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Bacterial infections of Skin

Learning objectives of bacterial infections of skin

Define Pyoderma and classify it.


List the normal flora of skin. Define impetigo. List the differentiating features of bullous and non-bullous impetigo. Describe the C/F, investigations of impetigo. Outline

the
management of impetigo.

Learning objectives of bacterial infections of skin

Define folliculitis , classify it and describe the management of it. Describe the C/F, investigations and management of ecthyma/ cellulites/ erysipelas/ furuncle/ carbuncle/ SSSS.

List the skin infection produced by B- hemolytic streptococci.

List the skin infection produced by staphylococci.

Normal flora of skin


Classification:

1. Resident flora: grow on skin & relatively


stable in no. and composition at particular sites 2. Transient flora: lie on skin surface without attachment, unable to multiply & disappear within short time 3. Transient or temporary residents

Normal Skin Flora


Major bacterial groups
Coryneforms (Gram +ve, pleomorphic rods) Corynebacterium (Aerobic & lipophilic) Brevibacterium (Aerobic & non-lipophilic) Propinobacterium (Anaerobic)

Contd

- Staphylococci (Gram +ve cocci, aerobs)


S. epidermidis, S. hominis, S.hemolyticus, S. saprophyticus

Minor bacterial groups


Acinetobacter (25%) Micrococci

Fungal group
Pityriasporum

Bacterial infection of the skin (Pyoderma)


Classification of pyodermas
1. Primary
Impetigo Ecthyma Folliculitis
Superficial Deep
* * * * Folliculitis of leg Furuncle Carbuncle Sycosis Barbae

2.

Cellulitis/ Erysipelas Pyonychia SSSS TSS Secondary


Secondary infection of preexisting dermatoses eg. Atopic dermatitis, Scabies

Impetigo (contagious superficial infection)


Non-bullous Bullous
Staph. aureus All ages Bullae of 1-2cm Persist for 2-3 day Thin, flat, brownish crust

1. Cause - Streptococcal (Group A) - Staph. aureus (Phage Groups II) 2. Pre-school and young school age 3. Very thin walled vesicle on an erythematus base 4. Transient 5. Yellowish-brain crusts (thick)

Contd

6. Irregular peripheral extension without healing 7. Regional adenitis 8. Constitutional symptoms present 9. Face (around the nose, mouth & limbs) 10. Palms & sole spared 11.MM, very rare

Central healing with peripheral extension Rare Absent occur anywhere May involved May involved

Predisposing factors
Malnutrition Diabetes Immuno-compromise status

Complications
Streptococcal infection PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Ecthyma
Streptococcal & staph

Common in children
Small bullae or pustules on erythematous base Formation of adherent dry crusts Beneath which ulcer present Indurated base Heals with scar and pigmentation Buttocks, thighs and legs, commonly affected

Folliculitis
Superficial folliculitis
Infection of hair follicles Commonly caused by staph. aureus

Children
Scalp & limb Rarely painful Heals in a week

Folliculitis
Deep folliculitis of leg
Chronic
Staph. aureus

Hair follicles of leg


Multiple

Atrophic scar

Furuncle (Boil)
Acute

Staph. aureus
Small, follicular noduler -- Pustule--necrotic-discharge pus Painful Constitutional symptoms

Heals with scar

Age: Adult
Site: Neck, Wrist, Waist, Buttocks, Face

Complication
Cavernous Sinus thrombosis, (upper lip & check) Septicemia (malnutrition)

Carbuncle
Extensive infection of a group of contagious follicles
Staph. aureus Middle or old age

Predisposing factors
Diabetes Malnutrition Severe generalized dermatoses During prolonged steroid therapy

Painful, hard lump Suppuration begins after 5-7 days Pus discharge from multiple follicular orificies Necrosis of intervening skin Large deep ulcer

Constitutional symptoms

Sycosis barbae
Beard region Pustules surrounded by erythema Males After puberty After trauma

Upper lip and chin


Staph. aureus

Cellulitis
Acute/sub-acute/chronic
Inflammation of loose connective tissue Streptococcal (Group A) Erythematous, edematous, swelling Pain/tenderness Constitutional upset

Pyonychia
Acute
Erythematous swelling of proximal and lateral

nail fold
Painful

Staphylococcal scalded skin synotrane (Ritters Disease)


Exotoxin of staph (Phage Group II) Acantholysis Occult staph. upper respiratory tract infection or purulent conjunctivitis Infants and children Tender red skin

Staphylococcal scalded skin synotrane (Ritters Disease)


Denuded skin Heals 7 - 14 day Dont grow staph. from blister fluid

Complication 2%
Cellulitis Pneumonia

Prognosis : Rule

Principles of therapy of pyoderma


Good personal hygiene Management of predisposing factors Local
Attend to traumas, Pressure, Sweating, Bites Treat pre-existing dermatosis Investigate carrier sites: Nose, Axilla, Perineum

Systemic
Treatment of disease like DM Nutritional deficiency Immunodeficiency

Principles of therapy of pyoderma


Local therapy
Cleaning with soap-water and weak KMN04
solution Removal of crusts with KMN04 soluation Application of antibacterial cream

Systemic therapy
Antibiotics

Recurrent staphylococcal infection


Persistent nasal carriage
Abnormal neutrophitic chumotaxis

Deficient intracellular killing


Immunodeficient status D.M.

T/t of staph. carriage elimination


Nasal & perineal care Rifampicin 600 mg/d 7-10 days Clindamycin 150 mg/d 3 months Topical mupirocin Replacement of microflora with a less pathogenic stains of S.aurus (strain 502)

S.aureus produces skin infection


I. Direct infection of skin and adjuscent tissues
a. b. c. d. e. f.
a. b.

Impetigo Ecthyma Folliculitis Furunculosis Carbuncle Sycosis


Staphylococcal scalded skin syndrome Toxic shock syndrome

II. Cutaneous disease due to effect of bacterial toxin

-hemolytic streptococcus produces skin infection


I. Direct infection of skin or subcutaneous
a. b. c. d. e. f. g. Impetigo (non bullous) Ecthyma Erysipelas Cellulitis Vulvovaginitis Blistering distal dactylitis Necrotizing fascitis Eczema infection

II. Secondary infection

III. Tissue damage from circulating toxin


Scarlet fever

IV. Skin lesion attributed to allergic hypersensitivity to streptococcal antigens


E.Nodosum Vasculitis

V. Skin disease provocated or influenced by streptococcal infection (mechanism uncertain)


Guttate psoriasis

Consider the following in relation to bacterial infection of skin

a.

Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus.

b. Bullous impetigo is caused by streptococci

c. In erysipelas, inflammation is limited to dermis and upper


part of subcutaneous tissue.

d.

Furunculosis is caused by Streptococcus

Thank you