skin, and soft tissue infections: impetigo: -impetigo is superficial localized epidermis-skin...

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Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis- skin infection. -Caused by Streptococcus or Staphylococcus bacteria. -Most common in children; particularly those in unhealthy living conditions. -Impetigo is highly contagious: -The fluid that oozes from the blisters touches other skin site. -Types of impetigo: 1-Nonbullous impetigo . 2-Bullous impetigo .

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Page 1: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

Skin, and Soft Tissue Infections:

Impetigo:-Impetigo is Superficial localized epidermis-skin infection.

-Caused by Streptococcus or Staphylococcus bacteria.

-Most common in children; particularly those in unhealthy living conditions.

-Impetigo is highly contagious: -The fluid that oozes from the blisters touches other skin site. -Types of impetigo: 1-Nonbullous impetigo. 2-Bullous impetigo.

Page 2: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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1-Non-bullous impetigo:-It begins as small vesicles that rupture quickly to form purulent erosions covered by honey-colored, adherent thick crusts.-Usually on face and extremities.-Lesions are superficial and limited to the epidermis, and are usually painless but may itch.

-Staphylococcus aureus accounts for 50-60% of cases.-About 20-45% of cases are due to a combination of Staphylococcus aureus and Streptococcus pyogenes.

Page 3: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Clinical presentation of Non-bullous impetigo:

Staphylococcus impetigo Streptococcus impetigo

-Swab could be taken from lesions for detection of MRSA.-The sores of impetigo heal slowly and seldom scar.-Permanent skin damage and scarring (very rare).

Page 4: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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2-Bullous impetigo:-Large superficial fragile blisters filled with pus that rupture to leave a reddish raw-looking base lesion. -Caused by epidermolytic toxin-producing strains of Staphylococcus aureus.

-Painless Lesions on the face, arms, or legs, and other.

-Itching single or multiple blister(s):-Yellow or honey-colored fluid-Oozing and crusting over

Page 5: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Bullous impetigo fluid-filled blisters are surrounded by red (erythematous) and itchy skin.

-Mainly seen in children younger than 2 years (about 90% of cases).

In Non-Bullous and Bullous impetigo:-Person-to-person transmission occurs in people living in crowded conditions and with poor hygiene.-Complication: Post-Streptococcus glomerulonephritis. Bullous impetigo

Page 6: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Ecthyma: (deep impetigo):-It is an ulcerative form of impetigo that extends deeper into the dermis.-It begins as a vesicle or pustule overlying an inflamed area of skin that deepens into a dermal ulceration with overlying crust.-The crust is gray-yellow and is thicker and harder than impetigo crusts. -Ecthyma is most often caused by Streptococcus species.

-The infection may start in skin that has been injured due to a scratch or insect bite.

Page 7: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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The stages of Ecthyma:The lesion begins as a pustule that later erodes and ultimately forms an crusty dermal ulceration . Ecthyma of lower extremities.

Page 8: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Folliculitis: -It is a purulent bacterial infection of the hair follicle.-Appears as a pinhead-sized erythematous papule topped by a superficial pustule located at the orifice of the hair follicle. -Staphylococcus aureus is the most common causative agent.

Page 9: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Furunculosis :(Boils):

-Painful focal (localized) purulent (Filled with pus)

inflammatory lesion of skin; within dermis due to

uncontrolled folliculitis and sebaceous glands infection.

-This Micro-abscess show a progressive local swelling and

erythema.

-Staphylococcus aureus

is the most common

cause.

Page 10: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Carbunculosis: -Larger and deeper purulent skin abscess of multifocal origin in deep dermis with multiple sinus tracts.-It is a number of furuncles connected together by sinus tracts.-It can be complicated by bacteremia.

Page 11: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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-The purulent lesions often rupture spontaneously and drain a purulent matter (mainly neutrophils), bringing immediate relief of pain. -Boil Lesions can occur anywhere on hair-bearing skin.

