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Bacterial Skin Infection

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* * * * Sycosis Barbae is a variant which occurs in the beard area, ofen spread by shaving. Pseudofollicultis is not an infection, but an inflammatory condition ... – PowerPoint PPT presentation

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Title: Bacterial Skin Infection


1
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2
Bacterial Skin Infection
3
Staph. Aureus Infection
  1. Direct infection of skin impetigo, ecthyma,
    folliculitis, furunculosis, carbuncle, sycosis.
  2. Secondary infection eczema, infestations,
    ulcers, etc.
  3. Effect of bacterial toxin staph.-associated
    scalded skin syndrome (SSSS), toxic shock
    syndrome.

4
strepto. Infection (GAS) (gp A streptococci)
  • Direct inf. of skin or subcut. tissue Impetigo,
    ecthyma, cellulitis, vulvovaginitis, perianal
    inf., strepto. ulcers, blistering distal
    dactylitis, necrotizing fasciitis.
  • 2ry inf. eczema, infestations, ulcers, etc.

5
  • Tissue damage from circulating toxin scarlet
    fever, toxic shock-like syndrome.
  • Skin lesions attributed to allergic
    hyper-sensitivity to strepto. antigens erythema
    nodosum, vasculitis.
  • Skin dis. provoked or influenced by strepto.
    inf. psoriasis especially guttate forms.

6
Predisposing factors
  • Mechanical disruption (inflammations, abrasions)
  • Prolonged use of steroids, topical or systemic
  • Presence of systemic illnesses (DM, malignancy)
  • Immunosuppression
  • Malnutrition
  • Anaemia

7
Impetigo
8
  • Acute contagious skin infection caused mostly by
    staph. Aureus and strept.
  • Affects children mainly esp. in summer times.

9
Clinical types
  • 1- Non-bullous impetigo
  • Caused by staph., strept. or both organisms.
  • 2- Bullous impetigo
  • Caused by staph aureus.

10
Non-bullous Impetigo
  • Staph. aureus or gp A stretp. (GAS) or both
    mixed infections.
  • May arise as 1ry inf. or as 2ry inf. of
    pre-existing dermatoses, e.g. pediculosis,
    scabies eczemas.
  • An intact st. corneum is probably the most
    important defense against invasion of pathogenic
    bacteria.

11
  • A thin-walled vesicle on erythematous base, that
    soon ruptures the exuding serum dries to form
    yellowish-brown (honey-color) crusts that dry
    separate leaving erythema which fades without
    scarring.
  • Regional adenitis with fever may occur in severe
    cases.

12
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  • Sites Exposed parts eg. face extremities.
    Scalp (in pediculosis). Any part could be
    affected except palms soles.
  • Complications Post-streptococcal acute
    glomerulo-nephritis AGN especially in cases due
    to strepto. pyogenes M. type 49.

14
Varities
  • Circinate impetigo with peripheral extension of
    lesion healing in the center.

15
  • Crusted impetigo
  • on the scalp complicating pediculosis. Occipital
    cervical LNs are usually enlarged tender.

16
  • Ecthyma (ulcerative impetigo) adherent crusts,
    beneath which purulent irregular ulcers occur.
    Healing occurs after few wks, with scarring.

17
  • Site more on distal extremities (thighs legs).

18
Bullous Impetigo
  • Age all ages, but commoner in childhood
    newborn (impetigo neonatorum).
  • Site face is often affected, but the lesions may
    occur anywhere, including palms soles.

19
  • The bullae are less rapidly ruptured (persist for
    2-3 days) become much larger. The contents are
    at first clear, later cloudy. After rupture,
    thin, brownish crusts are formed.

20
Treatment of impetigo
  • Treatment of predisposing causes e.g.
    pediculosis scabies.
  • Remove the crusts by hydrogen peroxide.
  • Topical antibiotic e.g. tetracycline,
    bacitracin, gentamycin, mupiracin (Bactroban),
    Fusidic acid (Fucidin).

21
  • Systemic antibiotics are indicated especially in
    the presence of fever or lymphadenopathy, in
    extensive infections involving scalp, ears,
    eyelids or if a nephritogenic strain is
    suspected, e.g. penicillin, erythromycin
    cloxacillin.
  • Azithromycin (Zithromax) 2 caps 500 mg daily
    for 3 days in adults.
  • In erythromycin-resistant S. aureus amoxicillin
    clavulanic a. (Augmentin) 25 mg/kg/day.

22
Folliculitis
23
  • inflammatory disease of the hair follicles, which
    may be infectious or non-infectious.

24
  • Superficial Folliculitis
  • (Bockharts Impetigo)

25
  • a dome-shaped pustule at the orifice of a hair
    follicle that heals within 7-10 days.

26
  • Caused by staph aureus and affects mainly
    extremities and scalp.
  • Topical steroids are a common predisposing
    factor.

27
  • Sychosis Vulgaris

28
  • Recurrent red follicular papules or pustules
    centered on a hair, usually remain discrete over
    the beard or upper lip, but may coalesce to
    produce raised plaques studded with pustules.
  • DD pseudofolliculitis of the beard, T. barae.

29
  • Pseudofolliculitis

30
  • from penetration into the skin of sharp tips of
    shaved hairs.

