Bacteria skin infections Flashcards by Iseoluwa Ojo

Functions of the skin

Prevents excessive ______
Important to _____ regulation
Involved in _____ phenomena
Barrier against __________

water loss

temperature

sensory

microbial invaders

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Wounds allow microbes to infect deeper tissues

T/F

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The skin has normal flora just like any other part of the body

T/F

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The skin’s flora is composed of _______,________, and ________ bacteria etc

aerobic cocci, aerobic and anaerobic coryneform

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Major function of skin flora is to ___________ by Providing __________ for pathogenic microorganism

By hydrolizing ______ of _____ to produce _________ which are toxic to many bacteria

prevent skin infections

ecological competition

lipids of sebum

free fatty acids

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Microbiota

____tolerant
Dense populations in skin _____
Total numbers determined by ________ and _________
May be opportunistic pathogens

Halo

folds

location and moisture content

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The ecology of particular areas of the skin is determined by the availability of moisture, presence of sebaceous lipids, and gaseous environment

T/F

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Skin

The process of infection involves the interaction between two organisms-the host and the invader

The clinical changes depends on the organisms, its virulence, and patient’s immunity

T/F

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INTRODUCTION

(Acute or Chronic?) bacteria infections generally produce some or all of the classical features of acute inflammation

These cardinal signs includes;
________,_________,__________,_________

Acute

erythema(redness), swelling/oedema, heat/warmth, pain/discomfort

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Most skin flora categorized in three groups:

————
__________
___________

Diphtheroids
Staphylococci
Yeasts

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Most skin flora categorized in three groups:

Diphtheroids (_________ and ________)
Staphylococci (Staphylococcus _____)
Yeasts (______ and _______)

Corynebacterium and Propionibacterium

epidermidis

Candida and Malassezia

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Bacteria skin infections are very (common or rare?)

Common

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____,__________, and ________ are the most common bacteria skin infections
Carbuncles,

Cellulitis, impetigo and folliculitis

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Impetigo: infection of _______Layer of epidermis

Ecthyma: infection of ____________ Of epidermis

Erysipelas: infection of _________

sub corneal

full thickness

upper half dermis

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Cellulitis : infection of the ________

Necrotizing factors: infection of ______ and ______

lower half of dermis

subcutaneous fat and deep fascia

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FOLLICULITIS

Introduction- folliculitis is infection of the ________.

Classification is by the _______of the hair
follicles which could be ______ or ______ folliculitis.

hair follicles

depth of involvement

superficial or deep

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FOLLICULITIS

Hair follicle can become inflamed by ______ injury, _______ or infection that leads to folliculitis.

physical; chemical irritation

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A furuncle develops when the ________ and ____________ are involved.

entire follicle

surrounding tissues

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Folliculitis: Causative Agent
Most commonly caused by ______
_____ tolerant
Tolerant of _______

Staphylococcus

Salt

desiccation

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Signs and symptoms of folliculitis

Infection of the hair follicle often called a _________

Called a _____ when it occurs at the eyelid base

Spread of the infection can produce _________ or ________

pimple

sty

furuncles or carbuncles

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Epidemiology and pathogenesis Of skin infections

The most common form is ______________

It could be multiple or single lesion and can appear on any ———————including head, neck, trunk,buttocks and extremities

superficial folliculitis

skin bearing hair

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Epidemiology and pathogenesis Of skin infections

commensal organisms like ____ can be seen in immunocompromised.

Occasionally, gram negative folliculitis can be seen in ________ patients treated with (short or long?) courses of antibiotics.

yeast

acne vulgaris

Long

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Epidemiology and Pathogenesis Of skin infections

The use of hot tubs and whirl pools has been classically associated with __________.

Patients with _________ are at increased risk because of higher rate of colonization with S. aureus.

______,________, or _________hair, use of topical _______, hot and humid weather, and diabetes mellitus are all predisposing factors
.

Pseudomonas folliculitis

atopic dermatitis

Shaving, plucking or waxing

corticosteroids

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Clinical features of bacterial skin infections

A (shallow or deep?? folliculitis appears as (small or large?) , tender, erythematous _____, often with a _______.

The lesions may be ________ and slighly tender. The lesions are ______ and may scar.

