1. Microbiology: A Systems Approach, 2 nd ed. Chapter 18: Infectious Diseases Affecting the Skin and Eyes

2. Figure 18.1

3. Skin Defenses Keratinized surface Constant sloughing off of cells from the stratum corneum Antimicrobial substances – Sebum – Sweat – Antimicrobial peptides in epithelial cells

4. 18.3 Normal Biota of the Skin Must be able to live in dry, salty conditions Microbes grow in dense populations in moist areas and skin folds or in hair follicles and glandular ducts

5. Three Main Categories Diphtheroids – Club-shaped – Gram positive – Not usually virulent – Propionibacterium acnes Microcci – Staphylococcus and Micrococcus – S. epidermis Yeasts – Low numbers, can cause opportunistic disease – Candida albicans – Malassezia

6. 18.4 Skin Diseases Caused by Microorganisms Acne – All follicle-associated lesions – Skin prone to pimples and acne Structure that traps the mass of sebum and dead cells, clogging the pores Exaggerated process of keratinization in and around the follicle, blocking the pore Overproduction of sebum when the sebaceous gland is stimulated by hormones – Propionibacterium acnes in the follicle releases lipases to digest the oil surplus, results in intense local inflammation that can eventually burst the follicle

7. Types of Lesions in Acne Comedo: skin initially swells over the pore leading out of a hair follicle – Pore closed- whitehead – Pore open but blocked with a dark plug of sebum- blackhead Pustule or papule: when the lesion erupts on the surface Cysts: pustules that come to involve deeper layers of skin

8. Impetigo Superficial bacterial infection Causes the skin to flake or peel off Highly contagious Usually seen in children Either Staphylococcus aureus or Streptococcus pyogenes Looks like peeling skin, crusty and flaky scabs, or honey-colored crusts Lesions usually found around mouth, face, and extremities Itches

9. Figure 18.2

10. Figure 18.4

11. Cellulitis Caused by a fast-spreading infection in the dermis and the subcutaneous tissues Causes pain, tenderness, swelling, and warmth Lymphangitis often occurs

12. Staphylococcal Scalded Skin Syndrome (SSSS) Dermolytic condition Caused by Staphylococcus aureus Mostly in newborns and babies Can be thought of as a systemic form of impetigo Bullous lesions Desquamation of the skin

13. Figure 18.7

14. Gas Gangrene Clostridial myonecrosis Caused by Clostridium perfringens Two forms – Anaerobic cellulitis – True myonecrosis

15. Figure 18.8

16. Chickenpox Generally a mild disease In immunocompromised people, can be life threatening Fever and abundant rash that begins on scalp, face, and trunk; radiates in sparse crops to the extremities (centripetal distribution) Lesions form macules and papules to itchy vesicles filled with a clear fluid In several days, encrust and drop off Shingles: the virus enters the sensory endings that innervate dermatomes and becomes latent- them reemerges

17. Figure 18.10a

18. Figure 18.11

19. Smallpox Naturally occurring smallpox no longer occurs, but may be a bioterrorism threat Fever and malaise, then a rash in the pharynx Spreads to the face and progresses to the extremities Initially a macular rash, then turns to popular, vesicular, and pustular before crusting over Two forms – Variola minor – Variola major Highly virulent Causes toxemia, shock, and intravascular coagulation

20. Figure 18.10b

21. Maculopapular Rash Diseases Measles Rubella Fifth disease Roseola

22. Measles Also known as rubeola Sore throat, dry cough, headache, conjunctivitis, lymphadenitis, and fever Koplik’s spots appear then turn in to red maculopaular exanthem Erupts on the head then progresses to the trunk and extremities until most of the body is covered Complications can result – Pneumonia – Laryngitis – Secondary bacterial infections – Subacute sclerosing panencephalitis (SSPE)

23. Figure 18.12

24. Rubella Also known as German measles Relatively minor rash disease with few complications Two forms – Postnatal infection – Congenital infection Teratogenic virus Transmission of virus to a fetus in utero Mother can transmit the virus even if she is asymptomatic Fetal injury varies depending on the time of infections

25. Fifth Disease Erythema infectiosum “slapped-cheek” appearance Spreads on the body but is most prominent on arms, legs, and trunk Maculopapular, blotches run together Low-grade fever and malaise

26. Roseola Common in young children and babies Most cases proceed without the rash stage; others result in maculopapular rash High fever Fourth day, fever disappears, and rash can appear

27. Scarlet Fever Most often the result of a respiratory infection with Streptococcus pyogenes

28. Warts Also known as papillomas Affect children more than adults Benign squamous epithelial growths Various types – Seed warts – Genital warts – Plantar warts

29. Molluscum contagiosum Smooth waxy nodules on the face, trunk, and limbs May be indented in the middle May contain milky fluid Common in children Most often causes nodules on the face, arms, legs, and trunk in children; mostly in genital areas in adults

30. Large Pustular Skin Lesions Leishmaniasis Cutaneous anthrax

31. Leishmaniasis Zoonosis transmitted by female sand flies Several different forms, depending on the species of Leishmania that is involved – Cutaneous leishmaniasis – Espundia – Systemic leishmaniasis

32. Cutaneous Anthrax Most common and least dangerous version of infection with Bacillus anthracis Caused by endospores entering the skin through small cuts or abrasions Papule that becomes increasingly necrotic then ruptures to form a black eschar

33. Ringworm (Cutaneous Mycoses) Dermatophytes Confined to the nonliving epidermal tissues and their derivatives Different names all beginning with the word tinea

34. Superficial Mycoses Involve the outer epidermal surface Ordinarily innocuous infections with cosmetic rather than inflammatory effects Tinea versicolor caused by Malassezia furfur

35. 18.7 Eye Diseases Caused by Microorganisms Conjunctivitis – Infection of the conjunctiva – Fairly common – Can be caused by specific microorganisms, contaminants, or accidental inoculation of the eye – Inflammation and discharge Bacterial infections- milky discharge Viral infections- clear exudate

36. Figure 18.21

37. Trachoma Chronic Chlamydia trachomatis infection of the epithelial cells of the eye Major cause of blindness in certain parts of the world First signs of infection- mild conjunctival discharge and slight inflammation of the conjunctiva Followed by marked infiltration of lymphocytes and macrophages As these cells build up, they impart a pebbled appearance to the inner aspect of the upper eyelid Eventually, pannus occurs

38. Figure 18.22

39. Keratitis More serious infection than conjunctivitis Invasion of deeper eye tissues occurs, can lead to complete corneal destruction Any microorganism can cause this condition One of the more common causes: herpes simplex virus Preliminary symptoms: gritty feeling in the eye, conjunctivitis, sharp pain, and sensitivity to light

40. River Blindness Chronic parasitic (helminthic) infection Onchocerca volvulus transmitted by black flies The worms eventually invade the entire eye, producing inflammation and permanent damage to the retina and optic nerve