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Pyogenic bacterial infections

Gram-negative
Gram-positive Escherichia coli
Klebsiella
Enterobacter
Proteus
Serrata
Staphilococcus
Pseudomonas

Streptococcus Neisseria (meningitidis

gonococcus)

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 Staphilococcal infections
• Skin lesions: foliculitis (boils, carbuncles)
impetigo, scalded skin,
• Surgical wounds and burns
• Acute mastitis
• Pharingytis
• Pneumonia
• Endocarditis
• Food poisoning
• Bone osteomyelitis
• Toxic shock syndrome
• Urinary Tract Infections
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 Staphilococcal pathogenesis

Surface proteins: bind endothelial cells –

extracellular matrix and artificial materials
Enzymes: degrades lipids on the skin surface,
antibiotic resistance,
Toxins: hemolytic toxins, enterotoxins, exfoliative
toxins, toxic shock syndrome toxin

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 Streptococcal infections
• Skin :Impetigo, Erysipelas, Scarlat fever, folliculitis
• Acute Mastitis
• Oropharynx
• Lungs
• Heart valve
• Urinary tract infections
• Meningitis
• Osteomyelitis
• Postesreptococcal syndromes: Rheumatic fever,
Glomerulonephritis, Erythema nodosum

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 Pathology
Whether the lesion is located (skin, breast, lungs, bones,
or heart valves), ther’s a supurative inflammation that is
distinctive for its local destructiveness in staphilococcal
and minimal destruction in Streptococcal infections.
Excluding impetigo that is an infection
restricted to the superficial epidermis, the local skin
lesions are centered around the hair follicles
• Furuncle : skin and subcutaneous tissue
• Carbuncle: deeper suppuration that spread laterally
beneath the deep subcutaneous fascia and then burrows
superficially to erupt in multiple adjacent skin sinuses

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impetigo

foliculitis

furuncule carbuncle 7
 Pathology cont
• Pharyngitis: epiglotic edema, punctate abscesses of tonsils,
sometimes accompanied by cervical lymphadenitis
• Lobar pneumonia and bronchopneumonia
• Acute mastitis:during the early weeks of nursing cracks
and fissures in the nipple develops and are the portal of
entry to streptococcus and staphilococcus. Usually
unilateral tend to cause a diffuse spreading infection that
eventually involves the entire organ, the destroyed breast
tissue is replaced by fibrous scar, changes that may later be
mistake for neoplasm
• Osteomyelitis: hematogenic or direct

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 Osteomyelitis
• Subperiosteal new bone formation in the affected
area is present, representing periosteal elevation
from encroaching pus. If not successfully treated, pus
enlarges the bone appearing as increased lucency,
which surrounds sclerotic, dead bone .

• This inner dead bone is called the sequestrum

(sequestered from blood supply), and the outer
periosteal reaction laminates to form the involucrum.

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Dir: Thomas McCarthy 2003
( Piter Dinklage (Finbar 15
 Actinomycosis
• Anaerobic bacterial opportunistic infection
(saprophyte of the mouth and tonsils) the
most common human infection is caused by
A. israelii
• Cervicofacial, thotacic and abdominal tissue
• Dental extractions,poor oral hygiene,
abdominal surgery appendicitis
diverticulitis bronchoaspiration IUD

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 Actinomycosis pathology
• In biopsy “sulfur” granule enveloped by
purulent exudate
• deep purple round to oval 100 to 300
microns with pinkish clublike structures
radiate from the periphery of the granules
(splendor hoppli phenomenon). Filaments
of actinomyces are found infrequently in
pus
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Dir:Peter Weir 2003
Russel Crowe

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 Viral infections

• Transient infections (elicits an effective immune response that

eliminates the virus. May or may not confer immunity)

• Chronic latent infections (Herpes family)

• Chronic productive infections (HBV, HCV, HIV)
• Transforming infections (HPV, HBV, EBV)

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 West Nile Virus

• West Nile virus is a virus mainly

transmitted to people through the bite of an
infected mosquito.
• Mosquitoes transmit the virus after
becoming infected by feeding on the blood
of birds which carry the virus

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 Natural history
• Most people infected with the virus have no
symptoms
• 20% flu-like symptoms.
• In 0.02% the virus can cause severe
encephalitis

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• The encephalitis was characterized by
mononuclear inflammation consisting mostly of
lymphocytes and plasma cells, with variable
penetration of the inflammatory cells into CNS
parenchyma
• These viral encephalitic changes had their highest
density in the midbrain, pons, and cerebellum
• White matter pathology, on the other hand, was in
large part limited to edema and perivascular
mononuclear inflammation

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Figure 1. (click image to zoom) Histopathologic features of
West Nile virus encephalitis.Top left, Perivascular chronic
inflammation (arrow) was seen in varying degrees throughout
the central nervous system (H&E, x100).Top right, Microglial
nodules (arrow) were seen in the same distributions as
perivascular inflammation and generally were noted to surround
large neurons (H&E, x200).Bottom left, Individual Purkinje cell
death (arrow) and frank necrosis were seen in the cerebellum
(H&E, x200).Bottom right, A mild chronic meningitis (arrow)
occupied the subarachnoid space covering the cerebral
.(hemispheres (H&E, x100

