Important diseases (1)

Skin, Mucosal Membrane and

Eyes
 Skin
• Outer layer epidermis, inner layer dermis.

• The skin is a physical barrier against microorganisms.

• Moist areas of the skin (such as the armpit) support larger

populations of bacteria than dry areas (such as the scalp).

• Human skin produces antibiotics called defensins.

 STRUCTURE AND FUNCTION OF THE
SKIN

• The outer portion of the skin (epidermis) contains

keratin, a waterproof coating- prevent water from
entering body.
• The inner portion of the skin, the dermis, contains
hair follicles and sweat pores that provide
passageways for microorganisms.
• The skin generates antimicrobial substances.
• Embedded in the dermis, durable part of the skin,
sebaceous glands and sweat glands.
• Sebaceous glands produce an oily secretion called
sebum (consist mainly organic acids and lipid).
Maintain acidic skin pH that discourage pathogen
growth. Increase sebum secretion in puberty,
contribute to the development of acne.
 STRUCTURE AND FUNCTION OF THE
SKIN – cont.

• Sweat glands – watery secretion through

pores in the skin. In armpits and groin,
these glands secrete organic substances
in the sweat that lower the skin pH, again
inhibiting the growth of pathogens.
• High salt content in sweat also inhibits
many microorganisms.
 Mucous membrane
• Lining of tissues and organs that open to the
exterior of body, especially those of respiratory
tract, digestive and urogenital system.

• Thin epidermal layer and a deeper connective

tissue layer.

• Epithelial cells secrete mucus by goblet cell–

preventing drying and cracking of mucus
membrane. Mucus trap pathogen.
 Eyes

• External protective structures- eyelids,

eyelashes, conjunctiva (a mucuos
membrane covering the inner surface of
each eyelids and the anterior region of
each eye), cornea, lacrimal gland (secrete
lacrimal fluid (tears))
• Tears contain lysozyme – enzyme that
break down bacterial cell wall. No normal
microflora in eyes.
 NORMAL MICROBIOTA OF THE
SKIN
• Microorganisms that live on skin are resistant to
desiccation and high concentrations of salt.
• Gram-positive cocci predominate on the skin.
Staphylococcus (salt tolerant), Micrococcus and
coryneform bacteria (eg: Corynebacterium and
Proprionibacterium acnes)
• The normal skin microbiota are not completely
removed by washing.
• Members of the genus Propionibacterium
metabolize oil from the oil glands and colonize
hair follicles.
• Malassezia furfur yeast grows on oily secretions
and may be the cause of dandruff.
 MICROBIAL DISEASES OF THE
SKIN
1. Localized infections (sties,
pimples, and carbuncles)
result from S. aureus entering
hair follicle - foliculitis
- producing pus, can goes
into blood and antibiotic
cannot reach.
- Removed. Furuncle —
Staphylococcus aureus
- Easily spread: carrier with
no symptom.
2. Scalded skin syndrome

- Toxemia occurs when toxins

enter the bloodstream.
- S. aureus – 2 different
exotoxin, both called
exfoliatins toxin
The patient a few hours
- Often baby than adult. after the diagnosis of
Reddened area begin at staphylococcal scalded
skin syndrome, when
mouth spread within 24-48 hrs. 90% of the total body
- High fever-- bacteremia, area was blistered.
septicemia and death within 36
hrs.
3. Erysipelas (reddish patches) also called St. Anthony fire.
Streptococci produce toxic byproducts (Group A beta
hemolytic toxin) and enzyme hyaluronidase.
4. Impetigo, a highly contagious skin infections caused
by Staphylococci, Streptococci, or both together.
-Most in children- Easily transmitted- day care center.
Why adults are not susceptible is unknown.
Treatment: penicillin.
5. Scarlet fever (sometime called scarlatina)-
Streptococcus pyogenes –produce erytrogenic
toxin (red producing), scarlet fever rash.
Three different erythrogenic toxins have been
identified. A person can develop scarlet fever
once from each toxin – streptococcal pyrogenic
exotoxins.

