CHAPTER 16: INFECTIONS OF THE SKIN

BACTERIAL SKIN INFECTIONS

1. STAPHYLOCOCCI: STAPHYLOCOCCUS AUREUS
DISEASE: FOLLICULITIS

DEFINITION: a pyogenic (pus-producing) infection involving the hair follicle. It is characterized by

localized painful inflammation and heals rapidly after draining the pus.

ETIOLOGIC AGENT: Staphylococci: Staphylococcus Aureus

MODE OF TRANSMISSION: Folliculitis from infectious agents may spread by sharing razors, towels, or
through Jacuzzis or hot tubs. It can also spread from one part of the body to another.

SIGNS AND SYMPTOMS: In the initial stages, folliculitis may look like a rash, a patch of small red bumps,
or yellow- or white-tipped pimples. Over time, this can spread to nearby hair follicles and progress to
crusty sores.

DIAGNOSIS: Doctors tend to diagnose folliculitis based on a physical examination. The doctor may
examine the skin, take note of symptoms, and review the person’s medical and family history. They may
take a swab of the infected skin to test for which bacteria or fungus has caused the folliculitis. In rare
cases, a skin biopsy may be required to exclude the possibility of other causes.

TREATMENT: Home therapy for mild cases of bacterial folliculities includes use of an over-the-counter
anti-bacterial like benzoyl peroxide (Clearvisil, Proactiv), chlorhexidine (Hibicens), or Phisoderm twice a
day.

PREVENTION: Take a bathe or shower daily with a mild soap, avoid sharing towels, washclothes, or
other personal items.

DISEASE: FURUNCLE

DEFINITION: an extension of folliculitis and is also known as boil. It is characterized by larger and painful
nodules with underlying collection of dead and necrotic tissue.

ETIOLOGIC AGENT: Staphylococci: Staphylococcus Aureus

MODE OF TRANSMISSION: The bacteria cause an infection only if they enter the skin through a scrape,
irritation, or injury of some kind. Sometimes friction on the skin--from clothing, for example--will cause a
hair follicle to swell up. This can make the opening close up, trapping the bacteria inside and starting an
infection.

SIGNS AND SYMPTOMS: A boil starts out as a red lump. Usually within 24 hours, the lump fills with pus
and looks round with a yellow-white tip. Pus or other fluid may drain from the boil. There may be
swelling around the boil. The boil may hurt only when you touch it or it may be quite painful all of the
time. Lymph nodes near the boil may also swell. You are most likely to notice swollen lymph nodes in
the neck, armpit, or groin area.

DIAGNOSES: The healthcare provider will examine the infected area. Tell your provider if you have had a
boil longer than 2 weeks or if you have boils often. If you have boils often, you may have lab tests of
your blood or urine. These tests can check for conditions that might make you more likely to have the
sores, such as diabetes or kidney or liver disease.

TREATMENT: Treatment for stubborn furuncles generally includes steps to promote drainage and

healing. Warm compresses can help speed the rupturing of a furuncle. Apply a warm, moist compress
throughout the day to facilitate drainage. Continue to apply warmth to provide both healing and pain
relief after a boil has ruptured.

PREVENTION: Wash your hands often. Follow wound care instructions from your doctor, which may
include gentle cleansing of wounds and keeping wounds covered with bandages. Avoid sharing personal
items such as sheets, towels, clothing, or razors. Wash bedding in hot water to kill the bacteria.

DISEASE: CARBUNCLE

DEFINITION: represents a coalescence of furuncles that extends into the subcutaneous tissue with
multiple sinus tracts.

Carbuncles can develop anywhere. But they are most common on the back and the nape of the neck.
Men get carbuncles more often than women. The bacteria that cause this condition spread easily. So,
family members may develop carbuncles at the same time. Often, the cause of a carbuncle cannot be
determined.

ETIOLOGIC AGENT: Staphylococci: Staphylococcus Aureus

MODE OF TRANSMISSION: An active boil or carbuncle is contagious: the infection can spread to other
parts of the person's body or to other people through skin-to-skin contact or the sharing of personal
items.

SIGNS AND SYMPTOMS: The boils that collect to form carbuncles usually start as red, painful bumps.
The carbuncle fills with pus and develops white or yellow tips that weep, ooze, or crust. Over a period of
several days, many untreated carbuncles rupture, discharging a creamy white or pink fluid.

