty Dermatovenereology of 3rd Faculty of Medicine and Faculty Hospital Kralovske Vinohrady in PragueHospital Kralovske Vinohrady in Prague
Head: Prof. Petr Arenberger, MD, MBAHead: Prof. Petr Arenberger, MD, MBA
Bacterial skin infections
- Pyoderma
- Skin infections caused by corynebacteria
- Mycobacteria
- Borreliosis
- Anthropozoonoses
- Actinomycosis
Pyoderma
- Bacterial infection of skin caused by pyogenic cocci
- Staphylococcus aureus
- Beta hemolytic streptococcus group A
- Pyoderma bound to follicles
- Pyoderma bound to sweat glands
- Superficial pyoderma
- Deep pyoderma
Pyoderma bound to follicles
- Purulent inflammation of hair follicles and hairballs
- Frequent infections (shaving, friction with clothing)
- Most Staphylococcus aureus - coagulase - vertical spread
Ostiofolliculitis - impetigo Bockhardt - Subcorneal pustules in the ostium of the follicle
Folliculitis - purulent inflammation of the follicle - 2 forms - Folliculitis simplex disseminata - Folliculitis barbae
Folliculitis barbae
Folliculitis - therapy
- ATB solutions (erythromycin, clindamycin)
- Disinfecting solutions containing iodine or salicylic acid
- Systemic ATB according to the sensitivity
Furunculus
- Follicular skin abscesses that arise from folliculitis
or primarily
- Neck, axilla, buttocks, groins
- Hot and humid environment, obesity, hyperhidrosis,
diabetes mellitus, malnutrition, HIV immunodeficiency
- Follicular pustule followed by erythematosus painful bump with a central yellowish pin
- Lymphadenopathy, fever
Furunculus
Carbunculus
- Merging several neighboring furunculi
- Extensive hump, which is emptied with several fistulas
- Neck
- Fever
- Leukocytosis
- Bacteremia
Furunculus - therapy
- Saloxyl
- Systemic antibiotics according to sensitivity
- Ev. incision
- The carbuncle surgical incision required!
Pyoderma bound to sweat glands - Hidradenitis suppurativa axillaris
- Chronic suppurative disease
- Apocrine sweat glands - axilla, perianogenital area
- Inflammatory infiltrates, abscesses, fistulas
- Total excision, systemic retinoids, antibiotics
Pyoderma bound to the nail - paronychia
- Suppurative disease of lateral nail fold
- After injury
- Disinfecting solution – potassium permanganate,
antibiotic ointment
Impetigo- Superficial pyoderma
- Streptococci ( maculovesiculous form )- Staphylococci (bullous form)
- Maculovesiculous form - red macula with vesicles, pustules followed by crust formation
- Bullous form - Bull on erythematous base
followed by red scaling leasions
- Face - nasal entrance
Impetigo - http://www.stefajir.cz/q=impetigo
Impetigo - therapy
- Topical treatment with antiseptic solution and antibiotic ointment (mupirocin, a. fusidicum, bacitracin)
- In case of failure of local treatment – systemic atb according
to sensitivity
- Hygiene
- Streptococcus type A - the risk of glomerulonephritis – Urine
Deep pyoderma
- Ecthyma - ulcerative pyoderma in infected excoriations of itching dermatoses
- Erysipelas
- Phlegmona - diffuse spreading infection of the skin,
subcutaneous tissue, along fascia, tendons, muscles
- Necrotising fasciitis - inflammation of deep fascia and soft tissue + systemic response
Erysipelas- Frequent acute infection of the skin and
subcutaneous tissue
- Streptococcus pyogenes
- The spread of infection via lymphatic vessels
– entrance - injuries, interdigital mycosis ..
- Fever up to 40 C, chills- Within few hours in the affected area (mostly legs or face) - sharply bordered erythema
- Skin is warm, painful, edema, lymph nodes swollen
Erysipelas
Erysipelas - therapy
- Applied parenteral penicillin (usually procaine benzylpenicillin 10 x 1.5 mil.j.i.m. finished by benzathine benzylpenicillin 1.5 mil.j.i.m.)
- Nikolsky phenomenon of the unafflicted skin- Acantholytic intraepidermal blister of stratum granulosum- Systemic anti- staphylococcal ATB - ad integrum in 2 weeks
Toxic shock syndromes
- Rare shock states with skin symptoms and multiorgan involvement caused by staphylococci and beta-hemolytic streptococci group A ( producing toxins )
- Alteration of the general condition, generalized macular rash followed by desquamation of palms and soles after 1-2 weeks, raspberry tongue, erythema, mucosal erosion
Scarlatina - scarlet fever- A streptococcal tonsillitis accompanied by rash
- Children between 3 to 10 years of age - Streptococcus pyogenes group A - beta hemolytic - Pyrogenic exotoxin A
- Entrance – nasopharynx - Within 1-6 days tonsillitis with fever
- Maculopapular rash – goose skin – bending areas of limbs- Face with perioral fading- Petechial enanthema on the palate, raspberry tongue- After 1-2 weeks lamellar scaling of palms, soles
dg.: clinical state, cultivation, leukocytosis in KO
Therapy of scarlatina:
- Isolation
- Parenteral application of Procaine Penicilin G i.m. 3-5 days, finished by application of Benzatinpenicilin i.m., ev. erythromycin, cephalosporins, clindamycin
- Ulcerative and granulomatous processes (ev. lymphadenitis) caused by other mycobacteria than M. tuberculosis and M. leprae - Granuloma of swimming pools - Mycobacterium marinum - bumps in the area of trauma for 2-3 weeks - lymphadenitis - excision - cryotherapy - ATB
Leprosy
- Chronic granulomatous intracellular infection caused by bacteria Mycobacterium leprae
- The transfer by air from the nasal secretions of persons with
leprosy lepromatosa to the mucous tissue of breathing vessels of susceptible host
- Long incubation period ( from months till 30 years)
- The most common manifestation of the skin and peripheral nerves
- Early stage - leprosy indeterminata- Border forms - tuberculoid leprosy and leprosy lepromatosa- Transient forms - bordeline (dimorphic) leprosy
Diagnostic criteria of leprosy:- Hypopigmented or erythematous leasions with loss
of sensitivity
- Enlarged peripheral nerves
- Acid - resistant rods in skin swabs or biopsy (Ziehl-Neelsen dying ) - cultivation is not possible
+ History, stay in endemic areas
- Therapy - a combination of: - Rifampicin with dapsone or klofazimin - 6 months in TT, BT - 24 months in LL, BL
Borreliosis
- Infection caused by Borrelia burgdorferi sensu lato
- The most common carrier – tick Ixodes ricinus
- Affects the skin, nervous system, joints, heart
- Acute manifestation occurs in the area of the bite after
7-10 days and is sometimes accompanied by non-specific
systemic symptoms
- Erythema chronicum migrans – specific sign
Erythema chronicum migrans
Acrodermatitis chronica atrophicans
- Appears from few years to decades after infection
- Affects skin acral extensor parts of arms and legs
around the joints
- Slight swelling of livid coloured skin
- After regression of edema - skin atrophy
Borreliosis
- Diagnostics - serology (ELISA, Western blot)
- IgM antibodies reach peak between 3rd to 6th week after infection (in ECM often negative)