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137 Cards in this Set

  • Front
  • Back

How often does skin slough off?

Every 25-45 days

What is the criteria of normal flora?

1. resistance to drying

2. resistance to salt

3. grow in clumps

Normal Flora species

Staphylococcus epidermidis

Corynebacterium diptheriae

Candida sp

Staph aureus




Flat, lesion with color change


small elevated solid bump


Elevated lesion filled with clear fluid


Large vesicle


Small elevated lesion filled with pus


Small purpura (reddish purplish discoloration due to blood in small areas of tissue)


Deeper dissue, decreased blood flow and therefore antibiotics don't penetrate well

Staphylococcus Aureus

Gram + cocci in cluster

Staph Aureus infection

Folliculitis (hair follicle infection)

Sty (eyelash infection)

Cellulitis and boils


Must lance to drain boil and culture

Staph Aureus

Impetigo (bullous)

on surface of skin impetigo


vesicle around mouth

Carrier state of Staph Aureus

Nose (20-40%)

Skin (25%)

Transmission of S. aureus


What is the major cause of skin disease in the US?

community acquired MRSA

What are the virulence factors of S. Aureus

Adhesins, antibiotic resistance, cytotoxic factors

peptidoglycan, clumping factor, Protein A (binds to Fc to IgG and no signaling of immune cells)

Coagulase (causes clotting, hide inside and not be recognized), siderophobes, breaks hyaluronidase which holds skin together, collagen binding proteins

Where can S. Aureus cause infection in the body?

Surface (impetigo)

Enteritis (diarrhea)

Toxic Shock

Everywhere in body


Food Poisoning

2 Types of MRSA

Community acquired

Hospital Acquired

Which RMRSA contains the PVL gene?

Community acquired

Which MRSA is resistant to all antibiotics except Vancomycin?

Hospital acquired

Treatment of S. Aureus

Methicillin, penicillin, vancomyocin

Prevention of S. Aureus


Maintain innate immunity

New vaccine for compromised dialysis patients

What is S. aureus Toxemia

The toxin is responsible for symptoms

No bacteria at site of skin manifestation

What are the s. aureus toxicemias?

Toxic Shock syndrome

Scalded skin syndrome

Scalded Skin Syndrome

Toxemia of s. aureus

Bacteria colonize in the intestine of newborn and children less than 2

Toxin enters the bloodstream and affects the epidermis

Virulence factors of Scalded Skin syndrome

Exfoliative toxin a and B

-destruction of intracellular connective tissue

-skin peels off in sheets

Toxic Shock Syndrome
Colonization elsewhere, toxin enters bloodstream

Effects: fever, vomiting, sunburn-like rash, leads to peeling skin

When does Toxic Shock Syndrom occur?

-menstrual TSS occurs in association with tampons, incidence rises w/ increases in absorbency, tampons too long

-nasal surgeries

Virulence factors of Toxic Shock Syndrome

(ability to stimulate t cells and induce TNF and IL-2

Diagnosis of Toxic Shock
Culture on blood agar

Verify TSST-1 toxin with

1) RIA


3) PCR

Gram stain of Streptococcus Pyogenes

(Group A Strep

Gram positive cocci in chains

(greater invasiveness than staph)

Skin infections cause by group a strep
1) impetigo


2) Erysipelas

-infection of dermal layer, tissue destruction, can lead to sepsis

3)late sequelae

-acute glomerulonephritis

-rheumatic fever (less common)

How do you get GAS? (Epidemiology)
Direct contact with lesion (highly infectious)
Virulence Factors for GAS
-Hyaluronic acid capsule

-M protein (outside cell wall fuzzy fibril layer that inhibits phagocytosis)

Lta is anchored to proteins on bacterial surface, including m protein, mediate bacterial adherence to host epithelial cells
Streptokinase, hyaluronidase
Diagnosis of GAS
-Gram + cocci in chains

-Culture Beta hemolytic

-Catalase -

-Group A carbohydrate teichoic acids

Treatment of GAS infection

Must prevent late sequaelae

-acute glomerulonephritis

-follows infections with skin M types of S. progenies

-Immune complex disease type III

-No live bacteria (has cleared and gone)

