CHAPTER 19: MICROBIAL DISEASES OF THE SKIN AND WOUNDS

Functions of the skin • Cuts, scrapes, surgery, burns, bites, etc. Normal Microbiota of the Skin
• Allow microbes to infect the deeper tissues of the
• Prevents excessive water loss body Skin microbiota
• Regulates temperature • In most cases, other body defenses eliminate
• Involved in sensory phenomena infection • Made up of various microbes
• Assists in vitamin D formation • Can result in severe or fatal diseases o Yeast
• Barrier against microbial invaders  Malassezia
Skin microbiota o Bacteria
Composed of two main layers  Staphylococcus, Micrococcus,
• Normally harmless microbes present on the skin and the diphtheroids
• Dermis • Compete with potential pathogens for nutrients
• Epidermis and space May produce disease
• Cannot be completely removed through
Wounds cleansing • If penetrate epidermis or if immune system is
• Typically grow in moist areas of the skin suppressed
• Trauma to any tissue of the body
• Waste products cause body odor

VIRAL DISEASES OF THE SKIN AND WOUNDS

Causative agent/ Pathogen and Diagnosis, treatment, and
Disease Gram Signs and symptoms Pathogenesis Epidemiology
Bacteria virulence factors prevention
Diagnosis
 Isolation of Gram-
Infection of the hair
positive bacteria in
follicle  S. epidermidis
grapelike clusters from
• Sty when it occurs  Staphylococcus lacks virulence
pus
at the eyelid base transmitted via factors and
Treatment
Facultative • Spread of direct contact rarely causes
• Dicloxacillin
anaerobic; infection into or by fomites disease
Folliculitis Staphylococcus (semisynthetic penicillin)
+ cocci surrounding tissues  Infection can  S. aureus
(pimple) aureus is the drug of choice
arranged in can produce spread into the transiently
• Vancomycin is used to
clusters furuncles blood and colonizes the skin
treat resistant strains
• Carbuncles occur move to organs or mucous
Prevention
when multiple beyond the skin membranes of
• Hand antisepsis
furuncles grow most people
• Proper procedures in
together
hospitals to minimize
MRSA infections
Staphylococcal  Skin becomes red  Some  No scarring  Disease occurs Diagnosis
Scalded Skin Staphylococcus and wrinkled and Staphylococcus because dermis primarily in  by characteristic
+
Syndrome aureus forms blisters aureus strains is unaffected infants sloughing of skin
(SSSS)  Outer epidermis • One or two  Death is rare  Transmitted by Treatment
 peels off in sheets different but may be due person-to-person  Treated by
exfoliative toxins to secondary spread of administration of
cause SSSS infections bacteria antimicrobial drugs such
as Cloxacillin
Prevention
 Widespread presence of
S. aureus makes
prevention difficult

