Download - K 10 Skin Infections
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Mikroorganisme yang
menyebabkan penyakit di kulit
( bakteri & virus) Bakteri : Mybobacterium leprae
Virus DNA : HHV! dan HHV"
HHV# ( V$V) Variola virus
%arvovirus B!
HHV' & HHV
H%V Molluscum contagiosum virus
Virus NA : Measles virus
ubella virus
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MycobacteriaMycobacteria
(Acid *ast Bacilli)(Acid *ast Bacilli)
+bligate pat,ogens
Mycobacterium tuberculosis- TB Mycobacterium bovis- bovine TB Mycobacterium leprae- Hansen's disease,
(leprosy) ,Morbus Hansen
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Morbus Hansen ( -eprosy )Morbus Hansen ( -eprosy )
%enyebab : Mycobacterium leprae
Mengandug se.umla, besar mycolic acids di permukaan
selnya/ Berkembang biak lambat sekali/
Mengin0eksi kulit1 sara01dan selaput lendir/ Belum dapat dibiakkan di -aboratorium atau cell culture1
tapi suda, dapat dibiakkan di mouse 0oot pads danarmadillo/
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-eprosy-eprosy
-eprosy 2ara in0eksinya belum diketa,ui1 tapi mungkin melalui
respiratory droplets 3ebanyakan orang resisten ter,adap in0eksi dan tidak sampai
berkembang active disease
Kontak yang lama dan intim dengan pasien
lepromatous via :
Nasal secretion
Skin lesions
Inhalation
TransmisiTransmisi
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%er.alanan %enyakit :%er.alanan %enyakit :
Di kulit pasien timbul discolored patc,es yang tidak itc,
or ,urt
%atc,es seperti pada tinea (ring4ormlike patc,es)1dengan pinggir yang meninggi/
%asien mengelu, adanya loss o0 0eeling 4it,in t,e patc, o0
discolored skin
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LeprosyLeprosy
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-eprosy 5 ge.alage.ala lain:
loss o0 eyebro4s t,ick or lumpy earlobes loss o0 0eeling (burns or scars) painless ulcers on t,e 0eet drop 0eet de0ormities o0 ,ands and6or 0eet
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Facial appearance yang klasik pada advanced leprosy
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LeprosyLeprosy
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ulcers, resorption of boneulcers, resorption of bone
worsened from careless use of hands (nerve damageworsened from careless use of hands (nerve damage
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Diagnosis -epra:
%ada penyakit yang tela, lama1 pasien mengelu, adanyanumbness or tingling di tangan dan kaki ( ,ands and 0eet)
%embesaran syara0 di lengan dan le,er
Mycobacterium leprae di.umpai di lesi kulit/( skin lesions)
7lkus yang tidak nyeri (painless ulcers) terin0eksi1
8 kemudian ulkus yang terin0eksi ini akan mengalaminekrosis/
3arena tanpa nyeri1 in0eksinya tanda disadari pasien akanmenyerang .aingan lebi, dalam ( tulang)
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!da dua bentuk utama :
"# Tuberculoid leprosy (TT
$# %epromatous leprosy (%%
&entuk lain: &orderline leprosy
Low TT BT BB BL LL High
prognosis jejek
'anifestasi Klinis'anifestasi Klinis
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9uberculoid -eprosy (99)
Biasanya pada pasien dengan daya ta,an tubu, yang relati0tinggi/
%ada skin smear tidak di.umpai bakteri/
%asien tidak menularkan penykit ke orang lain/
kin patc,es sedikit1 bentuknya variabel 1 tapi sering bagianpinggr meninggi dan bagian central rata ( 0lat )
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9uberculoid -eprosy (99)
Biasanya pasien mengelu, adanya loss o0 0eeling inskin patc,es
;ika tangan atau kaki terlibat dan menyebabkan loss
o0 0eeling pada sala, satu tangan atau kaki sa.a/
