[MICRO 20] LEC 12 - Microbial Skin Infections

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Propionibacterium acnes

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1

Propionibacterium acnes

What microbe causes acne?

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Chronic Ulcers Causes:

Bacterial: Treponema pallidum Haemophilus ducreyi Corynebacterium diphtheriae Bacillus anthracis Nocardia Mycobacterium

Fungal: Sporothrix

Viral: Herpes Virus

All of the following skin conditions can be caused by Staphylococcus aureus except one, which one is it and identify a microbe that causes it:

A. Impetigo B. Intertrigo C. Chronic Ulcers D. Folliculitis

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Pasteurella multocida

Microbe that is a common source of infection following animal bites

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4

Staphylococcus aureus

Furuncles are caused by what microbe?

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Folliculitis and Intertrigo

Candida albicans can cause which skin syndrome/s?

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Clean surgical wounds

Group A streptococci can infect what kind of wounds?

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Clostridium Enterobacteriaceae Pseudomonas aeruginosa

Trauma wounds can be infected by which kinds of microbes?

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Pseudomonas aeruginosa Staphylococcus aureus Enterobacteriaceae

Burns can be infected by which microbes?

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9

Folliculitis

Haemophilus influenzae can cause which skin syndrome/s?

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Impetigo and Cellulitis

Group A streptococci can cause which skin syndrome/s?

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11

Localized Cutaneous Infections

Can lead to infections of subcutaneous tissues or even muscles

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Folliculitis

Inflammation of hair follicles

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Hydradenitis Supprativa

Inflammation of glands, Extensive scarring with multiple sinuses in and around the axilla

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Furuncles

Large, red, extremely tender abscess or pustule caused by the inflammation of a hair follicle or a sebaceous gland

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Carbuncle

Larger and deeper lesion created by aggregation and secondary interconnection of furuncles

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Little Thief

Furuncles are known as "little ____"

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Little coal

Carbuncles are known as "little ____"

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Impetigo

Most common presentation of Staphylococcus aureus

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19

Bullous Impetigo

Bubble-like epidermal swellings that could peel away like a localized scalded skin syndrome

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Bone

The common sight of infection of Miscellaneous systemic infections is the _____

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Osteomyelitis

Established in the highly vascular metaphyses of a variety of bones (often femur, tibia, ankle, or wrist)

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Osteomyelitis

Abscess formation in the affected area results in an elevated, tender lump, and necrosis of the bony tissue

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Secondary osteomyelitis

Develops after traumatic injury, specifically compound fracture or surgery in cancer and diabetes patients

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Pneumonia with multiple lung abscesses

Usually in children with cystic fibrosis and measles, Most serious complications of influenza

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Staphylococcal bacteremia

Bacteria released from infection site or colonized medical devices

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Polyarthritis

deforming arthritis; infection of joints

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Meningitis

Invades cranial vault; severe form

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Staphylococcal Scalded Skin Syndrome (SSSS)

also known as ritter's disease

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Staphylococcus aureus

A gram positive Staphyloccus that is its most pathogenic variant

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Which protein gives Staphylococcus aureus anti-phagocytic properties

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FALSE. Staphylococcus aureus is resistant to heat and drying

TRUE OR FALSE: Staphylococcus aureus is NOT resistant to heat and drying

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Exotoxins

virulence factors that contribute to the pathogenesis

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FALSE. Endotoxins are only found in gram-NEGATIVE bacteria

TRUE OR FALSE: Endotoxins are only found in gram-positive bacteria

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  1. Surface Proteins

  2. Invasins

  3. Surface factors

  4. Biochemical properties

Identify the virulence factors of toxigenic staphylococcal diseases

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Fibronectin

binding protein (FnBP); responsible for attaching to host cell

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Surface factors

inhibit phagocytic engulfment capsule

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Invasins

promote bacterial spread in tissues

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leukocidin, kinases, hyaluronidase

Identify three invasins

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39

Surface proteins

promote colonization of host tissues adhesins

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Biochemical properties

enhance staphylococcus survival in phagocytes

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41

Superantigens

bind directly to class II major histocompatibility complexes (MHC II) of antigen-presenting cells outside the normal antigen-binding groove

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Cytokines

The release of ______ in large amounts causes the symptoms of toxic shock syndrome

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Superantigens

Exotoxins can become _____

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44

10%

What is the %carriage rate of staphylococcus aureus in pre-menopausal women

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45

TRUE

TRUE OR FALSE. Staphylococcus aureus can be a part of normal flora

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FALSE. Staphylococcus aureus are catalase and coagulase positive

TRUE OR FALSE. Staphylococcus aureus are catalase and coagulase negative

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47

Vancomycin

The drug ________ is taken if you have Methicillin Resistant Staphylococci (MRSA)

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  1. Dicloxacillin

  2. Erythromycin

  3. Cephalexin

Antibiotics used in the treatment of toxigenic staphylococcal diseases

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49

Secondary to the alteration of beta-lactam ring and some peptidoglycan transpeptidase often called as the penicillin binding protein

What are the basis of resistance of Staphylococcus aureus against methicillin?

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50

plasmid mediated

Penicillinase production is ______ mediated

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penicillin resistant

Most strains of S. aureus are now _____ resistant

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52

No. Infection is localized in the hair, nail, or upper layer of the skin

Do superficial mycoses invade living tissues?

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53

Pityriasis

used to describe skin conditions which wherein the scales appear similar to oats or wheat

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54

Pityriasis versicolor

chronic, mild infection of stratum corneum

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faint or tan to pink spots

How does pityriasis versicolor appear in white skin?

