Bacterial infections

Impetigo contagiosa

is superficial contagious disease. it has two forms

Impetigo streptococcia

Primary infection is caused by streptococcus, and the suprainfection by staphylococcus.

Clinical picture

It is seen in children in summer on the place of bite of insekt. It is localized on the

extremitis,face, sclap. The lesion is supraficial subcorneal vesicle on erytematous base which
becomes crust.Complication: acute glomerular nephritis.

Differential diagnosis : tinea barbe profunda

Impetigo bullosa

Caused by staphylococcus aureus.

Clinical picture

It is seen in all ages. On clinicaly unchaged skin, large tense or non tense bullae.They can persist
for few days and than they form crusts.Threre is the regional lymhodenophaty

Secondary impetisation becomes during the suprainfection by staphylococcus and streptococcus

in scabies, ezema

diagnosis -based on clinical picture and laboratory

Differential diagnosis : alergic contact dermatitis, herpes simplex

Ecthyma

represnts the deep form of impetigo.Caused by streptococcus.Changes are localized on the lower
extremities.Primay lesion is pustule with inflammatory base which speads and form crust and
lives the scar.

Angulosus infectosus

It is caused by sterptococcus or staphylococcus seen in chlidren.It is localized on the angles of

the lips as eythema and desquamation. It can be conatious. Dif. diagnosis candida.
Treatment

Local- water, soap,antiseptic (hypermangan),removing crusts

Topical antibiotics gentamicin(stapylococcus), erytromycin (streptococcus)

General : cephalosporin, erytromycin

Staphylococcus scaled skin syndrome (SSSS)

is the disese caused by stapylococcus which froms bullae. Primary infection in children on is
conjuctiva and nasopharinx and in adults is pneumonia and bacteriemia.Factors : HIV,
malignancy, alchoholism.

Clinical picture : Mostly commonly seen in childern up to 5 years old, while in adults is rare. It
starts acute as generalized erythrema. There is dethachment of epidermis and there are eroded
live-red painful surfaces. There are not bullae. Nikolsky sign positive. It retives in 7-10 days with
treatment.

diagnosis : histological picture, culture of material

Differntial diagnosis : TEN

Treatment : antistapylococcus therapy.

Cellulitis

it is acute disease of the dermis and hypodermis caused by Streptococcus pyogenes and
Stapylococcus aureus. Infection can be on healty skin and also on dermatosis (ulcus cruris
varicosum, tinea pedis,chronic eczema).

Clinical picture: changes are seen on any part of the skin, but most commonly on legs on face.
The disease is followed by chronic edema. Cellulitis is seen in difuse erythema and edema with
non sharp margins and changes are worm and painfull.

Differential diagnosis : Erysipelas

Treatment : Streptococcus pyogenes -penicilin, prokainamid, ampicilin

Staphylococcus aureus-wide spectrum antibiotcs

Local -treatment of predisosing factors.

Folicular staphylococcia
it represents inflammation of folicule of the hair.

Clinical picture: changes are seen on the regions which have hair: hair, beard,legs. It is seen as
supraficial papulo-pustular restricited on folicul of hair with edematous base.

Differntial diagnosis : impetigo conatgiosa, tinea barbae profunda.

Treatment :

Local-water,soap, antispeptic,

local antibiotcs -clinadmycin, erytromycin

general: macrolides, cephalosporins.

Furunculs and curbunculs

is necrotic pyococcus infection of skin which starts from hair.

Clinical picture :

Furuncules can be seen on any part of the skin with hair. Most commonly they are seen on the
face, neck, tighs,hands and anogenital region.Changes start with inflammated hair which in few
hours develops in live erytematous, firm, worm and painfull inflammated nodule. Furuncolosis
can last for months and years. It is seen in persons who have atpic dermatitis, anemia...

Curbuncules is composed from the group of the furucules.The intensity of the inflammation and
numeber of the sinuses depends of size of anglomerat.

Differntial diagnosis : stapylococcal foliculitis, antrax, inflammated epidermal cysts.

Treatment : erytromycin, cefalosporins,vacomycin

Lupus vulgaris

is the most common form of the tuberculosis of the skin and also in persons with good immunity.
It comes from other inflammation spots : lymph nodes,bones...

Clinical picture : changes are seen on face, neck, but also on other regions. They can cover
buccal, nasal and conjuctival mucosa. It is seen in all ages and in both genders.

Basic change is translucend nodule of gelatious consitency and pink color which is called
lupo.Lupomes group in shaply demarcated plaque which spreads centarly and in the middle there
is atrophy.Appreance of the lupoms on scar is charcteritic.Lupus is progressive it can last for
years and it can lead to ulcerations, crusts. On old changes there can be spinocelluar and
basocelluar cancer.
Histology: In upper dermis there is the typical tuberculom.Centarly are localized epiteloid and
gigant Langerhas cells with lymphocyte. Caseous necrois can be not there, and bacili are rarely
seen. In epidermis are seen seconadry changes: or it is thinig and atrophic or there is akantosis
with hyperkeratosis.

Differntial diagnosis : sarcoidosis, leishmania, lepara, III stage of syphlis