Microbial Diseases of

the Skin and Eyes

Skin
 The skin is generally inhospitable to the growth of
certain microbes but supports the growth of some

 Salt inhibits microbes

 Lysozyme hydrolyzes peptidoglycan

 Fatty acids inhibit some pathogens

 Mucous Membranes

 Line body cavities

 Epithelial cells attached to an extracellular matrix
 Cells secrete mucus
 Some have cilia
 Normal Microbiota of the Skin

 Gram-positive, salt-tolerant bacteria

Staphylococci
Micrococci
Diphtheroids
 Vigorous washing reduce but does not eliminate the the
normal microbiota
- microorganisms in hair follicles & sweat
glands reestablish normal population after
washing.
 Increase number of microorganism in moist
areas of the body ( Armpits )

Body Odor
Microbial Diseases of the Skin
 Skin lesions & rashes does not necessarily
indicate infections of the skin but maybe
manifestations of systemic disease.
 Exanthem
Skin rash arising from another focus of
infection
 Enanthem
Mucous membrane rash arising from another
focus of infection
BACTERIAL DISEASES OF THE
SKIN
 Staphylococcus & Streptococcus
1. Come in contact with the skin & are
adopted to the skin’s physiologic
conditions
2. Produce invasive & damaging enzymes
Staphylococcal Skin Infections
 Staphylococcus
- spherical, Gram- positive
- irregular grape-like clusters
 Types of Staph.
1. Coagulase-positive
- produces Coagulase – an enzyme
that clots fibrin.
- fibrin clot protects the organism from
phagocytosis
2. Coagulase- negative
- does not produce Coagulase
- 90% of skin normal flora
- pathogenic only when skin barrier is
broken ( Insertion & removal of catheter)
 Staphylococcus epidermidis
- Gram-positive cocci, coagulase-negative
- found in human skin
- found in catheters surrounded by slime
layer of capsular material
- protection against dessication &
disinfection
 Staphylococcus aureus
- Gram-positive cocci, coagulase-positive
- most pathogenic
- forms golden yellow colonies
 Toxins produced by Staph. Aureus:
1. Leukocidin
2. Exfoliative toxin
3. Enterotoxin
Problems in Staph. Infection:
1. Dangers to surgical wounds
- S. aureus is carried by hosp. staff &
visitors
2. Antibiotic resistance
- only 10% are sensitive to Penicillin
 3. Favorarable environment provided by nasal
passages
4. Hair follicles as reservoirs

Staphylococcal Skin Infections:

1. Folliculitis
- Infections of hair follicles
 Sty
Folliculitis of an eyelash
 Furuncle ( Boil )
Abscess; pus surrounded by inflamed tissue
 Carbuncle
Inflammation of tissue under the skin
 Impetigo of the newborn
- Stap. Aureus
- thin walled vesicles on the skin that rapture
& crust
 Scalded skin syndrome
- Stap. aureus toxin entering the bloodstream
- newborn or children below 3yrs. Old
- lesions develop into a bright red area then
peels off
Streptococcal Skin Infections
 Streptococcus
- gram- positive, spherical, in-chains
- causes a wide range of disease
- produces & secretes toxins, enzymes &
virulence factors
Toxins & Enzymes produced:
1. Streptokinase
2. Hyaluronidase
3. Deoxyribonucleases
4. Leukocidins
5. Erythrogenic toxins
6. Exotoxin A
Streptococcal Skin Infections
1. Erysipelas
- Streptococcus pyogenes
- starts as sore throat skin erupts into
reddish patches
with raised
margins
2. Impetigo
- seen in toddlers & adults
- associated with Staph. Infection
3. Cellulitis
- infection of the connective tissue with
inflammation of the subcutaneous layer.
4. Myositis – infection of the muscles
5. Necrotizing fasciitis
- Infection of the deeper layer of the sub-
cutaneuos tissue and into the fascia
 Infections by Pseudomonads
 Pseudomonads
- Gram-negative, aerobic rod
- Widespread in soil, water & soap
- Resistant to most antibiotics & disinfectants
Pseudomonas aeroginosa
- opportunistic pathogen
- produces Endotoxin P
- implicated in most nosocomial infection
- indwelling medical tubes & devices
mops, vases & diluted disinfectants
Diseases caused by Pseudomonas:
1. Pseudomonas dermatitis
- self-limiting rash (2wks), swimming pools &
saunas
- enters through the hair follicles
2. Otitis externa / Swimmers ear
- infection of the external ear
3. Post-burn infections
- Pyocyanin produces a blue-green pus
Tx: Fluoroquinolones
Silver sulfadiazine
 Acne
 Comedonal acne
Occurs when sebum channels are blocked with shed
cells
 Inflammatory acne
Propionibacterium acnes
Gram-positive, anaerobic rod
Treatment:
Preventing sebum formation (isotretinoin)
Antibiotics
Benzoyl peroxide to loosen clogged follicles
Visible (blue) light (kills P. acnes)
 Nodular cystic acne
Treatment: isotretinoin
 VIRAL DISEASES OF THE SKIN

