BACTERIAL SKIN INFECTIONS

Most

common bacterial skin infection of childhood

Highly

contagious
by Staph aureus or Strep

Caused

STAPH
Staphylococcus aureus, often referred to simply as staph, are bacteria commonly carried on the skin or in the nose of healthy people.

 Transmission:

Direct contact with lesions or with nasal carriers.And articles contaminated like towel, toys, clothing, or household items. Incubation period: 1-3 days ( 1-10 days) Dried streptococci in the air are not infectious to intact skin. Scratching may spread the lesions.

Impetigo: 1- Non-bullous impetigo (Impetigo contagiosa ) Painless, fluid filled blisters- usually red and itchy but not sore.

Staph aureus

A large, single bulla with surrounding erythema and edema on the thumb of a child; the bulla has ruptured only in the center and clear serum exudes from it.

 B-

Ecthyma Is a more serious form of impetigo in which the infection penetrates deeper into the skins second layer, the dermis.

 Painful,

fluid-filled sores that turn into deep ulcers, usually on the legs and feet. A hard thick , gray- yellow crust covering the sores. Swollen lymph glands in the affected area Little holes the size of pinheads to the size of pennies appear after crust recedes Scars that remain after the ulcers heal

 Complications:

Generally rare and it includes: 1. Spread of infection to other organ as bone (Osteomylitis, joint (septic arthritis) or lung (pneumonia) 2. Acute glomerulnephritis The prognosis is usually good. 3. Rheumatic Fever is very rarely reported 4. Henoch Schoenlein purpura: [acute allergic vasculitis. 5. Staphylococcal Scalded Skin Syndrome (4S syndrome):

Isolate the infected child. Remove the crust . Washing with soap and water and letting the impetigo dry in the air. An application of the antiseptic gentian violet. (old) Topical antibiotic as Mupirocin, Bacitracin, Retambulin other agents used topically are tetracycline; gentamycin; soframycin; fusidic acid (act on staph inf.)

More severe cases require oral antibiotics such as dicloxacillin, flucloxacillin or erythromycin. Alternatively amoxicillin combined with clavulanate potassium, cephalosporins(1st generation) and many others may also be used as an antibiotic treatment. 4. Systemic Antibioticss are used if - Patient has fever; lymphadenopathy. Wide spread infection. Resistant to topical drugs; Immunosuppressive diseases.

 Gently

wash lesions 3 times a day with warm, soapy washcloth, crusts carefully removed topical antibiotic as ordered oral antibiotics as ordered

Apply

Administer Severe

infections may need to be treated with IV antibiotics

 Child

can spread impetigo by touching another part of the skin after scratching infected areas
the childs hands frequently with antibacterial soap

Wash

Distract

child from touching lesions

Good hand washing to prevent spread Cut childs nails short, wash hands often with antibacterial soap Do not share towels, utensils with infected child May return to school or daycare 24 hours after antibiotics started

Finish full course of antibiotics (usually 10 days) When a person has impetigo, it is common for them to get it a second time in the space of 6-9 months. This usually occurs in people aged 12-16.

Acute

contagious disease caused by the D. bacillus characterized by a generalized systemic toxaemia emanating from localized inflammatory focus. Diptheria usually affects the tonsils, pharynx, larynx and occasionally the skin.

Or KLEBS-LOEFFLER BACILLUS Aerobic gram-positive bacillus Incidence increased in autumn and winter
INCUBATION PERIOD: 1-7 DAYS; AVE. 2-4 days TRANSMISSION: Droplet (respiratory) or skin transmission, which later develops into tissue necrosis, which is mediated by its toxin.

 Range

from a moderate sore throat to toxic life threatening diptheria of the larynx or of the lower and upper respiratory tracts.

I.

II.

Nasal presence of serosanguinous discharge ( coryza, with increasing viscosity, possibly epistaxis, low grade fever, whitish gray membrane may appear over nasal septum Faucial or Pharyngeal- appearance of a thin film of fibrin which rapidly increases in thickness to form a pseudomembrane which bleeds easily upon removal. The lesion is not usually confine to the tonsil areas but tends to spread over the soft palate and uvula.

 Breath

is fetid. general malaise, low grade fever, anorexia 1-2 days later; whitish gray membranous patch on tonsils, soft palate, and uvula. Lymph node swelling, fever, rapid pulse (bull neck)

III. Laryngeal- hoarseness with noisy breathing ( brassy metallic cough) most serious type usually occuring in and children below 4 years old
IV.

Other Forms- membrane formation is rarely found, for example conjunctive, genitalia, and alimentary canal. -

 Most

attributable to toxin of generally related to extent of local

Severity

disease

Most

common complications are myocarditis and neuritis occurs in 5%-10% for respiratory disease

Death

Untreated

patients are infectious for 2-3 weeks Antibiotic treatment usually render patients noninfectious within 24 hours.

