MICP

• Macule


  A flat, distinct, discolored area of skin that usually does not include a change in skin texture or thickness

  
• Papule


  A small, well-defined bump in the skin

  
• Vesicle


  A small fluid-filled bladder, sac, cyst, or vacuole within the body
• Bullae


  Bigger than a vesicle
• Pustule


  A bulging patch of skin that's full of a yellowish fluid called pus
• Plaque


  Raised red patches covered with a whitish buildup of dead skin cells called scale

  
• Nodule


  Abnormal tissue growths that can be found anywhere in the body (more than 5mm)
• Urticaria


  Red and sometimes itchy bumps on your skin

  
• Petechiae


  Tiny spots of bleeding under the skin or in the mucous membrane

  
• Purpura


  Discoloration of the skin or mucous membranes due to hemorrhage from small blood vessels
• Ecchymosis


  Discoloration of the skin resulting from bleeding underneath, typically caused by bruising

  
• Ulcer


  Open round sores that develop when blood can't flow to an injury
• Eschar


  Dead tissue that forms over healthy skin and then, over time, falls off (sheds)
• Staphylococcus aureus


  • Gram-positive coccus
  • Arranged in grapelike clusters
  • A usual member of the microbiota of the body, frequently found in the upper respiratory tract and on the skin
  • The most dangerous of all of the many common staphylococcal bacteria
• Skin infections transmitted through

  1. Direct contact with person having purulent lesions

  2. From hands of healthcare hospital workers

  3. From fomites like bed linens, contaminated articles

  
• Clinical Findings of Staphylococcus Aureus

  • Folliculitis
  • Furuncle
  • Carbuncle
  • Stye or Hordeolum
  • Impetigo
  • Staphylococcal scalded skin syndrome (SSSS / Ritter's disease)
• Folliculitis


  A common skin condition in which hair follicles become inflamed, a pyogenic (pus producing) infection involving the hair follicles
• Furuncle


  An infection of a hair follicle that has a small collection of pus (called an abscess) under the skin, an extension of folliculitis
• Carbuncle


  A red, swollen, and painful cluster of boils that are connected to each other under the skin, representing a coalesce of furuncles that extends into the subcutaneous tissue with multiple sinus tracts

  
• Stye or Hordeolum


  Involves one or more of the small glands near the base of the eyelashes, a red & painful folliculitis often filled with pus
• Pyoderma/ Impetigo


  An infection common in young children, primarily involving the face and limbs, starting as a macule which later becomes a pus-filled vesicle that ruptures and forms a honey-colored crust
• Staphylococcus Scalded Skin Syndrome (SSSS)

  Also known as Ritter's Disease, primarily found in newborns and young children, caused by an exfoliative toxin that affects only the outer layer of the skin with no scarring

  
• Treatment and Prevention


  • Beta Lactam antibiotics
  • Incision and drainage (I & D)
  • Use Standard Precautions for skin, burn, and wound infections if they are minor
  • Contact Precaution if major, SSSS
  • Standard Precautions for infections caused by methicillin-resistant S. aureus (MRSA); add Contact Precautions if wounds cannot be contained by dressing
• Staphylococcus epidermidis


  • Part of the normal flora of the skin
  • Associated with "stitch abscess", UTI and endocarditis
  • Causes infections in individuals with prosthetic devices, cardiac devices, CNS shunts
• Streptococcus pyogenes


  • Gram positive cocci arranged in pairs or chains
  • Belongs to Group A beta hemolytic streptococcus (causes complete hemolysis of the blood)
  • Major virulence factor is M protein which is anti-phagocytic
  • Produces enzymes and toxins responsible for the pathogenicity
  • Some strains are encapsulated
  • Associated with severe systemic infections
• Clinical Findings of STREPTOCOCCUS PYOGENES

  • Pyoderma (impetigo)
  • Erysipelas
  • Cellulitis
  • Necrotizing fascitis

  
• Pyoderma (Impetigo)


