PowerPoint to accompany

Microbiology:
A Systems Approach
Cowan/Talaro

Chapter 18
Infectious Diseases
Affecting the Skin and
Eyes
Copyright The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
 Chapter 18
Topics
- Skin Defenses
- Eye Defenses
- Skin Diseases
- Eye Diseases

2
 Skin Defenses
• Skin
• Normal flora

3
 Skin
• Epidermis
– Stratum corneum (dead cells are sloughed off)
• Keratin (protein)
– Waterproof the skin
– Protects from microbial invasion
– Replaced every 25-45 days
– No nerve endings or blood vessels

4
 Skin continued
• Dermis
– Source for epidermis cells
– Connective tissue (fibers)
– Nerves, blood vessels, lymphatic
– Hair follicles, glands (sebum, lysozyme)
• Subcutaneous layer

5
The different layers of the skin are important defenses of the
skin.

6
Fig. 18.1 A cross-section of skin
 Normal flora
• Survive dry and salty conditions
• Dense populations in the skin folds
• Types
– Diphtheroids (Propionbacterium acnes)
– Micrococci (Staphylococcus epidermis)
– Yeast (Candida albicans)

7
 Eye defenses
• Eye
• Normal flora

8
 Eye
• Conjunctiva
– Thin membrane that covers the eye, except the cornea
– Secretes oil and mucous-containing fluids
• Best defense
• Cornea
– Covers the iris
– Several layers of epithelial cells
– Epithelial cells can regenerate if damaged
• No lymphocytes, no inflammation
– Immune privilege
9
The main parts of the eye that are important eye defenses.

10
Fig. 18.2 The anatomy of the eye.
The best defense of the eye is the film of tears, which
originates from the lacrimal apparatus of the eye.

11
Fig. 18.3 The lacrimal apparatus of the eye.
 Normal flora
• Very few present
• Resemble skin normal flora
– Diphtheroids
– Staphylococci
– Micrococcus
– Streptococci
– Yeast

12
 Skin Diseases
• Acne
• Impetigo
• Cellulitis
• Staphylococcal Scalded Skin Syndrome (SSSS)
• Gas gangrene
• Hansen’s Disease
• Skin rashes
• Warts
• Large skin lesions
13
 Acne
• Bacterial infection
• Follicle-associated lesion
• Types
– Comedo
– Whitehead
– Blackhead
– Pustule
– Cystic
14
Features of acne.

15
Checkpoint 18.1 Acne
 Impetigo
• Types
– Staphylococcus aureus
– Streptococcus pyogenes
• Peeling skin

16
An example of impetigo.

17
Fig. 18.4 Impetigo lesions on the face
 Staphylococcus aureus
• Associated with a number of diseases,
including impetigo
• Enzymes
– Coagulase
– Hyaluronidase
– Staphylokinase
– Lipases
• Most study non-spore forming pathogen
18
Scanning Electron Micrograph (SEM) and colonies of
Staphylococcus aureus, the causative agent of impetigo.

19
Fig. 18.5 Staphylococcus aureus
A positive coagulase test is a primary method of identifying
Staphylococcus aureus.

20
Fig. 18.6 The coagulase test.
A miniturized test system for the identification of
Staphylococcus.

21
Fig. 18.7 Miniaturized test system used in further
 Streptococcus pyogenes
• Associated with a number of disease,
including impetigo
• Beta hemolytic
• M protein

22
Pathogenesis of S. pyogens involves the conversion of
plasminogen to plasmin, which can degrade host tissue.

23
Fig. 18.8 Plamin activation by S. pyogens
Features of impetigo caused by either Streptococcus pyogenes
or Staphylococcus aureus.

24
Checkpoint 18.2 Impetigo
 Cellulitis
• Bacterial infection
• Fungal infection
• Infection of the dermis and subcutaneous
tissues
• Lymphagitis
• Immunocompromised individuals are at risk

25
Features associated with cellulitis.

26
Checkpoint 18.3 Cellulitis
 SSSS
• Bacterial infection
• Affects mostly newborns and babies
• Bullous lesions
• Desquamation (lose of protetive keratinized
layer)

27
Exofoliative toxin causes the major signs and symptoms of
SSSS.

28
Fig. 18.9 Staphylococcus scalded skin syndrome in a newborn
Features of SSSS or desquamation diseases.

29
Checkpoint 18.4 Major Desquamation Diseases
 Gas Gangrene
• Bacterial infection
• Anaerobic
• Toxins
• Gas formation
• Two forms
– Localized
– Diffused (myonecrosis)
30
An example of myonecrosis, where the necrosis has spread to
other areas of the body.