Pseudomembrane and swelling indicative Stains Conditions, history Serological assay Schicks test: determine susceptibility or immunity of diptheria. 1/50 of the dose of diptheria toxin is injected intracutaneosly. If positive, a red spot at the point of injectio will appear within 48 hours. Moloney test: done to determine hypersensitivity to diptheria toxoid. ID injection of 0.1 cc of luid toxoid. Positive , an erythema is produced at the site of injection within 24 hours.

26

Diptheria Antitoxin: 20,000-80,000 units depending upon duration of symptoms, area of involvement and severity of the disease (IM) Antibiotic Therapy Penicillin or erythromycin: prevent secondary infection Supportive treatment: a. respiratory support b. Isolation until 3 cultures are (-) after antiobiotic therapy is completed c. Bed rest for 2-3 weeks d. Antipyretic : fever e. Sedative : keep quiet in bed

28

1.

2.

3. 4.

Most effectve method is mass immunization of the entire population. Isolation of patients must be isolated 1-7 days or until2 successive cultures show that they are no longer contagious. Identification and treatment of contacts. - antibiotics for 7 days. Reporting cases to public healyh authorities.

 Patients

should be strictly in bed. Permitted t sit up during on meals or whiule the beds are being made. They may have bed bath but not tub bath or showers. Medical procedures done to the patients is tracheostomy or placing an intubation tube to serve as a patent air way so that patients may be able to breathe.

 Passive

immunization: maximum duration of immunity 4 weeks . Minimum 7 days. Advisable to persons who are susceptible and have been directly exposed to an unquestioned case of the disease. Given IM 1,000- 1,500 units of antitoxin. Active immunization{: desirable is between 6 mos 12 mos. 2 reasons: infants exhibit natural immunity and does not respond yet to the immunizing agent.

Routine DTaP Primary Vaccination Schedule

Dose
Primary 1 Primary 2 Primary 3 Primary 4

Age
2 months 4 months 6 months 15-18 months

Interval
--4 wks 4 wks 6 mos

The

number of doses of DT needed to complete the series depends on the childs age at the first dose: if first dose given at <12 months of age, 4 doses are recommended if first dose given at >12 months, 3 doses complete the primary series

Booster Doses
4-6

years, before entering school years of age if 5 years since last dose (Td) 10 years thereafter (Td)

11-12 Every

Routine Td Schedule Persons >7 years of age

Dose Primary 1 Primary 2 Primary 3 Interval --4 wks 6-12 mos

Booster dose every 10 years

http://www.hhmi.princeton.edu/sw/2002/psidelsk/Microlinks.htm

 Aerobic,

Gram negative coccobacillus Alcaligenaceae Family Specific to Humans Colonizes the respiratory tract

Whooping Cough (Pertussis)

http://microvet.arizona.edu/Courses/MIC420/lecture_notes/bordetella_pertussis/ gram_pertussis.html

 Very

Contagious Transmission occurs via respiratory droplets

http://www.universityscience.ie/imgs/scientists/whoopingcough.gif

http://www.ratbags.com/rsoles/history/2000/12december.htm

Period of Communicability: Catarrhal to early Paroxysmal stage Incubation period: 7- 10 days but can be as long as 21 days.

Mainly affects infants younger than 6 months and kids 11-18 years old.

1.

Catarrhal stage : last 1- 2 weeks, early symptoms being indistinguishable from those of an ordinary cold, dry hacking cough, appears tired and listless, cough becomes more severe and racking and is accompanied by suffusion.

2. Paroxysmal stage : lasts 4-6 weeks, appearance of a typical whoop, 5-10 coughs in rapid succession during expiration, followed by a long draw-out inspiratory phase in which the patient attempts to inhale air though the tigthened vocal cords with the resultant prolonged crowning, noise and whoop. During the attacks, the face becomes congested, the eyes teary, and frequently the eyeballs protrude; the tongue, congested at times to the point of becoming purple, hangs from the mouth. The attack ceases only with the expulsion of the so called mucous pluug from the larynx.

3.

Convalescence stage paroxysm decreases in number and severity.

 Production

of large amounts of mucuos Mucoid material becoming entangled with cilia and enmeshing the B. pertussis which are present in large numbers B. pertussis produces a toxin which has a special affinity for the nervous system, rendering its hyperirritable and the cough is initiated.

 Nasopharyngeal

Culture

1.

2. 3.

