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, [Link], 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 [Link], 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 [Link] (strain 502)
[Link] 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
[Link] 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