Superficial carbuncles -- which have multiple openings on the skin's surface -- are less likely to leave a
deep scar. Deep carbuncles are more likely to cause significant scarring. Other carbuncle symptoms
include fever, fatigue, and a feeling of general sickness. Swelling may occur in nearby tissue and lymph
nodes, especially lymph nodes in the neck, armpit, or groin.
DIAGNOSIS: Your doctor can usually diagnose a carbuncle by looking at your skin. A pus sample may also
be taken for lab analysis. It’s important to keep track of how long you’ve had the carbuncle. Tell your
doctor if it’s lasted longer than two weeks. You should also mention if you’ve had the same symptoms
before. If you keep developing carbuncles, it may be a sign of other health issues, such as diabetes. Your
doctor may want to run urine or blood tests to check your overall health.

TREATMENT:

Home care

To soothe your pain, speed healing, and lower the risk of spreading the infection: Place a clean, warm,
moist cloth on your carbuncle several times a day. Leave it on for 15 minutes. This will help it drain
faster. Keep your skin clean with antibacterial soap. Change your bandages often if you’ve had surgery.
Wash your hands after touching your carbuncle.

Medical treatment

Your doctor will use one or more of the following medical treatments to heal your carbuncle:

 Antibiotics. These are taken orally or applied to your skin.

 Pain relievers. Over-the-counter medications are typically sufficient.
 Antibacterial soaps. These may be suggested as part of your daily cleaning regimen.
 Surgery. Your doctor may drain deep or large carbuncles with a scalpel or needle.

You should never try to drain a carbuncle yourself. There’s a risk that you’ll spread the infection. You
could also end up infecting your bloodstream.

PREVENTION: Proper hygiene reduces your risk of developing a carbuncle. Avoid close contact with
someone who has a staph infection, boil, or carbuncle; Wash your hands frequently with antibacterial
soaps and gels, which can help prevent the spread of bacteria; Bathe regularly with soap; Don't share or
re-use washcloths, towels, and sheets.

DISEASE: STY OR HORDEOLUM

DEFINITION: folliculitis occurring at the base of the eyelids.

ETIOLOGIC AGENT: Staphylococci: Staphylococcus Aureus

MODE OF TRANSMISSION: Touching mucus from the nose and then rubbing the eye is one way of
moving staphylococcal bacteria to the eyelid. The infection from one stye can sometimes spread and
cause more styes.

SIGNS AND SYMPTOMS: The way a stye develops includes:

 A painful, red and tender lump develops on the eyelid.

 The lump gets larger and may develop a white or yellow top. This means there is pus in the stye,
and is called 'pointing'. The point can be along the edge of the eyelid (where eyelashes grow), or
it can be inside the eyelid. It is not usual for it to be on the outside of the eyelid.
 The stye can irritate the eye, causing it to water, and it can feel like there is something 'in the
eye' (like when an eyelash gets onto the surface of the eye).
  The surface over the stye may break, releasing the pus, or the swelling may go away without
bursting, when the body's immune system is able to control the infection.
 If the pus drains out of the stye, the lump goes away quite quickly. Otherwise, the swelling may
take longer to go down.

DIAGNOSES: A stye can usually be diagnosed from a visual exam and a review of your medical history.
No special tests or screenings are needed to make a diagnosis.

TREATMENT: Styes often fade away on their own without treatment. You should avoid touching a stye
as much as possible. Never try to pop a stye. It contains bacteria-filled pus, which can spread the
infection into your eye and elsewhere. Stye treatment usually involves some simple home remedies,
such as using a warm compress or flushing your eye with saline.

PREVENTION:

Warning – do not squeeze a stye. If the stye is not ready to burst, the infected pus may be squeezed into
the tissue next to the stye, causing the infection to spread further.

Wash your hands with soap and water before touching your eyes. Clean your eyelids with a Q-tip dipped
in warm water and mild soap or shampoo. Remove eye makeup every night before sleeping. Avoid
sharing towels with someone who has a stye. Residual bacteria may be on the towel.

DISEASE: IMPETIGO

DEFINITION: common in young children and primarily involves the face and the limbs. Initially it starts as
a flattened red spot (macule) which later becomes a pus-filled vesicle that ruptures and forms crust
(honey-colored crust).