Warts / Verruca
- Papillomaviruses, benign skin growth
- person to person contact, sexually
Tx: Removal
- Cold liquid nitrogen, Electrodessication
Acid burning
 Poxviruses
Smallpox (Variola)
- Smallpox virus (Orthopox virus)
Variola major has 20% mortality
Variola minor has <1% mortality
- transmitted by respiratory route & infects
internal organs
- Eradicated
- bioterrorism
 Herpesviruses

Chicken pox / Varicella zoster

- Varicella-zoster virus/Human herpes virus 3
- mild childhood disease
- low mortality rate, high if contracted later in
life
- Mortality is due to complications
- Encephalitis & Pneumonia
- Serious fetal damage in 2% cases if it
occurs during pregnancy
 Respiratory route localizes in skin after 2wks

Infected skin is vesicular

then fills with pus then
raptures

Scab Heal
 Starts in the trunk then spreads to the extremities
 Virus may remain latent in dorsal root ganglia
- Central nerve gangliion
- persists as viral DNA ( antibodies cannot
penetrate the CNS)
Shingles / Herpes zoster
- Reactivation of latent HHV-3 releases viruses
that move along peripheral nerves to skin.
- latent Varicella-zoster virus located at the
Dorsal root ganglion ( spine)

Reactivated ( decades later ) - Stress

Low resistance

Virions produced by reactivated DNA

move down peripheral nerves
Cutaneous Sensory Nerves of the skin
( SHINGLES)
-Vesicles similar to chicken pox
-Unilateral( follows the cutaneous nerves)
- Waist, face, upper chest, back
- Severe burning, stinging pain for months
to years ( Post Herpetic Neuralgia)
- Adults
 Herpes simplex 1 and Herpes
simplex 2
 Human herpes virus 1 and HHV-2
- Oral/Respiratory & Skin contact
- Cold sores or fever blisters (vesicles on lips)
1. HHV-1
- Subclinical, Infancy
- Herpes gladiatorum (vesicles on skin)
Herpes whitlow (vesicles on fingers)
HHV-1 can remain latent in trigeminal nerve ganglia
2. HHV-2
- Genital herpes, Sexual contact
- Herpes encephalitis (HHV-2 has up to a 70%
fatality rate)
 - HHV-2 can remain latent in sacral nerve
ganglia
TX: Acyclovir

Men Women
 Measles (Rubeola)
 Measles virus
 Transmitted by respiratory route
 Incubation period: 10-12 days
 Infectious even before symptoms occur
 Humans are the only known reservoirs
 Macular rash
 Koplik's spots
- lesions in the oral cavity
- tiny red patches with central white specks
on the oral mucosa opposite the molars.
 Symptoms develop like common colds

 Macular rash starts on the face then spreads to

the trunk & extremities
 Prevented by vaccination
MMR
- given age 1 yr
 Complications:
1. Middle ear infection
2. Pneumonia
3. Subacute sclerosing panencephalitis
- males
- 1-10 yrs. After recovery from measles
 Rubella (German Measles)
 Rubella virus
 Respiratory route
 Incubation period: 2-3 wks
 Milder disease than Rubeola often goes
undetected
 Macular rash and fever
 Congenital Rubella Syndrome
- severe birth defect if during 1st trimester
- Deafness, cataract, heart defect, mental
retardation
 A 1905 list of skin rashes included #1-measles, #2-
scarlet fever, #3-rubella, #4-Filatow-Dukes (mild
scarlet fever), and #5-
Fifth Disease / Erythema Infectiosum
- Human parvovirus B19
- mild flu-like symptoms
- facial rash “ Slapped cheek”
Roseola
- Human herpesvirus 6
- high fever and rash, lasting for 1-2 days
- recovery leads to immunity
 FUNGAL DISEASES OF THE
SKIN &
NAILS
Cutaneous Mycoses
 Dermatomycoses: Tineas or Ringworm
Metabolize keratin
Trichophyton infects hair, skin, nails
Epidermophyton infects skin and nails
Microsporum infects hair and skin
 Treatment:
Oral griseofulvin
Topical miconazole
 Candidiasis
 Candida albicans (yeast)
 Candidiasis may result from suppression of
competing bacteria by antibiotics
 Occurs in skin; mucous membranes of
genitourinary tract and mouth
 Thrush is an infection of mucous membranes of
mouth
 Topical treatment with miconazole or nystatin
 Microbial Diseases of the Eye
 Conjunctivitis (pinkeye)
- Haemophilus influenzae
- Various microbes
- Associated with unsanitary contact lenses
 Neonatal gonorrheal ophthalmia
- Neisseria gonorrhoeae
- Transmitted to newborn's eyes during
passage through the birth canal
- Prevented by treatment newborn's eyes with
antibiotics / Silver nitrate
 Chlamydia trachomatis
Inclusion conjunctivitis
- Transmitted to newborn's eyes during
passage through the birth canal
- Spread through swimming pool water
- Treated with tetracycline
Trachoma
- Greatest cause of blindness worldwide
- Infection causes permanent scarring;
scars abrade the cornea leading
to blindness
 Herpetic Keratitis
- Herpes simplex virus 1 (HHV-1)
- Infects cornea, may cause blindness
- Treated with trifluridine
 Acanthamoeba keratitis
- Transmitted from water
- Associated with unsanitary contact lenses