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Miroslav Votava Agents of skin-manifested infections – I + II Lecture for 3rd-year students

Institute for Microbiology, Medical Faculty of Masaryk University and St. Anna Faculty Hospital in Brno. Miroslav Votava Agents of skin-manifested infections – I + II Lecture for 3rd-year students 4th December , 20 15. Common superficial injuries – revision. Staphylococcus aureus

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Miroslav Votava Agents of skin-manifested infections – I + II Lecture for 3rd-year students

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  1. Institute for Microbiology, Medical Faculty of Masaryk University and St. Anna Faculty Hospital in Brno Miroslav Votava Agents of skin-manifested infections – I + II Lecture for 3rd-year students 4thDecember, 2015

  2. Common superficial injuries– revision • Staphylococcusaureus • Streptococcuspyogenes • beta-hemolytic streptococci of other groups (above all G, F, C) ! Attention in case of a foreign body in the wound (splinter, thorn) and in case of deeper stab wounds (fork soiled by horse manure): Clostridiumtetani

  3. Severe contused wounds – revision • Agents of clostridial myonecrosis (mostly Clostridium perfringens, C. septicum, C. novyi, C. histolyticum) clostridial myonecrosis = anaerobic traumatosis = gas gangreneor malignant edema • Clostridiumtetani • Staph. aureus, Strept. pyogenes & other pyogenic bacteria

  4. Wounds sustained in water– revision • In fresh water: Pseudomonas aeruginosa Aeromonas hydrophila otherpseudomonads and aeromonads • In salt water: Vibrio parahaemolyticus, V. vulnificus Mycobacterium marinum (also in fresh-water swimming pools, tanks and aquaria)

  5. Injuries sustained in the tropics– revision Mainly on feet • soil nocardiae (Dermatophilus congolensis, Rhodococcus equi) • atypical mycobacteria (Mycobacterium ulcerans, Mycobacterium haemophilum) • micromycetes (Sporothrix schenckii, Paracoccidioides brasiliensis)

  6. Surgical wounds – revision Staphylococcus aureus coagulase-negative staphylococci (mainly Staphylococcus epidermidis) Enterobacteriaceae (Escherichia coli, Proteus mirabilis) Streptococcus pyogenes anaerobes (Peptostreptococcus micros, Peptostreptococcus anaerobius, Bacteroides fragilis)

  7. Burns – revision Almost everything, but predominantly: Pseudomonas aeruginosa Staphylococcus aureus Streptococcus pyogenes other streptococci enterococci candidae and aspergilli

  8. Man-inflicted bites – revision members of oral microflora - „oral streptococci“ (Streptococcus sanguinis, S. oralis, S. anginosus) - anaerobes (Fusobacterium nucleatum ssp. nucleatum, Porphyromonas gingivalis) Staphylococcus aureus

  9. Animal bites – revision Most often: Pasteurella multocida (cats, dogs) Less often: Staphylococcus aureus(any animal) Capnocytophaga canimorsus (dogs) Streptobacillus moniliformis (rats) Spirillum minus (mice, rats, cats, dogs) Francisella tularensis (cats) & many others

  10. Other injuries by animals – revision Francisella tularensis (rodents, hares – tularemia) Bartonella henselae (cat scratch disease) Erysipelothrix rhusiopathiae (pigs, carps – erysipeloid) Bacillus anthracis (herbivores – skin anthrax, pustula maligna) Burkholderia mallei (horses, donkeys – glanders, malleus) …

  11. Infections with skin symptoms • primary skin infections • secondary infections of already diseased skin • skin symptoms of systemic infections Etiology: bacterial viral fungal parasitic

  12. Primary acute bacterial skin infections I acne vulgaris –Propionibacterium acnes carbunculusnuchae – Staph. aureus ecthymagangraenosum – Ps. aeruginosa erysipelas – Streptococcus pyogenes erysipeloid – Erysipelothrix erythrasma – Corynebact. Minutissimum folliculitis – Staph. aureus, P. aeruginosa furunculosis (boil) – Staph. aureus