ETIOLOGIC AGENT: It may be caused by both S. aureus and S. pyogenes.

MODE OF TRANSMISSION: The skin is usually itchy, so the child scratches and spreads the infection
from under their fingernails to other areas of the body or to another person. Infection can also be
spread by handling contaminated clothing or articles.

SIGNS AND SYMPTOMS: Initially it starts as a flattened red spot (macule) which later becomes a pus-
filled vesicle that ruptures and forms crust (honey-colored crust). If large areas of the skin are affected,
symptoms may also include: fever, swollen lymph glands, general feeling of unwellness (malaise).

DIAGNOSES: Impetigo may be diagnosed by an experienced clinician on the basis of the appearance of
the infection. It may also be diagnosed by taking a swab of the blisters or crust and checking for the
presence of bacteria.

TREATMENT: Impetigo can be treated with prescription antibiotic ointments or creams, which need to
be reapplied until the sores have completely healed. Antibiotic syrups or tablets may also be prescribed.
It is important to complete any course of antibiotics you are prescribed. If left untreated, impetigo can
lead to skin abscesses.

PREVENTION: Children with impetigo should stay home until they are no longer contagious if the lesions
can’t be reliably covered. Adults who work in jobs that involve close contact should ask their doctor
when it’s safe for them to return to work.

Good hygiene is the no. 1 way to prevent impetigo. Take a bath or shower regularly. Use soap to keep
your skin clean. Watch out for skin that's scraped or irritated, like a mosquito bite. Keep those areas
clean and covered and don't scratch. Wash your hands regularly with soap. Keep your nails short and
clean.

DISEASE: STAPHYLOCOCCAL SCALDED SKIN SYNDROME

(RITTER’S DISEASE)

DEFINITION: primarily a disease found in newborns and young children.

ETIOLOGIC AGENT: Staphylococci: Staphylococcus Aureus

MODE OF TRANSMISSION: Staphylococcal scalded skin syndrome almost always affects children < 6
years (especially infants); it rarely occurs in older patients unless they have renal failure or are
immunocompromised. Epidemics may occur in nurseries, presumably transmitted by the hands of
personnel who are in contact with an infected infant or who are nasal carriers of Staphylococcus aureus.
Sporadic cases also occur.

SIGNS AND SYMPTOMS: It is manifested by sudden onset of perioral erythema (redness) that covers the
whole body within two days. When slight pressure is applied over the skin, it causes displacement of the
skin. This is known as positive Nikolsky sign. Bullae and cutaneous blister formation will soon follow and
will later undergo desquamation. Antibodies against the exfoliative toxin are produced within 7 to 10
days enabling the skin to become intact again. The toxin responsible for these manifestations is the
exfoliative toxin. Only the outer layer of the epidermis is affected hence there will be no scarring.

DIAGNOSES: Diagnosis of SSSS is usually made via a clinical exam and a look at your medical history.

Because the symptoms of SSSS can resemble those for other skin disorders such as bullous impetigo and
certain forms of eczema, your doctor may perform a skin biopsy or take a culture to make a more
definitive diagnosis. They may also order blood tests and tissue samples taken by swabbing the inside
the throat and nose.

TREATMENT: In many cases, treatment will usually require hospitalization. Burn units are often best
equipped to treat the condition. Treatment generally consists of: oral or intravenous antibiotics to clear
the infection, pain medication, creams to protect raw, exposed skin.

Nonsteroidal anti-inflammatories and steroids aren’t used because they can have a negative effect on
the kidneys and immune system. As the blisters drain and ooze, dehydration can become a problem.
You’ll be told to drink plenty of fluids. Healing typically begins 24–48 hours after treatment is started.
Full recovery follows just five to seven days later.

PREVENTION: If there is an outbreak of SSSS in either a neonatal care unit or childcare facility, the
possibility of a staphylococcal carrier in the vicinity should be investigated. Identification of the
healthcare worker, childcare worker, parent or visitor colonized or infected with Staphylococcus aureus
is key to managing the problem. Once identified these individuals should be treated with oral antibiotics
to eradicate the causative organism. To prevent further infections these places should employ strict
hand washing with antibacterial soap or sanitizers.