Deep ; large

papules; central pustule.

pruritic; painful

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Diagnosis and Differential diagnosis The diagnosis of bacterial folliculitis is usually based on ______ Gram stain and bacterial cultures can help to identify the causative organisms, especially in recurrent or treatment-resistant cases. The differential diagnosis includes other forms of folliculitis as well as ___________,__________,____________ and _________

clinical inspection. acne vulgaris, rosacea, ,pseudofolliculitis barbae , and keratosis pilaris

TREATMENT of skin infections antibacterial washes that contain _______ or _______ Antibacterial ointments (_______ or __________ 2%)

chlorhexidine or triclosan. bacitracin or mupirocin

Treatment of skin infections appropriate oral b-lactamase inhibitor antibiotics, _______ and ________ (e.g clindamycin), _______ can be used for serious cases.

macrolides and lincosamides flouroquinolones

PSEUDOMONAL FOLLICULITIS Pseudomonal folliculitis is associated with the use of _________,_______ and, rarely, ____________.

whirlpools, hot tubs swimming pools

PSEUDOMONAL FOLLICULITIS P.________ gains entry via ________ or _____ in the skin. The lesions arise _____ after exposure and resolve in ________

aeruginosa hair follicles; breaks 8–48 hours 7–14 days.

Clinical features of Pseudomonal folliculitis Associated symptoms do not imply __________ of P. aeruginosa These symptoms includes ; __________,_______,_________

systemic spread painful eyes, malaise, fever

Diagnosis of Pseudomonal folliculitis The diagnosis can be confirmed by isolation of P. aeruginosa, especially serotype ______, from lesions. The differential diagnosis includes _____________ folliculitis, insect bites, ________,___________, ________ folliculitis, miliaria and acne vulgaris.

O-11 S. aureus papular urticaria, Majocchi’s granuloma eosinophilic

TREATMENT Treatment is generally not indicated in immunocompetent hosts as it is usually a self-limited process. Lesions usually resolves spontaneously within seven to ten days In the case of widespread eruptions, recurrences, immunosuppression or associated systemic symptoms, an oral fluoroquinolone and topical gentamicin can be used.

PREVENTION of Pseudomonal folliculitis Personal hygiene and maintenance of _____ and _______ Hand hygiene Avoid sharing of _______

pools and tubs towels

Furuncles and Carbuncles A furuncle is a ______,_________ , firm or fluctuant mass of _______ ———- material arising from the _________. It is commonly known as ______ or ________

tender, erythematous walled-off ; purulent hair follicles boil or abscess.

Furuncles and Carbuncles Carbuncles are an aggregate of ____________________ that form (broad or narrow?) (flat or swollen?) , erythematous, (shallow or deep?) and (painful or painless?) masses that usually open and drain through ________.

infected hair follicles Broad; swollen; deep; painful multiple tracts

Furuncles extended ______,_______, _______ and tenderness Carbuncles Numerous sites of _________, Usually in areas of ________ skin

redness, pus, swelling draining pus; thicker

EPIDEMIOLOGY AND PATHOGENESIS Furuncles tend to occur in _______ and __________ ________ is the most common causative organism, though recurrent furuncles in the _________ region can be secondary to (aerobic or anaerobic?) bacteria.

adolescents and young adults. S. aureus ; anogenital region anaerobic

Five percent of cutaneous abscesses are ______, caused by a _________ reaction (e.g. _______________)

sterile foreign body ruptured cyst

Furuncles Predisposing factors include (acute or chronic?) _______ carriage, Diabetes mellitus, obesity, poor hygiene, Immunodeficiency states, such as in chronic granulomatous disease and ____ syndrome.

Chronic S. aureus Job

Furuncles The most common locations are the ___,______,______ ,______,_______ and perineum. Sites prone to ______ or _____ , such as the area ______, are distinctly susceptible.

face, neck, axillae, buttocks, thighs friction or minor trauma under a belt

Furuncles usually begin as a _____,_____, red nodule that ______ and becomes ______ and _________; _______ results in decreased pain.

hard, tender enlarges painful and fluctuant rupture

Furuncles Epidemiology: endogenous Two species commonly found on the skin – ________ ———— – _______ ———— Transmitted through _________ or _______

Staphylococcus epidermidis Staphylococcus aureus direct or indirect contact

Treatment of furuncles ________ (semi-synthetic penicillin) ______ or _______ used to treat resistant strains May require —————- – Prevention of furuncles Hand _______ Proper ——————- and surgical openings, aseptic use of catheters or indwelling needles, and appropriate use of antiseptics

