Nodules: rounded lesions

SKIN BACTERIAL INFECTIONS

Urticaria: seen in patients with allergic reaction

- May overlap; has elevation

Bleeding under the Skin

Petechiae: pin-point skin lesions; head of the needle

- Dengue

Purpura: bleeding is greater than 3 mm

Ecchymosis: greater than 3 mm; bruises, blood

clots, black eye

STAPHYLOCOCCUS AUREUS
- Gram-positive round-shaped bacterium
- Usually arranged in grapelike clusters
- A usual member of the microbiota of the body,
frequently found in the upper respiratory tract
Vesicle: small fluid-filled blister on the skin less than
and on the skin
5 mm in diameter
- Most dangerous of all of the many common
- Formation of fluid under the skin
staphylococcal bacteria
- Chicken pox; has water on the lesion
- Produces enzymes and toxins for its
pathogenicity and through direct invasion and
Bulla: more than 5 mm; fluid-filled sac/lesion
destruction of tissues
- Burns

Mode of Transmission – Skin infections are

Macule: flat skin lesion; small patch of skin altered in
transmitted through
color
1. Direct contact with a person having purulent
- Rashes not elevated; discoloration
lesions
2. From the hands of healthcare hospital workers
Papule: skin elevation; small bumps on the skin; no
3. From fomites, like bed linens, and contaminated
pus; can have discoloration
equipment
- Solid; palpable; less than 5mm in diameter
- Solitary (isa lang) or maramihan
Clinical Findings
- Warts, nunal (elevated), pimple without pus
- Folliculitis
- Furuncle
Pustule: small bumps on the skin that contain pus
- Carbuncle
- Pimple with pus
- Sty or Hordeolum
- Impetigo
- Staphylococcal Scalded Skin Syndrome
(SSSS / Ritter’s disease)

Plaque: flat but elevated

 Folliculitis Sty of Hordeolum (Kuliti)
- A pyogenic (pus-producing) infection involving - Involves one or more of the small glands near
the hair follicles the base of the eyelids
- A common skin condition - It is red and painful, often filled with pus

Characterized by:
- Localized painful inflammation
- Heals rapidly after draining the pus

Pyoderma (Impetigo)
- Infection common in young children and
primarily involves the face and limbs
- Starts as macule which later becomes a
Furuncle (Boils) pus-filled vesicle that ruptures and forms
- An infection of several hair follicles that has a honey-colored crust
small collection of pus (called an abscess) - There maybe enlargement of the regional
under the skin lymph nodes but no sign of systemic infection
- An extension of folliculitis - Can also be caused by Staphylococcus
pyogens
Characterized by: - A purulent skin infection that is localized and
- Larger and painful nodules with the underlying commonly involves the face, the upper and
collection of dead and necrotic tissue lower extremities
- Starts as vesicles then progress to pustules
- The lesion ruptures and forms honey-colored
crusts

Carbuncle
- A red, swollen, and painful cluster of boils that
are connected to each other under the skin
- Represents a coalesce of furuncles that
extends into the subcutaneous tissue with
multiple sinus tracts
- ‘Coalase’ = nagdidikit-dikit
Staphylococcal Scalded Skin Syndrome
- Also known as SSSS / Ritter’s Disease
- Primarily found in newborns and young
children
- ‘Scalded’ = parang napaso
Manifestations:
- Exfoliative toxin: responsible for the
Streptococcus Pyogens
manifestations of the disease
- Only the outer layer of the skin is affected, - Gram-positive cocci arranged in pairs or
hence there will be no scarring chains
1. Sudden onset of periodical erythema or bullous - Belongs to Groups A beta-hemolytic
(redness) that covers the whole within 2 days - Major virulence factor is M protein which is
2. (+) Nikolsky sign: when pressure is applied to anti-phagocytosis (prevents the attack of
the skin, it causes displacement of the skin phagocytes)
(wrinkles and tissue paper-like appearance) - Produces enzymes and toxins responsible for
3. Bullae and cutaneous blister the pathogenicity
4. Desquamation - Some strains are encapsulated
- Maybe associated with severe systemic
Laboratory Diagnosis infections
a. Microscopic examination of Gram-stained
specimen (gram-positive cocci) Erysipelas (St. Anthony’s Fire)
b. Culture: gray to golden colonies
- Superficial form of cellulitis
c. Qualities of the microorganism
- Follows a respiratory or skin infection
○ Catalase Positive: aerobic bacteria
- Affects the upper dermis and extended into
○ Coagulase Positive: clots plasma
the superficial cutaneous lymphatics

