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Bacterial Infections Normal Skin Flora Streptococcal Skin Infections ➢Impetigo, Ecthyma, Cellulitis & Necrotizing Fascitis

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Bacterial Infections Normal Skin Flora Streptococcal Skin Infections ➢Impetigo, Ecthyma, Cellulitis & Necrotizing Fascitis Bacterial Infections Normal Skin Flora Streptococcal Skin Infections ➢Impetigo, Ecthyma, Cellulitis & Necrotizing Fascitis. ➢Strep. Toxins: ▪ TS-like Syndrome ▪ Scarlet Fever ➢Allergic hypersensitivity to strept. Antigens: ▪ Erythema Nodosum ▪ Vasculitis ➢Provoked diseases: Guttate Psoriasis Staphylococcal Skin Infections ➢Impetigo, Ecthyma, Folliculitis, Boils, Carbuncles. ➢Staph. Exotoxins: ▪ Bullous Impetigo ▪ SSS Syndrome ▪ Toxic shock Syndrome ▪ Scarletina Bacterial Infections ➢Impetigo ▪ Non-Bullous Impetigo (Impetigo Contagiosum) ▪ Bullous Impetigo ➢Cellulitis & Erysipelas ➢Folliculitis ➢Furunculosis ➢Intertrigo ➢Erythrasma ➢Pitted Keratolysis Impetigo ➢It is an acute contagious superficial pyogenic infection of the skin. ➢Clinically; 2 types: ▪ Non-Bullous (Impetigo contagiosum) ▪ Bullous Impetigo Non-Bullous Impetigo ➢Causative Organism: ▪ Group A Streptococci ▪ Staph. Auerus ➢Host defense: ▪ Mainly by intact stratum corneum. ➢Mode of transmission: ▪ Direct contact or indirect through towels, flies,…etc ➢Predisposing Factors: ▪ Overcrowding ▪ Bad Hygiene ▪ Itchy skin diseases (e.g. pediculosis, scabies, eczema…) ▪ Hot humid climate as in summer ➢Age: ▪ Mainly preschool children. ➢Sites: ▪ Face (around mouth & nose) ▪ Limbs ▪ Scalp (look for Pediculosis) ▪ Any other sites, except palms & Soles ➢Clinical picture: ▪ Thin-walled vesicles on erythematous base, that soon ruptures and the exuding serum dries to form yellowish-brown (honey-color) crusts. ▪ Crusts dry and separate leaving erythema which fades without scarring. ▪ Regional lymph adenitis with fever and other constitutional symptoms may occur in severe cases. ➢Varieties ✓Circinate Impetigo ▪ With peripheral extension & healing in the center. ✓Crusted Impetigo ▪ It occurs in the face & scalp with pediculosis. ▪ Crust is thick and gummy. ▪ L.N. are usually affected. ✓Ecthyma (Ulcerative Impetigo) ▪ It is characterized by the formation of adherent crusts, beneath which purulent irregular ulcers. ▪ Healing occurs after few weeks, with scarring. ▪ Sites: Buttocks, thighs & legs. ➢Complications: ▪ Post-streptococcal acute glomerulonephritis, especially in cases due to strept. pyogens M. type 49, 12, 25. ▪ It occurs 3 weeks later (10 days in throat infections). Bullous Impetigo ➢Causative Organism: ▪ Staph. Auerus through Staphylococcal Exotoxins. ➢Age: ▪ All ages, but common in childhood and newborn (Impetigo Neonatorum). ➢Sites: ▪ Face (around mouth & nose). ▪ Any other sites, even palms & Soles. ➢Clinical picture: ▪ Bullae are less rapidly ruptured (persist for 2-3 days) and become more large. ▪ The contents are first clear, later cloudy. ▪ Thin brownish crusts are formed after rupture of bullae. Fresh Lesions Fluid Level Bulla Break Crusted Lesions Treatment of Impetigo ➢Treat predisposing causes ▪ e.g. pediculosis and scabies ➢Remove the crusts (Topical antiseptics) ▪ K Permengnate ▪ Hydrogen Peroxide ▪ Betadine Shampoo & Solutions…. ➢Topical Antibiotics (Cream or Ointment) ▪ Mupiracin ▪ Fusidic acid ▪ Gentamycin 0.1 & 0.3% ▪ Tetracycline ▪ Bacteriacin…. ➢Systemic Antibiotics ▪Indications: Fever or Lymphadenopathy Extensive Lesions (esp. in scalp, ear or eyelids) Nephropathic strains are suspected ▪Examples: Penicillins Cloxacillin & Amoxicillin… Azithromycin & other Macrolides Cellulitis ➢ It is an acute, subacute or chronic inflammation of the subcutaneous tissue. ➢ It is usually caused by group A streptococci, but staph. aureus and H. influenza is also implicated, esp. in facial cellulitis in young children. ➢ Periorbital and orbital cellulitis may result in intracranial sepsis and ocular damage. ➢Clinically: ▪ Sites: head, neck & extremities. ▪ Fever, chills, and malaise. ▪ Diffuse ill-defined, non-palpable borders, red, tender, indurated skin. In severe infections, vesicles, bullae, pustules or necrotic tissue may be present. ▪ Ascending lymphangitis and regional lymph node involvement may occur. Erysipelas ➢ It is due to infection of the demis & upper subcutaneous tissue by group A streptococci, which reaches the dermis through a wound or small abrasion. ➢ It is regarded as a superficial (dermal) form of cut. cellulitis. ➢ A female predominance exists, except in young patients, where it is more commonly seen in boys. ➢Clinically: ▪ Sites: face & legs. ▪ High fever & rigors. ▪ Well-demarcated erythematous, hot, tender swelling of the skin. ▪ Vesicles or bullae may occur. ▪ Lymphadenopathy & lymphangitis are frequent. ▪ When the infection resolves, desquamation & postinflammatory pigmentary changes may occur. Treatment of Cellulitis & Erysipelas ➢Systemic antibiotics: ▪ Penicillin (e.g. Benzyl 600-1200 mg IV/6 hrs For 10 days) ▪ Erythromycin (in patients allergic to Penicillin). ➢Rest & analgesic. Furunculosis (Boils) ➢ It is a staphylococcal infection similar to, but deeper than folliculitis & invades the deep parts of the hair follicles. ➢ Boils occur in all ages, but common in young males. ➢ Common sites: neck & buttocks. ➢ Predisposing Factors: ▪ Weak immunity: DM, anemia, HIV … ▪ Itchy diseases: sweat rash, scabies… ▪ Alcholism, obesity… ➢Clinically: ▪ Small inflammatory nodules which extend & penetrate deeper. ▪ The purulent & necrotic center is formed in a few days , the boils ruptures & discharges pus. ▪ Pus may spread & cause more boils to develop. ▪ Fever, headache & loss of appetite. ➢Treatment: ▪ As impetigo. ▪ Systemic antibiotics are necessary. ▪ Surgical incision may be needed. Pseudofolliculitis Barbae ➢ This is a sterile inflammatory pustular eruption secondary to ingrowing coarse hairs that penetrate into the skin by the sharp tips of shaved hairs. ➢ It is common in the beard area and under the neck. Also, in the hirsutes. ➢Treatment: ▪ Before therapy is initiated, the patient should be given a candid explanation regarding the cause. ▪ It should be stressed that the only way to cure the disease is to stop shaving. ▪ Shaving technique adjustment. ▪ Topical steroid & antibiotics. ▪ Laser hair epilation. Sycosis Barbae ➢ Deep-seated chronic staphylococcal infection of the beard & moustache area, involving the whole length of the hair follicle in males, after puberty. ➢ It may be associated with nasal carriage of staph. ➢ Clinically: Discrete edematous, red follicular papules or pustules centered on hairs, may coalesce to produce raised plaques studded with pustules. ➢Treatment: as impetigo Erythrasma ➢ It is chronic localized superficial infection of skin caused by Corynebacterium minutissimum. ➢ Sharply-defined but irregular brown, scaly patches usually localized to groins, axilla, toe clefts (?DM) or extensive lesions. ➢ Wood’s light: Coral-red fluorescence (Coporporphin III). ➢ Treatment: ▪ Topical: Azole antifungal, Erythromycin oint., Clindamycin lotion, Fucidic acid (2 weeks). ▪ Oral: Erythromycin (for 5 days). Erythrasma Pitted Keratolysis ➢ It is a non-inflammatory bacterial infection caused by Corynebacterium minutissimum that produce a specific proteolytic enzyme which digests the stratum corneum. ➢ There is usually no evidence of inflammation or erythema. ➢ Hyperhidrosis and malodor of the skin are very common. ➢ It consists of small crater-like depressions in the stratum corneum, 1-7 mm in diameter, on the weight-bearing regions of the soles of the feet. ➢ These small pits may coalesce into large craters, rings of craters, or erosions. ➢ Treatment: ▪ Buffered glutaraldehyde 2% or aluminum chloride 25% in alcohol solution: to treat PK and the predisposing factor of hyperhidrosis. ▪ Topical treatment leads to rapid resolution with: ▪ Fusidic acid, erythromycin, clindamycin. ▪ Miconazole, clotrimazole and tetracycline. .
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