Chapter 21 Skin and Eye Infections

Layers of the Skin

1. Epidermis: Thin, outermost layer of skin.
a. Stratum Corneum: Exterior surface of the epidermis. Composed of dead skin
cells and rich in keratin, a tough fibrous protein present in hair and nails.
2. Dermis: Thick middle layer containing connective tissue and embedded structures such
as blood vessels, nerves, muscles, hair follicles, sweat glands, and sebaceous glands
(associated with hair follicles and produces a nutrient rich substance called sebum).
3. Hypodermis: Consists of fibrous and adipose (body fat) connective tissue.

Microbiomes of skin varies heavily depending on the moisture of a given area.

Betaproteobacteria and propionibacteria are common in dry and sebaceous regions.
Corynebacterium and Staphylococcus are found in moist regions. Sebum-rich areas such as the
back, the folds at the side of the nose, and the back of the neck all have distinct, less diverse
microbial communities.
Skin bacteria can be either helpful or harmful, either through the production of antimicrobial
substances and outcompeting pathogens, or by causing infections in open wounds.
Malassezia fungus is commonly found on skin.
Circoviridae, Papillomaviridae, and Polyomaviridae are common viruses on skin

Characteristics of Skin Infections:

● Abscess: Localized collection of pus
● Bulla/Bullae: Fluid-filled blister no more than 5mm in diameter
● Carbuncle: Deep, pus-filled abscess generally formed from multiple furuncles
● Crust: Dried fluids from a lesion on the surface of the skin
● Cyst: Encapsulated sac filled with fluid, semi-solid matter, or gas, located just below the
upper layers of skin.
● Folliculitis: A localized rash due to inflammation of hair follicles
● Furuncle (Boil): Pus-filled abscess due to infection of a hair follicle
● Macules: Smooth spots of discoloration on the skin
● Papules: Small raised bumps on the skin
● Pseudocyst: Lesion that resembles a cyst but with a less defined boundary
● Pustules: Fluid or pus-filled bumps on the skin
● Suppurative: Producing pus; purulent
● Ulcer: Break in the skin; open sore
● Vesicle: Small, fluid-filled lesion
● Wheal: Swollen, inflamed skin that itches or burns, such as from an insect bite.

Skin Infection Transmission: Injury or damage to skin can allow microbes to enter deeper,
more nutrient abundant tissues.

Structures Supporting the Eye:

● Lacrimal Gland: Produces and secretes tears. Found above the eye
 ● Lacrimal Punctum: Small openings on the inside edge of the upper eyelid and lower
eyelid near the nose that collect tears
● Lacrimal Ducts: Conveys tears from the puncta to the lacrimal sac
● Lacrimal Sac (Dacryocyst): Tear reservoir
● Nasolacrimal Duct: Passes from the lacrimal sac to the inner nose. Chemicals in tears
act as antimicrobials in the nose. This is why your nose runs when you cry.

Structures of the Eye:

● Conjunctiva: Mucous membranes that act as the surface of the eyeball and inner
eyelid.
● Cornea: Disk through which light passes into the pupil and lens. Protects the lens.
● Pupil: Hole through which light passes to the lens
● Iris: Muscle that controls the amount of light that passes into the eye.
● Lens: Focuses light
● Vitreous Humor: Eye juice
● Retina: Tissue that processes light as neurological signals
● Fovea: Spot of highest focus
● Optic Nerve: Nerve connecting the eye and retina to the brain. Blindspot.

Infections of the Eye:

● Conjunctivitis: Inflammation of the conjunctiva
● Blepharitis: Inflammation of the eyelids
● Keratitis: Inflammation of the cornea
● Dacryocystitis: Inflammation of the lacrimal sac

Staphylococci:
● Gram Positive
● Grapelike Clusters
● S. epidermidis and S. hominis are prevalent staphylococcal species.
● S. aureus: Contagious, spread through skin to skin contact and often carried in the nose.
Very prevalent in community settings and often nosocomial. Has resistant strains such
as methicillin-resistant S. aureus (MRSA). Particularly dangerous for
immunocompromised as little can be done about it.
Staphylococci are often resistant to antibiotics

The pathogenicity of staphylococci is often increased by chemicals secreted by some strains:

● Coagulase: Plasma-clotting protein involved in abscess formation
● Leukocidins: Kills white blood cells and contributes to production of protein A.
● Protein A: Inhibits phagocytosis by bonding to the constant region of antibodies.
● Toxic Sock Syndrome Toxin-1
● Staphylolysins: Hemolysins produced by staphylococci that are cytotoxic for skin cells
and white blood cells.

