cutaneous infections and infestations dr. mohammed alshahwan md
TRANSCRIPT
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CUTANEOUS INFECTIONS AND INFESTATIONS
DR. MOHAMMED ALSHAHWAN MD
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OBJECTIVES 1. General understanding of the causative
organisms of common skin infection(CSI).
2. Focus on CSI clinical presentation.
3. Overview of the basic investigations done and general knowledge of first line therapy.
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BACTERIA (impetigo , erysipelas &cellulits )
VIRUS (wart ,herpes simplex & herpes zoster)
FUNGUS (Tinea , candidasis)
PARASITE (Lieshmaniasis ,scabies & pediculosis)
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BACTERIAL I. Impetigo Superficial non-follicular infection due to
staphylococcus and streptococcus Children not sick pustule (honey-colored crust ) Face and Acral areas Primary or secondary
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II. Erysipelas deep cutaneous infection (Dermal) due to streptococcus after penetrating trauma (
CHRONIC LYMPHEDEMA) sick Face and Acral areas Unilateral sharply demarcated edematous red
plaque
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III. Cellulitis deep cutaneous infection (up to SC FAT) due to streptococcus after penetrating trauma (
CHRONIC LYMPHEDEMA) sick Face and Acral areas Unilateral Diffuse (NOT well demarcated)
edematous red plaque Blood Culture in immuocompramized pts.
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VIRAL INFECTIONWART Human papilloma virus (HPV) Direct contact Asymptomatic transmition Delay in presentation Oncogenic potential (HPV 16 and 18) High recurrence rate
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CUTANOUS ( HPV 1 and 3 )
common wart
flat wart
planter wart
GENITAL (HPV 6 and 11)
classic
condyloma acuminata
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GENITAL WART
*STD
*Oncogenic HPVs ( Cervical cancer)
*Usually more persistent and difficult to treat .
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TREATMENT* Tissue destructive modalities Keratolytic (salicylic acid and podophyllin) Cryotherapy ( Liquid nitrogen) Electrotherapy CO2 laser
* Immunotherapy
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HERPES SIMPLEX
Human Herpes virus I and II
Direct contact
Asymptomatic transmition
Latency
High recurrence rate
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CUTANEOUS ( HSV I ) orolibialis Initial Herpatic whitlow Recurrence herpes ophtalmicus
GENITAL ( HSV II )
Initial Recurrence
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Incubation period : 7- 10 days. After 24-48 hours of burning and tingling sensation the patient develop grouped vesicles on erythematous base which ulcerate within 24 hours.
The whole illness is around 7-10 days.
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Tzank smear
Direct fluorescent antibody test
Viral culture
Blood serology
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VARICELLAE ZOSTER VIRUS (VZV)
RESPIRATORY DROPLETS CHICKENPOX ( Children)
HERPES ZOSTER (Adult) is due to reactivation of VZV which was dorminant in nerve root ganglion
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CHICKENPOXIncubation period : 2 weeksProdrom of respiratory coryza followed
by disseminated red macules with central vesicles.
The whole illness : 3 weeks The patient contagious 5 days before
and 5 days after skin eruption
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HERPES ZOSTERAfter 24-48 hours of burning and tingling
sensation the patient develop grouped vesicles on erythematous base which ulcerate within 24 hours.
The whole illness is around 7-10 days.
Post-herpetic neuralgia (PHN) which usually persist for around 4 weeks.
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It is almost always DERMATOMAL
SPINAL (Thoracic )
CRANIAL ( Trigeminal)
SERIOUS involvement1.Ophthalmic division of trigeminal nerve.
2. Geniculate ganglia (Ramsey-hunt syndrome)
3.Sacral ganglia.
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TreatmentHERPES SIMPLEX Acyclovir 200 mg five time a day for a
weekHERPES ZOSTERAcyclovir 800 mg five time a day for a
week
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FUNGALDERMATOPHYTE
Tinea Pedis (most common)
1.Erosive interdigitalis
2. Hyperkeratotic type(T. rubrum)
3. Inflammatory type(T.mentagrophyte)
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Tinea corporis / Tinea cruris1.Hyperkeratotic type (T. rubrum) well-demarcated annular red
hyperkeratotic plaque with central clearing (Ring worm)
2.Inflammatory type (T.mentagrophyte) well-demarcated edematous red
plaque with superimposed pustules
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Tinea Capitis1.Hyperkeratotic (black dot) usually due to T. tonsurans 2. Inflammatory (Kerion) usually due to M. canis complex3. Favus * Due to T. schoenleinii * it characterized by the presence of
Scutulae .
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YEASTCandidosisDue to candida albicansIt is a commensal flora of the gut
which become pathogenic when the immune status of the person changed
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physiological (old age , neonate and pregnancy)
pathological ( DM, HIV and organ transplant)
Itrogenic (long course of Antibiotics)
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MUCOSAL
1. Oral
oral thrush
angular chilitis
2. Genital
valvuvaginitis
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CUTANEOUS
it favor wet areas
Candidal intertrigo ( Napkin rash)
peripherally spreading glazed red patch with scaly border and satellite pustules
Candidal paronychia
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pityriasis versicolor
Due to Malassezia furfur
Asypmtomatic
Well-demarcated brown patches with branny over the trunk and upper extremities
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1. Scraping,Clipping and Hair blucking
KOH/microscopy Culture
2. Skin biopsy Histopathology with PAS stain
Culture
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Topical Antifungal Nystatin preparation (oral thrush) Imidazoles e.g. cotrimazole and miconazoleSystemic Antifungal Imidazoles e.g. Itraconazole and fluconazole Allylamine e.g. Terbinafine Griseovulvin
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PROTOZOA
Lieshmaniasis
Protozoa called Lieshmania
Sand fly (premastigote)
Macrophage (Amastigote)
Lieshman-Donovan bodies
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Localized Cutaneous Well-demarcated ulcerated nodule over the exposed areas after a trip to an endemic area ( H/o of insect bite)
Disseminated Cutaneous Mucocutaneous Visceral
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Skin biopsy
Histopathology with Gimsa stain
Lieshman-Donovan bodies
Culture
PCR for DNA
Liesmanin test
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Resolve spontaneously leaving a scar
Antimony (Pentostam) either Intralesional or Intramuscular to shrink the lesion
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Scabies Mite called sarcoptes scabei which residue in burrows in the
stratum corneum laying eggs then dieing and the eggs will maturate in 2 weeks period and the cycle repeated.
Skin lesions are Secondary eczematous eruption due to immune reaction to the mite and eggs
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When to suspect scabies ?
1.pruritus mainly at night
2. Other member of the family also having severe pruritus
3. Pruritus and skin eruption is more severe in the flexors
Document See the mite or eggs
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Permethrin cream
Lindane cream
Malathion lotion
2.5% sulphur ointment
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PEDICULOSIS
Head lice (Pediculosis Capitis)
Children
Body lice (Pediculosis Corporis)
Homeless people and vagrants
Pubic lice (Pediculosis Pubis)
STD ( partner should be treated)
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The diagnosis can be conformed by seeing the lice eggs ( NITs)
Best treatment is SHAVING for head and pubic lice. Alternatives:
Permethrin creame rinse
Malathion lotion
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THANK YOU