7102008

1

Bacterial infections of Skin

Dr Sudha AgrawalBPKIHS Dharan

7102008

2

DEFENSES 1048715 Dry

1048715 1048715 Acidic (pH 54)

1048715 Temperature less than 37oC

1048715 1048715 Lysozyme and lipids

1048715 1048715Skin-associated lymphoid tissue (SALT)

Resident microflora1048715

7102008

3

Skin and infection

1048715 Entry Skin (pores hair

follicles) Wounds (scratches

cuts burns) Insect amp animal bites

1048715 Diseases Localized infections

with localandor systemic effect

Systemic infections

Multiplication Extracellular Intracellular ()

1048715 Damage Toxin Host immune response

7102008

4

Normal flora of skin

Classification

1 Resident flora grow on skin amp relatively

stable in no and composition at particular sites

2 Transient flora lie on skin surface without attachment unable to multiply amp

disappear within short time

3 Transient or temporary residents

7102008

5

Normal Skin Flora

Major bacterial groups

Coryneforms (Gram +ve pleomorphic rods)

Corynebacterium (Aerobic amp

lipophilic)

Brevibacterium (Aerobic amp non-

lipophilic)

Propinobacterium (Anaerobic)Contdhellip

7102008

6

Staphylococci (Gram +ve cocci aerobs)

S epidermidis S hominis Shemolyticus

Ssaprophyticus

Minor bacterial groups Acinetobacter (25) Micrococci

Fungal group Pityriasporum

7102008

7

Bacterial infection of the skin (Pyoderma)

Classification of pyodermas1 Primary

Impetigo Ecthyma Folliculitis

Superficial Deep

Folliculitis of leg Furuncle Carbuncle Sycosis Barbae

7102008

8

Cellulitis Erysipelas Pyonychia SSSS TSS

2 SecondarySecondary infection of preexisting dermatoses

eg Atopic dermatitis Scabies

7102008

9

Impetigo (contagious superficial infection)

Non-bullous Bullous1 Cause

- Streptococcal (Group A) Staph aureus- Staph aureus (Phage Groups II)

2 Pre-school and young school age All ages3 Very thin walled vesicle on an erythematus Bullae of

base 1-2cm4 Transient Persist for 2-3

day5 Yellowish-brownish crusts (thick) Thin flat

brownish crust Contdhellip

7102008

10

6 Irregular peripheral extension without Central healing with healing peripheral extension

7 Regional adenitis Rare

8 Constitutional symptoms present Absent

9 Face (around the nose mouth amp limbs) occur anywhere

10 Palms amp sole spared May involved

11MM very rare May involved

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

2

DEFENSES 1048715 Dry

1048715 1048715 Acidic (pH 54)

1048715 Temperature less than 37oC

1048715 1048715 Lysozyme and lipids

1048715 1048715Skin-associated lymphoid tissue (SALT)

Resident microflora1048715

7102008

3

Skin and infection

1048715 Entry Skin (pores hair

follicles) Wounds (scratches

cuts burns) Insect amp animal bites

1048715 Diseases Localized infections

with localandor systemic effect

Systemic infections

Multiplication Extracellular Intracellular ()

1048715 Damage Toxin Host immune response

7102008

4

Normal flora of skin

Classification

1 Resident flora grow on skin amp relatively

stable in no and composition at particular sites

2 Transient flora lie on skin surface without attachment unable to multiply amp

disappear within short time

3 Transient or temporary residents

7102008

5

Normal Skin Flora

Major bacterial groups

Coryneforms (Gram +ve pleomorphic rods)

Corynebacterium (Aerobic amp

lipophilic)

Brevibacterium (Aerobic amp non-

lipophilic)

Propinobacterium (Anaerobic)Contdhellip

7102008

6

Staphylococci (Gram +ve cocci aerobs)

S epidermidis S hominis Shemolyticus

Ssaprophyticus

Minor bacterial groups Acinetobacter (25) Micrococci

Fungal group Pityriasporum

7102008

7

Bacterial infection of the skin (Pyoderma)

