Transcript Pyoderma

Bacterial infections
Zora Dubská
Department of Dermatovenereology of 3rd Faculty of Medicine and Faculty
Hospital Kralovske Vinohrady in Prague
Head: 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.)
- Hypersensitivity to PNC - macrolides (erythromycin)
- Lincosamides (clindamycin)
- Cephalosporins
- The risk of recurrence and lymphedema
- Prevention of relapse - long-term application
of benzathinpenicilin every 2-4 weeks
Staphylococcal scalded skin syndrome - Lyell's syndrome
- A life-threatening disease – systemic response
- Staphylococcus aureus produces exotoxins
- Separation of the upper parts of epidermis - large areas
- Infants and children under 5 years of age - the risk of sepsis,
pneumonia
- Fever, generalized erythematous, macular rash,
bullas, leasions, scales, without scarring
- 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 )
- Toxins act as superantigens
- Source - soft tissue infections (streptoc. syndrome)
- Alteration of the general condition, generalized macular
rash followed by desquamation of palms and soles after 1-2
weeks, raspberry tongue, erythema, mucosal erosion
- Anti-shock therapy, antibiotics i.v. (antistaphylococcal)
streptococcal etiology - PNC, clindamycin, cephalosporins,
i.v. immunoglobulins, surgery
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
- Complications - Secondary infection
- Rheumatic fever
- Glomerulonephritis
Skin infections caused by corynebacteria
- Erythrasma - axilla, groins
- Reddish areas with satellite maculas
- Wood's lamp - red fluorescence
- Trichomycosis axillaris
- Yellowish deposits on axillary, pubic hair
- Keratoma sulcatum
- Pitting of the soles
Mycobacteriosis - cutaneous tuberculosis
- Specific chronic granulomatous inflammation of the skin
- Mycobacterium tuberculosis (BK)
- Histology – caseificating specific granulomas
- Dying with Ziehl - Neelsen method - cultivation
- Tuberculin (Mantoux) test
- I.d. application of tuberculin - + induration over 6 mm/72h
Clinical forms of skin tuberculosis
- Primary inoculative tuberculosis
- Primary complex - ulcer + regional lymphadenitis
- Tuberculosis verrucosa cutis
- Lupus vulgaris - the most common
- vitropression: yellowish brown colour
- Scrophuloderma
- Tuberculosis cutis ulcerosa
- Tuberculosis cutis miliaris
- Tuberculous gumma
Tuberkulidy
- Id - reaction - late allergic response
to microbial antigens
- Recurrent disseminated symmetric
non- infectious rashes as response to
hematogenous spread of mycobacterial
antigens to the skin
- Lichen scrophulosorum
- Papulonekrotical tuberculid
- Erythema induratum (Bazin)
Therapy of cutaneous tuberculosis
- The condition of the patient
- A combination of drugs is needed
- Never less than 6 months of therapy
- Short-term treatment 6-9 months, long 18-24 months
- Main drugs - isoniazid, rifampicin
- Ancillary drugs - streptomycin, pyrazinamide, ethambutol
Atypical mycobacteriosis
- 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)
- Correlation with the clinical state necessary
- Therapy - antibiotics - Doxycycline
- Amoxicillin
- Cefuroxime axetil
- Azithromycin
- Ceftriaxone i.v.
Anthropozoonoses
- Diseases caused by microorganisms transferred
from animals to humans
- Anthrax - Bacillus anthracis - cattle
- Tularemia - Francisella tularensis - rodents
- Erysipeloid - Erysipelothrix rhusiopathie
- Maleus - Pseudomonas mallei – toed ungulated animals
Erysipeloid
- Acute inflammation of skin of hand fingers
- After injury in people who are in contact with fish,
poultry
- Non-ulcerative painful red-livid hot bearing
in the area of injury after 2-7 days
- Penicilin p.o. 7-10 days, ev. erythromycin
Cat scratch disease
- A rare chronic infection with significant regional
lymphadenopathy
- Bartonella henselae
- Papule or vesicle in the area of the scratch after 10 days
- Systemic symptoms
- Regional lymphadenopathy persists 2-6 months
- In most cases benign
Actinomycosis - Chronic granulomatous disease
- Abscesses, fistulas, scars - men
- Fibrous facultative anaerobic bacteria - Actinomyces – G+
- A. Israel - commensals of oropharynx, intestines,
genital - mucosal injury
- Tough inflammatory infiltrates with elevated edges,
fistulas, ulcers
- Cervicofacial, thoracic, abdominal form
- Microscope - yellow granular bacterial conglomerates
- Therapy - Penicillin G i.v. weeks, surgery
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