31
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32
Frunculosis (boils)
33
  • It is a staphylococcal infection similar to, but
    deeper than folliculitis invades the deep parts
    of the hair folliculitis.
  • Occasionally several closely grouped boils will
    combine to form a carbuncle. The carbuncle
    usually occurs in diabetic cases. The site of
    election is the back of the neck.

34
Frunculosis
35
Cellulitis Erysipelas
36
  • Cellulitis is an infection of subcutaneous
    tissues.
  • Ersipelas Its due to infection of the dermis
    upper subcutaneous tissue by gp A streptococci.
    The organism reaches the dermis through a wound
    or small abrasion. It is regarded as a
    superficial dermal form of cut. cellulitis.

37
  • Erythema, heat, swelling and pain or tenderness.
  • Fever and malaise which is more severe in
    erysipelas.
  • In erysipelas blistering and hemorrhage.
  • Lymphangitis and lymphadenopathy are frequent.

38
  • Edge of the lesion well demarcated and raised in
    erysipelas and diffuse in cellulitis.

39
Complications
  • Recurrences may lead to lymphedema.
  • Subcutaneous abscess.
  • Septicemia.
  • Nephritis.

40
Treatment
  • Systemic antibiotics, especially penicillin, e.g.
    benzyl penicillin 600-1200 mg IV/6 hrs or
    cephalosporines.
  • Rest, analgesics.

41
Skin diseases related to coryneform bacteria
  • Erythrasma

42
  • It is mild, chronic, localized superficial
    infection of skin by Coryn. Minutissimum.
  • Clinically sharply-defined but irregular brown,
    scaly patches

43
  • usually localized to groins, axillae, toe clefts
    or may cover extensive areas of trunk limbs.
    Obesity DM may coexist.
  • Coral red fluorescence under woods light.

44
Coral red fluorescence under woods light.
45
Treatment
  • Topical treatment with azole antifungal agents
    for 2 weeks or topical fucidin.
  • Erythromycin orally.

46
Case History 1
  • A mother brings 5 yr old Johnny to surgery. He
    has developed this rash, which is weeping and
    crusting.

47
  • What is the diagnosis?

48
Impetigo
  • A highly infectious skin disease, which commonly
    occurs in children.

49
  • What is the likely causative organism?

50
  • The causative organism is usually Staphylococcus
    Aureus or can be strep pyogenes.

51
  • What is the treatment?

52
Impetigo
  • Treatment
  • Mild localised cases - use topical antibiotic
    Polyfax
  • Widespread or more severe infections use
    systemic antibiotics, such as flucloxacillin (or
    erythromycin if penicillin allergic)

53
Johnnys mum asks if Johnny has to have any time
of off school. What should you tell her?
  • A He does not have to be excluded from school so
    long as he is on antibiotics
  • B He has to remain off of school for 5 days from
    the onset of the lesions
  • C He must remain off of school until the lesions
    have crusted or healed
  • D He must remain off of school until he has
    completed the antibiotic course.

54
Case History 2
  • A 27 year old business man attends surgery
    complaining of pain and itching in the beard
    area. You examine him and see the following

55
  • What is the Diagnosis?

56
Folliculitis
  • Inflammation of the hair follicle.
  • Presents as itchy or tender papules and pustules
    at the follicular openings.
  • Complications include abscess formation and
    cavernous sinus thrombosis if upper lip, nose or
    eye affected.

57
  • What is the causative organism?

58
  • Most common cause is Staph Aureus.
  • Other organisms to consider include
  • Gram negative bacteria usually in patients with
    acne who are on broad spec antibiotics
  • Pseudomonas (Hot tub folliculitis)
  • Yeasts (candida and pityrosporum)

59
  • What is the treatment?

60
Folliculitis treatment
  • Topical antiseptics such as Chlorhexidine
  • Topical antibiotics, such as Fusidic acid or
    Mupirocin
  • More resistant cases may need oral antibioics
    such as Flucloxacillin
  • Hot tub folliculitis ciprofloxacin2
  • Gram negative trimethoprim

61
What is the Diagnosis?
62
What is the Diagnosis?
63
  • What is the most common causative organsism?

64
Cellulitis
  • Streptococcus Group A Strep Pyogenes.
  • Others include Group B, C, D strep,
    Staphylococcus Aureus, haemophilus influenzae
    (children) and anaerobic bacteria (e.g
    Pasteurella spp. After animal bites)

65
Treatment of cellulitis
  • Oral Flucloxacillin or erythromycin if allergic
  • Co-amoxiclav in facial cellulitis
  • If severe systemic upset, may require admission
    for IV antibiotics.
  • After the acute attack has settled, especially in
    recurrent episodes consider the underlying cause

66
What is the Diagnosis?
67
What is the diagnosis?
Painful red nodule
68
Furunculosis (boils) and carbuncles
  • Deeper Staphylococcal abscess of the hair
    follicle
  • Coalescence of boils leads to the formation of a
    carbuncle
  • Treatment is with systemic antibiotics and may
    need incision and drainage.
  • Consider looking for underlying causes, such as
    diabetes

69
What is the diagnosis?
70
What is the diagnosis?
71
What is the diagnosis?
72
What is the diagnosis?
73
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