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 – I Propionibacterium acnes – acne vulgaris Staphylococcus aureus - folliculitis Primary acute bacterial skin infections – II - local redness, heat, swelling, and a highly characteristic raised, indurated border, no localized purulence - the legs and face are the most frequently affected sites - on the face is a butterfly distribution involving the cheeks and the bridge of the nose erysipelas – Streptococcus pyogenes (GAS) Primary acute bacterial skin infections – III hordeolum (stye) – Staph. aureus Impetigo ! - Staph. aureus, - Str. pyogenes lymphangoitis – Strept. pyogenes Stye Primary acute bacterial skin infections – IV Panaritium (whitlow) Staphylococcus aureus paronychium Staphylococcus aureus Primary acute bacterial skin infections – V erythema migrans – Borrelia burgdorferi - ticks (Ixodes ricinus) - serology, PCR - doxycycline in adults http://images.google.cz 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 - Mycobacterium tuberculosis – lupus vulgaris actinomycosis – Actinomyces israelii Secondary infections of skin lesions - decubitus (bedsore), trophic ulcer – neighbouring and endogenous flora (staphylococci, streptococci, enterococci, enteric bacteria, pseudomonads, anaerobes, yeasts) - infected intertrigo (raw) – S. aureus, P. acnes - sec. infected dermatomycoses – S. pyogenes - infected wounds – will be discussed individually Skin symptoms of systemic bacterial infections roseola (rash in typhoid fever) – Salmonella Typhi disseminated gonorrhoea – Neisseria gonorrhoeae infective endocarditis – splinter haemorrhages 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 Infective endocarditis – splinter haemorrhages hopkinsvasculitis.org Rash - meningococcemia – Neisseria meningitidis scarlatina (scarlet fever) – Streptococcus pyogenes Fungal infections cutaneous mycoses 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 – M. gypseum, M. canis, M. audouinii, T. mentagrophytes var. mentagrophytes 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 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 cdc.gov Typical molluscum bumps. Note the pearly appearance and the dimple in the center of the bumps. Fifth Disease/Erythema infectiosum - Erythrovirus (Parvovirus) B19 Sixth Disease/ Exanthem subitum, Roseola infantum, "Sudden Rash", rose rash of infants, 3-day fever http://img405.imageshack.us Fifth Disease/Erythema infectiosum 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 hand, foot and mouth disease – coxsackievirus A16, Enterovirus genus herpes simplex (cold sore) – HSV 1, Simplexvirus genus varicella (chicken pox) – varicella-zoster virus, VZV, Varicellovirus genus Skin symptoms in viral diseases – III 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 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 en.wikipedia.org Leishmaniasis www.vet.uga.edu Edvard Munch (1863-1944): Death in a Room