Microbial Diseases of the Skin
and Wounds
Chapter 19
Functions of the skin
Prevents excessive water loss
Important to temperature regulation
Involved in sensory phenomena
Barrier against microbial invaders
Wounds allow microbes to infect deeper tissues
[INSERT FIGURE 19.1]
Composed of two main layers:
Dermis
Epidermis
Microbiota
Halotolerant
Dense populations in skin folds
Total numbers determined by location and
moisture content
May be opportunistic pathogens
Most skin flora categorized in three
groups:
Diphtheroids (Corynebacterium and
Propionibacterium)
Staphylococci (Staphylococcus epidermidis)
Yeasts (Candida and Malassezia)
Folliculitis
Causative Agent
Most commonly caused by Staphylococcus
Salt tolerant
Tolerant of desiccation
Signs and symptoms
Infection of the hair follicle often called a pimple
Called a sty when it occurs at the eyelid base
Spread of the infection can produce furuncles or
carbuncles
Furuncles
extended redness, pus,
swelling and tenderness
Carbuncles
Numerous sites of draining pus
Usually in areas of thicker skin
Epidemiology: endogenous
Two species commonly found on the skin
Staphylococcus epidermidis
Staphylococcus aureus
Transmitted through direct or indirect contact
Diagnosis
Gram-positive cocci
in grapelike
arrangements
isolated from pus,
blood, or other fluids
[INSERT TABLE 19.1]
[INSERT TABLE 19.2]
Treatment
Dicloxacillin (semi-synthetic penicillin)
Vancomycin or Bactrim used to treat resistant strains
May require surgical draining
Prevention
Hand antisepsis
Proper cleansing of wounds and surgical openings,
aseptic use of catheters or indwelling needles, and
appropriate use of antiseptics
Scalded Skin Syndrome
Staphylococcal
scalded skin
syndrome (SSSS)
Bacterial agent is
Staphylococcus
aureus
Toxin mediated
disease
Signs & Symptoms
Skin appears burned
(scalded)
Other symptoms include
malaise, irritability, fever;
nose, mouth and genitalia
may be painful
Exfolative toxin released at infection site
causes split in epidermis
Outer layer of skin is lost
Causes body fluid loss and increase susceptibility to
secondary infection
Epidemiology
5% of S. aureus strains produce exfoliatins
Disease can appear at any age group
Most frequently seen in infants, the elderly and
immunocompromised
Transmission is generally person-to-person
Prevention and treatment
Only preventative measure is patient isolation
Treatment includes bactericidal antibiotics
Anti-staphylococcals such as penicillinase-resistant
penicillins like cloxacillin
Treatment also includes removal of dead skin
Impetigo (Pyoderma)
Characterized by pus production
Causative agents:
Pyodermic cocci
80% cases caused by S. aureus
Others caused by Streptococcus pyogenes
Group A Streptococcus
Gram-positive coccus, arranged in chains, -hemolytic
Signs & Symptoms
Superficial skin infection
Blisters just below outer
skin layer
Blisters replaced by
weepy yellow crust
There is little fever or pain
Lymph nodes enlarge
near area
May result in erysipelas
Epidemiology
most prevalent among children
Most affected are two to six years of age
Disease primarily spread person-to-person
Also spread by insects and fomites
Prevention and treatment
Prevention is directed at cleanliness and
avoidance of individuals with impetigo
Prompt treatment of wounds and application of
antiseptics can lessen chance of infection
Active cases are treated with penicillin,
erythromycin or vancomycin
Features of impetigo caused by Streptococcus pyogenes or
Staphylococcus aureus
Penicillin, erythromycin or vancomycin Penicillin or erythromycin
Acne
Follicle-associated lesion
Causative agent
Most serious cases caused by Propionibacterium
acnes
Gram-positive, rod-shaped diphtheroids
feed on sebum and keratin in plugged pores &
follicles
Epidemiology: endogenous
[INSERT FIGURE 19.7]
Prevention
remove oils as often as possible
Treatment
prophylactic tetracycline
Benzoly peroxide or salicylic acid
New treatment uses blue light radiation
Accutane in severe cases
Rocky Mountain Spotted Fever
Causative agent:
Rickettsia rickettsii
Obligate, intracellular
bacterium
Gram negative, non-
motile, coccobacillus
Signs and symptoms
Flu-like symptoms
Rash of faint pink spots
Begins on wrists and ankles then spreads to other parts of body
Petechiae subcutaneous hemorrhages (50%)
Bacteria are released into blood and taken up
by cells lining vessels
Results in apoptosis
Bacterial toxin released in bloodstream can
cause disseminated intravascular coagulation
Shock or death can occur when certain body
systems become involved
Commonly targets heart and kidney
Epidemiology
Zoonotic disease
Spread from animals to
humans
Main vectors include wood tick,
Dermacentor andersoni and the
dog tick, Dermacentor variabilis
Vectors remain infected for life
Transovarian transmission
occurs
[INSERT DISEASE AT A GLANCE 19.2]
Prevention
No vaccine currently available
Prevention should be directed towards:
Use protective clothing
Use tick repellents containing DEET
Carefully inspecting body
Removing attached ticks carefully
Treatment
Antibiotics are highly effective in treatment if
given early
Doxycycline and chloramphenicol used most often
Without treatment mortality around 20%
With early diagnosis and treatment, mortality
drops to around 5%
