1. Bacterial infections Zora Dubská Department of Dermatovenereology of 3rd Faculty of Medicine and Faculty Hospital Kralovske Vinohrady in Prague Head: Prof. Petr Arenberger, MD, MBA

2. Bacterial skin infections - Pyoderma - Skin infections caused by corynebacteria - Mycobacteria - Borreliosis - Anthropozoonoses - Actinomycosis

3. Pyoderma - Bacterial infection of skin caused by pyogenic cocci - Staphylococcus aureus - Beta hemolytic streptococcus group A - Pyoderma bound to follicles - Pyoderma bound to sweat glands - Superficial pyoderma - Deep pyoderma

4. Pyoderma bound to follicles
Purulent inflammation of hair follicles and hairballs
Frequent infections (shaving, friction with clothing)
Most Staphylococcus aureus - coagulase - vertical spread

5. Ostiofolliculitis - impetigo Bockhardt   - Subcorneal pustules in the ostium of the follicle

6. Folliculitis - purulent inflammation of the follicle         - 2 forms - Folliculitis simplex disseminata                          - Folliculitis barbae

7. Folliculitis barbae

8. Folliculitis - therapy - ATB solutions (erythromycin, clindamycin) - Disinfecting solutions containing iodine or    salicylic acid - Systemic ATB according to the sensitivity

9. Furunculus - Follicular skin abscesses that arise from folliculitis
or primarily - Neck, axilla, buttocks, groins - Hot and humid environment, obesity, hyperhidrosis,
diabetes mellitus, malnutrition, HIV immunodeficiency - Follicular pustule followed by erythematosus    painful bump with a central yellowish pin - Lymphadenopathy, fever

10. Furunculus

11. Merging several neighboring furunculi
Carbunculus
Merging several neighboring furunculi
Extensive hump, which is emptied with several fistulas
Neck
Fever
Leukocytosis
- Bacteremia

12. Furunculus - therapy - Saloxyl - Systemic antibiotics according to sensitivity - Ev. incision - The carbuncle surgical incision required!

13. Pyoderma bound to sweat glands       - Hidradenitis suppurativa axillaris - Chronic suppurative disease - Apocrine sweat glands - axilla, perianogenital area - Inflammatory infiltrates, abscesses, fistulas - Total excision, systemic retinoids, antibiotics

14. Pyoderma bound to the nail - paronychia   - Suppurative disease of lateral nail fold
    - After injury   - Disinfecting solution – potassium permanganate,
antibiotic ointment

15. Impetigo - Superficial pyoderma - Streptococci ( maculovesiculous form ) - Staphylococci (bullous form) - Maculovesiculous form - red macula with     vesicles, pustules followed by crust formation - Bullous form - Bull on erythematous base
followed by red scaling leasions
- Face - nasal entrance

16. Impetigo - http://www.stefajir.cz/q=impetigo

17. Impetigo - therapy - Topical treatment with antiseptic solution and antibiotic    ointment (mupirocin, a. fusidicum, bacitracin) In case of failure of local treatment – systemic atb according
to sensitivity Hygiene Streptococcus type A - the risk of glomerulonephritis – Urine                          

18. subcutaneous tissue, along fascia,
Deep pyoderma - Ecthyma - ulcerative pyoderma in infected                           excoriations of itching dermatoses - Erysipelas Phlegmona - diffuse spreading infection of the skin,
subcutaneous tissue, along fascia,
tendons, muscles - Necrotising fasciitis - inflammation of deep fascia
and soft tissue + systemic response

19. Erysipelas
Frequent acute infection of the skin and subcutaneous tissue - Streptococcus pyogenes - The spread of infection via lymphatic vessels
– entrance - injuries, interdigital mycosis Fever up to 40 C, chills - Within few hours in the affected area (mostly legs    or face) - sharply bordered erythema - Skin is warm, painful, edema, lymph nodes swollen