Dicloxacillin Vancomycin or Bactrim surgical draining antisepsis; cleansing of wounds

Scalded Skin Syndrome __________ scalded skin syndrome (SSSS) Bacterial agent is __________ ——— mediated disease

Staphylococcal Staphylococcus aureus Toxin

Signs & Symptoms of SSSS •Skin appears ———- (______) –Other symptoms include malaise, irritability, fever; nose, mouth and genitalia may be _______

burned; scalded painful

SSSS __________ toxin released at infection site causes ——- in epidermis – (Inner or Outer?) layer of skin is lost -Causes ____ loss and increase susceptibility to __________

Exfolative split Outer body fluid; secondary infection

Epidemiology of SSSS –___% of S. aureus strains produce _______ – Disease can appear at any age group •Most frequently seen in ______,_______ and immunocompromised – Transmission is generally _________

5; exfoliatins infants, the elderly person-to-person

Impetigo (________) Characterized by ____ production

Pyoderma pus

Impetigo Causative agents: – _________ ______ – 80% cases caused by ________ – Others caused by _______ _______

Pyodermic cocci S. aureus Streptococcus pyogenes

Impetigo – Others caused by Streptococcus pyogenes Group ___ Streptococcus – Gram- ______ coccus, arranged in _____, __ -hemolytic

A; positive chains; β

Signs & Symptoms of impetigo •(Superficial or deep?) skin infection •Blisters just below ________ layer •Blisters replaced by _________ •There is little ______ or _____ •Lymph nodes enlarge near area •May result in _______

Superficial ; outer skin layer weepy yellow crust fever or pain erysipelas

Epidemiology of impetigo – most prevalent among (children or adult?) Most affected are ______ years of age – Disease primarily spread from __________ Also spread by ————-

Children two to six person-to-person insects and fomites

Prevention and treatment of impetigo – Prevention is directed at ________ and ________ of individuals with impetigo – ________ treatment of wounds and application of ________ can lessen chance of infection – Active cases are treated with ________, ________ or ________

cleanliness and avoidance Prompt ;antiseptics penicillin, erythromycin or vancomycin

Acne _______-associated lesion Causative agent Most serious cases caused by __________ ———— – Epidemiology: ____genous

Follicle Propionibacterium acnes endogenous

Acne Propionibacterium acnes – Gram- _______, ______-shaped ______ feed on ______ and ______ in ______ pores & ______

positive; rod diphtheroids sebum ; keratin plugged ; follicles

Prevention of Acnes remove ______ as often as possible

oils

Treatment of impetigo •prophylactic _________ •_________ or _________ acid •New treatment uses _________ ________ •_________ in severe cases

tetracycline Benzoly peroxide ; salicylic acid blue light radiation Accutane

ERYSIPELAS Erysipelas is primarily an infection of the _______ with significant _______ involvement. It has a distinctive clinical presentation and is most often caused by ________ _______ (group ___ streptococci).

dermis , lymphatic involvement. Str. pyogenes (group A streptococci).

Pathogenesis and Epidemiology of Erysipelas Erysipelas is a disease of the very ________ , the ________, the ________, and those with ________ or _______ ——- ulcers.

young, the aged, the debilitated, and those with lymphedema or chronic cutaneous ulcers.

Pathogenesis and Epidemiology of Erysipelas (Women or Men?) outnumber (women or men?) , except for very (young or old?) patients, where (boys or girls?) are more commonly affected. There is ____eased frequency during the warmer/hot months and most cases are isolated.

Women Men; young Boys incr

Most cases of erysipelas are caused by infection with group ____ streptococci and less often by group _____________ S. aureus, Pneumococcus species, Klebsiella pneumoniae, Yersinia enterocolitica, and Haemophilus influenzae type b have been known to cause an erysipelas-like infection

A G, B, C or D.

Clinical Features of erysipelas The classic lesion of erysipelas, with its well-defined margins, involves the _________ . Nowadays, however, the _________ is the most common location. After an incubation period of _________, there is an abrupt onset of fever, chills, malaise and nausea. A few hours to a day later, a (small or large?) plaque of _________ develops that progressively spreads

face ; lower extremity 2 to 5 days a small plaque of erythema

Clinical Features of erysipelas The area is clearly demarcated from uninvolved tissue, hot, tense and indurated with _____________. The affected area is painful to ________ and maybe ________ to touch . Regional ________ is normally present. ________, ________, ________ and small areas of ________ may also form.

non-pitting edema. palpation ; warm lymphadenopathy . Pustules, vesicles, bullae and small areas of hemorrhagic necrosis .