• The bacteria Diagnosis

invade where • Transmitted by Impetigo: presence of
 Impetigo: red the skin is person-to-person vesicles
Mostly:
Impetigo cocci patches form on Virulence factors: compromised contact or via Treatment
Staphylococcus
the face and limbs impetigo • Acute fomites Impetigo: Topical: Mupirocin
aureus
+  Erysipelas: • M protein glomerulonephr • Impetigo occurs Oral: Clindamycin or
Some:
infection spreads • Hyaluronic acid itis can result if most in children Amoxicillin
Streptococcus
to the lymph • Pyrogenic toxins infection • Erysipelas can Erysipelas: Penicillin
pyogenes coccus nodes spreads to the also occur in the Prevention
Erysipelas arranged in kidneys elderly Proper hygiene and
chains cleanliness
• Most cases are
caused by S.
pyogenes
Diagnosis
• Various
Early diagnosis is difficult
enzymes • S. pyogenes enters through breaks in
because symptoms are
Necrotizing Streptococcus facilitate the skin
+ nonspecific
fasciitis pyogenes invasion of • Usually spread person-to-person
Treatment
tissues
Clindamycin and Penicillin
• Exotoxin A and
Prevention
streptolysin S
damage cells
and tissues
• Diagnosed by visual
• Propionibacteria examination of the skin
are normal • Treated with antimicrobial
Rod- microbiota drugs and drugs that cause
Propionibacterium
Acne + shaped • Typically begins in exfoliation of dead skin cells
acnes
diptheroids adolescence but • Accutane is used to treat
can occur later in severe acne
life • Ultraviolet light is also used
to destroy bacteria
Cat Scratch Bartonella • Fever, malaise, • Endotoxin is the • Transmitted by cat bites or scratches Diagnosed with serological
- bacillus
Disease henselae localized swelling primary and by blood-sucking arthropods testing
 at infection site virulence factor Antimicrobials: Rifampin,
Ciprofloxacin, Gentamicin
• Infection can Diagnosis can be difficult
occur in burn • Pyocyanin discoloration
victims indicates massive
• Found in soil, • Bacteria grow infection
• P. aeruginosa is
decaying under the • Treatment is difficult
• Blood infection inhabitant of
matter, moist surface of the because of multi-drug
causes fever, water and soil
environments burn resistance of P.
chills, and shock • Bacterium rarely
• VF: Fimbriae, • The bacteria aeruginosa;
Aerobic; • Blue-green color part of the
Pseudomonas Pseudomonas adhesins, kills cells, Simultaneous use of
- rod-shaped from the bacterial human
Infection aeruginosa capsule, toxins, destroys tissue, Penicillin and
bacterium pigment, microbiota
enzymes and triggers Aminoglycoside
pyocyanin, occurs • Can infect almost
• Rarely causes shock • P. aeruginosa is
in massive any organ or
disease despite • Debridement widespread, but
infections system once in
virulence of burn is infections typically don't
body
factors required for occur in healthy
topical individuals
antimicrobials
to be effective
Diagnosis
• R. rickettsii serological testing
• Nonitchy spotted • Rickettsias do does not Treatment
rash on trunk and not use glucose secrete any Severe: Rocky Mountain S.F.
• Transmitted via
Spotted Fever Intracellular appendages as a nutrient toxins Doxycycline/Chlorampheni
Rickettsia rickettsii - bite of infected
Rickettsiosis parasite • Organ failure can • Pathogen • Disease occurs col
tick
occur in severe avoids digestion from damage Prevention
cases in phagosome to blood use of tick repellents and
vessels avoidance of tick-infested
areas
Treatment
endospore- Characterized by Ciprofloxacin and
Cutaneous forming; an eschar postinfection immunization
Bacillus anthrasis + Prevention
Anthrax rod-shaped • Black, painless
bacterium ulcer control of the disease in
animals
Endospore- Death of muscle and • C. perfringens is Diagnosis
Clostridium - forming connective tissue most often Apperance
species bacilli • Blackening of isolated • Traumatic event must introduce Treatment
Gas gangrene Most isolated: rod- infected muscle • Bacterial endospores into dead tissue Rapid treatment is crucial
Clostridium shaped, and skin endospores • Mortality rate exceeds 40% • Surgical removal of
+
perfringens anaerobic, • Presence of gas survive harsh dead tissue
spore- bubbles conditions • Administration of
 forming • Vegetative cells antitoxin and large
secrete 11 doses of intravenous
toxins Penicillin and
Clindamycin
Prevention
• proper cleaning of
wounds
Smallpox infection
Poxviruses are DNA occurs by • Variola virus
viruses inhalation of virus stocks are
• Produce various • Viruses spread maintained in U.S.
• Treatment requires
Diseases progress proteins that from the and Russian labs
immediate vaccination
Poxviruses through a series of interfere with the respiratory tract for research