Treatment of Choice – Beta-Lactam antibiotics

Manifestations:
- Develops resistance to penicillin derivatives
- Localized raised areas associated with pain
like methicillin and nafcillin
- Erythema
- Oxacillin: the only penicillin derivative
- Warmth
antibiotic that has remained active
- Lymphadenopathy
- Incision and drainage (I & D)
- Systemic manifestations

Prevention
- Use Standard Precautions for skin, burn, and Cellulitis
wound infections if they are minor - Involves the skin and the SC tissue
- Contact Precaution if major SSSS - The infected skin and the normal skin are not
- Standard Precautions for infections caused by clearly differentiated
methicillin-resistant S. aureus (MRSA); add - Local inflammation with systemic signs
Contact Precautions if wounds cannot be
contained by dressing

Staphylococcus Epidermis
- Part of the normal flora of the skin
- Associated with “stitch abscess”, UTI, and
endocarditis
- Causes infection in individuals with prosthetic
devices, cardiac devices, CNS shunts
 c. Bacitracin test: antibiotic susceptibility test
Necrotizing Fascitis
with (+) zone of inhibition of growth around the
- Also known as “Flesh-eating” Infection / Bacitracin disc
Streptococcal Gangrene
- Involves deep SC tissue Treatment of Choice: Penicillin
- Starts as cellulitis then becomes bullous and - In case of penicillin allergy, macrolides
gangrenous (erythromycin, azithromycin) or
- It spreads to the fascia then the muscle and cephalosporins are alternate drugs
fat - The drainage of pus and thorough
- May become systemic and cause multi-organ debridement of infected tissues
failure to death

Pseudomonas Aeruginosa
- An opportunistic aerobic gram-negative
bacillus that is frequent and common cause of
nosocomial infection (hospital-acquired)
- Capable of water-soluble pigments
(pyocyanin-blue)
- Resistant to most antibiotics
- Virulence is attributed to adhesins (flagella,
pili, LPS), toxins (exotoxin A, pigments) and
enzyme
Complications of Streptococcal Infection - Infects extensive skin burns, which can be a
1. Acute Glumerolous Nephritis source of sepsis
- Commonly associated with skin infections - Has been cultured from washbasins,
2. Rheumatic Fever respirator tubing, nursery cribs, and even
- Associated with throat infections antiseptic-containing bottles
- Non-supporative, immune-mediated - Causes corneal keratitis in wearers of contact
complications lenses, endocarditis, and osteomyelitis in
3. Scarlet Fever / Scarlatina intravenous drug abusers, external otitis
- Develop in some people who have strep (swimmer’s ear) in healthy individuals, and
throat severe external otitis is diabetics
- Manifested by the strawberry tongue, bright
red rash that covers most of the body, sore Mode of Transmission
throat, and fever - Colonization or previously injured skin