Prevention of GAS skin infections
No vaccine

Treat rapidly so you don't build antibodies

Toxemia of staph

Necrotizing fasciitis

Flesh eating strep

Rapid disease course, destroys tissue as quickly as removed

Epidemiology of Necrotizing fasciitis
can cause death and loss of limbs
Virulence Factors of necrotizing fasciitis
-Pyrogenic exotin A (SPE A) -superantigen: bypasses regular immune system and your own response kills you, overrides regulatory system inflammation (fever causing)

-Streptolysin O (SLO) lyses cells, assist spread through tissues and exaggerated immune response

Diagnosis of necrotizing fasciitis
culture on blood agar

Beta hemolytic Group A

Immunological Assays for toxin

Treatment for Necrotizing Fasciitis
-antibiotics (penicillin)

-wound debridement almost always necessary

Strep Toxic Shock Syndrome


similar to staph toxic shock

less frequent rash and more frequent bacteremia, shock and organ damage

Toxin TSS-1

Propionibacterium acne
opportunistic pathogen, normal flora grows out of control

Acne: inflammatory, whitehead (closed comedo), Blackhead (open comedo)

Treatment of acne
-benzoyl peroxide

-rein A

-blue light

Pseudomonas Aeruginosa

Gram stain and where is it found?

Aerobic gram - rod

Naturally found in soil and water

Strict aerobe

Very common

Pseudomonas dermatitis
Disease of Pseudomonas aeurginosa

-rash from swimming in pool/hot tubs

Ottis externa
Disease of Pseudomonas aeruginosa

ear infection of external canal

-outer ear canal

-swimmer's ear

Epidemiology of Pseudomonas Aeurginosa
opportunistic pathogen ,lives in the dirt , comes across frequently

-nosocomial infections (resides in sink drains)

-Very naturally antibiotic resistant, few antibiotics effective


Virulence Factors of pseudomonas aeruginosa
produces exotoxin A

dense biofilm in cystic fibrosis patients lungs

Diagnosis of Pseudomonas Aeruginosa
culture on routine media

-non-lactose fermentor mac agar

-oxidase +

- Grape-like odor

-green, green-blue pigment

3 ways pathogens attack
1) breach of intact skin

2) skin manifestation of a systemic infection (infection is all over but can only see it on skin)

3) Toxin-mediated skin damage

rubeola virus


-macular red flat rash, face, starts at trunk

-KOPLICK'S SPOTS: tiny red patches, white center, enough to diagnose

Epidemiology of measles

can be highly virulent (w/in 7 ft of infected patient, 90% change of getting it)

-humans only reservoir (human to human spread)

-mortality in very young and old

-spread by respiratory droplets (7ft)

-rare serious sequelae occur

Subacute Schlerosing Panencephalitis (SSPE)
Rare event 1/million male children and young adults infected

1-10 years after measles infection brain issues, disorientation, can't walk

always fatal

Worst Case scenario

Diagnosis of Measles
look for signs and symptoms

-rash and koplick's spots

Treatment for measles

Quarantine not real effective spread before you had symptoms

Prevention of measles
Vaccine MMR

-live attenuated strain of virus (pass it until not an infection but still giving measles-1 cell memory and b cell memory, downside is can't get disease

Measles, mumps, rubella vaccine
German Measles (Rubella)
Low-grade fever and rash

encephalitis rare (brain issues)

Real problem is congenital rubella syndrome (spread through respiratory route to pregnant woman

Epidemiology of Rubella
-spread by respiratory route

-severe birth defects when mom infected during 1st trimester and ability to stop mitosis, baby usually not even born

(-used to do a blood test for rubella before marriage)

Prevention of Rubella
Vaccine MMR, live attenuate strain of virus
Fifth Disease (parvovirus B19-distemper)
fifth eyrthema infectiosum

5th of list of skin rashes

Butterfly rash of face for kids

Spike a fever and then it goes away

Epidemiology of fifth disease
-Mild flu-like symptoms

-Slapped cheek butterfly rash

-Self-limiting so no treatment

-Human herpesvirus 6 (HHV6)