• Vaccination discontinued
stages immune response throughout the • Monkeypox cases
in 1980s
• Orthopoxvirus body have increased
(variola virus) • Other poxviruses over the past
causes smallpox are spread by decade
direct contact
Orthopox virus Immunity: Cow pox virus
Smallpox
(variola) (vaccinia)
Diagnosis
Presence: lesions
• Spread between
Slow-spreading skin Immunoassay reveals
• Painful lesions mucous membranes
lesions presence of viral antigens
caused by of mouth and
• Herpetic Treatment
Produce various inflammation and genitals
Herpes Herpes virus 1 and gingivostomatitis, Acyclovir or its derivatives
proteins that act as cell death • Herpes infections in
infection 2 whitlow, herpes help control the disease but
virulence factors • Fusion of adults are not life
gladiatorum do not cure it
infected cells threatening
• Recurrence of Prevention
forms syncytia • Neonatal infections
lesions is common Health care workers can
can be fatal
wear gloves to limit
exposure
Diagnosis: observation
• Warts develop
• Transmitted via Treatment
• Benign epithelial several month
direct contact • Various techniques to
growths on the after infection
and fomites remove warts
skin or mucous Some strains trigger • Most warts are
• Individuals can • New warts can develop
Warts Papillomavirus membranes oncogenes in host harmless
spread viruses as a result of latent
• Can form on chromosome • Papillomavirus
among locations viruses
many body es may
on their own • Covered warts usually
surfaces precipitate
body diappear within 2
some cancers
months
 • Highly contagious • Infection spreads Diagnosis
infectious disease from the characteristic lesions
• Characterized by respiratory tract to • Chickenpox occurs Treatment
lesions on the back the skin via blood mostly in children No treatment; Relief:
Chickenpox and trunk that spread and lymph • VZV infected 90% of Acetaminophen and
across body • Infected dermal children prior to antihistamines
• Virus becomes cells cause immunization Prevention
latent within sensory characteristic rash • Disease is more Vaccine available against
Varicella-zoster
nerves of chickenpox severe in adults chickenpox
virus (VZV)
• Occurs following • Chickenpox is • ~20% of people
reactivation of the usually a mild who have had
virus disease chickenpox develop
• Lesions are localized • Virus becomes shingles
Shingles Oral acyclovir
to skin along an latent in nerve • Risk of shingles
infected nerve ganglia increases with age
• Pain may last after • Reactivated VZV
lesions have healed causes shingles
• Infection spreads
from the
• Children develop a
respiratory tract
mild rash
throughout the Diagnosis
• Adults may develop
body via the observation of rash and
arthritis and • Spread by
Rubella virus blood serological testing
Rubella encephalitis respiratory secretions
(rubivirus) • The immune Treatment
• Congenital infection • Infects only humans
response to Prevention
can result in birth
infected cells Vaccination
defects or death of
contributes to the
fetus
disease severity in
adults
• Measles is highly Diagnosis
• Immune contagious based on signs of measles
• Characterized by response to • Spread via Treatment
• Adhesion and
Koplik's spots infected cells respiratory droplets Treatment involves
Measles Measles virus fusion proteins help
• Subacute sclerosing causes most • Humans are the administration of vitamin A,
(Rubeola) (morbillivirus) virus avoid immune
panencephalitis is rare symptoms only host antibodies against measles,
recognition
complication • Disease can be • Vaccination has and ribavirin;
fatal in children reduced spread of Prevention
the disease MMR vaccine
• Also referred to as fifth disease
Erythema B19 virus
• Respiratory disease that manifests as a rash
infectiosum (erythovirus)
• Adults may also develop anemia and joint pain
Human Herpes • Endemic disease of children
Roseola
Virus 6 • Characterized by a rose-colored rash
Mycoses of the Hair, Nails, and Skin • Subcutaneous • Hypo- or hyperpigmented patches of scaly skin
• In the hypodermis and muscles • Pathogens and virulence factors
• Mycoses are diseases caused by fungi • Caused by Malassezia furfur
• Systemic
• Most are opportunistic pathogens • Normal inhabitant of human skin
• Affect numerous systems
• Mycoses are classified by infection Wound Mycoses
location Superficial Mycoses
• Superficial • Some fungi grow in deep tissues but do
• Most common fungal infections
• Occur on the outer surfaces • Occur on the hair, nails, and outer skin layers not become systemic
• Cutaneous • Signs and symptoms • Fungi eventually grow into the epidermis
• Occur in the skin • Pityriasis versicolor to produce skin lesions