espons ter,adap pengobatan biasanya cepat
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Borderline -eprosy
%ada skin smears di.umpai sedikit atau
banyak bakteri /
many skin patc,es1 some 0eeling loss1 patc,esabout t,e same on bot, sides o0 t,e body
severe nerve damage1 loss o0 0eeling and
strengt,1 de0ormities in bot, ,ands and bot, 0eet
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Borderline -eprosy
Borderline leprosy dibagi atas
Borderline tuberculoid (B9)
Borderline (BB)
Borderline lepromatous (B-)
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%epromatous %eprosy (%%
ada pasien dengan daya tahan tubuhrendah
ada skin patches di)umpai se)umlah besar'ycobacterium leprae
asien adalah infectious sehingga diobati
Skin patches, sering disertai dengandaerah*daerah menebal atau raised lumps
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-epromatous -eprosy (--) *acial skin becomes t,ick1 lumpy1 reddis,1 terutama
diatas alis mata1 pipi1 ,idung dan telinga/
Bridge o0 t,e nose mungkin secara perla,anla,an
akan mencekung ( sink )
;ika tidak diobati maka akan ter.adi kerusakan sara0 danparalisis
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-epromatous -eprosy (--)
-oss o0 0eeling and strengt, a00ects bot, ,ands and
bot, 0eet e
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!cid fast, auramine*rhodamine stains
Skin lesions or nasal scraping
!naesthetic checks
+ranulomatous formation
%epromin skin test : not for %epromatous leprosy
DiagnosisDiagnosis
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Tuberculoid leprosy:
apsone combined with rifampin
%epromatous leprosy:
apsone, rifampin and clofa-imine
&orderline leprosy: with .N%(erythema nodusum leprosum
Thalidomine
9reatment9reatment
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H=%=V>>DA=H=%=V>>DA=
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H7MAN H=%= V>7H7MAN H=%= V>7
!/ Herpes simpleks virus type !/ ( HV!)
"/ Herpes simpleks virus type "/( HV")
#/ Varicella ?oster virus ( V$V)
@/ 2ytomegalovirus ( 2MV)
/ =pstein Barr virus ( =BV)
'/ Human Herpes virus '/( HHV ')
/ Human Herpes virus / (HHV )
/ Human Herpes virus (HHV ):
(3aposiCs arcoma Herpesvirus :3HV)/
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i0atsi0at Virus Herpesi0atsi0at Virus Herpes
Virion: sp,eris1 icosa,edral capsid
enom : linear1 DNA untai ganda
%rotein: E # .enis protein pada virion=nvelope: glikoprotein1 reseptor *c
eplikasi: nucleus bertunas dari membran nuclear/
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i0atsi0at Virus Herpesi0atsi0at Virus Herpes
2iri k,as in0eksi ole, virus ,erpes:
! Menyebabkan in0eksi laten
" Menetap secara inde0initi0 pada penderita
#/ Dapat direaktivasi terutama pada immuno
suppressed ,ost
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!/ Virus ,erpes simpleks tipe ! ,anya pada manusia1 tidak memiliki vektor6reservoir ,e4an
>n0eksi laten: 9rigeminal ganglia
7sia terin0eksi: anak balita
9ransmisi6 penularan: kontak langsung1 saliva
e.ala 3linis:
a/ >n0/ %rimer:gingingostomatitis1 p,aryngotonsilitis1
keratocon.uctivitis1 in0 neonatal/
b/ ecurent in0: 0ever1 keratitis/
c/ >n0 primer6 recurrent: Herpes kulit di atas pinggang1 pd tangan1
siku1 ,erpatic 4it,lo41 ec?ema ,erpeticum1 genital ,erpes1
,erpes encep,alitis1 ,erpes meningitis/
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Virus ,erpes simpleks tipe "Virus ,erpes simpleks tipe "
9idak memiliki vektor6 resevoir ,e4an/
7sia terin0eksi: de4asa muda
>n0eksi latent : acral ganglion
9ransmisi: seFual
e.ala klinis:
!/ >n0 primer: >n0 neonatal