20. Erysipelas

21. Erysipelas - therapy - Applied parenteral penicillin (usually procaine
    benzylpenicillin 10 x 1.5 mil.j.i.m. finished by
benzathine benzylpenicillin 1.5 mil.j.i.m.) - Hypersensitivity to PNC - macrolides (erythromycin)                                          Lincosamides (clindamycin)                                          Cephalosporins - The risk of recurrence and lymphedema - Prevention of relapse - long-term application
of benzathinpenicilin every 2-4 weeks

22. Staphylococcal scalded skin syndrome - Lyell's syndrome - A life-threatening disease – systemic response - Staphylococcus aureus produces exotoxins - Separation of the upper parts of epidermis - large areas - Infants and children under 5 years of age - the risk of sepsis,
pneumonia - Fever, generalized erythematous, macular rash,    bullas, leasions, scales, without scarring - Nikolsky phenomenon of the unafflicted skin - Acantholytic intraepidermal blister of stratum granulosum - Systemic anti- staphylococcal ATB - ad integrum in 2 weeks

23. Toxic shock syndromes
Rare shock states with skin symptoms and     multiorgan involvement caused by staphylococci and     beta-hemolytic streptococci group A ( producing toxins ) - Toxins act as superantigens
- Source - soft tissue infections (streptoc. syndrome) - Alteration of the general condition, generalized macular    rash followed by desquamation of palms and soles after 1-2    weeks, raspberry tongue, erythema, mucosal erosion - Anti-shock therapy, antibiotics i.v. (antistaphylococcal)    streptococcal etiology - PNC, clindamycin, cephalosporins,    i.v. immunoglobulins, surgery

24. Scarlatina - scarlet fever - A streptococcal tonsillitis accompanied by rash - Children between 3 to 10 years of age   - Streptococcus pyogenes group A - beta hemolytic        - Pyrogenic exotoxin A - Entrance – nasopharynx
- Within 1-6 days tonsillitis with fever - Maculopapular rash – goose skin – bending areas of limbs - Face with perioral fading - Petechial enanthema on the palate, raspberry tongue - After 1-2 weeks lamellar scaling of palms, soles

25. dg.: clinical state, cultivation, leukocytosis in KO Therapy of scarlatina: - Isolation - Parenteral application of Procaine Penicilin G i.m. 3-5 days,    finished by application of Benzatinpenicilin i.m., ev.    erythromycin, cephalosporins, clindamycin - Complications - Secondary infection                          Rheumatic fever                          Glomerulonephritis

26. Skin infections caused by corynebacteria - Erythrasma - axilla, groins              - Reddish areas with satellite maculas            
- Wood's lamp - red fluorescence - Trichomycosis axillaris     - Yellowish deposits on axillary, pubic hair - Keratoma sulcatum       - Pitting of the soles

27. Mycobacteriosis - cutaneous tuberculosis - Specific chronic granulomatous inflammation of the skin - Mycobacterium tuberculosis (BK) - Histology – caseificating specific granulomas - Dying with Ziehl - Neelsen method - cultivation - Tuberculin (Mantoux) test     - I.d. application of tuberculin - + induration over 6 mm/72h

28. Clinical forms of skin tuberculosis - Primary inoculative tuberculosis       - Primary complex - ulcer + regional lymphadenitis - Tuberculosis verrucosa cutis - Lupus vulgaris - the most common
- vitropression: yellowish brown colour   - Scrophuloderma - Tuberculosis cutis ulcerosa
- Tuberculosis cutis miliaris - Tuberculous gumma

29. Tuberkulidy      - Id - reaction - late allergic response                                  to microbial antigens           - Recurrent disseminated symmetric
non- infectious rashes as response to
hematogenous spread of mycobacterial
antigens to the skin      - Lichen scrophulosorum      - Papulonekrotical tuberculid      - Erythema induratum (Bazin)