Clinical Findings
1. Blue-green pus hat exudes a sweet grape-like
odor
- Blue-green due to water-soluble pigments
2. Other skin infections are folliculitis and
secondary infections in individuals with acne
and nail infections resulting from immersion in
contaminated water
3. Osteochondritis: most common cause of
Laboratory Diagnosis inflammation of the bone and cartilage of the
a. Microscopy: gram stain of samples of infected foot following a penetrating injury
tissue will show gram-positive cocci in pairs and
chains associated with leukocytes Laboratory Diagnosis
b. Culture: positive beta hemolysis in blood agar a. Gram stain: gram-negative bacilli arrange
individually and in pairs
b. Culture: flat colonies with green pigmentation
 c. Oxidase test is positive: aerobic and can use
Clostridium Perfringes
oxygen as a terminal electron acceptor in
respiration - Formerly known as C. welchii, or Bacillus
welchii
Treatment & Prevention - Gram-positive bacteria
- P.aerogenosa: resistant to most antibiotics - Anaerobic and rarely produce endospores
hence C & S must be done - Produces 4 lethal toxin: alpha (most lethal),
- Preventive measures must be done and beta, iota, epsilon toxin
focused on preventing contamination of sterile - Toxins: cause massive hemolysis, bleeding,
hospital equipment and instruments and and tissue destruction
cross-contamination of patients by hospital - Associated with soil and water, and also feces
personnel
Mode of Transmission
- Colonization of the skin following physical
Pseudomonas Aeruginosa trauma and surgery
A Aerobic
Clinical Findings
E Exotoxin A 1. Cellulitis
- Common bacterial skin infections that cause
R Rod / Resistance redness, swelling, and pain in the infected
U UTI, burns, injuries area of the skin
2. Suppurative Myositis
G Green-blue dressing - An acute intramuscular infection that develops
secondary to hematogenous microorganisms
I Iron-containing lesions spread into the body of skeletal muscle,
N Negative grams manifested by abscess formation of large
muscle groups
O Odor of grapes 3. Myonecrosis or gas gangrene

S Slime capsule sometimes

A Adherin pili

Clinical Findings of Pseudomonas Aeruginosa

- Ocular keratitis contact lens wearers,
endocarditis, and osteomyelitis in IV drug
users
- External otitis (swimmer’s ear) in healthy
people, and severe external otitis in diabetics Clostridial Myonecrosis (Gas Gangrene)
- Many persons with cystic fibrosis die of
respiratory failure caused by P. aeruginosa - A life-threatening infection following trauma or
infection surgery
- P. aeruginosa frequently infects extensive skin - Characterized by massive tissue necrosis with
burns, which can lead to sepsis gas formation, shock, renal failure, and death
within 2 days of onset
- Gangrenous tissue
- Brutal killer

Laboratory Diagnosis
a. Microscopic detection of gram-positive bacilli
and culture under an anaerobic conditions
Treatment & Prevention 3 Forms of Anthrax Disease
- Surgical wound debridement
- High-dose penicillin therapy
Patient Care
- Use Standard Precautions

Ingested the infected meat of the infected animal

Bacillus Anthracis
- A gram-positive bacterium
- 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
Involvement of the skin
- The only permanent (obligate) pathogen
within the genus Bacillus
- Grows slowly in soil types that meet specific
moisture conditions
- Endospores survive in soil tests for up to 60
years

Virulence Factors – 2 exotoxins

1. Edema Toxin
- Local edema (swelling) and interferes with Spores of anthrax is inhaled by the patient;
phagocytosis by macrophages dangerous
2. Lethal Toxin
- Targets and kills macrophages, which
disables an essential defense of the host
Protective Agent
- A cell receptor-binding protein that binds the
toxins to target cells and permits their entry

Anthrax Disease
- Bacterial disease caused by bacillus anthracis
that can affect skin, and lungs, or
gastrointestinal tract depending on the portal
of entry of the etiologic agent
- Disease of Herbivores: strikes primarily
grazing mammals, such as cattle and sheep
- People at risk are those who handle animals, Mode of Transmission
hides wool, and other animal products - Inoculation into the open skin from either the
soil or infected animal products
 - Ingestion of infected meat or milk - Common during the summer season
- Inhalation of aerosolized spores
Laboratory Diagnosis Pathogens
a. Blood test detects both inhalation and - Common are Haemophilus influenzae
cutaneous cases of anthrax within an hour subspecie aegyptius (most common),
b. The peripheral blood contains a large number Streptococcus pneumoniae and other bacteria
of B. anthracis which is easily seen on gram Patient Care
stain - Standard Precaution
c. Spores can be done using Dorner stain or Wirtz Reservoirs
Conklin - Infected humans
Mode of Transmission
- Human-to-human transmission occurs via
contact