"/ >n0 primer6 recurent: ,erpes kulit di ba4a, pinggang1 pd tangan1 siku1
,erpetic 4it,lo41 genital ,erpes1 ,erpes meningitis/
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#/ Varicella$oster Virus (V$V)#/ Varicella$oster Virus (V$V)
A/ Varicella (c,ickenpoF)Gcacar air
angat menular1 terutama pada anak
Masa inkubasi : : !"! ,r1 transmisi: sal na0as1 con.unctiva
3linis: malaise1 demam1 dia4ali ras, pada badan kemudian pada 4a.a,1 kaki
& tangan1 "@ ,r kemudian muncul makula1 papul8a dan erupsi vesicular
pada kulit dan mukosa/ 3omplikasi: encep,alitis1 pneumonia/
B/ $oster ( Herpes $oster )
>n0eksi akut pada syara0 & dorsal root ganglion
>n0lamasi& nyeri ,ebat pd ganglia unilateral pada badan1 kepala & le,er/
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Human ,erpes virus 'Human ,erpes virus '
9 lymp,tropic HHV ': !'/
3linis:: eFant,ema subitum pd in0ant (roseola in0antum)
demam1 skin ras,/
Human Herpes Virus 9lyp,otropic HHV : ! >n0 pada anak/ Dekat dg si0at cytomegalovirus/
Human Herpes Virus Disebut .uga 3HV (3aposiCs arcoma asscociated Herpes
Virus)1 seFually transmitted/
Virus di.umpai pada I penderita arcoma 3aposi (tumor
vascular) pada penderita A>D/
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%+JV>>DA=%+JV>>DA=
-argest & most compleF o0 viruses
9,ree poF viruses o0 medical important:
mallpoF virus1 vaccinia virus1 and molluscum contagiosum/
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%+JV>>DA=%+JV>>DA=
tructure & composition: +val or brick s,aped1 @nm (lengt,) F "#nm ()
eFternal sur0ace s,o4s ridges1 contains core & lateral
bodies 2omposition: DNA (#I)1protein (I)1 lipid(I)
enome: linear double stranded DNA1 MK !F!'
ric, in adenine & t,ymine bases1 lo4guaninepluscytosine
2ontain E! polypeptides L many en?imes in core
=nvelope ()
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tructure & composition:
Very resistant to inactivation
%arapoFvirus: "'F!'nm1 smaller t,an
ort,opoFvirus
genomes: MK J!'1 ,ave a
,ig,er guaninepluscytosine
content ('#I)
7ni
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VA22>N>A & VA>+-AVA22>N>A & VA>+-A
(%oFvirus in0ection in ,umans)(%oFvirus in0ection in ,umans)
! : ;enner introduced vaccination 4it, live
virus
!' : KH+ 4orld4ide campaign to
eradicate smallpoF
! : smallpoF 4as o00icially declared
eliminated
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2omposition o0 vaccinia & variola viruses:2omposition o0 vaccinia & variola viruses:
O Host : variola : only ,umans & monkeys
vaccinia : broad ,ost range1 including
rabbits & miceO ro4 on c,orioallantoic membrane o0 !!" days
old c,ick embryo1 but variola produces muc,
smaller pocksO ro4 in several types o0 c,ick & primate cell
lines
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%at,ogenesis o0 smallpoF:%at,ogenesis o0 smallpoF:
%ortal o0 entry : mucous membranes o0 upper
respiratory tract
A0ter viral entry :
!/ primary multiplication in t,e lymp,oid tissue draining t,e site o0 entry
"/ transient viremia and in0ection o0 reticulo
endot,elial cells t,roug,out t,e body #/ secondary p,ase o0 multiplication in t,ose cells
@/ secondary1 more intense viremia
/ clinical disease
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2->N>2A- *>ND>N :2->N>2A- *>ND>N :
>ncubation period o0 variola (smallpoF) G !" days
!) *ever & malaise : ! days
") =Fant,ems appear
papular (!@ days vesicular (!@ days)
pustular ("' days)
crusts 0ormed ("@ 4eeks a0ter !stsign o0 lesion)
and leaving pink t,at 0aded slo4ly
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-AB/ D>AN+>:-AB/ D>AN+>:
a/ >solation & identi0ication : skin lesions specimen (c,oice 0or viral isolation)
