dms. skin infections

7/23/2019 DMS. Skin Infections.

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The MycobacteriaThe Mycobacteria

(Acid Fast Bacilli)(Acid Fast Bacilli)

Obligate pathogens

Mycobacterium. tuberculosis- TB Mycobacterium bovis- bovine TB

Mycobacterium. leprae- Hansen's disease (leprosy)


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Emerging DiseasesEmerging Diseases

Hansens Disease(1!") # $eprosy ca%sed byMycobacterium leprae large amo%nts o& mycolic acids on the cell

s%r&ace

m%ltiplies 'ery sloly

mostly in&ects sin* ner'es and m%co%smembranes

ne'er c%lti'ated in laboratory media or cellc%lt%re* b%t has been c%lti'ated in mo%se&oot pads


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$eprosy ro%te o& in&ection is not non* b%t probably 'iarespiratory droplets

most people are resistant and do not de'elop acti'e disease

$ong and close contract ith lepromateo%s patients

+asal secretion

,in lesions

-nhalation

Transmissions.Transmissions.


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$eprosy # the disease process

patients de'elop discolored patches on sin

that do not itch or h%rt

ringorm/lie patches* may ha'e raised edges

patients e0perience loss o& &eeling ithin the

patch o& discolored sin


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LeprosyLeprosy


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$eprosy # other symptoms loss o& eyebros

thic or l%mpy earlobes

loss o& &eeling (b%rns or scars) painless %lcers on the &eet

drop &eet

de&ormities o& hands andor &eet


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Classical facial appearance of advanced leprosy


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$eprosy # diagnosis

in more ad'anced disease patient e0periences

n%mbness or tingling in hands and &eet

enlarged ner'es appear in arms and nec

leprosy bacilli can be &o%nd in sin lesions

painless %lcers become in&ected

in&ected %lcers become necrotic

lac o& pain allos in&ection to become deep and

attac bone


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To main &orms.

12 T%berc%loid leprosy (TT)

32 $epromato%s leprosy ($$)

Others &orms. Borderline leprosy

Low TT BT BB BL LL High

Poor prognosis

Diseases 4rod%ctionDiseases 4rod%ction


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T%berc%loid $eprosy (TT) %s%ally in persons ith relati'ely high

resistance

no bacilli in sin smear

person cannot pass leprosy on to others

sin patches are &e* are 'ariable inappearance* b%t o&ten ha'e raised marginsand &lat centers


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T%berc%loid $eprosy (TT)

%s%ally only in'ol'es loss o& &eeling in sinpatches

hen hands or &eet in'ol'ed it o&ten happensearly and ca%ses loss o& &eeling or strength inonly one hand or &oot

%s%ally responds 5%icly to treatment


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Borderline $eprosy

&e to many bacilli in sin smears

many sin patches* some &eeling loss* patchesabo%t the same on both sides o& the body

se'ere ner'e damage* loss o& &eeling andstrength* de&ormities in both hands and both&eet


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Borderline $eprosy

Depending on here it &alls along the line beteen

the to e0tremes* borderline leprosy is di'ided into.

borderline t%berc%loid (BT)

borderline (BB)

borderline lepromato%s (B$)


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$epromato%s $eprosy ($$)

in persons ith 'ery lo resistance

large n%mbers o& leprosy bacilli in sinpatches

patients are in&ectio%s %ntil treated

n%mero%s sin patches* o&ten ith raisedl%mps or thicened areas


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&acial sin becomes thic* l%mpy* reddish*especially o'er the eyebros* chees* nose* andears2

bridge o& the nose may grad%ally sin in

ner'e damage and paralysis appear late i& nottreated


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loss o& &eeling and strength a&&ects both

hands and both &eet e5%ally

response to treatment is o&ten slo

treatment m%st be contin%ed &or at least 3years


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Acid &ast* a%ramine/rhodamine stains

,in lesions or nasal scraping

Anaestheic checs

6ran%lomato%s &ormation

$epromin sin test . not &or $epromato%s leprosy

DiagnosisDiagnosis


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T%berc%loid leprosy.

Dapsone combined ith ri&ampin

$epromato%s leprosy.

