INFECTIONS and INFESTATIONS

INFECTIONS and INFESTATIONSINFECTIONS and INFESTATIONS

Dr. D. Czarnecki MD MBBSDr. D. Czarnecki MD MBBS

InfectionsInfections

• FolliculitisFolliculitis• Pustules and papules Pustules and papules

scattered across the scattered across the shinshin

• This case was caused This case was caused by using plastic by using plastic occlusion on a occlusion on a glucocorticosteroid glucocorticosteroid creamcream


• FolliculitisFolliculitis

• An out break of An out break of folliculitis was reported folliculitis was reported after hot tubs became after hot tubs became fashionable. Poor fashionable. Poor maintenance allowed maintenance allowed pseudomonas to pseudomonas to proliferate and infect proliferate and infect the follicles of those the follicles of those who used the tubs. who used the tubs.


• CellulitisCellulitis• The infection is The infection is

spreading through the spreading through the skin. It is indurated, red, skin. It is indurated, red, hot, and sore.hot, and sore.

• This case was a wound This case was a wound infection developing infection developing after surgery for skin after surgery for skin cancercancer


• ErysipelasErysipelas• The infection is The infection is

spreading through the spreading through the outer layer of the skin. outer layer of the skin.

• It is indurated, red, hot, It is indurated, red, hot, and sore.and sore.


• LymphangitisLymphangitis

• The infection is The infection is spreading through the spreading through the lymphatics. lymphatics.



• An abscessAn abscess

• A localized collection of A localized collection of pus. pus.


• Surgical drainage is Surgical drainage is indicated.indicated.


• TineaTinea

• There is a raised edge There is a raised edge and a clearing centre. and a clearing centre.

• You must look at the You must look at the feet.feet.

• Topical therapy on its Topical therapy on its own may be adequate.own may be adequate.


• TineaTinea

• There is a raised edge There is a raised edge and a clearing centre. and a clearing centre.

• You must look at the You must look at the feet.feet.

• You must take You must take scrapings for fungal scrapings for fungal culture – before culture – before prescribing antifungal prescribing antifungal agents.agents.


• Tines (ringworm)Tines (ringworm)

• The is a raised edgeThe is a raised edge

• The centre is red and The centre is red and scaly because a scaly because a glucocorticosteroid glucocorticosteroid cream was used in error cream was used in error (tinea incognito)(tinea incognito)

• The nails are the source The nails are the source of infectionof infection

Tinea nailsTinea nails

There is yellow-white discolouration and the There is yellow-white discolouration and the nails are ‘crumbling’nails are ‘crumbling’



• Hair loss, inflammation Hair loss, inflammation and scalingand scaling

• There may be There may be fluorescence under a fluorescence under a Woods lampWoods lamp

• Gently pull out some Gently pull out some hair for fungal culturehair for fungal culture



• The annular lesions The annular lesions have a raised edge with have a raised edge with a clearing centrea clearing centre

• This case was caused This case was caused by Micosporum canis by Micosporum canis (from the cat)(from the cat)


• ScabiesScabies

• There are burrows – There are burrows – silvery tracts in the silvery tracts in the skin. skin.

• The mite can be seen in The mite can be seen in scrapings taken from a scrapings taken from a burrow.burrow.


• ScabiesScabies

• A mite is visible. A mite is visible.

• Skin scrapings are Skin scrapings are taken from a burrow, taken from a burrow, potassium hydroxide is potassium hydroxide is added ant then this is added ant then this is examined under a examined under a microscope confirm the microscope confirm the diagnosis.diagnosis.


• Post scabetic papulesPost scabetic papules

• Itchy papules on the Itchy papules on the penis are scabies until penis are scabies until proved otherwiseproved otherwise. .

• A hypersensitivity A hypersensitivity reaction to the mite is reaction to the mite is believed to be the believed to be the cause. Intralesional cause. Intralesional triamcinolone is an triamcinolone is an effective treatment.effective treatment.

ScabiesScabies

Itchy papules on the penis Itchy papules on the penis are scabies until proved are scabies until proved otherwiseotherwise..

A louse crawling along the hairA louse crawling along the hair


• Herpes simplex (HS)Herpes simplex (HS)

• The grouped blisters The grouped blisters have ruptured to leave have ruptured to leave erosionserosions

• Type II HS has a Type II HS has a predilection for the predilection for the genitaliagenitalia

Herpes virus enters the skin

Travels along the axon

Lies dormant in the nerve body

Is activated, travels along the axon to the surface

Blisters on the surface – the immune system can kill the virus

The immune system cannotkill the virus in the axon


• Herpes simplex (HS) Herpes simplex (HS) lies dormant in the lies dormant in the ganglionganglion

• There is no cure – treat There is no cure – treat the outbreaksthe outbreaks

• Topical therapy is Topical therapy is ineffectiveineffective

Herpes simplex in a neonateHerpes simplex in a neonate


• Asymptomatic Asymptomatic shedding is very shedding is very common - infectivecommon - infective

• Beware of vaginal Beware of vaginal herpes simplex in herpes simplex in pregnant womenpregnant women

• Swab for herpes, PCR Swab for herpes, PCR is accurateis accurate

Herpes simplex in a childHerpes simplex in a child

The classical scalloped edgThe classical scalloped edgee

Chicken poxChicken poxVaricellaVaricella

• The varicella virusThe varicella virus

• The lesions are at The lesions are at different stages of different stages of evolution.evolution.

• Some are papules, Some are papules, some are vesiclessome are vesicles

• The virus lies dormant The virus lies dormant in the dorsal root in the dorsal root gangliaganglia

Chicken poxChicken poxVaricellaVaricella

• Vesicles caused by Vesicles caused by chicken poxchicken pox

• The lesions are at The lesions are at different stages of different stages of evolution.evolution.

• Some are papules, Some are papules, some are vesiclessome are vesicles

• The virus can remain The virus can remain dormant for yearsdormant for years


• Herpes zosterHerpes zoster

• This is due to re-This is due to re-activation of the activation of the chicken pox virus.chicken pox virus.

• The virus replicates in The virus replicates in the nerve body and the nerve body and travels to the surface travels to the surface where is causes the where is causes the painful eruptionpainful eruption

Grouped lesions in a Grouped lesions in a dermatomal distributiondermatomal distribution

HerpetiformHerpetiform

• Herpes zoster incidenceHerpes zoster incidence

• 50-9 4.6 / 1000 (5% 50-9 4.6 / 1000 (5% PHN)PHN)

• 60-9 6.9 (10%)60-9 6.9 (10%)• 70-9 9.5 (17%)70-9 9.5 (17%)• 80+ 10.9 (20%)80+ 10.9 (20%)

• HIV + men - 29.4/1000HIV + men - 29.4/1000• HIV - men - 2/1000HIV - men - 2/1000 NEONATE with grouped NEONATE with grouped

lesions in a dermatomal lesions in a dermatomal distribution. Is it zoster?distribution. Is it zoster?


• Herpes zosterHerpes zoster

• Some of the lesions are Some of the lesions are haemorrhagic – a sign haemorrhagic – a sign that it is a severe case.that it is a severe case.

• The lesions are in The lesions are in various stages of various stages of evolutionevolution

INFECTIONS and INFESTATIONS

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