  13. Primary acute bacterial skin infections II hidradenitissuppurativa – Staph. aureus hordeolum (stye) – Staph. aureus impetigo – Staph. aureus, Str. pyogenes lymphangoitis – Streptococcus pyogenes panaritium – Staphylococcus aureus paronychium – Staphylococcus aureus sycosisbarbae – Staphylococcus aureus

  14. Primary chronic bacterial skin infections actinomycosis – Actinomyces israelii chronicsubcutaneous abscesses – Actin. israelii, Nocardia asteroides, Rhodococcus equi skingranulomas – Mycobacterium marinum, M. haemophilum, M. chelonae leprosy – Mycobacterium leprae lupusvulgaris – Mycob. tuberculosis scrophuloderma – M. tuberculosis, M. bovis

  15. Secondary infections of skin lesions decubitus (bedsore), trophic ulcer – neighbouring and endogenous flora (staphylococci, streptococci, enterococci, enteric bacteria, pseudomonads and other Gram-negative non-fermenting rods, anaerobes, yeasts) infected atheroma – S. aureus, Propion. acnes infected intertrigo (raw) – S. aureus, P. acnes sec. infected dermatomycoses – S. pyogenes infected wounds – discussed in previous lecture

  16. Skin symptoms of systemic bacterial infections roseola (rash in typhoid fever)– Salmonella Typhi disseminated gonorrhoea – Neisseria gonorrhoeae erythemamigrans – Borrelia burgdorferi infectiveendocarditis – will be dealt with by sepsis meningococcemia – Neisseria meningitidis scarlatina (scarlet fever) – Streptococcus pyogenes SSSS (staphylococcal scalded skin syndrome) – Staphylococcus aureus toxic shock syndrome – S. aureus, S. pyogenes syphilis – Treponema pallidum

  17. Etiology of skin fungal infections Etiology differs in • superficialmycoses, like pityriasisversicolor – Malassezia furfur (prev. Pityrosporum ovale) • mucocutaneousmycoses – Candida albicans and other species of candidae • cutaneous mycoses – typical dermatophytes • subcutaneous mycoses • opportuneskin mycoses in immunodeficites

  18. Etiology of cutaneous mycoses – I Three genera of dermatophytes: • Trichophyton e.g. Trichophyton rubrum • Microsporum e.g. Microsporum canis • Epidermophyton only Epidermophyton floccosum

  19. Etiology of cutaneous mycoses – II tinea pedis – Trichophyton rubrum, Trich. mentagrophytes var. interdigitale, Epidermophyton floccosum onychomycosis – T. rubrum, E. floccosum tinea corporis – T. rubrum, Microsporum canis, M. gypseum, T. mentagrophytes var. mentagrophytes, E. floccosum tinea capitis, type ectothrix – M. gypseum, M. canis, M. audouinii, T. mentagrophytes var. mentagrophytes, T. verrucosum type endothrix – T. tonsurans favus – Trichophyton schoenleinii

  20. Etiology of subcutaneous mycoses pheohyphomycosis (lesions with pigmented hyphae) – genera Alternaria, Aureobasidium, Cladosporium, Culvularia, Exophiala, Phaeoannelomyces, Phoma, Wangiella & others chromoblastomycosis (warty nodules with sclerotic bodies) – Cladophialophora, Fonsecaea, Phialophora mycetoma eumycoticum (swollen lesion with draining tracts containing small grains) – Acremonium, Exophiala, Madurella, Pseudoallescheria (= Scedosporium) sporotrichosis (dimorphic fungus) – Sporothrix schenckii

  21. Etiology of opportune skin mycoses in immunodeficites Fusarium solani, Fusarium oxysporum, Fusarium verticillioides Pseudoallescheriaboydii (= teleomorf, sexual phase of anamorf Scedosporium apiospermum) Penicilliummarneffei (systemic infection with skin manifestations) Scopulariopsis brevicaulis