Dapsone* ri&ampin and clo&a7imine

Borderline leprosy. ith E+$(erythema nod%s%m lepros%m)

Thalidomine

TreatmentTreatment


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HE84E,9-8-DAEHE84E,9-8-DAE


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H%man Herpes 9ir%sesH%man Herpes 9ir%ses

12 Herpes simples 'ir%s type 12

32 Herpes simples 'ir%s type 32"2 9ariocella 7oster 'ir%s2:2 ;ytomegalo'ir%s,H9)2


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,i&at/si&at 9ir%s Herpes,i&at/si&at 9ir%s Herpes 9irion. spheris* icosahedral capsid

6enom . linear* D+A %ntai ganda 4rotein. ? "< @enis protein pada 'irion En'elope. glioprotein* reseptor Fc

8epliasi. n%cle%s bert%nas dari membran n%clear2

;iri has in&esi 'ir%s herpes.12Menyebaban in&esi laten

32 Menetap secara inde&eniti& pada penderita

"2 ,ering reati& pada imm%nos%ppressed host


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-n&esi 'ir%s herpes pada man%sia-n&esi 'ir%s herpes pada man%sia

12 9ir%s herpes simples tipe 1

- hanya pada man%sia* tida memilii 'etorreser'oir hean- -n&esi laten. ,acral ganglia- sia terin&esi. ana balita- Transmisi pen%laran. onta langs%ng* sali'a

- 6e@ala >linis.a2 -n&2 4rimer.gingingostomatitis* pharyngotonsilitis*

eratocon@%cti'itis* in& neonatal2

b2 8ec%rent in&. &e'er* eratitis2

c2 -n& primer rec%rrent. Herpes %lit di atas pinggang* pd tangan*

si%* herpatic ithlo* ec7ema herpetic%m* genital herpes*

herpes encephalitis* herpes meningitis2


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3232 9ir%s herpes simples tipe 39ir%s herpes simples tipe 3

Tida memilii 'etor rese'oir hean2 sia terin&esi. deasa m%da Transmisi. se0%al 6e@ala linis.12 -n& primer. -n& neonatal32 -n& primer rec%rent. herpes %lit di baah pinggang* pd

tangan* si%* herpetic ithlo* genital herpes* herpes

meningitis2


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"2 9ir%s 9aricella/oster"2 9ir%s 9aricella/oster

A2 9aricella (chicenpo0)Ccacar air

,angat men%lar* ter%tama pada ana m2i . 1/31 hr* transmisi. sal na&as* con@%cti'a 6>. malaise* demam* diaali rash pada badan em%dian pada

a@ah* ai tangan* 3/: hr em%dian m%nc%l ma%la*

pap%la dan er%psi 'esic%lar pada %lit dan m%osa2 >ompliasi. encephalitis* pne%monia2

B2 oster.

-n&esi a%t pada syara& dorsal root ganglion -n&lamasi nyeri hebat pd ganglia %nilateral pada badan*

epala leher2


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H%man herpes 'ir%s =H%man herpes 'ir%s = T/ lymphtropic HH9 =. 1G=2 6>. e0anthema s%bit%m pd in&ant (roseola in&ant%m)

demam* sin rash2

H%man Herpes 9ir%s !

T/lyphotropic HH9 !. 1GG -n& pada ana2 Deat dg si&at cytomegalo'ir%s2

H%man Herpes 9ir%s

Diseb%t @%ga >,H9 (>aposis ,arcoma asscociated Herpes 9ir%s)*s0%ally transmitted2

9ir%s di@%mpai pada G penderita ,arcoma >aposi (t%mor'asc%lar) pd penderita A-D,2


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4OI9-8-DAE4OI9-8-DAE

$argest most comple0 o& 'ir%ses

Three po0 'ir%ses o& medical important.,mallpo0 'ir%s* 'accinia 'ir%s* and moll%sc%m

contagios%m2


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4OI9-8-DAE4OI9-8-DAE

,tr%ct%re composition./ O'al or bric shaped* :nm (length) 0 3"nm (

)

e0ternal s%r&ace shos ridges* contains core lateral

bodies/ ;omposition. D+A (")*protein (G)* lipid(


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,tr%ct%re composition.

/ 9ery resistant to inacti'ation

/ 4arapo0'ir%s. 3=01=nm* smaller than

orthopo0'ir%s

genomes. MJ


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9A;;-+-A 9A8-O$A9A;;-+-A 9A8-O$A

(4o0'ir%s in&ection in h%mans)(4o0'ir%s in&ection in h%mans)

1!G . Nenner introd%ced 'accination ith li'e 'ir%s

1G=! . JHO orldide campaign toeradicate smallpo0

1G . smallpo0 as o&&icially declaredeliminated


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;omposition o& 'accinia 'ariola 'ir%ses.;omposition o& 'accinia 'ariola 'ir%ses.

