Skin

Microbial Diseases of the

Skin and Eyes

• The skin is generally inhospitable to the growth of Mucous Membranes

certain microbes but supports the growth of some
• Line body cavities
• Epithelial cells attached to an extracellular matrix
• Salt inhibits microbes
• Cells secrete mucus
• Some have cilia
• Lysozyme hydrolyzes peptidoglycan

• Fatty acids inhibit some pathogens

 Normal Microbiota of the Skin
• Increase number of microorganism in moist
• Gram-
Gram-positive, salt-
salt-tolerant bacteria areas of the body ( Armpits )
Staphylococci
Micrococci
Diphtheroids Body Odor
• Vigorous washing reduce but does not eliminate
the the normal microbiota
- microorganisms in hair follicles & sweat
glands reestablish normal population after
washing.

Microbial Diseases of the Skin

• Skin lesions & rashes does not necessarily
indicate infections of the skin but maybe
manifestations of systemic disease.
• Exanthem
Skin rash arising from another focus of
infection
• Enanthem
Mucous membrane rash arising from another
focus of infection
 BACTERIAL DISEASES OF THE SKIN Staphylococcal Skin Infections

• Staphylococcus & Streptococcus • Staphylococcus

1. Come in contact with the skin & are - spherical, Gram-
Gram- positive
adopted to the skin’
skin’s physiologic - irregular grape-
grape-like clusters
conditions
2. Produce invasive & damaging enzymes

• Types of Staph.
• Staphylococcus epidermidis
1. Coagulase-
Coagulase-positive - Gram-
Gram-positive cocci,
cocci, coagulase-
coagulase-negative
- produces Coagulase – an enzyme - found in human skin
that clots fibrin.
fibrin. - found in catheters surrounded by slime
- fibrin clot protects the organism from layer of capsular material
phagocytosis - protection against dessication &
2. Coagulase-
Coagulase- negative disinfection
- does not produce Coagulase • Staphylococcus aureus
- 90% of skin normal flora
- Gram-
Gram-positive cocci,
cocci, coagulase-
coagulase-positive
- pathogenic only when skin barrier is
- most pathogenic
broken ( Insertion & removal of catheter)
- forms golden yellow colonies
• Toxins produced by Staph. Aureus:
Aureus: 3. Favorarable environment provided by nasal
1. Leukocidin passages
2. Exfoliative toxin 4. Hair follicles as reservoirs
3. Enterotoxin
Problems in Staph. Infection: Staphylococcal Skin Infections:
1. Dangers to surgical wounds 1. Folliculitis
- S. aureus is carried by hosp. staff & - Infections of hair follicles
visitors
2. Antibiotic resistance
- only 10% are sensitive to Penicillin

• Sty • Impetigo of the newborn

Folliculitis of an eyelash - Stap.
Stap. Aureus
• Furuncle ( Boil ) - thin walled vesicles on the skin that rapture
Abscess; pus surrounded by inflamed tissue & crust
• Carbuncle
Inflammation of tissue under the skin
• Scalded skin syndrome Streptococcal Skin Infections
- Stap.
Stap. aureus toxin entering the bloodstream
• Streptococcus
- newborn or children below 3yrs. Old
- gram-
gram- positive, spherical, in-
in-chains
- lesions develop into a bright red area then
- causes a wide range of disease
peels off
- produces & secretes toxins, enzymes &
virulence factors

Toxins & Enzymes produced: Streptococcal Skin Infections

1. Streptokinase 1. Erysipelas
2. Hyaluronidase - Streptococcus pyogenes
3. Deoxyribonucleases - starts as sore throat skin erupts into
4. Leukocidins reddish patches
patches
5. Erythrogenic toxins with raised
6. Exotoxin A margins
2. Impetigo 3. Cellulitis
- seen in toddlers & adults - infection of the connective tissue with
- associated with Staph. Infection inflammation of the subcutaneous layer.

5. Necrotizing fasciitis
4. Myositis – infection of the muscles - Infection of the deeper layer of the sub-
sub-
cutaneuos tissue and into the fascia
 Infections by Pseudomonads
Diseases caused by Pseudomonas:
• Pseudomonads 1. Pseudomonas dermatitis
- Gram-
Gram-negative, aerobic rod - self-
self-limiting rash (2wks), swimming pools &
- Widespread in soil, water & soap saunas
- Resistant to most antibiotics & disinfectants - enters through the hair follicles
Pseudomonas aeroginosa 2. Otitis externa / Swimmers ear
- opportunistic pathogen - infection of the external ear
- produces Endotoxin P 3. Post-
Post-burn infections
- implicated in most nosocomial infection - Pyocyanin produces a blue-
blue-green pus
- indwelling medical tubes & devices Tx:
Tx: Fluoroquinolones
mops, vases & diluted disinfectants Silver sulfadiazine