30. Therapy of cutaneous tuberculosis     - The condition of the patient     - A combination of drugs is needed     - Never less than 6 months of therapy
    - Short-term treatment 6-9 months, long months
    - Main drugs - isoniazid, rifampicin
    - Ancillary drugs - streptomycin, pyrazinamide, ethambutol

31. Atypical mycobacteriosis - Ulcerative and granulomatous processes (ev
Atypical mycobacteriosis - Ulcerative and granulomatous processes (ev. lymphadenitis)     caused by other mycobacteria than M. tuberculosis     and M. leprae   - Granuloma of swimming pools        - Mycobacterium marinum        - bumps in the area of trauma for 2-3 weeks        - lymphadenitis        - excision        - cryotherapy        - ATB

32. Leprosy - Chronic granulomatous intracellular infection caused by
bacteria Mycobacterium leprae - The transfer by air from the nasal secretions of persons with
leprosy lepromatosa to the mucous tissue of
breathing vessels of susceptible host - Long incubation period ( from months till 30 years) - The most common manifestation of the skin and peripheral
nerves - Early stage - leprosy indeterminata - Border forms - tuberculoid leprosy and leprosy lepromatosa - Transient forms - bordeline (dimorphic) leprosy

33. Diagnostic criteria of leprosy:
Hypopigmented or erythematous leasions with loss of sensitivity
Enlarged peripheral nerves
Acid - resistant rods in skin swabs or biopsy       (Ziehl-Neelsen dying ) - cultivation is not possible + History, stay in endemic areas
Therapy - a combination of:                - Rifampicin with dapsone or klofazimin                         - 6 months in TT, BT                          - 24 months in LL, BL

34. Borreliosis - Infection caused by Borrelia burgdorferi sensu lato - The most common carrier – tick Ixodes ricinus - Affects the skin, nervous system, joints, heart - Acute manifestation occurs in the area of the bite after
     7-10 days and is sometimes accompanied by non-specific
  systemic symptoms - Erythema chronicum migrans – specific sign

35. Erythema chronicum migrans

36. Acrodermatitis chronica atrophicans - Appears from few years to decades after infection - Affects skin acral extensor parts of arms and legs
around the joints - Slight swelling of livid coloured skin After regression of edema - skin atrophy

37. Borreliosis   - Diagnostics - serology (ELISA, Western blot)        - IgM antibodies reach peak between 3rd to 6th week after          infection (in ECM often negative)   - Correlation with the clinical state necessary   - Therapy - antibiotics - Doxycycline                                      Amoxicillin                                      Cefuroxime axetil                                      Azithromycin                                      Ceftriaxone i.v.

38. Anthropozoonoses     - Diseases caused by microorganisms transferred        from animals to humans - Anthrax - Bacillus anthracis - cattle - Tularemia - Francisella tularensis - rodents - Erysipeloid - Erysipelothrix rhusiopathie - Maleus - Pseudomonas mallei – toed ungulated animals

39. Erysipeloid Acute inflammation of skin of hand fingers - After injury in people who are in contact with fish,
poultry - Non-ulcerative painful red-livid hot bearing
    in the area of injury after 2-7 days - Penicilin p.o days, ev. erythromycin

40. Cat scratch disease - A rare chronic infection with significant regional    lymphadenopathy - Bartonella henselae - Papule or vesicle in the area of the scratch after 10 days - Systemic symptoms - Regional lymphadenopathy persists 2-6 months - In most cases benign

41. Actinomycosis - Chronic granulomatous disease
- Abscesses, fistulas, scars - men
- Fibrous facultative anaerobic bacteria - Actinomyces – G+
- A. Israel - commensals of oropharynx, intestines,                                                  genital - mucosal injury
- Tough inflammatory infiltrates with elevated edges,
fistulas, ulcers
- Cervicofacial, thoracic, abdominal form
- Microscope - yellow granular bacterial conglomerates
- Therapy - Penicillin G i.v. weeks, surgery

42. Thank you for your
attention