Wirtz Conklin Staining Method

Treatment & Prevention

- Antibiotics, like penicillin or doxycycline, are
the drugs of choice
- Vaccination of livestock in endemic areas;
single dose of live, attenuated vaccine is
used, which is unsafe for use in humans Haemophilus Influenzae Biogroup Aegyptius
- Vaccine approved for humans: contains - Known as the Koch-Weeks bacillus
inactivated form of antigen toxin to prevent - Gram-negative bacterium
entry of 2 toxins into the host’s cells - Rod-shape (coccobacillus)
- For people who have been exposed to B. - Causative agents of acute and often purulent
anthracis: 3 doses of the vaccine over 4 conjunctivitis
weeks, along with antibiotic treatment, are - Caused worldwide seasonal epidemics
recommended (summer)
- Virulence: pili
Patient Care - Transmission: mechanical
- Standard Precautions - Sulfunamide and gentamycin effective
- Add Contact Precautions for cutaneous
anthrax patient if there is a large amount of
uncontaminated drainage Streptococcus Pneumoniae
- Use soap and water for handwashing; alcohol - Gram-positive, facultatively anaerobic
does not have a specific activity pathogen, in pairs, encaptsulated
- Aerobic = alpha hemolytic; Anaerobic = beta
hemolytic
OCULAR BACTERIAL INFECTIONS
- Lancet shaped
- Virulence: adhesin, capsule, toxin,
Bacterial Conjunctivitis (Pink Eye) pneumolysin, and IgA
- Inflammation / infection of conjuctiva
- Involves irritation, reddening of conjunctiva; Chlamydia Trachomatis
edema of eyelids, mucopurulent discharge, - A small gram-negative bacterium and obligate
sensitivity to light; highly contagious intracellular pathogen; cell with high lipid
 - Susceptible to sufonamides - Corneal vascularization
- associated with eye infections such as
conjunctivitis, and trachoma
- Chlamydia trachomatis bacterium = most
commonly spread through vaginal, oral, and
anal sex

2 Forms:
a. Elementary body: non-replicating infectious
particle
Chlamydia Keratoconjunctivitis
b. Reticulate body: replication and growth
- Also known as Trachoma / Chronic
Keratoconjtivitis
- Caused by serotypes A, B, and C

Transmission
- Eye-to-eye by droplets
- Fomites
- Eye-seeking flies (in poor living conditions)

Signs & Symptoms

- Follicular conjunctivitis with diffuse
inflammation involving entire conjuctiva
Conjunctivitis due to C. Trachomatis
○ Progress to conjunctiva scarring
- Also known as “swimming pool conjunctivitis” producing in-turned eyelids → ulceration
- Adults: occur with non-gonococcal urethritis or → scarring → invasion of vessels into
cervicitis (genital to eyes transfer) cornea → loss of vision (frequent cause
- There is mucopurulent eye discharge that of blindness)
occurs with pneumonia or chlamydial
nasopharyngitis
Neisseria Gonorrheae (Gonococcus)
Transmission - A kidney bean-shaped, gram-negative
- Acquired in non/poor chlorinated swimming diplococcus
pool - Common cause of STI in
neonates–”Opthalmia Neonatorum”
- Adults: transmitted through finger-to-eye
contact, involving infectious genital secretions

Signs & Symptoms

- Redness and swelling of conjunctiva
Chlamydial Conjunctivitis - With purulent eye discharge
- If untreated = leads to corneal ulceration,
- Also known as Inclusion conjunctivitis / perforation and blindness
Paratrachoma
- Caused by serotypes D to K Prevention
- Adults: associated with genital infection - Neonate: 1% silver nitrate (Crede’s
- Newborn: acquired upon the passage in birth prophylaxis) after birth, or;
canal ○ Silver nitrate: not available:
- 1% tetracycline eye ointments, or;
Signs & Symptoms - 0.5% erythromycin eye ointments
- Swelling of eyelids with mucopurulent keratitis ○ Erythromycin (most used)
- Corneal infiltrates
 FOODBORNE DISEASES
A. Gastritis
- Inflammation of the gastric lining - Loss of haustra (fold of the large intestine),
B. Enteritis damages the lining, and produces false
- Inflammation of the small intestine pseudopolyp
C. Colitis
- Inflammation of the inner lining of the colon
D. Gastroenteritis
- Involves the stomach and intestines
E. Hepatitis
- inflammation of the liver
F. Dysentery
- inflammation of the intestines that causes
bloody or mucoidal diarrhea

