Institute for Microbiology, Medical Faculty of Masaryk University and St. Anna Faculty Hospital in Brno Miroslav Votava, Vladana Woznicová Agents of infections with skin manifestations Infections with skin symptoms • primary skin infections • secondary infections of already diseased skin • skin symptoms of systemic infections Etiology: - bacterial - viral - fungal - parasitic Bacterial skin infections Primary acute bacterial skin infections – Ia acne vulgaris – Propionibacterium acnes carbunculus nuchae – Staphylococcus aureus ecthyma gangraenosum – Pseudom. aeruginosa Primary acute bacterial skin infections – Ib erysipelas – Streptococcus pyogenes erysipeloid – Erysipelothrix rhusiopathiae Primary acute bacterial skin infections – Ic erythema migrans – Borrelia burgdorferi B. afzelii B. garinii B. burgdorferi sensu stricto Primary acute bacterial skin infections – IIa folliculitis - Staph. aureus, P. aeruginosa furunculosis (boil) - Staph. aureus hidradenitis suppurativa - Staph. aureus Primary acute bacterial skin infections – IIb hordeolum (stye) - Staph. aureus Impetigo - Staph. aureus, - Str. pyogenes lymphangoitis - Strept. pyogenes Primary acute bacterial skin infections – IIc panaritium Staphylococcus aureus paronychium Staphylococcus aureus sycosis barbae Staphylococcus aureus Primary chronic bacterial skin infections actinomycosis - Actinomyces israelii chronic subcutaneous abscesses - A. israelii, Nocardia asteroides, Rhodococcus equi skin granulomas - Mycobacterium marinum, M. haemophilum, M. chelonae leprosy - Mycobacterium leprae lupus vulgaris - Mycobacterium tuberculosis scrophuloderma - M. tuberculosis, M. bovis 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, P. acnes infected intertrigo (raw) – S. aureus, P. acnes sec. infected dermatomycoses – S. pyogenes infected wounds – discussed in previous lecture Skin symptoms of systemic bacterial infections roseola (rash in typhoid fever) – Salmonella Typhi disseminated gonorrhoea – Neisseria gonorrhoeae infective endocarditis – to 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 Fungal infections Etiology of skin fungal infections Etiology differs in… • superficial mycoses, like pityriasis versicolor – Malassezia furfur (syn. Pityrosporum ovale) • mucocutaneous mycoses – Candida albicans and other species of candidae • cutaneous mycoses – typical dermatophytes • subcutaneous mycoses • opportune skin mycoses in immunodeficites Etiology of cutaneous mycoses 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 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 Etiology of opportune skin mycoses in immunodeficites Fusarium solani, Fusarium oxysporum, Fusarium verticillioides Pseudoallescheria boydii (= teleomorf, sexual phase of anamorf Scedosporium apiospermum) Penicillium marneffei (systemic infection with skin manifestations) Scopulariopsis brevicaulis Viral infections Skin symptoms in viral diseases – I Macular (spotted) exanthem: morbilli – morbilli virus, Morbillivirus genus rubella – rubella virus, Rubivirus genus erythema infectiosum (the fifth disease) – parvovirus B19, Erythrovirus genus exanthema subitum (roseola infantum, the sixth disease) – HHV 6, Roseolovirus genus Umbiliform papulae: molluscum contagiosum – molluscum contagiosum virus, Molluscipoxvirus genus Skin symptoms in viral diseases – II Vesicles: herpes simplex (cold sore) – HSV 1, Simplexvirus genus herpes genitalis – HSV 2, Simplexvirus genus varicella (chicken pox) – varicella-zoster virus, VZV, Varicellovirus genus herpes zoster (shingles) – varicella-zoster virus, VZV, Varicellovirus genus variola vera (smallpox) – variola virus, Orthopoxvirus genus (continued) 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, Aphthovirus genus hand, foot and mouth disease – coxsackievirus A16, Enterovirus genus 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 Generalized congenital cytomegalic disease – cytomegalovirus, CMV, Cytomegalovirus genus Parasitic infections Skin symptoms in parasitoses – I Domestic parasitoses: scabies – itch mite, Sarcoptes scabiei pediculosis capitis – head louse, Pediculus capitis pediculosis corporis – body louse, Pediculus humanus (syn. Pediculus corporis) pediculosis pubis (phthiriasis) – pubic (crab) louse, Phthirus pubis 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 larvae Neotrombicula autumnalis 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 Homework 7 – solution Edvard Munch (1863-1944): Death in a Room Homework 8 Please give the name of the author and of the painting