2. STAPHYLOCOCCUS EPIDERMIS
S. epidermidis is part of the normal flora of the skin and is commonly associated with "stitch abscess,"
UTI, and endocarditis. It also causes infections in individuals with prosthetic devices.
 3. STREPTOCOCCI: STREPTOCOCCUS PYOGENES
DISEASE: PYODERMA IMPETIGO

DEFINITION: a purulent skin infection that is localized and commonly involves the face, and the upper
and lower extremities. It starts as vesicles then progresses to pustules. The lesions rupture and form
honey-colored crusts. There may be enlargement of the regional lymph nodes but no sign of systemic
infection.

ETIOLOGIC AGENT: Streptococci: Streptococcus pyogenes

MODE OF TRANSMISSION: The modes of transmission are direct contact, environmental contamination,
and houseflies.

SIGNS AND SYMPTOMS: Symptoms include red, itchy sores that break open and leak a clear fluid or pus
for a few days. Next, a crusty yellow or “honey-colored” scab forms over the sore, which then heals
without leaving a scar. It usually takes 10 days for sores to appear after someone is exposed to group A
strep.

DIAGNOSES: Doctors typically diagnose impetigo by looking at the sores (physical examination). Lab
tests are not usually needed.

TREATMENT: Impetigo is treated with antibiotics that are either rubbed onto the sores (topical
antibiotics) or taken by mouth (oral antibiotics). A doctor might recommend a topical ointment, such as
mupirocin or retapamulin, for only a few sores. Oral antibiotics can be used when there are more sores.

PREVENTION: Improved living conditions, improved personal hygiene and topical treatment of
impetiginous lesions can prevent the spread of impetigo to susceptible individuals.

DISEASE: ERYSIPELAS (ST. ANTHONY'S FIRE)

DEFINITION: follows a respiratory tract or skin infection caused by S. pyogenes. Patients manifest with
localized raised areas associated with pain, erythema, and warmth. It is grossly distinct from normal
skin. There is accompanying lymphadenopathy and systemic manifestations.

ETIOLOGIC AGENT: Streptococci: Streptococcus pyogenes

MODE OF TRANSMISSION: Skin infection spreads through a break in the skin, directly invading the
lymphatic system and causing erysipelas. Some risk factors that predispose people to develop erysipelas
are obesity, lymphedema, athlete’s foot, leg ulcers, eczema, intravenous drug abuse, poorly controlled
diabetes, and liver disease.
SIGNS AND SYMPTOMS: Symptoms include pain, redness, and rash and, often, fever, chills, and malaise.
Erysipelas is characterized by well-demarcated areas of bright red skin that are typically rough, raised,
and leathery. It occurs most often on the face but can also involve the hands, arms, legs, or feet.
Warmth, pain, and swelling are common as well.

DIAGNOSES: Erysipelas is usually diagnosed by the clinician looking at the characteristic well-
demarcated rash following a history of injury or recognition of one of the risk factors. Tests, if
performed, may show a high white cell count, raised CRP or positive blood culture identifying the
organism.

TREATMENT: The standard treatment for erysipelas is antibiotics. Penicillin is generally the first-line
treatment option for streptococcal infections. Other antibiotics may be used if there is an allergy to
penicillin.

 Cephalosporin-class antibiotics
 Clindamycin (brand names Cleocin, Clindacin, Dalacin)
 Dicloxacillin (brand names Dycill, Dynapen)
 Erythromycin (brand names Erythrocin, E-Mycin, Ery-Tab)
 Azithromycin (brand names Zithromax, AzaSite, Z-Pak)

Most cases can be treated with oral rather than intravenous (IV) antibiotics. Any pain, swelling, or
discomfort can be treated with rest, a cold compress, and elevation of the affected limb. Nonsteroidal
anti-inflammatory drugs like Advil (ibuprofen) or Aleve (naproxen) can be used to relieve pain and fever.
If the face is involved, chewing should be minimized to avoid pain in which case, a soft diet may be
recommended during the healing phase. Treatment is often monitored by marking the borders of the
rash with a marker pen. Doing so can make it easier to see if the rash is receding and the antibiotics are
working.

PREVENTION: Properly cleaning and covering wounds is important for people battling an open wound.
Effectively treating athlete's foot or eczema if they were the cause for the initial infection will decrease
the chance of the infection occurring again. People with diabetes should pay attention to maintaining
good foot hygiene. About one third of people who have had erysipelas will be infected again within
three years.