Gastritis & Gastric Ulcers

Signs & Symptoms
- Sharp or burning pain emanating from the
abdomen
- Severe ulcers can be accompanied by bloody
stools, vomiting, or both
- Worst at night, after eating, or under
psychological stress

Causative Agent
- Helicobacter Pylori: has the ability to survive
acidic environment
Establishment of Infectious Disease in the Digestive System
○ Bores hole in the GI lining and hides
○ Ulceration 1. Pharmacologic Action
- Some bacteria may alter normal intestinal
function without causing lasting damage to
their cells
Ex. vibrio cholerae – produces voluminous, watery
diarrhea due to its ability to induce increased
electrolytes into the intestine

2. Local Inflammation
- Invasion of the alimentary tract by microbes
can lead to inflammation
- Invasion is usually limited to the epithelial
layer but may spread to the deeper tissues
- Mouth: the gums are usually affected,
causing periodontitis
 - Intestines: infections can cause inflammation 7. Clostridium difficile
that can result to dysentery 8. Bacillus anthracis
9. Mycobacterium tuberculosis
3. Deep Tissue Invasion 10. Clostridium botulinum
- Certain organisms are able to spread to
adjacent tissues and enter the bloodstream
Clostridium Perfringes
- The parasite is often colonized by GUT
bacteria, and as a result, infection by this - Common source: beef, poultry, gravies, and
worm can lead to polymicrobial septicemia dried or pre-cooked foods
Ex. parasite Strongyloides – capable of burrowing - Occurs when foods are prepared in large
through the intestinal wall quantities and kept warm for a long time
before serving
4. Perforation - Develop diarrhea and abdominal cramps
- When the mucosal epithelium is perforated, within 6~24 hours (typically 8~12 hours)
the normal flora spills into sterile areas, and - Usually begins suddenly and lasts for less
invades deep tissues, often with serious than 24 hours
consequences - People infected with C. perfringes usually do
Ex. perforation of an inflamed appendix can lead to not have fever or vomiting
peritonitis
Clostridium Difficile
BACTERIAL INFECTIONS of the GIT - Gram-postive species of spore-forming
A. Bacterial Enterocolitis (food poisoning) bacteria
- An illness caused by the consumption of food - Clostridioides spp. are anaerobic, motile
contaminated with bacteria of bacterial toxins bacteria, ubiquitous in nature and especially
Causes prevalent in soil
- Bacillus cereus, Staphylococcus aureus, - Its vegetative cells are rod-shaped,
Clostridium perfringes, Vibrio parahemolyticus pleomorphic, occur in pairs or short chains