-very common rash

-High fever few days, rash lasts day or 2 longer

Five Exanthems
1. varicella

2. measles-rubeola

3. rubella

4. roseola

5. fifth disease






1 varicella is chicken pox

fever, vesicles, scabs, lasts 10 day

Latent infections in nerve cells-dorsal root ganglion of spine

Shingles, relapse of chicken pox

sits in spine until reactivation

very painful

most cases in adults over 50

increasing in younger adults

Epidemiology of Chicken pox



spread by respiratory secretions

most people get vaccine or have had chicken pox

mostly get it in childhood, secondary is cellulitis when scratching (treat with antibiotics)

complications are encephalitis pneumonia and is more dangerous in adults

Reye's Syndrome



in children

caused by taking aspirin for fever

vomiting and brain disfunction

should take tylenol or motrin

Treatment for Varicella-Zoster
Chicken pox: tylenol, motrin for fever and anti-itch treatment

Shingles: treat only severe cases-antiviral drugs

prevention of varicella-zoster

-live attenuated vaccine which causes latent infection

-attenuated vaccine virus can reactivate and cause herpes zoster

-children vaccinated appear to have a lower risk of zoster than people who were infected with wild type



Variola major (20% mortality rate)

Viriola minor (<10% mortality rate)

Epidemiology of smallpox
successfully eradicated

epidemics with mortality

biological warfare (us and Russia)

respiratory route (human to human only)

Prevention of smallpox
Vaccination COW POX

-successful elimination from earth?

-waning immunity in population

Monkey pox?

-conco-jumped from monkey to human (was an outbreak in 2003)

Herpes Simplex Virus

-Types, symptoms

HSV-1 and HSV-2

-cold sore, genital herpes, skin herpes (herpes gladitorum, wrestlers)

-whitlow (inoculation herpes)- dentists spread to hands from cold sores

Herpes encephalitis
Rase spread to brain

Latent infections in nerve ganglion

relapse (reactivation-stress, sun, UV)

Epidemiology of Herpes


-90% of population infected

HSV1 is oral previously

HSV2 genital previously

currently mixed

Treatment of Herpes
Acyclovir ACA Zovirax

Treatment must be early to prevent sores

Prevention of herpes
Prevent direct contact with lesions

Virus killed by soap


-How many types?

-Incubation period?


-more than 80 types

-incubation period is weeks

-infection lasts for years

-hyperplasia of sin cells

How are warts spread
spread from hand to hand
Treatment of warts
Cryosurgery:cold liquid nitrogen


Acid (over the counter)

Prevention of warts

None, not cancer association
Mooluscum Contagiosum

-name? symptoms?


wart-like in children

Direct contact, autoinoculation


What kind of infection?

Where does it grow?

3 genera


Fungal infection

Grows on keratin

1. trichophyton

2. microsporum

3. epidermophyton

AKA ringworm

Types of ringworm (dermatophyte)

tinea captis

-ringworm of scalp

tinea pedis

-athlete's feet

tinea crurls

jock itch

tinea ungulum

nail onychomycosis

Diagnosis of Dermatophyte (ringworm)
signs and symptoms (athlete's food)

Microscopy of skin scrapings for line of spores hyphae (at room temp is hyphae)

Culture which takes weeks

Treatment of Dermatophytes
topical non prescription (start at topical)

-miconazone, clotrimazole, not effective on hair


-griseofulvin, ketoconazole

Fungal skin infections

Candida albicans

-opportunistic infections

1. 2nd to antibiotic therapy

2. change in ph

skin cutaneous- thrush (around mouth) or vaginitis

Epidemiololgy of Candidiasis

-Groups at risk

1. infants- thrush

2. aids patients

3. obese-increased moisture

4. diabetics because of decreased circulation

Diagnosis of Candidiasis
signs and symptoms

Culture: german tube

Treatment of Candidiasis
topical miconazole, clotrimazole, takes yeast and tells species based on color

systemic infections with oral ketoconazole with antifungals

Parasitic infection

Caused by mite sarcoptes scabies

-burrow under skin to lay eggs

-causes itching and inflammation

-transmitted by intimate (sexual included)

-500,000 a year seek treatment

Treatment of scabies
various insecticides
Symptoms of scabies
2-6 weeks after initially infected because your immune system which is thought to produce the symptoms of itchiness associated with scabies, needs time to react to infection
How long if previously infected will it take to begin to show signs of infection?
48 hours
Symptoms of scabies
immense itchiness and tend to be worse after shower at night,

red blotches and lines of skin caused by burrowing into skin

Treatment of scabies
Pediculosis (lice)
parasitic infection

1. body lice (pedicures humans corporis)

spreads endemic typhus, public lice (crabs)

2. Head lice (pediculus), human capitis

Lice disease

-requires what?