Fig. 18.10 The clinical appearance of myonecrosis in 31

32
Fig. 18.11 Growth of Clostridium perfringens
Features of gas gangrene.

33
Checkpoint 18.5 Gas gangrene
 Hansen’s Disease
• Bacterial infection
• Chronic and progressive
• Skin and nerve disease
– Tuberculoid leprosy
– Lepromatous leprosy (LL)

34
Tuberculoid leprosy is less severe, and can be treated
effectively.

35
Fig. 18.12 Leprosy lesions
LL is a more severe lesion, and is associated with
disfigurement (lepromas).

36
Fig. 18.13 A clinical picture of lepromatous leprosy.
Features of leprosy.

37
Checkpoint 18.6 Leprosy
 Skin rashes
• Vesicular or pustular rash diseases
• Maculopapular rash diseases

38
 Vesicular rash diseases
• Elevated lesions filled with fluid
• Viral infection
– Chickenpox
– Smallpox

39
 Chickenpox
• Common
• Benign
• Life-threatening for immunocompromised
individuals
• Recuperation can result in Varicella-zoster
virus infection
– Reemerge as shingles (skin lesion)

40
Chicken pox reemerges as shingles, due to stress,
X-ray treatments, drug therapy, or a developing malignancy.

41
Fig. 18.15 Varicella-zoster virus reemergence as shingles/
 Smallpox
• Eliminated due to world-wide vaccine
program
• Very infectious viral disease (epidemic)
• Considered a bioterrorism agent

42
Examples of the rashes associated with chickenpox and
smallpox in humans.

43
Fig. 18.14 Images of chickenpox and small pox.
Features of chicken pox and small pox.

44
Checkpoint 18.7 Vescular/pustular rash
 Maculopapular rash diseases
• Flat to slightly raised colored bump
– Measles or rubeola
– Rubella
– Fifth disease
– Roseola

45
 Measles
• Viral infection
• Vaccine available (MMR-measles, mumps,
rubella), but disease still exists
• Koplik’s spots
• Exanthemum
• Complications – subacute sclerosing
panencephalitis (SSPE)
• Syncytia formation
46
An example of the rash of measles.

47
Fig. 18.16 The rash of measles.
 Rubella
• Viral infection
• Vaccine available (MMR)
• Mild
• Serious for a fetus (teratogenic)
– Disrupts fetus development

48
Fetal injury varies based on the time of infection.

49
Fig. 18.17 An infant born with congenital rubella
 Fifth disease
• Viral infection
• Erythema infectiosum
• Mild
• No vaccine

50
 Roseola
• Viral infection
• Latent period – reactivates as
mononucleosis-like or hepatitis-like
symptoms
• Immunocompromised individuals are at risk

51
Features for measles, rubella, fifth disease, and roseola.

52
Checkpoint 18.8 Maculopapular rach diseases
 Warts
• Papillomas
• Molluscum contagiosum

53
 Papillomas
• Viral infection
• Benign
• Nearly everyone is infected
• Different virus types
– Plantar warts (HPV-1)
– Flat warts (HPV-3,10,28,49)

54
 Molluscum contagiosum
• Viral infection
• Distributed world-wide (endemic)
• Spread by contact
• Inclusion bodies contain viruses

55
Features of papillomas and molluscum contagiosum.

56
Checkpoint 18.9 Wart and wart-like eruptions.
 Large skin lesions
• Leishmaniasis
• Cutaneous anthrax
• Ringworm
• Superficial mycoses

57
 Leichmaniasis
• Protozoan infection
– Cutaneous
– Mucocutaneous
– Systemic
• Zoonosis
• No vaccine

58
 Cutaneous anthrax
• Bacterial infection
• Endosporulation and germination
• Untreated cases can be fatal
• Vaccine available

59
Features of leishmaniasis and cutaneous anthrax.

60
Checkpoint 18.10 large pustula skin lesions
 Ringworm
• Fungal infection (mycosis)
– dermatophyte
• Conditions name – tinea
– Scalp (tinea capitis)
– Beard (tinea barbae)
– Body (tinea corporis)
– Groin (tinea cruris)
– Foot (tinea pedis)
– Hand (tinea poris)
– Nail (tinea unguium)
61
An example of ringworm of the scalp.

62
Fig. 18.18 Ringworm of the scalp.
An example of ringworm of the body.

63
Fig. 18.19 Ringworm of the body.
An example of ringworm of the feet and fingernail.

64
Fig. 18.20 Ringworm of the extremities
Fungal or dermatophyte spores associated with ringworm.

65
Fig. 18.21 Examples of dermatophyte spores.
 Superficial mycosis
• Fungal infection
– yeast
• Cosmetic effects with no inflammation
– Tinea versicolor

66
An example of tinea versicolor.

67
Fig. 18.22 Tinea versicolor
Features of cutaneous and superficial mycoses.

68
Checkpoint 18.11 Cutaneous and superficial mycoses.
 Eye Diseases
• Conjunctivitis
• Trachoma
• Keratitis
• River blindness

69
 Conjunctivitis
• Bacterial infection
• Viral infection
• Neonates are at risk during birth
• Inflammation

70
An example of neonatal conjunctivitis.

71
Fig. 18.23 Conjunctivitis
Features of neonatal, bacterial and viral conjunctivitis.

72
Checkpoint 18.12 Conjunctivitis
 Trachoma
• Bacterial infection
• Endemic
• Pannus - inflammatory
• Blindness – chronic and secondary
infections

73
An example of ocular trachoma.

74
Fig. 18.24 Ocular trachoma.
Features of trachoma.

75
Checkpoint 18.13 Trachoma
 Keratitis
• Viral infection
• Serious infection – complete corneal
destruction

76
Features of keratitis.

77
Checkpoint 18.14 keratitis
 River blindness
• Parasite infection
– Parasite contains bacteria (mutualism) that
contribute towards the infection
• Chronic
• Endemic

78
Features of river blindness.

79
Checkpoint 18.15 River blindness
Summary of diseases of the skin and eye.

Taxanomic organization of microorganisms causing 80

81
Fig. 18.p573