INFECTII CUTANATE BACTERIENE

FLORA BACTERIANA A PIELII:

FLORA REZIDENTA = flora cutanata normala
Bacterii nepatoene care coloni!ea!a permanent pielea
Bacterii
coci "ram#po!iti$i: Staphylococcus spp, Micrococcus spp
%acili "ram#po!iti$i: Corynebacterium spp
%acili "ram#neati$i: Acinetobacter spp
FLORA TRANZITORIE
Locali!ati o anumita perioa&a la ni$el cutanat
PATO"ENIA infectii cutanate %acteriene &epin&e &e factori ce tin &e $irulenta ermenilor
'a&erenta( re!i)tenta la faocito!a( pro&ucerea &e en&o*e+oto+ine, )i &e factori ce tin &e
a!&a: %ariera cutanta 'interitate( -i&ratare( p.( flora re!i&enta, )i imunitatea cutanata/
INFECTII CUTANATE BACTERIENE
PIODER0ITE
INFECTII CUTANATE BACTERIENE 1ECUNDARE
BOLI PRODU1E DE TO2INE BACTERIENE
ALTE INFECTII 0ICROBIENE
PIODERMITE =Infectii cutanate bacteriene produse de organisme piogene
I0PETI"O
Pio&ermita )uperficiala( contaioa)a( 3 forme:
Impetio $e!iculo) 'impetio Til%ur4#Fo+, # Streptococcus pyogenes
Impetio %ulo) # Staphylococcus aureus
Fa$ori!at &e:
alomerarile &in colecti$itati
iiena precara
le!iuni cutanate minore
afectiuni cutanate pree+i)tente
Clinic: $e!icule*%ule pe fon& eritemato) #5)e rup #5 )uprafete &enu&ate #5cru)te al%en#
%rune 'melicerice,
Diano)tic &iferential: Infectii -erpetice .16( can&i&o!e( $aricela( ec!ema( intepaturi &e
in)ecta
CO0PLICATII: "LO0ERULONEFRITA PO1T1TREPTOCOCICA
ECTI0A
Pio&ermita caracteri!ata prin formarea &e ulceratii acoperite &e cru)te a&erente
Aent etioloic: Streptococcus pyogenes( rar Staphylococcus aureus
Fa$ori!at &e
iiena precara
malnutritie
le!iuni cutanate minore
afectiuni cutanate pree+i)tente
Clinic: ulceratie )tantata acoperita &e o cru)ta a&erenta )i incon7urata &e -alou
eritemato#e&emato)
DIA"NO1TIC DIFERENTIAL: ULCERATII 6ENOA1E*ARTERIALE( ULCERATII
PO1TTRAU0ATICE( 6A1CULITA ULCERO#NECROTICA
CO0PLICATII: $in&ecare cicatriciala( celulita( lomerulonefrita po)t)treptococica
ERIZIPEL
Infectie %acteriana a &ermului )i te)utului )u%cutanat )uperficial
Aent etioloic: 89: Streptococ hemolitic de grup A(
Rar )tafilococ auriu( "ram #( ermeni anaero%i
Poarta &e intrare: mica pier&ere &e )u%)tanta 'ero!iune*ulceratie po)t#traumatica )au
epi&ermofitie,
Factori fa$ori!an;i: )ta!< $enoa)<*limfatic<( o%e!itate( imuno)upre)ie( iien< precar<
Clinic: placar& inflamator( net &elimitat '%urelet marinal, =i manife)t<ri )i)temice 'fe%r<(
fri)on,
Forme $e!iculoa)e( %uloa)e( -emoraice
Locali!ari frec$ente: mem%re inferioare )i fata
DIA"NO1TIC DIFERENTIAL: celulita( trom%ofle%ita profun&a( &ermatita &e contact(
intepaturi &e in)ecte
CO0PLICATII: ulcerare( reci&i$e #5limfe&em cronic ( lomerulonefrita po)t)treptococica(
faciale: trom%o!a )inu) ca$erno)
CELULITA
Infectie %acteriana a &ermului profun& )i a te)utului )u%cutanat
Aent etioloic: Streptococ hemolitic de grup A( )tafilococ auriu( "ram #( ermeni
anaero%i
Poarta &e intrare: mica pier&ere &e )u%)tanta 'ero!iune*ulceratie po)t#traumatic )au
epi&ermofitie,
Factori fa$ori!an;i: )ta!< $enoa)<*limfatic<( o%e!itate( imuno)upre)ie( iien< precar<