Complications of erysipelas are (common or rare?) and usually occur in patients with ____________. When the infection resolves, _______ and postinflammatory _______ changes may occur.

rare ; underlying disease. desquamation pigmentary

Diagnosis and Differential diagnosis of erysipelas Diagnosis is based primarily on ________ Routine laboratory evaluation will show an elevated _________with a (left or right?) shift. Blood cultures are positive in only about __% of cases. _____ from local ports of entry, pustules or bullae, the _____, and the _____ are helpful.

clinical findings.; leukocyte count Left ; 5; Swabs Throat, nares

Diagnosis and Differential diagnosis of erysipelas Culture of _______ biopsy specimens and the injection-_______ method yield poor results, especially in immunocompetent host . Anti- _______ and ______ titers are good indicators of streptococcal infections. Direct ________ and —————- tests can be used to detect streptococci within skin specimens.

skin ; re- aspiration DNase B and ASO immunofluorescence and latex agglutination

Differential Diagnosis of erysipelas ________ and other soft tissue infections (e.g. ________, ________ ________) as well as inflammatory causes of ‘_______________’ (e.g. ________ syndrome, contact ________)

cellulitis erysipeloid, necrotizing fasciitis. ‘pseudocellulitis’ . Sweet’s syndrome dermatitis

Treatment of erysipelas A 10–14-day course of _______ is the treatment of choice for erysipelas caused by _______. Although macrolides such as _______ may be used in _______ patients, there has been an increase in ________ among certain strains of Str. pyogenes. Hospital admission and intravenous or intramuscular antibiotics should be reserved for _______ and ________ patients.

penicillin ; streptococci. erythromycin ; penicillin-allergic macrolide resistance children and debilitated patients.

cellulitis Cellulitis is an infection of the (superficial or deep?) dermis and ______ caused most commonly by _______ and ______

Deep dermis subcutaneous tissue Str. pyogenes and S. aureus

Epidemiology and Pathogenesis Cellulitis in immunocompetent adults is most often caused by ________ or ________. The majority of cellulitis in childhood is caused by ________, and less commonly by ________ . A mixture of Gram-________ cocci and Gram-________ aerobes and anaerobes is associated with cellulitis surrounding ________ and ____________

Str. pyogenes or S. aureus. S. aureus ; H. influenzae positive ;negative diabetic ulcers and decubitus ulcers.

pathogenesis of cellulitis Bacteria may gain access to the ________ via an ________ or a ________ route. Usually, in immunocompetent patients, a _____________________ is responsible

dermis ; external ; hematogenous a break in the skin barrier

Cellulitis In immunocompromised patients, a __________ route is most common. Recurrent bouts of cellulitis may be caused by damage to the __________ system (e.g. previous __________________, __________ harvest or prior episode of _______________)

blood borne route lymphatic system lymph node dissection saphenous vein harvest of acute cellulitis

Lymphedema, alcoholism, diabetes mellitus, intravenous drug abuse, and peripheral vascular disease all predispose to cellulitis. T/F

Clinical features of cellulitis Cellulitis is often preceded by systemic symptoms, such as fever, chills and malaise. rubor (erythema), calor (warmth), dolor (pain), and tumor (swelling). The lesion usually has (ill or well?)-defined, (palpable or non-palpable?) borders. In severe infections, vesicles, bullae, pustules or necrotic tissue may be present.