Classification of pyodermas1 Primary

Impetigo Ecthyma Folliculitis

Superficial Deep

Folliculitis of leg Furuncle Carbuncle Sycosis Barbae

7102008

8

Cellulitis Erysipelas Pyonychia SSSS TSS

2 SecondarySecondary infection of preexisting dermatoses

eg Atopic dermatitis Scabies

7102008

9

Impetigo (contagious superficial infection)

Non-bullous Bullous1 Cause

- Streptococcal (Group A) Staph aureus- Staph aureus (Phage Groups II)

2 Pre-school and young school age All ages3 Very thin walled vesicle on an erythematus Bullae of

base 1-2cm4 Transient Persist for 2-3

day5 Yellowish-brownish crusts (thick) Thin flat

brownish crust Contdhellip

7102008

10

6 Irregular peripheral extension without Central healing with healing peripheral extension

7 Regional adenitis Rare

8 Constitutional symptoms present Absent

9 Face (around the nose mouth amp limbs) occur anywhere

10 Palms amp sole spared May involved

11MM very rare May involved

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

3

Skin and infection

1048715 Entry Skin (pores hair

follicles) Wounds (scratches

cuts burns) Insect amp animal bites

1048715 Diseases Localized infections

with localandor systemic effect

Systemic infections

Multiplication Extracellular Intracellular ()

1048715 Damage Toxin Host immune response

7102008

4

Normal flora of skin

Classification

1 Resident flora grow on skin amp relatively

stable in no and composition at particular sites

2 Transient flora lie on skin surface without attachment unable to multiply amp

disappear within short time

3 Transient or temporary residents

7102008

5

Normal Skin Flora

Major bacterial groups

Coryneforms (Gram +ve pleomorphic rods)

Corynebacterium (Aerobic amp

lipophilic)

Brevibacterium (Aerobic amp non-

lipophilic)

Propinobacterium (Anaerobic)Contdhellip

7102008

6

Staphylococci (Gram +ve cocci aerobs)

S epidermidis S hominis Shemolyticus

Ssaprophyticus

Minor bacterial groups Acinetobacter (25) Micrococci

Fungal group Pityriasporum

7102008

7

Bacterial infection of the skin (Pyoderma)

Classification of pyodermas1 Primary

Impetigo Ecthyma Folliculitis

Superficial Deep

Folliculitis of leg Furuncle Carbuncle Sycosis Barbae

7102008

8

Cellulitis Erysipelas Pyonychia SSSS TSS

2 SecondarySecondary infection of preexisting dermatoses

eg Atopic dermatitis Scabies

7102008

9

Impetigo (contagious superficial infection)

Non-bullous Bullous1 Cause

- Streptococcal (Group A) Staph aureus- Staph aureus (Phage Groups II)

2 Pre-school and young school age All ages3 Very thin walled vesicle on an erythematus Bullae of

base 1-2cm4 Transient Persist for 2-3

day5 Yellowish-brownish crusts (thick) Thin flat

brownish crust Contdhellip

7102008

10

6 Irregular peripheral extension without Central healing with healing peripheral extension

7 Regional adenitis Rare

8 Constitutional symptoms present Absent

9 Face (around the nose mouth amp limbs) occur anywhere

10 Palms amp sole spared May involved

11MM very rare May involved

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

4

Normal flora of skin

Classification

1 Resident flora grow on skin amp relatively

stable in no and composition at particular sites

2 Transient flora lie on skin surface without attachment unable to multiply amp

disappear within short time

3 Transient or temporary residents

7102008

5

Normal Skin Flora

Major bacterial groups

Coryneforms (Gram +ve pleomorphic rods)

Corynebacterium (Aerobic amp

lipophilic)

Brevibacterium (Aerobic amp non-

lipophilic)

Propinobacterium (Anaerobic)Contdhellip

7102008

6

Staphylococci (Gram +ve cocci aerobs)

S epidermidis S hominis Shemolyticus

Ssaprophyticus

Minor bacterial groups Acinetobacter (25) Micrococci

Fungal group Pityriasporum

7102008

7

Bacterial infection of the skin (Pyoderma)