Clinic: placar& inflamator impreci) &elimitat( limfanita* a&enopatie inflamatorie
DIA"NO1TIC DIFERENTIAL: eri!ipel( trom%ofle%ita profun&a ( &ermatita &e contact(
intepaturi &e in)ecta
CO0PLICATII: ulcerare( a%ce&are( fa)ceita*mio!ita( reci&i$e #5limfe&em cronic(
lomerulonefrita po)t)treptococica( faciale: trom%o!a )inu) ca$erno)*meninita
FA1CEITA 0ICROBIANA NECROZANTA '"AN"RENA 1TREPTOCOCICA,
Infectie profun&a pro&u)a &e 1treptococ rup A >*# ermeni anaero%i
Poarta &e intrare: le!iune minima 'intepatura*taietura,
Clinic: placar& eritemato#e&emato)( cal&( &urero)( necro!a te)uturilor )u%iacente( %ule(
pier&erea )en)i%ilitatii
Diano)tic &iferential: anrena a!oa)a 'Clo)tri&ium, )i alte anrene pro&u)e &e
a)ocieri &e ram neati$i )i anaero%i
FOLICULITA=Infectie a foliculului pilo)
FOLICULITA UPERFICIALA
infectie limitata la o)tiumul foliculului pilo)
Pu)tule foliculare incon7urate &e -alou eritemato)
Fata( )calp( e+tremitati
Netratata #5 cronici!area )au e$olutie )pre profun!ime
FOLICULITA PROFU!DA
afectea!a foliculul pilo) in intreime
Papulo#pu)tule eritemato#e&ematoa)e centrate &e folicul pilo)
Fata '%ar%a,( )calp( a+ile( pu%ian
DIA"NO1TIC DIFERENTIAL: Foliculite infectioa)e &e alte etioloii 'funice,( foliculite
neinfectioa)e 'cortico)teroi!i( an&roeni,( miliaria pu)tuloa)a( pu)tulo!e ne%acteriene
FURUNCUL
Infectie foliculara )i perifoliculara cu e$olutie )pre necro!a pro&u)a &e )tafilococ auriu
Factori fa$ori!anti: imuno)upre)ia( &ia%etul !a-arat( o%e!itatea( traumati!area mecanica
a pielii
Clinic: no&ul folicular inflamator cu ten&inta la a%ce&are )i e$acuare '%ur%ion=te)ut
necrotic( &etritu) celular( )ecretii purulente, #5 ulceratie #5 $in&ecare cu cicatrice
>*# )emne enerale
Locali!area: fata( at( %rate( fe)e( reiunea ano#enitala
Unic* multiple 'furunculo!a,
Furuncul antracoi&
"rup &e foliculi a&iacenti
Ceafa( umeri( coap)e
A)pect cla)ic &e ?)tropitoare@
1tare enerala alterata
Furuncul ?malin@ al fetei
CO0PLICATII: a%ce&are( &i)eminare )eptica( trom%o!a )inu)ului ca$erno)
PERIONI2I1 'PANARITIU,
Infectia te)uturilor moi periun-iale
Factori fa$ori!anti: traumati)me acute 'manic-iura,( iritatii cronice( &ermato!e
pree+i)tente
Acut: )tafilococ auriu( )treptococ pioen
Cronic: "ram neati$i( Can&i&a
Clinic: inflamatia repliului un-ial cu ten&inta la a%ce&are #5 retractia repliului un-ial &e
pe lama un-iala
Diano)tic &iferential: perioni+i) &e alte etioloii 'micotice( -erpetice,
CO0PLICATII: Di)trofie un-iala )ecun&ara( a%ce&are
.IDRADENITA 1UPURATI6A '.IDRO1ADENITA,
Inflamatie cronica( recurenta a lan&elor apocrine
Etioloie contro$er)ata: infectie %acteriana ')tafilococ auriu( )treptococi anaero%i( "ram
neati$i,* )in&rom &e oclu!ie foliculara
Clinic: no&uli inflamatori( ulcerea!a( fi)tuli!ea!a
Locali!are: a+ile( ano#enital
Diano)tic &iferential: furunculo!a( )crofulo&erma
Complicatii: : reci&i$e( cronici!are( fi)tule( fi%ro!<( retrac;ii
INFECTII CUTANATE BACTERIENE 1ECUNDARE AI0PETI"INIZAREA =infectarea
%acteriana a unor afectiuni cutanate pree+i)tente ' &e e+/ &ermatita atopica,
BOLI PRODU1E DE TO2INE BACTERIENE:
