1. INFECTIONS and INFESTATIONS Dr. D. Czarnecki MD MBBS

2. Infections FolliculitisFolliculitis Pustules and papules scattered across the shinPustules and papules scattered across the shin This case was caused by using plastic occlusion on a glucocorticosteroid creamThis case was caused by using plastic occlusion on a glucocorticosteroid cream

3. Infections FolliculitisFolliculitis An out break of folliculitis was reported after hot tubs became fashionable. Poor maintenance allowed pseudomonas to proliferate and infect the follicles of those who used the tubs.An out break of folliculitis was reported after hot tubs became fashionable. Poor maintenance allowed pseudomonas to proliferate and infect the follicles of those who used the tubs.

4. Infections CellulitisCellulitis The infection is spreading through the skin. It is indurated, red, hot, and sore.The infection is spreading through the skin. It is indurated, red, hot, and sore. This case was a wound infection developing after surgery for skin cancerThis case was a wound infection developing after surgery for skin cancer

5. Infections ErysipelasErysipelas The infection is spreading through the outer layer of the skin.The infection is spreading through the outer layer of the skin. It is indurated, red, hot, and sore.It is indurated, red, hot, and sore.

6. Infections LymphangitisLymphangitis The infection is spreading through the lymphatics.The infection is spreading through the lymphatics. It is indurated, red, hot, and sore.It is indurated, red, hot, and sore.

7. Infections An abscessAn abscess A localized collection of pus.A localized collection of pus. It is indurated, red, hot, and sore.It is indurated, red, hot, and sore. Surgical drainage is indicated.Surgical drainage is indicated.

8. Infections TineaTinea There is a raised edge and a clearing centre.There is a raised edge and a clearing centre. You must look at the feet.You must look at the feet. Topical therapy on its own may be adequate.Topical therapy on its own may be adequate.

9. Infections TineaTinea There is a raised edge and a clearing centre.There is a raised edge and a clearing centre. You must look at the feet.You must look at the feet. You must take scrapings for fungal culture – before prescribing antifungal agents.You must take scrapings for fungal culture – before prescribing antifungal agents.

10. Infections Tines (ringworm)Tines (ringworm) The is a raised edgeThe is a raised edge The centre is red and scaly because a glucocorticosteroid cream was used in error (tinea incognito)The centre is red and scaly because a glucocorticosteroid cream was used in error (tinea incognito) The nails are the source of infectionThe nails are the source of infection

11. Tinea nails There is yellow-white discolouration and the nails are ‘crumbling’

12. Infections Tines (ringworm)Tines (ringworm) Hair loss, inflammation and scalingHair loss, inflammation and scaling There may be fluorescence under a Woods lampThere may be fluorescence under a Woods lamp Gently pull out some hair for fungal cultureGently pull out some hair for fungal culture

13. Infections Tines (ringworm)Tines (ringworm) The annular lesions have a raised edge with a clearing centreThe annular lesions have a raised edge with a clearing centre This case was caused by Micosporum canis (from the cat)This case was caused by Micosporum canis (from the cat)

14. Infections ScabiesScabies There are burrows – silvery tracts in the skin.There are burrows – silvery tracts in the skin. The mite can be seen in scrapings taken from a burrow.The mite can be seen in scrapings taken from a burrow.

15. Infections ScabiesScabies A mite is visible.A mite is visible. Skin scrapings are taken from a burrow, potassium hydroxide is added ant then this is examined under a microscope confirm the diagnosis.Skin scrapings are taken from a burrow, potassium hydroxide is added ant then this is examined under a microscope confirm the diagnosis.

16. Infections Post scabetic papulesPost scabetic papules Itchy papules on the penis are scabies until proved otherwise.Itchy papules on the penis are scabies until proved otherwise. A hypersensitivity reaction to the mite is believed to be the cause. Intralesional triamcinolone is an effective treatment.A hypersensitivity reaction to the mite is believed to be the cause. Intralesional triamcinolone is an effective treatment.

17. Scabies Itchy papules on the penis are scabies until proved otherwise.

18. A louse crawling along the hair

19. Infections Herpes simplex (HS)Herpes simplex (HS) The grouped blisters have ruptured to leave erosionsThe grouped blisters have ruptured to leave erosions Type II HS has a predilection for the genitaliaType II HS has a predilection for the genitalia

20. Herpes virus enters the skin Travels along the axon Lies dormant in the nerve body Is activated, travels along the axon to the surface Blisters on the surface – the immune system can kill the virus The immune system cannot kill the virus in the axon

21. Infections Herpes simplex (HS) lies dormant in the ganglionHerpes simplex (HS) lies dormant in the ganglion There is no cure – treat the outbreaksThere is no cure – treat the outbreaks Topical therapy is ineffectiveTopical therapy is ineffective Herpes simplex in a neonate

22. Infections Asymptomatic shedding is very common - infectiveAsymptomatic shedding is very common - infective Beware of vaginal herpes simplex in pregnant womenBeware of vaginal herpes simplex in pregnant women Swab for herpes, PCR is accurateSwab for herpes, PCR is accurate Herpes simplex in a child The classical scalloped edg e

23. Chicken pox Varicella The varicella virusThe varicella virus The lesions are at different stages of evolution.The lesions are at different stages of evolution. Some are papules, some are vesiclesSome are papules, some are vesicles The virus lies dormant in the dorsal root gangliaThe virus lies dormant in the dorsal root ganglia

24. Chicken pox Varicella Vesicles caused by chicken poxVesicles caused by chicken pox The lesions are at different stages of evolution.The lesions are at different stages of evolution. Some are papules, some are vesiclesSome are papules, some are vesicles The virus can remain dormant for yearsThe virus can remain dormant for years

25. Infections Herpes zosterHerpes zoster This is due to re- activation of the chicken pox virus.This is due to re- activation of the chicken pox virus. The virus replicates in the nerve body and travels to the surface where is causes the painful eruptionThe virus replicates in the nerve body and travels to the surface where is causes the painful eruption Grouped lesions in a dermatomal distribution

26. Herpetiform Herpes zoster incidenceHerpes zoster incidence 50-9 4.6 / 1000 (5% PHN)50-9 4.6 / 1000 (5% PHN) 60-9 6.9 (10%)60-9 6.9 (10%) 70-9 9.5 (17%)70-9 9.5 (17%) 80+ 10.9 (20%)80+ 10.9 (20%) HIV + men - 29.4/1000HIV + men - 29.4/1000 HIV - men - 2/1000HIV - men - 2/1000 NEONATE with grouped lesions in a dermatomal distribution. Is it zoster?

27. Infections Herpes zosterHerpes zoster Some of the lesions are haemorrhagic – a sign that it is a severe case.Some of the lesions are haemorrhagic – a sign that it is a severe case. The lesions are in various stages of evolutionThe lesions are in various stages of evolution