Classification of pyodermas1 Primary

Impetigo Ecthyma Folliculitis

Superficial Deep

Folliculitis of leg Furuncle Carbuncle Sycosis Barbae

7102008

8

Cellulitis Erysipelas Pyonychia SSSS TSS

2 SecondarySecondary infection of preexisting dermatoses

eg Atopic dermatitis Scabies

7102008

9

Impetigo (contagious superficial infection)

Non-bullous Bullous1 Cause

- Streptococcal (Group A) Staph aureus- Staph aureus (Phage Groups II)

2 Pre-school and young school age All ages3 Very thin walled vesicle on an erythematus Bullae of

base 1-2cm4 Transient Persist for 2-3

day5 Yellowish-brownish crusts (thick) Thin flat

brownish crust Contdhellip

7102008

10

6 Irregular peripheral extension without Central healing with healing peripheral extension

7 Regional adenitis Rare

8 Constitutional symptoms present Absent

9 Face (around the nose mouth amp limbs) occur anywhere

10 Palms amp sole spared May involved

11MM very rare May involved

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

5

Normal Skin Flora

Major bacterial groups

Coryneforms (Gram +ve pleomorphic rods)

Corynebacterium (Aerobic amp

lipophilic)

Brevibacterium (Aerobic amp non-

lipophilic)

Propinobacterium (Anaerobic)Contdhellip

7102008

6

Staphylococci (Gram +ve cocci aerobs)

S epidermidis S hominis Shemolyticus

Ssaprophyticus

Minor bacterial groups Acinetobacter (25) Micrococci

Fungal group Pityriasporum

7102008

7

Bacterial infection of the skin (Pyoderma)

Classification of pyodermas1 Primary

Impetigo Ecthyma Folliculitis

Superficial Deep

Folliculitis of leg Furuncle Carbuncle Sycosis Barbae

7102008

8

Cellulitis Erysipelas Pyonychia SSSS TSS

2 SecondarySecondary infection of preexisting dermatoses

eg Atopic dermatitis Scabies

7102008

9

Impetigo (contagious superficial infection)

Non-bullous Bullous1 Cause

- Streptococcal (Group A) Staph aureus- Staph aureus (Phage Groups II)

2 Pre-school and young school age All ages3 Very thin walled vesicle on an erythematus Bullae of

base 1-2cm4 Transient Persist for 2-3

day5 Yellowish-brownish crusts (thick) Thin flat

brownish crust Contdhellip

7102008

10

6 Irregular peripheral extension without Central healing with healing peripheral extension

7 Regional adenitis Rare

8 Constitutional symptoms present Absent

9 Face (around the nose mouth amp limbs) occur anywhere

10 Palms amp sole spared May involved

11MM very rare May involved

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

6

Staphylococci (Gram +ve cocci aerobs)

S epidermidis S hominis Shemolyticus

Ssaprophyticus

Minor bacterial groups Acinetobacter (25) Micrococci

Fungal group Pityriasporum

7102008

7

Bacterial infection of the skin (Pyoderma)

Classification of pyodermas1 Primary

Impetigo Ecthyma Folliculitis

Superficial Deep

Folliculitis of leg Furuncle Carbuncle Sycosis Barbae

7102008

8

Cellulitis Erysipelas Pyonychia SSSS TSS

2 SecondarySecondary infection of preexisting dermatoses

eg Atopic dermatitis Scabies

7102008

9

Impetigo (contagious superficial infection)

Non-bullous Bullous1 Cause

- Streptococcal (Group A) Staph aureus- Staph aureus (Phage Groups II)

2 Pre-school and young school age All ages3 Very thin walled vesicle on an erythematus Bullae of

base 1-2cm4 Transient Persist for 2-3

day5 Yellowish-brownish crusts (thick) Thin flat

brownish crust Contdhellip

7102008

10

6 Irregular peripheral extension without Central healing with healing peripheral extension

7 Regional adenitis Rare

8 Constitutional symptoms present Absent

9 Face (around the nose mouth amp limbs) occur anywhere

10 Palms amp sole spared May involved

11MM very rare May involved

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

7

Bacterial infection of the skin (Pyoderma)