direct eFam (electron microscope) :
rapid identi0ication o0 viral particles (P ! ,r) di00erentiate poFvirus in0ection 0rom
c,ickenpoF
viral isolation is carried out by inoculation o0 vesicular 0luid onto t,e c,orioallantoic
membrane ( 2AM ) o0 c,ick embryos
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-AB/ D>AN+>-AB/ D>AN+>
>n "# days vaccinia pocks are large 4it, necrotic
centers1 4,ereas variola pocks are muc, smaller
2ell cultures also be used 0or viral isolation
(ort,opoF1 parapoFviruses)
Agar gel precipitation L detect viral antigen1
identi0ies ort,opoFviruses as a group
b/ erology : H>1 Nt1 =->A1 >A or
immuno0luorescence tests antibodies appear a0ter !st4eek in0ection
cannot distinguis, among ort,opoFviruses
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Molluscum contagiosum virus (M2V)Molluscum contagiosum virus (M2V)
M2V: transmitted by close personal
contact1 including seFually/
9,e disease is n immunocompetent patients1 t,e
lesions are sel0limited but may last 0ormont,/
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2linical *indings:
2auses small1 pink1 papular1 4artlike
benign tumors o0 t,e skin or mucous
membranes/9,e lesions ,ave a c,aracteristic cup
s,aped crater 4it, a 4,ite core/
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%apovaviridae%apovaviridae
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%apovaviridae%apovaviridae
Virion: >cosa,edral 2omposition: DNA (!I)1 protein ()I
enome: ds DNA1 circular1 MK # million
=nvelope: none
eplication: nucleus
+utstanding c,aracteristic:
timulate cell DNA synt,esis
%olyomaviruses are signi0icant causes o0 ,uman disease
Viral oncoprotein interact 4it, cellular tumor supressor proteins
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>mportant properties o0>mportant properties o0
%apovaviruses%apovaviruses
Oncogenic potential tumor in natural host
esult o! natural in!ection" Benign tumor (#art)
Target tissue" $ur!ace epithelia
Most signi0icant ,uman illness"$%in #arts, plantar #arts !lat #arts
Laryngeal papillomas,
&ervical carcinoma
enital condyloma
mportant animal isolates" apillomaviruses !rom
co#s and rabbits
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Human %apillomavirus ( H%V)Human %apillomavirus ( H%V)/
seFually transmitted genital lesions1
premalignant and malignant disease o0
vulva1 cerviF1 penis and anus/ genital condylomas1 dysplasia to
invasive cervical cancer (H%V type !'1 !1
and !!1 #!1 ##1 #)/ -aryngeal papilloma in c,ildren: H%V '1 !!
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Asosiasi H%V dengan lesi klinis
9ypes H%V 2linical -esions uspectedoncogenic potential
! %lantar 4arts Benign
" 2ommon 4arts Benign
#1 !1 " *lat 4arts1 epidermodysplaciaverruci0ormis
arelymalignant
1=pidermodysplasia verruci0ormisin patients 4it, 2M> de0iciency #I progressto malignancy
Hands 4arts o0 meat &
animal ,andlers
benign
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'1 !! Anogenital condylomas8laryngeal papillomas :dysplasia and intra epit,elial neoplasmas1grades > & >>
-o4
1 !"1 !@
!1 !
! 5 "
#'1 @
=pidermodysplasiaverruci0ormis
ome progress to2a (e/g/ H%V !"1!1"
!#1 #" +ral local eipt,elial,yperplasia
%ossible progressionto 2a
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!'1 !1 #!1 ##1#1 #
Hig, grade dysplasia andcarcinomas o0 genitalmucosa1laryngeal andesop,agealcarcinomas8Bo4en disease
Hig, correlation4it, genital andoral carcinoma
"'1 "1 " 2utaneous 4arts Q
#1 @ -aryngeal 2a Maligna
# 3eratoacant,oma Benign
@!1 @" enital 4arts Benign
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9,ank RouS9,ank RouS