Host ./ 'ariola . only h%mans moneys

/ 'accinia . broad host range* incl%ding

rabbits mice 6ro on chorioallantoic membrane o& 1/13 days

old chic embryo* b%t 'ariola prod%ces m%ch

smaller pocs

6ro in se'eral types o& chic primate cell

lines


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4athogenesis o& smallpo0.4athogenesis o& smallpo0.

-4ortal o& entry . m%co%s membranes o& %pper

respiratory tract

- A&ter 'iral entry .

12 primary m%ltiplication in the lymphoid tiss%e draining the site o& entry

32 transient 'iremia and in&ection o& retic%lo/

endothelial cells thro%gho%t the body "2 secondary phase o& m%ltiplication in those cells

:2 secondary* more intense 'iremia


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;linical &indings .;linical &indings .

-nc%bation period o& 'ariola (smallpo0) C 13 days

12 Fe'er malaise . 1/< days32 E0anthems appear . / pap%lar (1/: days)

/ 'esic%lar (1/: days)

/ p%st%lar (3/= days)

"2 ;r%sts &ormed (3/: ees a&ter 1st

sign o& lesion) and lea'ing pin that &aded sloly


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$aboratory diagnosis.$aboratory diagnosis.

a2 -solation identi&ication . / sin lesions specimen (choice &or 'iral isolation)

/ direct e0am (electron microscope) .

rapid identi&ication o& 'iral particles (P 1 hr) di&&erentiate po0'ir%s in&ection &rom

chicenpo0

/ 'iral isolation is carried o%t by inoc%lation o& 'esic%lar &l%id onto the chorioallantoic

membrane o& chic embryos


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$aboratory diagnosis.$aboratory diagnosis.

/ in 3/" days 'accinia pocs are large ith

necrotic centers* hereas 'ariola pocs are

m%ch smaller

/ cell c%lt%res also be %sed &or 'iral isolation

(orthopo0* parapo0'ir%ses)

/ agar gel precipitation K detect 'iral antigen*

identi&ies orthopo0'ir%ses as a gro%p

b2 ,erology . H-* +t* E$-,A* 8-A orimm%no&l%orescence tests

/ antibodies appear a&ter 1stee in&ection

/ cannot disting%ish among orthopo0'ir%ses


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Moll%sc%m contagios%m (M;9)Moll%sc%m contagios%m (M;9)

M;9. transmitted by close personalcontact* incl%ding se0%ally2 The disease is 5%ite common in children*

and the lesions can be ide spread in

patients ith red%ced cell%rar imm%nity2

-n imm%nocompetent patients* the lesionsare sel&/limited b%t may last &or month2


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;linical Findings.;a%ses small* pin* pap%lar* artliebenign t%mors o& the sin or m%co%s

membranes2 The lesions ha'e a

characteristic c%p/shaped crater ith a

hite core2


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4apo'a'iridae4apo'a'iridae


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-mportant properties o& 4apo'a'ir%ses-mportant properties o& 4apo'a'ir%ses

9irion. -cosahedral ;omposition. D+A (1)* protein (G) 6enome. ds D+A* circ%lar* MJ "/< million En'elope. none

8eplication. n%cle%s O%tstanding characteristic./ ,tim%late cell D+A synthesis

/ 4olyoma'ir%ses are signi&icant ca%ses o& h%man disease

/ 9iral oncoprotein interact ith cell%lar t%mor s%pressor proteins


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-mportant properties o& 4apo'a'ir%ses-mportant properties o& 4apo'a'ir%ses

Oncogenic potential t!or in natral host "eslt o# natral in#ection$ Benign t!or (wart) Target tisse$ %r#ace epithelia

Most signi&icant h%man illness$ %&in wartslaryngeal papillo!as cervical carcino!a !portant ani!al isolates$ Papillo!avirses #ro!

cows and rabbits

4 ill i4 ill i


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4apilloma'ir%s4apilloma'ir%s ;a%se. sin arts* plantar arts* &lat arts*

genital condylonmas* laryngeal papillomas inh%man2

H49 ./ se0%ally transmitted genital lesions*

/ premalignant and malignant disease o&

'%l'a* cer'i0* penis and an%s2

/ genital condylomas* dysplasia to

in'asi'e cer'ical cancer (H49 type 1=* 1*

and 11* "1* ""* "


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dms. skin infections

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