1INDRO0UL DE EPIDER0OLIZA 1TAFILOCOCICA ACUTA '1111 A 1tap-4lococcal
1cal&e& 1Bin 14n&rome,
1INDRO0UL 1OCULUI TO2IC
1CARLATINA
1INDRO0UL DE EPIDER0OLIZA 1TAFILOCOCICA ACUTA '1111 A1tap-4lococcal
1cal&e& 1Bin 14n&rome,
Afectiune ra$a caracteri!ata prin necroli!a epi&ermica
Pro&u)a &e to+inele epi&ermolitice ale unor tulpini &e )tafilococ auriu
Nou#na)cuti )i )uari( rar a&ulti imuno&eprimati
Clinic: infectie cutanata*mucoa)a urmata la 3#C !ile &e aparitia unui e+antem
)carlatiniform >fe%ra( fri)on #5 &ecolari epi&ermice ma)i$e
Locali!area: marile pliuri )i periorificial 're)pecta mucoa)ele,
DIA"NO1TIC DIFERENTIAL: impetio %ulo)( )in&rom L4ell( )in&rom 1te$en Do-n)on
CO0PLICATII: &e!ec-ili%re -i&ro#electrolitice( )epticemie
1INDRO0UL 1OCULUI TO2IC
Pro&u) &e to+ine ela%orate &e )tafilococul auriu 'T11T#E=To+ic 1-ocB 14n&rome To+in#
E, #5rol &e )uperantien #5-iperproliferare limf T #5 citoBine
Clinic: fe%ra( ra)- #5E#C )apt: &e)cuamare( )oc circulator( afectare multi)i)temica
Diano)tic &iferential: )oc )eptic
1CARLATINA
Infectie acuta pro&u)a &e tulpini &e 1treptococcu) p4oene) care ela%orea!a o to+ina
eritroenica
Poarta &e intrare: cutanata )au re)piratorie
Clinic: incu%atie 3#F !ile( apoi fe%ra( anore+ie( $ar)aturi >manife)tari leate &e poarta &e
intrare 'anina( )ecretii ale plaii cutanate,
Ra)- eritemato) punctiform
1triuri purpurice in pliuri
De)cuamare in lam%ouri mari 'e+tremitati,
0ucoa)a linuala: al%a #5&e)cuamata #5a)pect !meuriu
CO0PLICATII: RAA( lomerulonefrita( miocar&ita
DIA"NO1TIC DIFERENTIAL: ru%eola( eruptii po)tme&icamentoa)e
ERITRA10A
Infectie )uperficiala( locali!ata( cronica pro&u)a &e Corynebacterium minutissimum
Fa$ori!ata &e ume!eala )i cal&ura
Clinic: placi nereulate( %ine &elimitate( eritematoa)e #5 maronii( )cuame fine
Locali!are: in-inal( a+ilar( interfe)ier( inter&iital
Diano)tic &iferential: epi&ermofitii 'tinea cruri)( tinea pe&i),( intertrio can&i&o!ic(
pitiria!i) $er)icolor
GERATOLIZA PUNCTATA PLANTARA
Infectie )uperficiala a pielii &eterminata &e )pecii &e Cor4ne%acterii( 1treptom4ce)
Clinic: &epre)iuni punctiforme la ni$elul plantelor
1e a)ocia!a cu -iper-i&ro!a
ERIZIPELOID
Infectie %acteriana acuta pro&u)a &e Er4)ipelotri+ in)i&io)a
Per)oane care manipulea!a carnea &e pe)te( pa)are '%ucatari( macelari( pe)cari,
Clinic: incu%atie C#H !ile( apoi placa eritemato#$iolacee cu contur policiclic cu e+tin&ere
centrifua
Locali!are: &eete( maini( ante%rat
Diano)tic &iferential: eri!ipel( celulita( eritem cronic mirator
ANTRA2
Infectie cutanata pro&u)a &e Bacillus anthracis '%acil "ram po!iti$,
Tran)mitere acci&entala la om prin manipularea animalelor %olna$e* pro&u)e animale
contaminate
Clinic: incu%a;ie 3#C !ile( pu)tul<#5 %ula -emoraic< cu -alou eritemato)( ulterior
placar& infiltrat cu cru)t< necrotic< central<
Diano)tic &iferential: furuncul antracoi&
Tratament: Penicilina &o!e mari( NU c-irurieI
INFECTIA CU BORRELIA BURDORFERI 'BOALA LJ0E,
Infectie )i)temica pro&u)a &e Borrelia %ur&orferi
6ector capu)e )pp/ Ixodes ricinus
Clinic:
Precoce 'E#8 )aptamani, eritem cronic mirator
Tar&i$ '5 E an, acro&ermatita cronica atrofianta
1i)temic: afectare neuroloica )i car&iaca
Diano)ticul infectiilor %acteriene cutanate
Clinic
Epi&emioloic ')ur)a &e contaminare( teren( factori fa$ori!anti,
0icro%ioloic: e+/&irect '"ram,( culturi
Anti%iorama
In$e)tiatii paraclinice:
De autentificare: .L"( 61.( A1LO
Pentru &iano)tic &e focar infectio)( complicatii( factori fa$ori!anti &e teren
Principii &e tratament Kn infectiile %acteriene cutanate
Tratament local: Kn infec;ii )uperficiale
Toaleta =i &e!infectarea le!iunilor cu )olu;ii anti)eptice *%<i anti)eptice 'cloramin<(
permananat &e pota)iu,
Ba&i7on<ri cu anti)eptice 'coloran;i( clor-e+i&in<( alcool etilic( alcool io&at,
Compre)e ume&e pe le!iunile inten) e+u&ati$e
Anti%iotice topice 'neomicin<( aci& fu)i&ic( retapamulin,
Pan)ament )teril
Tratament )i)temic : infec;ii profun&e( e+tin)e( )au pro&u)e &e ermeni are)i$i( pe fon&
tarat
Anti%iotice )i)temic
Conform e+amenului micro%ioloic =i anti%ioramei
Anti%iotice &e elec;ie:
Infec;ii )treptococice: penicilina
Infec;ii )tafilococice: peniciline re!i)tente la L#lactama!<(
com%ina;ii 'Aumentin( Una)4n,( cefalo)porine( Muinolone(
macroli&e
Infec;ii mi+te: cefalo)porine>aminolico!i&e
C-irurical 'e$acuare colec;ii purulente,
Tratamentul factorilor fa$ori!an;i
Iien< corporal<
Re&ucerea reut<;ii
E$itarea Km%r<c<min;ii oclu!i$e( &in materiale )intetice
Tratarea precoce a po)i%ilelor por;i &e intrare
Tratarea e$entualelor %oli &e fon&
EPIZOONOZE
1CABIA =Ectopara!ito!a cutanata pro&u)a &e 1arcoptes scabiae
Epi&emioloie: contaminare prin contact &irect* -aine* len7erie '3H-#CN-,
Clinic: incu%atie C )aptamani#E luna
Le!iuni )pecifice: $e!icula perlata( =an;ul acarian
Le!iuni ne)pecifice: prurio( le!iuni ec!ematiforme( placi urticariene
Prurit pre&ominant nocturn
Forme clinice:
Normoerica
.ipererica ')ca%ia no&ular<,
.ipoerice ')ca%ia cru)toa)a( nor$eian<,
Diano)tic: CLINIC( EPIDE0IOLO"IC( PARAZITOLO"IC( .I1TOPATOLO"IC
Complicatii: 1uprainfectia( ec!emati!area( lic-enificarea
Tratament: Lin&an E:( %en!oat &e %en!il 3F#C9:( crotamiton E9:( permetrina F:( )ulf
pp/ E9:( i$ermectin< 'oral,> &epara!itare
PEDICULOZA
Afectiune infectioa)a pro&u)a &e Pediculus humanus )i Phthirius pubis
Epi&emioloie: tran)mitere prin contact &irect*cu o%iecte*len7erie
Iien< precar<
1upra$ie;uire Kn afara a!&ei: E9 !ile 'Ou<: E lun<,
Clinic: arii pruriinoa)e( cu e+coria;ii( prurio( impetiin!are( lic-enific<ri( -iperpiment<ri
Diano)tic: clinic( epi&emioloic( para!itoloic
Tratament : Lin&an E:( crotamiton E9:( permetrina F:( malat-ion 9(F:#E:( )ol/ aci&
acetic &iluat( &epara!itare
Bi%liorafie
E/ Giurcanenau C, Giurcaneanu , !edelcu I/ Dermato#$eneroloie Anote &e cur)
3/ "orsea , Popescu #, Popescu C$M/ Compe&iu &e &ermatoloie )i $eneroloie
C/ %abi& '/ Clinical Dermatolo4: A Color "ui&e to Diano)i) an& Treatment( 0o)%4( 399O
H/ ( Bolognia, ( (ori))o, #$ Papini$ Dermatolo4( 0o)%4( 399C
F/ *$Braun+"alco, G$Ple,ig, -$.ol&&, 1priner 399F Dermatolo4 an& 6enerolo4
N/ """#derm$%$#com
P/ """#dermis#net