  A purulent skin infection that is localized and commonly involves the face, and the upper and lower extremities, starting as vesicles then progressing to pustules lesions that rupture and form honey-colored crusts

  
• Cellulitis


  Involves the skin and subcutaneous tissue, the infected skin and the normal skin is not clearly differentiated, with local inflammation and systemic signs

  
• Erysipelas


  Also known as St. Anthony's fire, a superficial form of cellulitis that follows a respiratory or skin infection, affecting the upper dermis and extending into the superficial cutaneous lymphatics
• Necrotizing Fascitis


  Also known as 'flesh-eating' or streptococcal gangrene, involves deep subcutaneous tissue, starts as cellulitis then becomes bullous and gangrenous, spreads to the fascia then to the muscle and fats, may become systemic and cause multi-organ failure to death
• Complications of Strep Infections

  • Acute glomerulonephritis: commonly associated with skin infections
  • Rheumatic fever: associated with throat infections
  • Scarlet fever/ Scarlatina: develops in some people who have strep throat
• Treatment and Prevention


  • Penicillin
  • In case of penicillin allergy, macrolides (erythromycin, azithromycin) or cephalosporins are alternate drugs
  • Drainage of pus and thorough debridement of infected tissues
• Pseudomonas Aeruginosa


  • An opportunistic aerobic gram-negative bacillus
  • A frequent & common cause of nosocomial infection
  • Capable of water-soluble pigments (pyocyanin-blue)
  • Resistant to most antibiotics
  • Virulence is attributed to adhesins (flagella, pili, LPS), toxins (exotoxin A, pigments) & enzymes
• Pseudomonas Aeruginosa


  Aerobic, Exotoxin A, Rod/resistance, UTI, burns, injuries, Green-blue dressing, Iron-containing lesions, Negative gram, Odor of grapes, Slime/capsule sometimes, Adherin pili
• Clinical Findings of Pseudomonas Aeruginosa

  • Ocular keratitis in contact lens wearers, endocarditis and osteomyelitis in IV drug users
  • External otitis (swimmer's ear) in healthy people, and severe external otitis in diabetic patients
  • Respiratory failure caused by P. aeruginosa infection in many persons with cystic fibrosis
  • Frequent infection of extensive skin burns, which can lead to sepsis
• Clostridium Perfringens


  • Gram positive bacilli
  • Anaerobic and rarely produce endospores
  • Produce 4 lethal toxins: alpha, beta, iota, epsilon toxin (alpha: most lethal toxin because it causes massive hemolysis and bleeding and tissue destruction)
  • Associated with soil, water & feces
• Clinical Findings of Clostridium Perfringens

  • Cellulitis: common bacterial skin infection that causes redness, swelling, and pain in the infected area of the skin
  • Suppurative myositis: an acute intramuscular infection that spreads into the body of skeletal muscle, manifested by abscess formation of large muscle groups
  • Myonecrosis or gas gangrene: a life-threatening infection following trauma or surgery, characterized by massive tissue necrosis with gas formation, shock, renal failure, and death within 2 days of onset
• Bacillus Anthracis


  • A gram-positive, spore-forming rod: bamboo rod or medusa head appearance
  • Produces anthrax toxin resulting in an ulcer with a black eschar
  • Deadly disease to livestock and, occasionally, to humans
  • Able to grow slowly in soil types that meet specific moisture conditions
  • Endospores survived in soil tests for up to 60 years
  • Can be used in bioterrorism

  
• 3 Forms of Anthrax Disease

  • Cutaneous: inoculation into the open skin from either the soil or infected animal products
  • Gastrointestinal: ingestion of infected meat or milk
  • Inhalational: inhalation of aerosolized spores

  
• Laboratory Diagnosis of Anthrax

  • Blood test detects both inhalational and cutaneous cases of anthrax within an hour
  • The peripheral blood contains a large number of B. anthracis which is easily seen on gram-stain
  • Spores can be done using Dorner stain or Wirtz Conklin