Staphylococcal Infections:
 ● Pyoderma: purulent/pus producing skin infections. Folliculitis, to furuncles, to
carbuncles. Associated with S. aureus.
● Staphylococcal Scalded Skin Syndrome (SSSS): Superficial infection caused by S.
Aureus normally seen infants. Bacterial endotoxins cause erythema (red skin) then
severe peeling. Diagnosed by blood tests for high white blood cell counts, culturing, and
peeling. Treated by intravenous antibiotics and fluid therapy.
● Impetigo: Vesicles to pustules to bullae, often around nose and mouth. Common in
children and highly contagious. Can be caused by S. aureus, or Streptococcus
pyogenes individually or in tandem. Diagnosed through observation, culturing, and
susceptibility testing. Treated with topical or oral antibiotics. Cases caused by S.
pyogenes can lead to serious sequelae (pathological condition resulting from infection,
disease, injury, therapy, or other trauma) such as acute glomerulonephritis, severe
inflammation of the kidneys.

Streptococci:
● Gram positive
● Chains of spheres
● S. pyogenes is common and one of many species that causes Necrotizing Fasciitis
○ Necrotizing Fasciitis: Rare and life threatening condition also known as
FLESH-EATING BACTERIAL SYNDROME. Also caused by Klebsiella,
Clostridium, Escherichia coli, S. aureus and Aeromona hydrophila. Occurs when
the fascia (thin layer of connective tissue between the skin and muscle, becomes
infected. DOES NOT ALWAYS REQUIRE PORTAL OF ENTRY. Severe cases
caused by S. pyogenes occur when virulence factors responsible for adhesion
and invasion overcome host defenses. Invasins allow bacterial cells to adhere to
tissues and establish infections. Bacterial proteases unique to S. pyogenes
aggressively infiltrate and destroy host tissues, inactivate complement, and
prevent neutrophil migration to the infection site. Results in rapid tissue death of
large areas of skin which DETACHES FROM THE BODY. Debridement, the
surgical removal of dead or infected tissues and amputation are common
treatments, but are always supplemented with intravenous antibiotics and other
therapies.

Viral Infections of Skin and Eyes:

● Papillomas (Warts): Expression of common skin infections by human papillomavirus
(HPV) and are transmitted by direct contact. Common warts develop on fingers, the
backs of hands, around nails, and areas with broken skin. Plantar warts develop on the
sole of the foot and can grow inwards. Flat warts can develop anywhere on the body
and are smooth and numerous. Filiform warts are long, threadlike warts that grow
quickly. In some cases, the immune system can stop warts from forming or kill
established warts, but in most cases treatment is required. Common warts can be
treated with liquid nitrogen, topical applications of salicylic acid, electrosurgery,
curettage, excision, painting with cantharidin, laser treatment, treatment with bleomycin,
chemical peels and immunotherapy.
 ● Oral Herpes: Caused by herpes simplex virus (HSV) which is divided into
○ HSV-1: Transmitted orally and associated with ora; herpes. Infects mucous
membrane and manifests as cold sores or blisters around the lips. Treated with
antivirals to reduce symptoms and risk of transmission. Topica; medications
reduce symptoms
○ HSV-2: Transmitted sexually and results in genital herpes.
● Roseola: Caused by human herpesvirus-6 (HHV-6) and occasionally by HHV-7. Spread
by contact with saliva or respiratory secretions and common in children. Results in runny
nose, sore throat, cough, fever, and later a painless rash on the chest. Starts as macules
or papules surrounded by a white ring, then spreads to neck and arms. Can be treated
with ganciclovir, but usually subsides on its own.
● Viral Conjunctivitis: Eye inflammation that produces a much more watery discharge
than its bacterial counterpart. Spread through discharge.

Mycoses of the Skin:

● Cutaneous Mycoses: Mycoses that infect the epidermis, hair, and nails.
○ Tineas (Ringworm): Caused by dermatophytes, fungal molds that require
keratin for growth.
○ Cutaneous Aspergillosis: Caused by Aspergillus. Results in distinctive eschars
at the site of infection. Treated with antifungal medication in most instances, and
surgical+immunotherapy for burn victims and the immunocompromised.
■ Primary Cutaneous Aspergillosis: Occurs at the site of an injury (or
skin?). Often nosocomial and opportunistic. Associated with venipuncture
wounds, burns, surgical wounds, and occlusive dressing.
■ Secondary Cutaneous Aspergillosis: Occurs in the respiratory system
and disseminates systemically. More common.
● Subcutaneous Mycoses: Mycoses that penetrate the dermis and infect deeper tissues.
● Systemic Mycoses: Mycoses that spread throughout the body.