Classification of pyodermas1 Primary

Impetigo Ecthyma Folliculitis

Superficial Deep

Folliculitis of leg Furuncle Carbuncle Sycosis Barbae

7102008

8

Cellulitis Erysipelas Pyonychia SSSS TSS

2 SecondarySecondary infection of preexisting dermatoses

eg Atopic dermatitis Scabies

7102008

9

Impetigo (contagious superficial infection)

Non-bullous Bullous1 Cause

- Streptococcal (Group A) Staph aureus- Staph aureus (Phage Groups II)

2 Pre-school and young school age All ages3 Very thin walled vesicle on an erythematus Bullae of

base 1-2cm4 Transient Persist for 2-3

day5 Yellowish-brownish crusts (thick) Thin flat

brownish crust Contdhellip

7102008

10

6 Irregular peripheral extension without Central healing with healing peripheral extension

7 Regional adenitis Rare

8 Constitutional symptoms present Absent

9 Face (around the nose mouth amp limbs) occur anywhere

10 Palms amp sole spared May involved

11MM very rare May involved

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

8

Cellulitis Erysipelas Pyonychia SSSS TSS

2 SecondarySecondary infection of preexisting dermatoses

eg Atopic dermatitis Scabies

7102008

9

Impetigo (contagious superficial infection)

Non-bullous Bullous1 Cause

- Streptococcal (Group A) Staph aureus- Staph aureus (Phage Groups II)

2 Pre-school and young school age All ages3 Very thin walled vesicle on an erythematus Bullae of

base 1-2cm4 Transient Persist for 2-3

day5 Yellowish-brownish crusts (thick) Thin flat

brownish crust Contdhellip

7102008

10

6 Irregular peripheral extension without Central healing with healing peripheral extension

7 Regional adenitis Rare

8 Constitutional symptoms present Absent

9 Face (around the nose mouth amp limbs) occur anywhere

10 Palms amp sole spared May involved

11MM very rare May involved

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

9

Impetigo (contagious superficial infection)

Non-bullous Bullous1 Cause

- Streptococcal (Group A) Staph aureus- Staph aureus (Phage Groups II)

2 Pre-school and young school age All ages3 Very thin walled vesicle on an erythematus Bullae of

base 1-2cm4 Transient Persist for 2-3

day5 Yellowish-brownish crusts (thick) Thin flat

brownish crust Contdhellip

7102008

10

6 Irregular peripheral extension without Central healing with healing peripheral extension

7 Regional adenitis Rare

8 Constitutional symptoms present Absent

9 Face (around the nose mouth amp limbs) occur anywhere

10 Palms amp sole spared May involved

11MM very rare May involved

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

10

6 Irregular peripheral extension without Central healing with healing peripheral extension

7 Regional adenitis Rare

8 Constitutional symptoms present Absent

9 Face (around the nose mouth amp limbs) occur anywhere

10 Palms amp sole spared May involved

11MM very rare May involved

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

11

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

12

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

13

Malnutrition Diabetes Immuno-compromise status

Complications

PSGN (strep M-type 49) Scarlet fever Urticaria Erythema mutiforme

Predisposing factors

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

14

Ecthyma

Streptococcal amp staph

Common in children

Small bullae or pustules on erythematous base

Formation of adherent dry crusts

Beneath which ulcer present

Indurated base Heals with scar and pigmentation

Buttocks thighs and legs commonly affected

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

15

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

16

Folliculitis

Superficial folliculitis

Infection of hair follicles

Commonly caused by staph aureus

Children

Scalp amp limb

Rarely painful

Heals in a week

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

17

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

18

Deep Folliculitis

Deep folliculitis of leg

Chronic

Staph aureus

Hair follicles of leg

Multiple

Atrophic scar

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

19

Furuncle (Boil)

Acute

Staph aureus

Small follicular noduler -- Pustule--

necrotic--discharge pus

Painful

Constitutional symptoms

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

20

Heals with scar

Age Adult

Site Neck Wrist Waist Buttocks Face

Complication Cavernous Sinus thrombosis (upper lip amp check)

Septicemia (malnutrition)