DISEASE: CELLULITIS

DEFINITION: involves the skin and subcutaneous tissue. Unlike erysipelas, the infected and the normal
skin are not clearly differentiated. It is also manifested as local inflammation with systemic signs.

ETIOLOGIC AGENT: Streptococci: Streptococcus pyogenes

MODE OF TRANSMISSION: Cellulitis usually doesn't spread from person to person. Yet it's possible to
catch cellulitis if you have an open cut on your skin that touches an infected person's skin. You're more
likely to catch cellulitis if you have a skin condition like eczema or athlete's foot.

SIGNS AND SYMPTOMS: In general, cellulitis appears as a red, swollen, and painful area of skin that is
warm and tender to the touch. The skin may look pitted, like the peel of an orange, or blisters may
appear on the affected skin. Some people may also develop fever and chills.

DIAGNOSES: Doctors typically diagnose cellulitis by doing a physical examination and looking at the
affected skin. Blood or other lab tests are usually not needed.
TREATMENT: Cellulitis is treated with antibiotics. Most cellulitis infections can be treated with
antibiotics that are taken by mouth (oral antibiotics). More serious infections may need to be treated in
the hospital with intravenous (IV) antibiotics, which are given directly into a vein. If the infection is in the
arm or leg, then keeping that limb elevated can help decrease swelling and speed up recovery.

PREVENTION: Clean all minor cuts and injuries that break the skin (like blisters and scrapes) with soap
and water. Clean and cover draining or open wounds with clean, dry bandages until they heal. See a
doctor for puncture and other deep or serious wounds. If you have an open wound or active infection,
avoid spending time in: Hot tubs, Swimming pools, Natural bodies of water (e.g., lakes, rivers, oceans).
Wash hands often with soap and water or use an alcohol-based hand rub if washing is not possible.

STUDY

People with diabetes and those with poor circulation need to take extra precautions to prevent skin
injury. Good skin care measures include the following:

 Inspect your feet daily. Regularly check your feet for signs of injury so you can catch infections
early.
 Moisturize your skin regularly. Lubricating your skin helps prevent cracking and peeling. Do not
apply moisturizer to open sores.
 Trim your fingernails and toenails carefully. Take care not to injure the surrounding skin.
 Protect your hands and feet. Wear appropriate footwear and gloves.
 Promptly treat infections on the skin's surface (superficial), such as athlete's foot. Superficial skin
infections can easily spread from person to person. Don't wait to start treatment.

DISEASE: NECROTIZING FASCIITIS

DEFINITION: involves the deep subcutaneous tissue and is also known as - "flesh-eating" or
streptococcal gangrene. It starts as cellulitis then becomes bullous and gangrenous. It spreads to the
fascia then the muscle and fat. It may become systemic and cause multi-organ failure leading to death.

ETIOLOGIC AGENT: Streptococci: Streptococcus pyogenes

MODE OF TRANSMISSION: The bacteria most commonly enter the body through a break in the skin,
including: Cuts and scrapes, Burns, Insect bites, Puncture wounds (including those due to intravenous or
IV drug use), Surgical wounds. However, people can also get necrotizing fasciitis after an injury that does
not break the skin (blunt trauma).

SIGNS AND SYMPTOMS: The infection often spreads very quickly. Early symptoms of necrotizing fasciitis
can include: A red, warm, or swollen area of skin that spreads quickly, Severe pain, including pain
beyond the area of the skin that is red, warm, or swollen, Fever.

See a doctor right away if you have these symptoms after an injury or surgery. Even though minor
illnesses can cause symptoms like these, people should not delay getting medical care.

Later symptoms of necrotizing fasciitis can include:

 Ulcers, blisters, or black spots on the  Dizziness

skin  Fatigue (tiredness)
 Changes in the color of the skin  Diarrhea or nausea
 Pus or oozing from the infected area
DIAGNOSES: There are many infections that look similar to necrotizing fasciitis in the early stages, which
can make diagnosis difficult. In addition to looking at the injury or infection, doctors can diagnose
necrotizing fasciitis by: Taking a tissue sample (biopsy), Looking at bloodwork for signs of infection and
muscle damage, Imaging (CT scan, MRI, ultrasound) of the damaged area. However, it is important to
start treatment as soon as possible. Therefore, doctors may not wait for test results if they think a
patient might have necrotizing fasciitis.