Require blood from host

sensitization to louse saliva causes itching

female lay eggs called nits(stuck to hair follicles)

Epidemiology of head lice
very common school children disease

pubic lice is STD crabs

Treatment of pediculosis
Nix or Rid over the counter insecticides

-resistance to those common

-comb out nits with comb

Prevention of lice
Thourough cleaning of bedding, hat, bruised, stuffed animals

-caused by ?

spread by?


Caused by Leishmania sp

protozoan single cell,

spread by sand fly

affects about 12 million people globally SA, africa and middle east

cutaneous or systemic

Gas gangrene

-gram stain

-infection type?

Bacterial would infection

clostridium perfringens

gram positive rod

spore former

strick anaerobe

any organism can cause wound infection

Gas gangrene disease
degrades carbs to acid and gas through fermentation

H and Co2 bubles in tissue putting pressure on nerves, causing pain and cuts of blood flow

causing ischemia and necrosis

fatal if untreated

antibiotics can't get to infection

Epidemiology of gas gangrene

Who gets it?

1. improper abortions

2. wartime injuries

3. diabetes

C perfrigens virulence factors (Gas gangrene)
metabolism-gas production

Toxin production alpha toxin and beta toxin (necrotizing toxin)

Diagnosis of gas gangrene
Clinical signs (black color)

isolate bacterium and conduct toxin typing

must use anaerobic culture techniques

Treatment of gas gangrene
debridement of wound and amputation


Hyperbaric chamber

passive antibody against alpha toxin specific for toxin Y

Prevention of gas gangrene
clean and deride wounds, faster cleaned less chance of developing gas gangrene
Pseudomonas Aeruginosa

Gram stain

and where found?

Aerobic gram - rod found in soil/water

strick aerobe

Infections cause by aeruginosa
burn wounds (fluoresces)
Epidemiology of pseudomonas aeruginosa
opportunistic pathogen bc in dirt air

nosocomial infections in hospital

VERY ANTIBIOTIC RESISTANT, hard to treat and control

Virulence factors for pseudomonas aeruginosa
Exotoxin A

Dense biofilm in CF patients

Top causes of wound infections
Staph aureus

Coag - staph


E. Coli

Pseudomonas Aeruginosa

Ophthalmia neonatorum

Gram stain?


Bacterial eye infection

neisseria gonorrhoeae

gram - diplococci

chlamydia trachomatis

Epidemiology of Ophthalmia neonatorum
STD in adults, newborn infected during birth via infected birth canal
Treatment of ophthalmia neonatorum
instilled erythromycin instead of classically used silver nitrate
Inclusion conjunctivitis


Where acquired?


Chlamydia trachomatis

acquired in swimming pool, resolves itself and can scar

young adults

Tetracycline drops to treat



Chlamydia trachomatis: small obligate intracellular parasite
#1 preventable cause of blindness in world
Trachoma disease

What is it?

Lead to?


Chronic inflammation of cornea and conductive

Leads to trichiasis-eyelashes turn inward cause corneal scarring and pans

Panus formation gets into cornea can cause permanent blindness

How is trachoma transferred?
Carries from person to person on flies, towels, clothes,
Chlamydias odd life cycle
Obligate intracellular bacteria cannot complete life cycle out of cell.

Elementary body is infectious

reticulate body noninfectious but metabolically active in this form (gives symptoms)

replicate in cytoplasm of host cells

can't gram stain

cyst is EB and troph is Rb

Epidemiology of trachoma
north africa, native americans appalachia

worldwide 500 million cases per year and 2 million go blind

Transmission of trachoma
hand contact

shared towels


Treatment of trachoma
tetracycline ointment

surgery to prevent eyelash abrasion

Prevention of Trachoma
Higher living standards

Better sanitary practices

Health education

don't let flies near eyes

Conjunctivitis (pinkeye)


Strep pneumoniae

Haemophilus influenzae

Staph aureus

Pseud sp

Viral conjunctivitis also (not pus filled)

contact lenses increase prevalence

Herpes Keratitis
Viral infection of eye