Bright red rash on body, together with fever and

sore throat
• Patient who already has antibodies, will get
sore throat without scarlet fever rash. They can
transmit this fever to others.
• Treatment penicillin, resistant organisms.
Scarlet fever is contagious at first, but after 24 hours of antibiotics, it can no
longer be spread
6. Tetanus
• Vaccine-preventable disease.
• Does not spread from person to person.
• Infection from bacteria through skin.
• Jaw cramping, muscle spasms usually in
stomach, painful muscle stiffness all over the
body, trouble swallowing, headache, fever and
sweating, changes in blood pressure and a fast
heart rate.
• Treatment: antibiotics.
• Vaccination: DTaP (infant), 3 doses for pregnant
women.
 Viral Diseases of the Skin
1. Warts
• Papillomaviruses- human papillomavirus (HPV) cause skin
cells to proliferate and produce a benign growth called a
wart or papilloma.
• Warts are spread by direct contact.
• Can be distinguished by immunological tests and
microscopic examination.
• Treatment: excision of infected tissue and chemical agents.
2. Rubella/German measles, togavirus: Rubella virus -
skin rash, women only. Virus spread in blood and tissue
16-21 days before rash appear.
Infected person suffer from joint pain (virus attack to joint
membranes).

• Congenital rubella syndrome- If infected fetus 8 mth

pregnancy, organ defect. Damage from congenital
rubella syndrome includes stillbirth, deafness, eye
cataracts, heart defects, and mental retarded.
• Transmission by nasal secretion. Very dangerous to
children 5-14 yrs.

• Attenuated vaccine – before pregnancy to eliminate

transplacenta (MMR)- measles, mumps, and rubella
 Rubella
• In children, rubella is
often a mild disease, a
rash that begins on their
face and then spreads
from their head to their
toes.
• It can be a little itchy
• Unlike measles, children
with rubella often don't
have a fever and the rash
is fainter than the rash of
measles.
 Poxviruses

3) Smallpox (variola)
• Smallpox virus (orthopox virus)
– Variola major has 20% mortality
– Variola minor has <1% mortality
• Smallpox virus enter throat and respiratory tract > ~12
days incubation, its infect phagocytic cell and blood cells,
spread to skin cell and cause pus-filled vesicles, cause
fever, backache and headaches, scab appear first in the
mouth and throat, then rapidly to the face, forearms,
hands, and lower back.
Progression of smallpox: pus-filled vesicles and scabs on
face, body parts, throat and lower back.
4. Measles/ rubeola- fever with rash -
rubeola virus.
• Invades to lymphatic tissue and blood.
• Virus enter the body through nose, mouth or conjunctiva.
Symptom appear in 9-11 days in children and 21 days in
adult.
• Koplik’s spot, whitish spot on upper lips and cheek
mucosa, followed by fever, conjunctivitis and cough >
rash.
• very infectious- transmitted by the respiratory route, nasal
secretion
MMR vaccine - long-term immunity
• If the virus invade lungs, kidneys or brain, the common
childhood disease often is fatal.
Measles- Rubeola with Koplik’s spot
Children have measles before they were 10 years old.
5. Chickenpox (Varicella) and Shingles (Herpes Zoster)
• herpesvirus, one virus two diseases. Chickenpox (varicella,
children) and shingles (zoster, adult and
immunocompromised). Is localized in skin cells, causing a
vesicular rash.
• Chickenpox is a disease of childhood - 90% of cases occur in
children aged 14 years and younger
• After chickenpox, the virus can remain latent in nerve cells and
subsequently activate as shingles.
• Shingles (herpes zoster) is characterized by a vesicular rash
along the affected cutaneous sensory nerves.
• When virus release –fever and malaise. After 14-16 days skin
lesion at nerve end contain liquid.
Lesion at portal of entry at nerve end contain fluid. Painful and
itchy.
Lesion also portal of entry for secondary infection for Stap.
aureus. Can cause death – virus invade and damage cells that
line small blood vessel and lymphatic– blood clot- hemorrhage.
Death due to most blood vessel damaged in the
lung and accumulation of erythrocytes and
leukocytes in the alveoli.
• Very easilyy infected airborne.- highly
contagious.
• Treated with acyclovir or famciclovir in
immunocompromised patients. Treatment: live
attenuated vaccine