Hyperimmune pertussis gamma globulinrecommended for all patients under 2 years those severely affected; 1.25ml repeated every other day for 3or 4 doses. Antibiotics: tetracyclines, chloramphenicol, ampicillin, streptomycin or kanamycin. Supportive : Antipyretics, bedrest, quiet environment to reduce coughing, gentle suctioning, increase fluid intake and O2

Comfort of the patient A snug abdominal binder to give support will help prevent hernia. Care of nose and throat Diet: Small feedings and given frequently, lessen the danger of vomiting. No excitement should be permitted at anytime. Fluids are better given between meals sa as not to increase the bulk in the stomach. Temperatures of the food should be moderate. If patient vomits let him rest for 20 mins then feed him again. Isolation of patients during period of communicability.

 Active

immunization Passive immunization with hyper immune pertussis gamma globulin. Isolation : POC

Photo Courtesy of U.S. Centers for Disease Control and Prevention

Courtesy: Google image on tetanus

Courtesy: Google image on tetanus

Newborn showing risus sardonicus and generalized spasticity

Tetanus is an acute,often fatal,disease caused by an exotoxin produced by the bacterium Clostridiumtetani. But prevented by immunization with tetanus toxoid. It is characterized by generalized rigidity and convulsive spasms of skeletal muscles.The muscle stiffness usually involves the jaw (lockjaw)and neck and then becomes generalized.

 C.tetani

is a slender,grampositive,anaerobic rod that may develop a terminal spore,giving it a drumstick appearance. The organism is sensitive to heat and cannot survive in the presence of oxygen.The spores,in contrast,are very resistant to heat and the usual antiseptics. They can not survive autoclaving at 249.8 F (121 C)for 20 minutes. The spores are also relatively resistant to phenol and other chemical agents.

 The

spores are widely distributed in soil and in the intestines and faeces of horses,sheep,cattle,dogs,cats,rats, guinea pigs,and chickens.Manure-treated soil may contain large numbers of spores.Spores may persist for months to years. C. tetani produces two exotoxins, tetanolysin and tetanospasmin. The function of tetanolysin is not known with certainty. Tetanospasmin is a neurotoxin and causes the clinical manifestations of tetanus. Tetanospasmin estimated Human lethal dose 2.5 ng/kg

Occurrence: Tetanus occurs worldwide but is most frequently encountered in densely populated regions in hot,damp climates with soil rich in organic matter.

Reservoir:Organisms are found primarily in the soil and intestinal tracts of animals and humans.

 Mode

of Transmission:Transmission is primarily by contaminated wounds,Tissue injury( surgery,burns,deep puncture wounds,crush wounds,Otitis media ,dental infection,animal bites, abortion,and pregnancy) . Communicability Tetanus is not contagious from person to person.It is the only vaccinepreventable disease that is infectious but not contagious. Temporal pattern:Peak in winter and summer season Incubation Period: 8 DAYS ( 3-21 DAYS)

 Age

: I t is the disease of active age (5-40 years), New born baby, female during delivery or abortion Sex : Higher incidence in males than females Occupation : Agricultural workers are at higher risk Rural Urban difference:Incidence of tetanus is much lower than in rural areas Immunity : Herd immunity does not protect the individual Environmental and social factors: Unhygienic custom habits,Unhygienic delivery practices

Clinically it is confirmed by noticing the following features:

1.
2. 3.

4.

Risus sardonicus or fixed sneer. Lock jaw. Opisthotonos (extension of lower extremities, flexion of upper extremities and arching of the back. The examiners hand can be passed under the back of the patient when he lies on the bed in supine position.) Neck rigidity

(1)To provide supportive care until the tetanospasmin that is fixed in tissue has been metabolized
neutralize circulating toxin remove the source of tetanospasmin.

(2)To

(3)To

 Neonatal

tetanus can be prevented by immunizing womenof childbear

Cutaneous Anthrax

View Table
The primary lesion of cutaneous anthrax is a painless, pruritic papule that appears one to seven days after inoculation. Within one to two days, small vesicles or a larger, 1- to 2-cm vesicle forms that is filled with clear or serosanguineous fluid. As the vesicle enlarges, satellite vesicles may form.

Fitzpatricks Dermatology in General Medicine. Fifth Edition. Freedberk IM, Eizen, AZ, Wolff, K, Austen KF, Goldsmith LA, Katz SI, Fitzpatrick TB (eds.). New York: The McGraw Hill Companies, Inc; 1999.

Fluid within the vesicles may contain numerous, large gram-positive bacilli. As the lesion matures, a prominent, non-pitting edema surrounds it. Eventually, the vesicle ruptures, undergoes necrosis, and enlarges, forming an ulcer covered by the characteristic black eschar. Symptoms include low-grade fever and malaise. Regional lymphadenopathy is present early on.

 Cutaneous

anthrax Lesion located most commonly on upper extremities (especially the hands), neck, or face Systemic manifestations include fever, malaise, regional lymphadenopathy Painless lesion Solitary lesion Necrosis of skin and subcutaneous tissue occurs late and gradually Formation of black eschar Characteristic massive edema surrounds the lesion