Cutaneous Infections.pptx caused by microorganisms

This document consists bacterial fungal and viral cutaneous infections. Their management and control

1. Bacterial skin infections Impetigo Cellulitis Folliculitis

2. Impetigo Non bullous(90%) Bullous(10%) Staph Aureus GAS Staph Aureus Preschoolers All ages Honey coloured crusted lesions Thin walled bullae 0,5-3 cm Face around nares and mouth Extremeties NON specific

3. Diagnosis Clinical Treatment Mupirocin 2 % Oral antibiotics

4. Cellullitis . Infection of dermis and underlying subcutaneous tissue Group A Streptococcus and Staphylococcus are the most common causative bacteria Presents with indurated,warm erythematous macules with indistinct borders that can expand Erysipelas variant of cellulitis caused by GAS Lesions are rapidly advancing bright red with sharp margins Ecthyma complication of impetigo.Caused by GAS Characterized by a lesion with a rim of erythematousinduratinsurrounding an eschar which if removed forms a shallow ulcer

5. Necrotizing Fascitis Most extensive form of cellulitis involves deeper sc tissues.may progress to necrosis of underlying muscle SURGICAL EMERGENCY Broad spectrum Iv antibiotics

6. Folliculitis Hair follicle pyoderma Caused by- follicular occlusion of keratin,overhydration, bacterial or fungal infxn Bact- staph Deep or superficial Deep- extends beyond the confers of hair follicle to become furuncle or caburncle

7. SUPERFICIAL FUNGAL INFECTION

8. Viral Skin Infections

9. Viral infections Herpes simplex Warts (Verruca ) Molluscum Contagiosum

10. HSV-Etiology/Pathogenesis Infection divided into 3 stages Acute infection Virus replicates at site of inoculation on mucocutaneous surfaces resulting in primary lesions from which virus spreads rapidly to infect sensory nerve terminals where it travels via retrograde axonal transport to neuronal nuclei in regional sensory ganglia Lytic viral genes are transcribed Establishment and maintenance of latency In subset of infected neurons latent infection is established Latency associated viral genes are transcribed Reactivation of infection Latency gene expression converted to lytic gene expression Replication reactivates with concomitant anterograde axonal transport of newly assembled virus to a peripheral site at or near the original port of entry

11. HSV-Clinical Manifestations HSV 1 (herpes labialis ) Gingivostomatitis and pharyngitis most common May cause genital herpes in 10-20% following oral-genital contact Progression of classic herpes (3 stages) Developmental : prodromal erythema and papule Disease : vesicles, ulceration and crusting Resolution : dry flaking and residual swelling Lesions usually resolve in 5-15days

12. HSV-Clinical Manifestation HSV 2 Major cause of genital herpes, but may cause orolabial lesions that are indistinguishable from that caused by HSV 1 Associated with extensive genital lesions in different phases of evolution including vesicles, pustules, erythematous ulcers Males : glans or penile shaft Females : vulva, perineum, buttocks, vagina, cervix There is accompanying pain, dysuria , itching, vaginal and urethral discharge and tender inguinal lymphadenopathy . Herpetic sacral radiculomyelitis with urinary retention, neuralgias and constipation can occur. Lesions may require 2-3 weeks to resolve. Recurrence Infections with HSV 2 reactivate about 16 times more frequently than HSV 1 genital infections and occur about 3-4 times per year.

13. HSV-Clinical Manifestations Other cutaneous manifestations Herpetic Whitlow Infection of fingers by direct inoculation by direct spread from mucosal sites at time of primary infection Herpes Gladiatorum (althletes) Herpes rugbiagorum (rugby players) Eczema Herpeticum Results from widespread infection following inoculation of virus to skin damaged by eczema

14. Treatment Oral Valacyclovir or famcyclovir may shorten duration of disease

15. What’s the difference between TRUE LOVE and HERPES? HERPES lasts FOREVER!

16. Human Papilloma Virus Non-enveloped DNA virus affecting only humans More than 80 serotypes Cutaneous (non-genital): types 1, 2, 3, 4 Genital mucosa: types 6, 11, 16, 18 Isolated from epidermodysplasia verruciformis (EV): types 5, 8 Some types have malignant potential

17. HPV-Epidemiology Contagion depends on several factors: Location of lesions Quantity of virus present Degree and nature of contact HPV specific immunological status of the individual Patients with impaired cell-mediated immunity are particularly susceptible Source/reservoir - individuals with clinical or subclinical infection and environment Warts Non-genital warts occur most frequently in children and young adults Anogenital warts behave like sexually transmitted infections and transmit to partners with very high efficacy In children Non-genital wart type found in adults Consequence of sexual abuse or inoculation at birth or incidental spread of cutaneous warts Also genital mucosal infection (uterine cervix)

18. HPV- Clinical manifestations Classified by clinical location or morphology Cutaneous manifestations are varied Common warts ( verruca vulgaris ) Scaly, rough, spiny papules or nodules Occur as single or grouped papules on hands and fingers Flat warts ( verruca plana ) 2-4mm slightly elevated flat-topped papules with minimal scale Frequently found on face, hands, and lower legs Plantar and Palmar warts Thick, endophytic , hyperkeratotic lesions May coalesce to form mosaic warts Verruca may also be filiform , or cutaneous horns

19. HPV-Clinical manifestations Anogenital warts (condyloma acuminata) Epidermal and dermal papules or nodules on the perineum, crural folds and anus Vary in sized May extend internally into the vagina, urethra, and perirectal epithelium

20. HPV-Clinical Manifestations Mucosal infections Oral warts Small, slightly elevated, soft, often pink macules found on the buccal , gingival or labial mucosa or on the tongue or hard palate Mucosal lesions of the oral pharynx termed focal epithelial hyperplasia also contain HPVs In oral florrid papillomatosis multiple verrucae appear within the oral cavity Progression to verrucous carcinoma may occur Oral condylomata may occur from orogenital contact Warts may also appear in the urethra when meatal warts are present, and may spread to the urinary bladder Respiratory (laryngeal) papillomatosis Patients have multiple benign noninvasive warts usually involving the larynx, but may extend to the oropharynx and bronchopulmonary epithelia Condition may develop on any age but commonly occurs in infants Lesions may spontaneously remit, but recurrent is common because of persistence of persistence of viral DNA Types are the same as genital wart types

21. Treatment Self limiting Salicylic acid Liquid nitrogen Laser therapy T opical podophyllotoxin imiquimod

22. Pox Viruses Molluscum contagiosum

23. Molluscum Contagiousum DNA virus Viral infection of skin and mucous membranes generally affecting children, sexually active adults and immunocompromised Transmission is by person-to-person and possibly by fomites (pox viruses are resistant to dessication)

24. Molluscum Contagiosum Clinical Manifestations Lesions begin as minute papules that usually enlarge to 3-6mm and sometimes as large as 3cm Lesions are smooth, pearly to flesh-colored, dome-shaped papules often with central umbilication in which lies a curdlike core Lesions may occur on any area of the skin or mucous membranes and may resolve spontaneously with or without inflammation Immunocompetent cells are absent from the infected epidermis even if present in the dermis In adults with AIDS often occurs extensively on the genitalia

25. Diagnosis Clinical

26. Treatment Cryotherapy with topical liquid nitrogen Removal by curettage 0.9 % cantharidin 5% KOH

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