  22. Skin symptoms in viral diseases – I Macular (spotted) exanthem: morbilli – morbilli virus (Morbillivirus genus) rubella– rubella virus (Rubivirus genus) erythemainfectiosum (the fifth disease) – parvovirus B19 (Erythrovirus genus) exanthemasubitum (roseola infantum, the sixth disease) – HHV 6 (Roseolovirus genus) Umbiliform papulae: molluscumcontagiosum – molluscum contagiosum virus (Molluscipoxvirus genus)

  23. Skin symptoms in viral diseases – II Vesicles: herpessimplex (cold sore) – HSV 1 (Simplexvirus genus) herpesgenitalis – HSV 2 (Simplexvirus genus) varicella (chicken pox) – varicella-zoster virus (VZV, Varicellovirus genus) herpeszoster (shingles) – varicella-zoster virus (VZV, Varicellovirus genus) variolavera (smallpox) – variola virus (Orthopoxvirus genus)(continued)

  24. Skin symptoms in viral diseases – III Vesicles – cont.: vaccinia – vaccinia virus (Orthopoxvirus genus) cowpox and monkey pox – cowpox virus and monkey pox virus (Orthopoxvirus genus) tubera mulgentium (milkers´ nodules) – milker´s nodule virus (Parapoxvirus genus) aphthae epizooticae (foot and mouth disease) – foot-and-mouth disease virus (FMDV,Aphthovirus genus) hand, foot and mouth disease – coxsackievirus A16 (Enterovirus genus)

  25. Skin symptoms in viral diseases – IV Petechiae: Hemorrhagic fevers – Ebola fever, Ebola virus (Ebolavirus genus) Marburg disease, Marburg virus (Marburgvirus genus) Lassa fever, Lassa virus (Arenavirus genus) Generalizedcongenitalcytomegalic disease – cytomegalovirus (CMV, Cytomegalovirus genus)

  26. Skin symptoms in parasitoses – I Domestic (native) parasitoses: scabies – itch mite (Sarcoptes scabiei) demodicosis – human follicle mites (members of Demodex genus) pediculosis capitis – head louse (Pediculus capitis) pediculosis corporis – body louse (Pediculus humanus, syn. Pediculus corporis) pediculosis pubis (phthiriasis) – pubic (crab) louse (Phthirus pubis)

  27. Skin symptoms in parasitoses – II Infestation by native ectoparasites: cimicosis, urticaria cimicosa – bites by bedbug Cimex lectularius pulicosis – bites by human flea Pulex irritans, dog flea Ctenocephalides canis, cat flea Ctenocephalides felis, chicken flea Ceratophyllus gallinae ixodosis – bite by hard tick Ixodes ricinus culicosis – bites by common mosquito Culex pipiens trombiculosis, trombidiosis – bites by Neotrombicula autumnalislarvae

  28. Skin symptoms in parasitoses – III Tropical parasitoses: ulcus humidum (humid ulcer) – Leishmania major ulcus siccum (dry ulcer) – Leishmania tropica espundia – Leishmania braziliensis tungosis – chigoe flea Tunga penetrans dermatitis cercariosa – cercariae of Schistosoma, Bilharziella andTrichobilharzia genera dracunculosis – Dracunculus medinensis filariosis – filariae Loa loa and Onchocerca volvulus …

  29. Homework 10Jan HavickzoonSteen(1626-1679):TheSickWoman(c. 1665)

  30. Homework 10Anothertwopictures byJan HavickzoonSteen(1626-1679) on thesimilartopic:TheLovesickWoman (1960) TheDoctor´s Visit (1960-63)

  31. Homework 10 Successfulhomework 10 solvers: none

  32. Homework 11Please give the name of the author and of the painting

  33. Answer and questions The solution of the homework and possible questions please mail to the address mvotava@med.muni.cz Thank you for your attention

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