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

21

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

22

Carbuncle

Extensive infection of a group of contagious

follicles

Staph aureus

Middle or old age

Predisposing factors Diabetes

Malnutrition

Severe generalized dermatoses

During prolonged steroid therapy

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

23

Painful hard lump

Suppuration begins after 5-7 days

Pus discharge from multiple follicular orificies

Necrosis of intervening skin

Large deep ulcer

Constitutional symptoms

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

24

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

25

Sycosis barbae

Beard region

Pustules surrounded by erythema

Males

After puberty

After trauma

Upper lip and chin

Staph aureus

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

26

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

27

Cellulitis

Inflammation of loose connective tissue

Streptococcal (Group A)

Acutesub-acutechronic

Erythematous edematous swelling

Paintenderness

Constitutional upset

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

28

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

29

Pyonychia

Acute

Erythematous swelling of proximal and lateral

nail fold

Painful

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

30

Staphylococcal scalded skin synotrane (Ritterrsquos Disease)

Exotoxin of staph (Phage Group II)

Acantholysis

Occult staph upper respiratory tract infection or

purulent conjunctivitis

Infants and children

Tender red skin

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

31

Contdhellip

Denuded skin

Heals 7 - 14 day

Donrsquot grow staph from blister fluid

Complication 2

Cellulitis

Pneumonia

Prognosis Rule

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

32

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

33

Principles of therapy of pyoderma

Good personal hygiene Management of predisposing factors

Local Attend to traumas Pressure Sweating Bites Treat pre-existing dermatosis Investigate carrier sites Nose Axilla

Perineum

SystemicTreatment of disease like DM Nutritional deficiency Immunodeficiency

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

34

Principles of therapy of pyoderma

Local therapy

Cleaning with soap-water and weak

KMN04 solution

Removal of crusts with KMN04 soluation

Application of antibacterial cream

Systemic therapy

Antibiotics

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

35

Recurrent staphylococcal infection

Persistent nasal carriage

Abnormal neutrophitic chumotaxis

Deficient intracellular killing

Immunodeficient status

DM

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

36

Tt of staph carriage elimination

Nasal amp perineal care

Rifampicin 600 mgd 7-10 days

Clindamycin 150 mgd 3 months

Topical mupirocin

Replacement of microflora with a less

pathogenic stains of S aureus (strain 502)

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

37

S aureus produces skin infection

I Direct infection of skin and adjuscent tissuesa Impetigob Ecthymac Folliculitisd Furunculosise Carbunclef Sycosis

II Secondary infectionEczema infection

IIICutaneous disease due to effect of bacterial toxina Staphylococcal scalded skin syndromeb Toxic shock syndrome

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

38

szlig-hemolytic streptococcus produces skin infection

I Direct infection of skin or subcutaneousa Impetigo (non bullous)

b Ecthyma

c Erysipelas

d Cellulitis

e Vulvovaginitis

f Blistering distal dactylitis

g Necrotizing fascitis

II Secondary infectionEczema infection

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

39

III Tissue damage from circulating toxin

Scarlet fever

IV Skin lesion attributed to allergic

hypersensitivity to streptococcal antigens

E Nodosum

Vasculitis

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

40

V Skin disease provocated or influenced by

streptococcal infection (mechanism uncertain)

Guttate psoriasis

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

41

Consider the following in relation to bacterial infection of skin

bulla Cellulitis is the inflammation of subcutaneous tissue as well as dermis caused by Streptococcus

bullb Bullous impetigo is caused by streptococci

bullc In erysipelas inflammation is limited to dermis and upper part of subcutaneous tissue

bulld Furunculosis is caused by Streptococcus

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

42

Learning objectives of bacterial infections of skin

middot 1 Define Pyoderma and classify itmiddot 2 List the normal flora of skinmiddot 3 Define impetigo List the differentiating

features of bullous and non-bullous impetigo 4 Describe the CF investigations of

impetigo Outline the management of impetigo

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

43

Learning objectives of bacterial infections of skin

middot 1 Define folliculitis classify it and describe the management of it2 Describe the CF investigations and

management of ecthyma cellulites erysipelas furuncle carbuncle SSSS

3 List the skin infection produced by B- hemolytic streptococci

middot 4 List the skin infection produced by staphylococci

7102008

44

Thank you

7102008

44

Thank you