-Carbuncles are usually found in the thick fibrous inelastic skin of the neck and upper back.-Seen in 15-40 years of age.-Staphylococcus aureus is the most common cause.-Predisposed people are obese, diabetic, or with weak immunity.

Page 12: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Erysipelas:

-Infection in upper dermis layer of skin characterized by

diffusely spreading deep-erythematous and

edematous inflammation.

-Especially in the face or legs.

-The infection spreads in the superficial

lymphatics of the dermis.

-80% of cases are due to Streptococci, 2/3 of these are

due to Streptococcus pyogenes.

Page 13: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Cellulitis: -Deep diffused inflammation of dermis and subcutaneous layer of skin without necrosis.

-Streptococcus pyogenes and Staphylococcus aureus are the most common causative agents: (Superantigen and exfoliative toxins).

-Gram’s negative bacilli (E.coli, Pseudomonas) cause superficial cellulitis results in granulocytopenia and foot ulcer in diabetic patients.

-The spreading infection may rapidly turn life-threatening, due to lymph node invasion and bacteremia.

Page 14: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Cellulitis:Possible signs and symptoms include: -Redness -Swelling -Tenderness -Pain -Warmth -FeverRisk factors include:

Lymphedema Staphylococcus cellulitis and Bullous

History of cellulitis Intravenous drug useObesityWeakened immune systemSkin conditions

Page 15: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Staphylococcus cellulitis and Streptococcus cellulitis.

Invasive Group A Streptococcus cellulitis

Page 16: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Complications of Cellulitis: 1-Bacteria can spread rapidly throughout body entering lymph nodes and bloodstream. (Lymphadenitis, Bacteremia, or Septicemia).

2-Recurrent cellulitis due to damaged lymphatic drainage system.

3-In rare cases: -Infection spread to the deeper layer of tissue the fascial

lining causing necrotizing fasciitis.

Page 17: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Necrotizing Fasciitis: "Flesh-eating bacteria"

-A rapidly progressive deep diffused inflammatory infection

of the fascia, with secondary necrosis of the subcutaneous

tissues.-Frequency of necrotizing fasciitis linked to an increase in:

1-Diabetes mellitus2-Cancer3-Vascular insufficiencies

-Two types:

1- Type I: Describes a Polymicrobial infection.

2-Type II: Describes a Monomicrobial infection.

Page 18: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Type I : Polymicrobial infection:

-It is associated with Staphylococcus aureus, Streptococcus

pyogenes, other like Vibrio species, Bacteroides fragilis,

and Clostridium perfringens.

Type II: Monomicrobial infection:

-It is mainly caused by Group A Streptococcus or

methicillin-resistant Staphylococcus aureus (MRSA).

Page 19: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Necrotizing Fasciitis:-Rapid progression of severe pain with fever, and chills

-Swelling , redness, hotness, blister, gangrene and necrosis

-Blisters with subsequent necrosis, and Organ failure

-Mortality as high as 73 % if untreated

Complications:Renal failure, Septic shock with cardiovascular collapseScarring with limb deformity or lossToxic shock syndrome and SepticemiaExtensive muscle necrosis.

Antibiotic therapy and Surgical intervention: Combination of penicillin G and an aminoglycoside.

Page 21: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Acne vulgaris:-It is a disease that significantly affects most teenagers worldwide.-Several different types of acne lesions exist and include open or closed comedones, inflammatory papule, pustules, and nodule. -Limited to face, upper chest, and back.-Whitehead (closed) comedo.-Blackhead (open) comedo. -Acne affects mostly skin with the densest population of sebaceous follicles

Page 22: Skin, and Soft Tissue Infections: Impetigo: -Impetigo is Superficial localized epidermis-skin infection. -Caused by Streptococcus or Staphylococcus bacteria

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Causes of Acne vulgaris:Hormonal

Genetic

Psychological

Diet

Infectious AgentPropionibacterium acnesStaphylococcus epidermidis