Chicken pox Shingles

Fungal Diseases of the Skin and Nails
1. Cutaneous Mycoses
• Fungi that colonize the outer layer of the epidermis cause
dermatomycoses called ringworm, or tinea.
• Trichophyton: Infects hair, skin, and nails
• Epidermophyton: Infects skin and nails
• Microsporum: Infects hair and skin
– Tinea pedis -athlete’s foot-highly contagious
– Tinea corporis – body ringworm (infection in arms and legs)
– Tinea cruris – groin (in skin folds in pubic region)
• These fungi grow on keratin-containing epidermis, such as hair,
skin, and nails.
• Ringworm and athlete’s foot are usually treated with topical
antifungal chemicals.
• Diagnosis is based on the microscopic examination of skin
scrapings or fungal culture
• Treatment
– Remove dead epithelial tissues and applying topical
antifungal ointment.
 Opportunistic
fungal Infection
1. Candidiasis
• Candida albicans causes infections of
mucous membranes and is a common cause
of thrush (in oral mucosa) and vaginitis.
• C. albicans is an opportunistic pathogen that
may proliferate when the normal bacterial
microbiota are suppressed.
• Topical treatment with antifungal drug
 Superficial candidiasis
appear as thrush, milky
patches of inflammation on
oral mucous membrane
especially in infants, diabetic
and those receiving
prolonged antibiotic therapy.

Candidiasis

Candida infections of the nail

are very difficult to eradicate.
2) Aspergillosis: Aspergillus fumigatus .
– Enter through wound, burns, cornea, ear
(ulcerate eardrum)
– In immunosuppressed patients can cause
pneumonia.
– Treatment: antifungal.
– Prevention mainly depend host defense.
 BACTERIAL DISEASES OF THE EYE

1) Conjunctivitis (pinkeye)
• Inflammation cause by Stapylococcus aureus, Streptococcus
pneumoniae, Neisseria gonorrhoease, Pseudomonas sp. and
Haemophilus influenzae.
• Contagious especially among children.
• Treatment: sulfonamide ointment.

2) Neonatal gonorrheal ophthalamia (Ophthalamia

neonatorum)
– is caused by the transmission of Neisseria gonorrhoeae and
Chlamydia trachomatis. from an infected mother to an infant
during its passage through the birth canal cesarean.
– Infection can cause keratitis, an inflammation of cornea,
cornea destruction and blindness.
• All newborn infants are treated with an antibiotic to
prevent Neisseria and Chlamydia infection.
• Treatment: Penicillin/ tetracyclin.
Ophthalamia neonatorum
3) Trachoma
– Chlamydia trachomatis infection >> swollen
conjunctiva
– Leading cause of blindness worldwide
– Infection causes permanent scarring of eyelids; scars
abrade the cornea leading to blindness
– scar tissue forms on the cornea. Swollen conjuctiva.
• Transmission: direct contact, formite, insect vector and during birth
• Penicillin or Tetracyclin (resistant).

Chronic inflammation of the eyelid

 Viral Disease of the Eye

1) Epidemic Keratoconjunctivitis (EKC)/ shipyard eye

- Cause by adenovirus
- Often infect workers from dust particles in the environment.
- After 8-10d infection, conjunctiva become inflamed, and eyelid
edema, pain, tearing, and sensitive to light.

2) Acute hemorrhagic conjunctivitis (AKC)

- Cause by ENTEROVIRUS
- Disease cause chiefly in warm, humid climate, crowd and poor
hygiene.
- Severe eye pain, abnormal sensitivity to light, blurred vision,
hemorrhage under conjunctival membranes.
 Protozoan Disease of the Eye

• Acanthamoeba keratitis
• Protozoan –active (trophozoite)
–dormant (cystic)
• Transmitted from water can cause a serious form of
keratitis.
• Associated with unsanitary contact lenses
• Common in swimmers
 CLINICAL FEATURES
• Blurred vision and disproportionate pain
• Patchy anterior stromal infilterates
• Perineural infilterates (radial keratoneuritis)
• Infilterates coalesce –ring abcess, ulceration and
hypopyon
• White satellite lesions