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Bacterial skin infections 1

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  • 1. BACTERIAL SKIN INFECTIONS FOR PRIMARY HEALTH CARE WORKERS Digafe Tsegaye MD ,Dermato-venerologist Hon. Assistant Professor at MMS
  • 2. Introduction  The normal skin of healthy individuals is highly resistant to invasion by the wide variety of bacteria to which it is constantly exposed.  NATURAL RESISTANCE OF THE SKIN  Mechanical barier  Low PH (5.5)  Relative dryness of the skin  Sebum : antibacterial activity  unsaturated long-chain fatty acids ,free fatty acids (linoleic and linolenicacids)  Sweat :?? IGM ,IGA ,IGD  Normal flora
  • 3.  Most of the bacterial skin infections are caused principally by two organisms  These are  Staphylococcus aureus  Group A streptococcus  Others include coryenebacterium ,mycobacterium ,closteridia, bacillus anthracis
  • 4. Common primary bacterial skin infections( PYODERMAS)  S.aureus  Impetigo  Folliculitis  Furuncle  Carbuncle  Ecthyma  Paronychia  Scarlet fever  SSSS  TSS  S.pyogenes  Erysipella  Cellulitis  Scarlet fever  Lymphangitis  Thrmbophlebitis  Necrotizing fascitis  TSS
  • 5. Impetigo Non- bullous Bullous
  • 6. Non bullous impetigo • Accounts 70 % of impetigo • Children of all age group are affected • Constitutional symptoms are abscent • Etiology : Group A Streptococcus • Presents as honey colored or yellowish colored crusted lesions • Complicates skin conditions such as scabies ,eczema ,tinea capitis … • RX : cloxacilline , Augumentine , cefalexine
  • 7. Impetigo on the scalp
  • 8. Yellowish crustes on the face
  • 9. What do you see ?
  • 10. What do you see ?
  • 11. Impetigo complicating Eczema
  • 12. What do you see ?
  • 13. Impetigo complicating eczma
  • 14. Bullous impetigo • Affects infants • Caused by S.aureus ( toxin producing) • Presents clinically as blistering lesions ( Bullae) , or Errosions • RX : topical antibiotics +, Cefalexine , Augmentine or cloxacillne
  • 15. Turbid bullous lesions
  • 16. What do you see ?
  • 17. FOLLICULITIS  A pyoderma that begins within the hair follicle  Superficial/Bockhart's impetigo/  Deep /Sycosisbarbae/  Rx : local +systemic antibiotics
  • 18. What do you see ?
  • 19. FURUNCLE AND CARBUNCLE  A furuncle or boil is a deep- seated inflammatory nodule that develops about a hair follicle, usually from a preceding, more superficial folliculitis and often evolving into an abscess.  Arise in hair-bearing sites, particularly in regions subject to friction, occlusion.  They may complicate preexisting lesions
  • 20. carbuncle  Is formed when two or more furuncles join each other  Systemic symptoms are often present such as fever ,maliase  RX : systemic antibiotics ( Cloxacilline ,cefalexin ,Augmnetine) + incission and drainage
  • 21. Ecthyma  Ecthyma is usually a consequence of neglected impetigo  Untreated staphylococcal or streptococcal impetigo can extend more deeply, penetrating the epidermis, producing a shallow crusted ulcer  The lesions are slow to heal, requiring several weeks of antibiotic treatment for resolution
  • 22. ecthyma
  • 23.  Acute paronychia  Rx : cloxacilline 500 mg po qid for 7 dyas  Incise and draine the abscess
  • 24. Erysipelas  A distinct type of superficial cutaneous cellulitis with marked dermal lymphatic vessel involvement caused by group A beta-hemolytic streptococcs.  New born –GB Streptococcus  Rarely ; S.aureus
  • 25. Cellulitis  Involves more of the soft tissues, extending deeper into the dermis and subcutaneous tissue.  Group A streptococci are by far the most commonetiologic agents  But occasionaly GBSC in neww born ,Gm- in immunocompromised ,.. RX: rest ,po /Iv antibiotics
  • 26. Gangrenous cellulitis/Necrotizing fasciitis  Characterized by necrosis of the epidermis and deeper soft tissue structures including muscle  Characteristically rapidly developing, progressive, and accompanied by constitutional symptoms, severe pain, and tenderness, with changes in overlying skin that progress to bulla formation and frank necrosis.  Etiology : group A  streptococci, histotoxic Clostridia (including C. perfringens, C. septicum , anaeeobes  DM ,operative /traumatic wounds , malnutrition  MR :40 to 50 percent  Rx : surgical debridement amd pareentral antibiotics
  • 27. Other infections caused by Streptococcus  Acute lymphangitis  Scarlet fever  Ecthyma  Streptococcus intertrigo  Blistering distal dactylitis  Guttate psoriasis  Erythema marginatum  Purpura fulminans  Erythema multiforme like lesions
  • 28. Erythrasma.  well-defined but irregular reddish brown patches, occurring in the intertriginous areas, or by fissuring and white maceration in the toe clefts.  Corynebacterium minutissimum  Wood lamp examination of erythrasma reveals a coral-red fluorescence caused by coproporphyrin III.
  • 29. Pitted keratolysis  involves the stratum corneum of the web spaces and plantar surface.  Etio ; Micrococcus sedentarius  Rx : fusidic acid cream (Foban cream/erythromycin 500 mg qid for 7 days  Give treatment for
  • 30. Trichomycosis axillaris and pubis  bacterial infection of the hair shaft  nodular thickenings on the hair shaft, composed of colonies of aerobic Corynebacterium.  Benzoyl peroxide wash and gel are effective as treatment and prevention against recurrence of trichomycosis.
  • 31. Other less common infections  Anthrax  Caused by B. anthracis  Disease is acqired from contaminated meat , skin of infected animals  Painless Swelling with central black eshar  Rx : po doxycline 100mg po bd for 3 weeks
  • 32. Bacillary angomatosis  Etiology : Bartonella henselae  Exclusively present in HIV pts  RX : erythromycin 500 mg po qid for three weeks
  • 33. Cutaneous TB  Is rare but not uncommon  Presents in many ways  Scrofuloderma is the most common type  May be inoculated from outside or spread from distant or adjacent organs  Mode of acquistion  Hematogenous spread  Lymphatic spread  Direct inoculations  Direct extenesions  Hypersensitivity to mycobacterium tb
  • 34. Types of cutaneous TB  Tuberclosis chancre  Tuberclosis verucosa cutis  Orificial tuberculosis  Scrofuloderma  Lupus vulgaris  Mtestatic tuberclosis abcess  tuberclids
  • 35. Lupus vulgaris
  • 36. Tb lymphadenitis Lupus vulgaris
  • 37. Lupus vulgaris
  • 38. TB of the skin
  • 39. TB osteomyelitis with skin involvement
  • 40. Scrfuloderma
  • 41. TB verrucosa cutis
  • 42. Investigation and Treatment  Cxr ,CBC , ESR, Biopsy  Category III anti-tb drugs
  • 43. Tetanus  Caused by closteridia tetani  Anerobic gram negative bacteria  Conatminate necrotic and devitalized wound  May cause muscle spasm and respiratory failure  Treatment  High dose crystalline pencillne , diazepam  Prevention : TAT

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