Lecturer 3

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Wound infection
Wound contamination:- this is the presence
of non-replicating organism in the wound
Wound colonization:- this is the presence
of replicating organisms adherent to the
wound in the absence of injury to the host
E.g staph epidermis
Wound infection:- the presence of
replicating organisms that cause injury to
the host e.g staph aureus

Categories of wounds

Clean wound: the risk is about 1-3%

Clean contaminated: the risk is about 7 10%
Contaminated: the risk is about 20 -25%
Dirty and infected:

upto 40% risk

Early acute wound normal skin flora predominate
Staph aures and B-hemolytic streptococcus soon follow
In the case of patient with diabetic foot ulcers groupB strept and
staph aureus
After about 4 weeks facultative anaerobic gram-ve rod will
colonize the wound proteos, E.coli, and klebsiella
The risk of wound infection is increased by any factor that
debilitate the patients immune resistance or reduce tissue
partition.

Factors that contribute to immune

infection
Obesity
Tissues are relatively avascular

Malnutrition hypoxia
Protein deprivation significantly retard wound healing

Impairment to host defense mechanism

Initiated by diabetics mellitus

Shaving operating site

Shaving should be done just before the operation

Length of operations
The incidence of infection risese if the operation lasts
more than 2hours

Foreign bodies
Highest incidence of wond infection is associated with
cutting and silk sutures

Drains

Fungal disease
Mycosis of humans maybe divided into the
ffg
Superficial mycosis
Surface of the skin and hair

Cutaneous mycosis/dermatomycosis
Outer layer of the skin
Athlete foot and ring worm

Subcutaneous mycosis
Penetrates below the skin
Involves the subcutaneous, connective and bone tissue

Systemic or deep mycosis

Able to infect internal organ

Superficial mycosis and

dermatomycosis
the fungi that cause dermatomycosis are able
to infect only the epidermis, hair or nails
Damage to tissue is minimal
The lession appears as scaly or pigmented area
on the skin or as nodules on the shaft of hair.
We have tinea capitis, tinea corporis, tinea
crunis, tinea pedis
The hyphae of the dermatophyte grow into
keratinized tissue of the epridermis into the
hair shaft or into finger nails or toe nails.

 Transmission

Parasites of humans and animals

Person to person by direct or indirect contact
T capitis children, T pedis aldolescence
From pest and domestic animals to humans

Diagnosis
By clinical signs and symptoms
Microscopic examination
Culturing of tissue scrapping (SDA can be used)

Treatment
Removing the skin scales with a cleansing agent and removing
the infected hairs. Good hygiene generally prevent this
infection.
Tolnaflate
Griseofulvin
The infection of scalp and skin treatment 2-3 weeks is required
infected nails takes longer
Antifungal agents called azoles can also be used

Subcutaneous mycosis
The fungi are usually pre habitat of the soil
The most common type of sub cutaneous mycosis
is caused by sporothrix schenkii and the disease
is called sporotrichosis
The disease occurs most often in workers that get
in close contact with the soil.
Ulcerative lesions develops at the site of
inoculation spreads to regional lymph node
where swelling occur
Diagnosis is by culturing the lesion exudates
Yeast at 36C and mycellia at room temperature
Doses of potassium iodide over 4-6 weeks period
are fairly effective

Systemic mycosis
Involves two basic forms
Most prevalent form is a mild respiratory infection
Sever disseminated infection involving many tissues

The fungi lives in the soli as saprophytes

The conidia are inhaled into the respiratory tract where an acute self limiting
pneumonitis may result.
Systemic mycosis of the lung is often misdiagnosed as tuberculosis
No human to human transmission, but can be from soil or animal dropping
Diagnosis
Observing yeast form of the fungus in tissue specimen
Serological test are also available for some infection

Treatment
The use of chemotherapeutic agent such as
Amphotericin B
Flucytosine
Triazoles (fluconazole and triaconazole)
Surgical removal of large pulmonary lessions may be usefull in some cases

No vaccines available, avoiding areas like bird roots and caves

Opportunistic fungal
infection
Immunocompromise
Opportunistic fungi
Leucopaemia (bone marrow
failure)

Candida sp, Aspergillus sp

Cellular immunity (Tissue

transplant)

Cryptococcus ( fungi itch)

Diabetes

Rhizopus, saccharomyces, mucus

sp

Steroid therapy malignancy

(leukemia, lymphoma)

Cryptococcus , histoplasma

AIDS

Candida, cryptococcus,
histoplasma

candidiasis
A genus of true yeast that are not dimorphic it is about 4-6microns
Candida albicans is often part of the microflora of the skin and the mucus
membrane of the mouth, vagina and intestinal tract
Inflammation of this epithelial surfaces may occur following various
predisposing conditions
Thrush occurs in new born
Yeast vaginitis is common during pregnancy or in diabetes.
Candidiasis of the skin occurs where the skin is damp or irritated such as
between the upper legs or under the hand
Candididiasis used to be more prevelant in persons on drug spectrm
antibiotic therapy because many normal indigenous bacterial are
destroyed leaving lichens into which c.albicans can grow
Members of this genus can cause septicema, endocarditis, protected
pulmonary tract infection including kidney and other tissue infection
Candidiasis can be with imidazoles, various ointment or antifungal
antibiotics such as amphothecin B , Nystatis

Aspergillosis
Respiratory infection are the most
common lesion containing masses of
mycelia develops in the lungs or
bronchi lesions may also develop.
Can occur in immunosuppressed
patients such as leukemia
Chemotherapeutic agent
Amphothericin B

mucomycosis
It occurs in immunocompromised
patients
The fungi may penetrate into the
respiratory or intestinal mucosa or
enter through breaks in the skin