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viral antigens were seen within neuronal cell bodies and processes

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 Herpes infections
• Herpes family:
• Nuerotropic (alpha group) HSV-1-2, VZV

• Lymphotropic (beta group) CMV ,HHV 6 Exanthema

subitum

• Gamma-group EBV HHV8

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All herpesviruses replicate in the nucleus
of the cell. An accumulation of viral
proteins results in the formation of
characteristiceosinophilic intranuclear
inclusions

Herpes Virus

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 HSV 1 and 2
• Both viruses replicate in the skin and the mucous
membranes at the site of entrance cause vesicular
lesions and infect the neurons .
Replication take place in the epithelial
cells. In immunocompetent host ,primary HSV
infection resolves in a few weeks, although virus
remain latent in the nerve cells. Reactivation may
occur repeatedly with or without symptoms and
result in a spread of viruses from the neurons to
the skin or mucose
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 HSV cont.
• HSV Lesion:
• SELF LIMITED ”COLD” SORES AND
BLISTERS ; favor the facial skin around mucosal
orifices (lips, nose) blisters are formed by
intracellular edema and ballooning degeneration
of epithelial cells,
• Lips, nose

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 HVS Lesions cont.
• GINGIVOSTOMATIYIS:( HVS 1) usually
encountered in children vesicular eruption
extending from tongue to retropharynx and
causing cervical lymphadenitis
• CORNEAL LESIONS Epithelial keratitis and
Stromal Keratitis

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 HSV Lesions cont.
• GENITAL HERPES : Characterized by
vesicles on the genital mucous membranes
as well as external genitalia, which are
rapidly converted into superficial ulceration
rimmed by an inflammatory infiltrate
• HSV 2 is transmitted to neonates during
passage through to the birth canal(often
systemic and fulminating
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 HSV Lesion
• Cowdry type A intracellular inclusion :
contain intact and disrupted virions and
push darkly stained host cells chromatin to
the edges of the nucleus
although cell and nuclear size increase only
slightly Herpes virus produces inclusion-
bearing multinucleated syncytia that are
diagnostic in cytological smears
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Neonates and decreased cellular
immunity individuals may suffer
disseminated herpes infections
Encephalitis
Disseminated Skin lesions
Esophagitis, Bronchopneumonia
Hepatitis

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ransvaginalT HSV infection

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Herpes esophagitis

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Herpetic liver Infection

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Herpes encephalitis

Herpes immunostaining

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Dir Istvan Szabo 2004
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(Annette Bening (Julia
 Cytomegalovirus inclusion
disease

• CMV cause an asymptomatic

momonucleosis like infection in healthy
individuals but can also cause devastating
systemic infection in neonates and
immunosupressed patients or can be the
responsible of an intrauterine fetal death

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 CMV transmission

• Intrauterine
• Perinatal
• Mothers milk
• Respiratory droplet (preschool years)
• Sexual contact, fecal-oral route
• Blood transfusion (5% of blood donors are
carriers)
• Transplantation

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 CMV Cont.
• In immunocompetent patients CMV remains latent
in white blood cells
• immunocompromised : systemic disease affect
GIT, Liver, UTI and Kidney, Chorioretinitis,
Meningitis
• Neonatal CMV : 90% no clinical manifestations
10% (hemolytic Anemia jaundice,
thrombocytopenia, purpura, pneumonitis,
deafness, chorioretinitis, brain damage
• 50% death
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 CMV Pathology
• Cells infected by CMV are markedly enlarged
with a large e in purple inranuclear inclusion
surrounded by a clear halo and small basophilic
cytoplasmic inclusion, focal necrosis with minimal
inflammation
• CMV inclusions can be detectable in : Salivary
glands, kidney, liver, lungs, gut, pancreas, thyroid,
adrenals, brain.

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 ‫המטבח של מרתה‬
Dir Sandra Nethelbeck
(Martina Gedeck (Martha
(Sergio Castellitto (Mario
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 Molluscum Contagiosum

• Common self limited viral disease of skin caused

by Poxvirus
• Infection is usually spread by direct contact
particulary among children
• Multiple lesions may occur on the skin with a
predilection for the trunk and ano-genital area they
car also occur in the mucous membranes but
palms and soles are spread

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molluscum
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 Molluscum pathology
• The lesion is a firm, pink, umbilicated papule
0.2 - 0.4 cm liquid material can be expressed from
the central umbilication
• Histology: Cuplike verrucous epidermal
hyperplasia with“molluscum bodies” large
ellipsoid homogeneous intranuclear inclusion in
cells of the stratum granulosum , and the stratum
corneum (slightly eosinophilic in this level)
Numerous virions are present within molluscum
bodies
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Molluscum

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