3 Mechanisms of Food Poisoning Salmonella

1. Ingestion of preformed toxin
- A genus of rod-shaped gram-negative
- Present in contaminated food
flagellated facultatively anaerobic bacilli of the
- Signs & Symptoms – developed in few
family Enterobacteriaceae
hours, consisting of explosive diarrhea;
- Most frequently reported cause of
abdominal pain
food-related illness
- Casues: Staphylococcus aureus, Vibrio
- Salmonella bacteria typically live in animal
cholerae, Clostridium Botulinum
and human intestines and are shed through
2. Infection by toxigenic organisms
feces
- Involve secretory enterotoxin, dysentery
3. Infection by enteroinvasive organisms
- Proliferate, invade, destroy epithelial cells – Salmonellosis (Salmonella Poisoning)
dysentery - Humans become infected most frequently
through contaminated water or food
B. Gastroenteritis (Diarrhea) - Typhoid Fever & Gastroenteritis: most
- An inflammation of the lining of the intestines severe manifestation of Salmonella genus
Causes - Incubation Period: ½ ~ 48 hours
1. Escherichia coli
2. Salmonella sp Signs & Symptoms
3. Shigella sp - Abrupt onset of severe diarrhea and
4. Yersinia enterocolitica abdominal cramps
5. Vibrio cholera - Stools are offensive and putrefactive at first,
6. Clostridium perfringes later becoming watery, greenish and bloody
 - Tenesmus (straining at stool)
Vibrio Cholerae
- Concurrent nausea and vomiting
- Abdominal tenderness - Curved (comma-shaped), facultative
- Slight fever anaerobe, gram-negative bacilli
- It is widely distributed in aquatic
Management & Prevention environments, where it is a natura, free-living
- Proper canning, preservation and refrigeration organism
of foods - Naturally lives in brackish or saltwater where
they attach themselves easily to the
Treatment chitin-containing shells of crabs, shrimps, and
- Medical care: fluid and electrolytes other shellfish
- Potassium replacement is a life-saving
measure Cholera (El Tor)
- Treatment of shock if present
- An acute diarrheal infection caused by
- Antibiotics
ingestion of food or water contaminated with
- Nursing care: CBR and comfort measures
the bacterium Vibrio cholerae
- Causes severe watery diarrhea, which can
Shigella Dysenteriae lead to dehydration and even death if
- A species of the rod-shaped bacterial genus untreated
Shigella
- Gram-negative, non-spore-forming, Signs & Symptoms
facultatively anaerobic, nonmotile bacteria - Starts with acute colicky pains in the
- Release toxins that irritate the intestines abdomen, a profuse watery diarrhea,
- Invades villus of large intestine–can perforate yellowish becoming grayish-white sometimes
intestine or invade blood described as “rice-water stools,” vomiting
- Enters Peyer’s patches and instigates - Rapid heart rate
inflammatory response–endotoxin and - Low blood pressure
exotoxins - Loss of skin elasticity
- Dry mucous membranes
- Marked mental depression
Shigellosis (Bacillary Dysentery / Bloody Flux)
- Headache
- Infectious disease caused by a group of - Vomiting
bacteria called Shigella - Fever may or may not be present
- Most severe form of dysentery - Extreme thrist, thickly furred tongue, severe or
violent cramps in the legs and feet
Signs & Symptoms - Face appears shrivered
- Ushered in by chills followed by fever - Eyes sunken
- Nausea and vomiting, abdominal pain - Skin: ash-gray color
- Tenesmus - Washerwoman’s hand – because of rapid
- Severe diarrhea at first, mucoid and later dehydration
bloody, alternating with constipation
○ There is stomach cramps starting a day Management
or two after exposure to the bacteria - Antibiotics
- Bowel movements may be 30~40 times or
more in 24 hours
Clostridium Botulinum
- Extreme thirst and rapid dehydration
- Management: antibiotics and fluid, and - Anaerobic, rod-shape, endospore-forming
electrolytes replacement bacterium that produces a protein with
characteristic neurotoxicity
- Under certain conditions like low oxygen
conditions these organisms may grow in
 foods producing dangerous toxin–botulinum Cause
toxin - Streptococcus mutans

Botulinum Toxins
- Are one of the most lethal substances known
- Block nerve functions and can lead to
respiratory and muscular paralysis
- Grow in inadequately streilized canned foods
- Produces only under anaerobic conditions
and in alkaline or neutral nonacid foods
- Easily destroyed by boiling
Periodontitis / Gingivitis
- Inflammation of the gums or gingiva
Botulism
- Commonly occurs because a film of plaque or
- A paralytic illness caused by a nerve toxin bacteria accumulates on the teeth
that is produced by the bacterium Clostridium - Treponema denticola and Porphyromonas
botulinim gingivalis
- Severe form of food poisoning when the toxin
containing food are ingested

Sign & Symptoms

- Extreme weakness
- Dizziness
- Difficulty in breathing, swallowing, and
speaking
- Marked vertigo
- Disturbances of vision
Treatment
- Antitoxin

MOUTH INFECTIONS
A. Dental carries
- Tooth decay

B. Peridontal disease Acute Necrotizing Ulcerative Gingivitis

- Inflammation of structures that support teeth
- Also known as Vincent’s disease or Trench
Mouth
C. Gingivitis
- Has a sudden onset with gingiva, showing
- Mild form of gum disease
punched-out crater-like ulcerations, covered
with a whitish pseudomembrane, surrounded
D. Periodontitis
by a demarcated zone of erythema
- Chronic gum disease can cause bone
- Any area of the mouth can be affected
destruction and tooth loss
- There is spontaneous bleeding and breath
has fetid odor
E. Acute necrotizing ulcerative gingivitis

Causative Agent
Dental Carries - Prevotell intermedia
- Involves the dissolution of solid tooth surface Treatment
due to the metabolic action of bacteria - Metronidazole