MYCOSES OF THE HAIR, NAILS, AND SKIN

Causative agent/ Pathogenesis Epidemiology Diagnosis, treatment, and Notes
Mycoses
Bacteria prevention
Diagnosis
Infected skin is pale green under
ultraviolet light
• Fungi produce keratinase, which dissolves keratin
microscopic examination
• Fungi are often transmitted via shared hair brushes
Superficial Mycoses Malassezia furfur Treatment
and combs
Topical: Ciclopirox
• Disease occurs most often in adolescents
Antifungal imidazole:
Ketoconazole shampoos
Prevention
Diagnosis
• Dermatophytes are among
• Dermatophytes • Clinical observation
the few contagious fungi Dermatophytoses
colonize skin, • KOH preparation of skin or nail
3 genera cause most • Dermatophytes classified by • Cutaneous lesions caused by
nails, and hair samples confirms diagnosis
dermatophytoses natural habitat some fungi that grow in the
• Use keratin as Treatment
• Microsporum o Anthropophilic: skin
Cutaneous Mycoses nutrient source • Topical: Terbinafine (1-4 weeks)
• Trichophyton associated with • Caused by dermatophytes
• Infection is rare • Chronic cases: Griseofulvin
• Epidermophyton humans • Cell-mediated immune
• Fungi must • Limited infections treated with
floccosum o Zoophilic: associated responses damage deeper
invade living topical agents
with animals tissues
layers of skin • Widespread infections treated
o Geophilic: soil fungi
with oral drugs
Wound Mycoses
four species of Diagnosis • Painless lesions form that
Chromoblastomycosis ascomycete fungi: Presence of golden brown bodies progressively worsen
• Fonsecaea in skin sample • People who work barefoot in
 pedrosoi Treatment the soil are at risk
• F. compacta removal of infected tissues and
• Phialophora administration of antifungal drugs
verrucosa Prevention
• Cladophialophora Wearing shoes reduces number of
carrionii infections

Diagnosis
by observation of hyphae in skin
sample, biopsy material, or
• Acquired when spores enter wounds
over 30 genera of cerebrospinal fluid Disease is permanently
Phaeohyphomycosis • Disease is variable in presentation
fungi Treatment destructive to tissues
• Depends on site of fungal colonization
treated with itraconazole
Prevention

Diagnosis • Pricks and scrapes introduce

based on symptoms and presence fungi into people
of fungi in clinical samples • People who work barefoot in
some genera of soil Treatment soil most at riskT
Mycetomas
fungi surgical removal of mycetoma • umorlike lesions form on skin,
and antifungal therapy fascia, and bones
Prevention • Infections are prevalent in
countries near the equator
• Pricks and splinters introduce
fungi into humans
Diagnosis
• Occurs most often in
based on patient's history, clinical
gardeners and farmers
signs, and observation of fungi in
• Subcutaneous infection
clinical samples
usually limited to the arms
Treatment
Sporotrichosis Sporothrix schenckii and legs
Cutaneous lesions are treated with
• Fixed sporotrichosis remains
antifungal drugs
localized
Prevention
• Lymphocutaneous
wearing proper attire to avoid
sporotrichosis occurs when
inoculation of the fungus
the fungus enters the
lymphatic system
PARASITIC INFESTATIONS OF THE SKIN
Causative agent/ Signs and Pathogen and virulence factors Pathogenesis and Diagnosis, treatment, and
Disease symptoms prevention
Bacteria epidemiology
Cutaneous • Infected macrophages Diagnosis
• Produces • Protozoan transmitted by stimulate inflammatory microscopic identification of the
Leishmaniasis Leishmania
large, painless female sand flies responses protozoa
skin lesions • Leishmaniasis is endemic in Treatment
 Mucocutaneous parts of the tropics and Antimicrobials are needed for
• Skin lesions subtropics severe infections
enlarge to Prevention
encompass reducing exposure to the
mucous reservoir host
membranes
Visceral
• Parasite is
spread by
macrophages
throughout
body
• Characterized
by intense Diagnosis
itching and observing mites, eggs, or fecal
rash at matter in skin samples or the
• Itching blisters occur where
infection site • The mite Sarcoptes scabiei is characteristic burrows
female mites lay eggs
• Lesions the causative agent Treatment
• Mites transmitted via
Scabies Sarcoptes scabiei common • Inflammation and damage to Treated with mite-killing lotions
prolonged body contact
between the nerve endings occur as the and cleaning of contaminated
• Epidemics occur in crowded
fingers, around mites burrow items
conditions
the genitalia, Prevention
and on the good personal hygiene
wrists, elbows,
and knees