Ill Non-palpable

Clinical features of cellulitis Ascending ______ and ________ lymph node involvement may occur. Children usually have cellulitis of the _______ and ______ region, whereas in adults the _________ are most often affected

lymphangitis regional head and neck extremities

Clinical features of cellulitis In intravenous drug abusers, the ___________ are often involved. Complications are (common or rare?) , but include ___________ (if caused by a ___________ strain of streptococci), ___________ and ___________ bacterial ___________. Damage to ___________ can lead to recurrent cellulitis.

upper extremities ; rare acute glomerulonephritis ; nephritogenic lymphadenitis ; bacterial endocarditis. lymphatic vessels

Diagnosis and differential diagnosis of cellulitis The diagnosis of cellulitis is usually ________ . The leukocyte count is usually ________ or ________ Blood cultures are almost always ________ in immunocompetent hosts. An important exception is ________ cellulitis, where there is usually ________ leukocyte count with a (left or right ?) shift and ________ blood cultures. In children and immunocompromised patients, atypical organisms are more common, and ________ and ________ may be appropriate

clinical ; normal only slightly elevated ; negative H. influenzae ; an increased left ; positive needle aspiration and skin biopsy

differential diagnosis of cellulitis The differential diagnosis of lower extremity cellulitis includes _________________ and other inflammatory diseases, such as _________________, _________________, and _________________ (especially _________________).

deep vein thrombosis stasis dermatitis superficial thrombophlebitis panniculitis lipodermatosclerosis

Treatment of cellulitis In most cases of cellulitis, treatment should be targeted against _________ and _________. Mild cases require a ___- day course of an _________ that has good Gram- _________ coverage. Hospitalization and parenteral antibiotics should be reserved for patients who are seriously ill and those who have _________ cellulitis.

Str. pyogenes and S. aureus 10- ; oral antibiotic Gram- positive facial cellulitis.

Treatment of cellulitis _________ or _______ ulcers complicated by cellulitis require ____________ coverage (e.g. piperacillin/tazobactam or, in penicillin-allergic patients, metronidazole plus ciprofloxacin).

Diabetic or decubitus ulcers broad-spectrum coverage

Impetigo Impetigo is a (common or rare?) , (mildly or highly?) contagious, (superficial or deep?) skin infection that primarily affects (children or adults?).

common highly superficial children.

Impetigo The condition presents in both ________ and _________ forms . The primary pathogens in these forms of impetigo are _________ and, less commonly, _________ (_________).

both non-bullous and bullous forms . Staphylococcus aureus group A b-hemolytic Streptococcus (Streptococcus pyogenes).

Worldwide, ________ is the most common bacterial skin infection in children.

impetigo

Predisposing factors to impetigo include ______ temperature, ——- humidity, ____ hygiene, an ________ and skin ______.

warm high Poor Atopic diathesis trauma

Nasal, axillary, pharyngeal and/or perineal S. aureus colonization imparts an increased risk for developing impetigo T/F

Pathogenesis Non-bullous impetigo Non-bullous impetigo (or ______ impetigo) is usually caused by ______ and, on occasion, ______. Infection occurs at (minor or major?) sites of trauma (e.g. chickenpox, insect bite, abrasion, laceration, burn). Trauma exposes ______ proteins which allow the bacteria to ______, ______ and establish infection

crusted ; S. aureus Str. pyogenes. minor cutaneous adhere, invade and establish infection

Pathogenesis: Bullous impetigo The etiologic agent of bullous impetigo, _________ , elaborates several exfoliative toxins and bullous impetigo is considered a (localized or generalized?) form of staphylococcal _________ syndrome . In both diseases, _________ formation is mediated by _________ binding to the _________ protein , _________ and cleaving its extracellular domain, thus leading to _________ within the _________ _________ layer.

S. aureus; exfoliative toxins localized ; scalded skin syndrome . blister ;exfoliative toxin desmosomal ; desmoglein 1 acantholysis ; epidermal granular layer.

Bullous Impetigo In contrast to non-bullous impetigo, lesions can occur on _______ . Although the differential diagnosis for non-bullous and bullous impetigo is extensive, the history , physical examination and ———- tests can often establish the diagnosis.

intact skin ancillary

TREATMENT of impetigo Primary treatment involves _______ care, including cleansing , removal of _______, and application of _______. For healthy patients with a few, isolated superficial lesions and no systemic symptoms , either _______ 2% _______ or _______ cream or ointment can be prescribed. For patients with limited disease, there is evidence that these _______ medications are at least equally (if not more) effective than _______

Local wound ; crusts wet dressings. mupirocin ; ointment fusidic acid ; topical medications oral antibiotics

Majority of bacterial skin infection are caused by ______________________ species.

Staphylococcus and Streptococcus

Antibiotics are used _______ with consideration for _______ pattern Gram negative coverage is indicated in ________ under ____years and patient with _________ or immunocompromised

emperically resistance children; 3yrs diabetes

Bacteria skin infections Flashcards

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