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56

Light or dark areas

How does pityriasis versicolor appear in dark skin?

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57

Malassezia furfur

The most common causative agent of Pityriasis versicolor

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58

Yes

Is Malassezia furfur part of the normal skin flora?

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sebaceous glands

Malassezia furfur are especially found in skin areas rich in what?

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60
  1. M. globosa

  2. M. sympodialis

  3. M. obtusa

  4. M. slooffiae

Other than Malassezia furfur, what are the other etiologic agents of Pityriasis versicolor?

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Hyperpigmentation

Induced enlargement of melanosomes, which are found in the basal layer of the epidermis

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Hypopigmentation

Due to melanosome abnormalities related to dicarboxylic acids produced by M. furfur which diminishes melanin synthesis by tyrosinase activity

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Pruritus

itchy skin due to various inflammatory responses

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Oral Medications: Ketoconazole, Itraconazole, Fluconazole

Used for extensive tinea versicolor infections

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Topical treatment: Selenium sulfide, Imidazoles, Ciclopriox Olamine, Bifonazole, Terbinafine

Treatment when there are only selected areas involved in tinea versicolor

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66

Human papillomavirus

Double-stranded naked DNA virus that belongs to the Papovaviridae family

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DNA, Capsid protein

The detection of HPV _____ or _____ is indicated for HPV Infection

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  1. HPV 1, HPV 2, HPV 3 HPV 4, HPV 5

How many main subtypes are there for HPV?

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HPV Type 16/18

Which types of HPV is associated with cervical malignancy, oropharyngeal cancer, nasopharyngeal cancer, and anal cancer

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Condyloma acuminata

warts found in the perianal region

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Cervical dysplasia and neoplasia

most severe manifestation of HPV infection and can lead to cervical cancer in the future

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  1. Spontaneous regression (may take many months)

  2. Electrocautery

  3. Cryotherapy

  4. Chemical treatment: e.g. podophyllin

Which treatment options are available for HPV infection?

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73

Viral exanthem

Eruptive skin rashes including measles, acquired through the respiratory route, selected viral airborne infections

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Respiratory invaders

Most common cause of respiratory infection (even before bacterial or fungal infections)

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S. pyogenes S. pneumoniae M. pneumoniae Chlamydia

Give an example of microbial professional respiratory invaders capable of adhesions to normal mucosa

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resist destruction in alveolar macrophages

Legionella is considered a professional respiratory invader due to its ability to ______

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interfering with cells

Bardatella pertussis, M. pneumoniae, and A. pneumoniae are all professional respiratory invaders capable of _______

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damaging local tissues

C. diphtheria and S. pneumoniae are professional respiratory invaders capable of _____

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  1. Adhesion to normal mucosa

  2. Ability to interfere with cells

  3. Ability to resist destruction in alveolar macrophages

  4. Ability to damage local tissues

What are the requirements of being categorized as a professional respiratory invader?

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  1. Initial induction and damage by respiratory virus

  2. Local defenses impaired

  3. Local foreign body or tumor

  4. Depressed immune responses

  5. Depressed resistance

What are the requirements of being categorized as a secondary respiratory invader?

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Pneumocystis carinil, CMV, M. tuberculosis

Which microbes are considered as secondary respiratory invaders capable of depressing immune response?

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S. aureus, S. pneumoniae

Which microbes are considered as secondary respiratory invaders capable of Initial induction and damage?

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S. aureus, Pseudomonads

Which microbes are considered as secondary respiratory invaders capable of impairing local defenses?

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84

Rubeola virus

The causative agent of measles

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Envelope (Attachment proteins):

  1. H protein (hemagglutinin protein)

  2. F protein - also a hemolysin

  3. M protein (matrix protein)

Help with attachment of virus to receptor cells

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86

nasopharynx and regional lymph nodes

Where does Rubeola virus replicates in the human body?

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87

2-3 days

Primary viremia occurs how many days after exposure?

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5-7 days after exposure with spread to other tissues

Secondary viremia occurs how many days after exposure?

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  1. Attachment and penetration

  2. Disassembly and replication

  3. Maturation

  4. Budding

What are the steps to Rubeola pathogenesis?

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90

syncythium formation

Measles virus replication in tissue and certain organs is characterized by the formation of giant multinucleate cells called?

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91

10-14 days

What is the incubation period of measles virus

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92

4 days before to 4 days after rash onset

What is the communicability period of measles virus

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Cough, Coryza, Conjunctivitis

Measles prodrome is identified by the 3 C's, which are?

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Koplik’s spots on buccal mucosa

whitish plaques seen in the second molar of oral cavity

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Measles recovery phase (10-14 days)

Desquamation of skin like a soft glove sock appearance wherein your skin will start to desquamate and slough off

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subacute sclerosing panencephalitis

Degenerative condition where patients will be normal up until several years during the preschool age when they start to be clumsy they start to fall, they start to deteriorate in school, and later on they can become paralyzed and succumb to coma and (This may occur 5-7 years after measles bout)

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  1. Pneumonia - most common cause of death

  2. Diarrhea

  3. Otitis media

  4. Encephalitis

  5. SSPE - subacute sclerosing panencephalitis

Serious complications of measles

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98

acute, past

IgM indicates _____ infection, IgG indicates _____ infections

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99

Live, attenuated vaccines

  1. Monovalent measles

  2. Bivalent MR (Measles ,rubella)

  3. Trivalent MMR

  4. Quadrivalent MMRB

What type of vaccines are used against measles?

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100

9, 12, 15

In the philippines, measles vaccine is given at ___ months with the booster those at ____ and _____ months

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