NURS 220 Mod 4 Skin and Eye Infections

Keratin

waterproof protein in epidermis

Nerves and blood vessels

compose the dermis

Fat

composes subcutaneous later; acts as cushion

Physical Barriers of Host Defense

keratin, layers of skin, tight junctions, perspiration

Chemical Barriers of Host Defense

salt, lysozyme, IgA antibodies, low pH, sebum, antimicrobial peptides

Biological Protection of Host Defense

normal microbiota

Wounds and hair follicles, what pathogenic strategy?

breach of structure

IgA protease, what pathogenic strategy?

secretion of enzymes

antigenic drift, what pathogenic strategy?

modification of antigens

Changes in physical appearance of skin

first sign of infection

Staphylococcus aureus and Streptococcus pyogenes

• gram pos and beta-hemolytic

• staph resistant to penicillin

• strep sensitive to bacitracin

• spread through close contact

Cellulitis

• S aureus and S pyogenes

• edema and erythematous rash

• DIFFUSE BORDERS

• oral antibiotics, IV vancomycin in severe cases

Impetigo

• S aureus and S pyogenes

• oozing vesicles that dry to form HONEY colored crusts

• cleanse w antibacterial soap, topical mupirocin application or oral antibiotics (based on severity)

Necrotizing Fasciitis (flesh eating bacteria)

• S aureus and S pyogenes

• intense pain at infection site, reddening/purple/bronze mottle rash, high fever, tissue destruction, shock, organ system failure, death

• aggressive antibiotic therapy, hyperbaric therapy, surgical debridement, amputation

Boils/Folliculitis

• S aureus

• single boil=furuncle

• cluster of boils=carbuncle

• enlarged, painful pustules

• washing with antibacterial soap, topical/oral antibiotics, incision and drainage if necessary

Staphylococcal-Scalded Skin Syndrome

• S aureus

• fever, rough erythematous rash, desquamation, bullae formation

• IV nafcillin, supportive care, topical care (similar to burn therapy)

Erysipelas

• S. pyogenes

• fever, edema, painful itchy erythema

• DELINEATED BORDERS

• oral or IM penicillin

Scarlet Fever

• S pyogenes

• florid rash, strawberry tongue, circumoral pallor, pasta lines, high fever, systemic upset

• beta-lactam antibiotics

General Treatment and Prevention of Bacterial Skin Infections

• oral antibiotics: superficial infections

• IV antibiotics/surgical interventions: deep infections

• lancing and draining: boils, carbuncles, abscesses

• good hygiene in general

• cuts, abrasions, wounds should be cleaned properly

Pseudonomal Skin Diseases

• P. aeruginosa (gram neg bacillus)

• associated with moist conditions/repeatedly wet skin

• fruity odor (trimethylamine), green pus/discoloration (pyocyanin)

• antibiotics

• limit water exposure/submergence of skin

Gas Gangrene

• Clostridium perfingens (gram pos bacillus)

• usually occurs after penetrating trauma

• excruciating pain, gas bull, myonecrosis

• surgical excision, antibiotics, hyperbaric treatments

• proper wound care, anti-toxin vaccine

Acne Vulgaris

• Propionibacterium acnes (gram pos rod)

• MOST COMMON skin disease in US

• comedones, papules, pustules, nodes/cysts on face, shoulders, back/chest

• topical/oral antibiotics, vitamin A derivatives

• low sugar diet, gentle daily cleansing, avoiding oily skin products

Cutaneous Anthrax

• B. anthracis (gram pos bacillus)

• black eschar

• 20% mortality rate if untreated

• potential bioweapon

Chickenpox

• Pediatric

• Varicella zoster virus (VZV)

• itchy, vesicular rash emerging in waves before scabbing over, fever, headache, malaise

• symptomatic

• vaccine

Measles

• pediatric

• morbillivirus

• koplik spots, itchy confluent maculopapular rash, fever

• symptomatic

• MMR vaccine

Rubella

• pediatric

• rubivirus

• fine pink spreading maculopapular rash, congestion, lymphadenopathy, eye inflammation

• congenital rubella syndrome: deafness, cataracts, heart defects, microcephaly, blueberry muffin rash, miscarriage

• symptomatic

• MMR vaccine

Shingles

• varicella zoster virus (VZV)

• tingling, asymmetric vesicular rash that runs along nerve root, painful!

• symptomatic, acyclovir if within 72 hours

• shingrix vaccine

Warts

• human papillomavirus (HPV)

• raised, bumpy projections or small flat elevations

• topical medications, freezing, excision

• avoidance of direct contact and fomites

Smallpox

• various major and various minor viruses

• large indented lesions filled with viscous fluid, emerge around mouth, spread over face and head to trunk, then extremities

• no cure, comfort measures

• vaccine

Candidiasis

• fungal

• candida albicans

• edema, irritation, erythema (may or may not have vesicles), thick white coating on mucus membranes

• topical or oral antifungals

• prophylaxis, strict adherence to hygiene protocols

Dermatomycoses

• various dermatophytes (keratin-degrading fungi)

• hair loss, redness, itching

• OTC medications

• avoid contact with infected ppl/moist environments

Leishmaniasis

• protozoan

• leishmania (over 21 species0

• fever, weight loss, organ enlargement, skin lesions

Pediculosis (lice)

• arthropod

• pediculus humanus (capitis or corporis) and pthirus pubis

• intense itching, erythematous papule, purpuric spots on thighs/buttocks, abdomen

• lindane or malathion, nit-picking, whole home treatment

• avoid infested patients, famine decontamination

Scabies

• arthropod

• sarcoptes scabiei

• intensely itchy lesions due to allergic reaction to mite saliva

• permethrin cream, comfort measures to reduce itching

• avoidance of infested patients, fomite decontamination

Conjunctivitis

• eye infection

• various bacterial and viral agents

• bright red conjunctiva, itching, tearing, discharge, eyelid edema

• antibiotics for bacterial infections, comfort measures for bacterial and viral infections

• meticulous hand hygiene, patient isolation, decontamination

Blepharitis

• eyelid infection

• staphylococci, propionibacterium

• inflammation of eyelids close to lashes, edema, trichiasis, frequent relapses

• STYE (hordeola)

• ophthalmic antibiotics

• throw away all contact lenses and makeup that is leading to reinfection

Keratitis

• infection of eye cornea

• various bacterial, viral, and protozoan agens

• if caused by HSV-1 = herpetic keratitis (hides in trigeminal nerve root and leads to lifelong relapses)

• acanthamoeba = protozoan cause that leads to characteristic ring infiltrate destruction of cornea and severe pain

• inflammation of cornea, photophobia, blurry vision, corneal ulceration

• gangciclovir if viral, antibiotics if bacterial or protozoan, possible surgery (corneal transplant)

• patient education to reduce flare ups, consistent and correct cleaning of contact lenses

Trachoma

• result of repeated chlamydial conjunctivitis infections

• chlamydia trachomatis

• damage to oil glands, eyelashes turn in causing corneal abrasions

• azithromycin, doxycycline

• clean water supplies, elimination of flies