Acne VIRAL DISEASES OF THE SKIN

• Comedonal acne
Occurs when sebum channels are blocked with shed
Warts / Verruca
cells - Papillomaviruses,
Papillomaviruses, benign skin growth
• Inflammatory acne - person to person contact, sexually
Propionibacterium acnes
Gram-
Gram-positive, anaerobic rod
Tx:
Tx: Removal
Treatment: - Cold liquid nitrogen, Electrodessication
Preventing sebum formation (isotretinoin
(isotretinoin)) Acid burning
Antibiotics
Benzoyl peroxide to loosen clogged follicles
Visible (blue) light (kills P. acnes)
• Nodular cystic acne
Treatment: isotretinoin
 Poxviruses Herpesviruses
Smallpox (Variola
(Variola)) Chicken pox / Varicella zoster
- Smallpox virus (Orthopox
(Orthopox virus) - Varicella-
Varicella-zoster virus/Human herpes virus 3
Variola major has 20% mortality - mild childhood disease
Variola minor has <1% mortality - low mortality rate, high if contracted later in
- transmitted by respiratory route & infects life
internal organs - Mortality is due to complications
- Eradicated - Encephalitis & Pneumonia
- bioterrorism - Serious fetal damage in 2% cases if it
occurs during pregnancy

• Respiratory route localizes in skin after 2wks

Infected skin is vesicular

vesicular
then fills with pus then
raptures

Scab Heal
• Starts in the trunk then spreads to the extremities
• Virus may remain latent in dorsal root ganglia
- Central nerve gangliion
- persists as viral DNA ( antibodies cannot
penetrate the CNS)
CNS)
Shingles / Herpes zoster Cutaneous Sensory Nerves of the skin
- Reactivation of latent HHV-
HHV-3 releases viruses ( SHINGLES)
that move along peripheral nerves to skin.
-Vesicles similar to chicken pox
- latent Varicella-
Varicella-zoster virus located at the
-Unilateral( follows the cutaneous nerves)
Dorsal root ganglion ( spine)
- Waist, face, upper chest, back
Reactivated ( decades later ) - Stress - Severe burning, stinging pain for months
Low resistance to years ( Post Herpetic Neuralgia)
- Adults
Virions produced by reactivated DNA
move down peripheral nerves

Herpes simplex 1 and Herpes simplex 2

• Human herpes virus 1 and HHV- HHV-2

- Oral/Respiratory & Skin contact
- Cold sores or fever blisters (vesicles on
lips)
1. HHV-
HHV-1
- Subclinical, Infancy
- Herpes gladiatorum (vesicles on skin)
Herpes whitlow (vesicles on fingers)
HHV-
HHV-1 can remain latent in trigeminal nerve
ganglia
 Measles (Rubeola
(Rubeola))
• Measles virus
• Transmitted by respiratory route
• Incubation period: 10-
10-12 days
• Infectious even before symptoms occur
• Humans are the only known reservoirs
• Macular rash
• Koplik's spots
2. HHV-
HHV-2
- lesions in the oral cavity
- Genital herpes, Sexual contact
- tiny red patches with central white specks
- Herpes encephalitis (HHV-
(HHV-2 has up to a 70%
on the oral mucosa opposite the molars.
fatality rate)

• Symptoms develop like common colds • Prevented by vaccination

MMR
• Macular rash starts on the face then spreads to - given age 1 yr
the trunk & extremities • Complications:
1. Middle ear infection
2. Pneumonia
3. Subacute sclerosing panencephalitis
- males
- 1-10 yrs. After recovery from measles
 Rubella (German Measles) • A 1905 list of skin rashes included #1- #1-measles,
#2-
#2-scarlet fever, #3-
#3-rubella, #4-
#4-Filatow-
Filatow-Dukes
• Rubella virus
(mild scarlet fever), and #5-
#5-
• Respiratory route
Fifth Disease / Erythema Infectiosum
• Incubation period: 2-
2-3 wks
• Milder disease than Rubeola often goes - Human parvovirus B19
undetected - mild flu-
flu-like symptoms
• Macular rash and fever - facial rash “ Slapped cheek”
cheek”
• Congenital Rubella Syndrome Roseola
- severe birth defect if during 1st trimester - Human herpesvirus 6
- Deafness, cataract, heart defect, mental - high fever and rash, lasting for 1-1-2 days
retardation - recovery leads to immunity

FUNGAL DISEASES OF THE SKIN &

NAILS
Cutaneous Mycoses
• Dermatomycoses:
Dermatomycoses: Tineas or Ringworm
Metabolize keratin
Trichophyton infects hair, skin, nails
Epidermophyton infects skin and nails
Microsporum infects hair and skin
• Treatment:
Oral griseofulvin
Topical miconazole
 Candidiasis
• Candida albicans (yeast)
• Candidiasis may result from suppression of
competing bacteria by antibiotics
• Occurs in skin; mucous membranes of
genitourinary tract and mouth
• Thrush is an infection of mucous membranes of
mouth
• Topical treatment with miconazole or nystatin
Microbial Diseases of the Eye
• Conjunctivitis (pinkeye)
- Haemophilus influenzae
- Various microbes
- Associated with unsanitary contact lenses
• Neonatal gonorrheal ophthalmia
- Neisseria gonorrhoeae
- Transmitted to newborn's eyes during
passage through the birth canal
- Prevented by treatment newborn's eyes with
antibiotics / Silver nitrate
• Chlamydia trachomatis
Inclusion conjunctivitis
- Transmitted to newborn's eyes during
passage through the birth canal
- Spread through swimming pool water
- Treated with tetracycline
Trachoma
- Greatest cause of blindness worldwide
- Infection causes permanent scarring;
scars abrade the cornea leading to
blindness
• Herpetic Keratitis
- Herpes simplex virus 1 (HHV-
(HHV-1)
- Infects cornea, may cause blindness
- Treated with trifluridine
• Acanthamoeba keratitis
- Transmitted from water
- Associated with unsanitary contact lenses