TREATMENT: Necrotizing fasciitis is a very serious illness that requires care in a hospital. Antibiotics and
surgery are typically the first lines of defense if a doctor suspects a patient has necrotizing fasciitis. Since
necrotizing fasciitis can spread so rapidly, patients often must get surgery done very quickly. Doctors
also give antibiotics through a needle into a vein (IV antibiotics) to try to stop the infection.

Sometimes, however, antibiotics cannot reach all of the infected areas because the bacteria have killed
too much tissue and reduced blood flow. When this happens, doctors have to surgically remove the
dead tissue. It is not unusual for someone with necrotizing fasciitis to end up needing multiple surgeries.
In serious cases, the patient may need a blood transfusion.

PREVENTION: There's no sure way to prevent a necrotizing fasciitis infection. However, you can reduce
your risk with basic hygiene practices. Wash your hands frequently with soap and treat any wounds
promptly, even minor ones. If you already have a wound, take good care of it.

4. PSEUDOMONAS AERUGINOSA
DISEASE: OSTEOCHONDRITIS

DEFINITION: Osteochondritis dissecans is a joint condition whereby a variable amount of bone and its
adjacent cartilage loses its blood supply. Osteochondritis dissecans can involve the bone and cartilage of
virtually any joint. Elbows and knees are most commonly affected. Usually, only a small portion of the
affected cartilage is involved. Osteochondritis dissecans most commonly affects boys between 9 and 18
years of age.

ETIOLOGIC AGENT: Pseudomonas Aeruginosa

MODE OF TRANSMISSION:

SIGNS AND SYMPTOMS: Pain and swelling of a joint — often brought on by sports or physical activity —
are the most common initial symptoms of OCD. Advanced cases of OCD may cause joint catching or
locking.

DIAGNOSIS: The doctor will perform a physical examination and will assess the joint's stability. The
doctor may order tests, including the following: X-rays, which will show the bone, locate the lesion and
reveal its size. A magnetic resonance imaging test (MRI), along with an ultrasound.

Osteochondritis dissecans can be suggested clinically by observing the lack of full range of motion with
"locking" of the joint at a certain angle. It is at this angle that the loosened cartilage and bone is literally
being "pinched" as the joint is attempting to move. Ultimately, osteochondritis dissecans is best
diagnosed with imaging studies, such as magnetic resonance imaging scan (MRI scan) or an arthrogram.
TREATMENT: There is no cure as such, but the condition can be treated by a variety of means depending
on the size and location of the lesion as well as the age of the patient and the degree of symptoms.
Arthroscopic surgery is a procedure that is frequently used as a treatment to remove the loose cartilage
and bone tissue from the joint. It can also be used to encourage healing by drilling and fixation of lesions
that are only partially detached.

Sometimes, especially in the very young (juvenile) form, osteochondritis dissecans can spontaneously
correct itself.

PREVENTION: It is only possible to prevent osteochondritis dissecans by preventing trauma or injury to

the affected joint.

5. CLOSTRIDIUM PERFRINGENS
DISEASE: GAS GANGRENE

DEFINITION: Gas gangrene is a life-threatening infection following physical trauma or surgery

characterized by massive tissue necrosis with gas formation, shock, renal failure, and death within two
days of onset.

ETIOLOGIC AGENT: Clostridium Perfringens

MODE OF TRANSMISSION: Most gangrene infections occur in situations where open wounds from an
injury or surgery are exposed to bacteria. Non-traumatic gas gangrene, a rarer form of gas gangrene, can
develop when blood flow to body tissues is compromised and bacteria gets inside. There is a greater risk
in people who have a peripheral vascular disease, atherosclerosis, or diabetes mellitus.

SIGNS AND SYMPTOMS: Common symptoms include increased heart rate, fever, and air under the skin.
Skin in the affected area also becomes pale and then later changes to dark red or purple. These
symptoms usually develop six to 48 hours after the initial infection and progress very quickly.

DIAGNOSIS: Your doctor will diagnose gas gangrene based on your child's symptoms, along with
laboratory tests to find Clostridium bacteria such as cultures and smears of a blood sample and
secretions from the infected area.

TREATMENT: If gas gangrene is suspected, treatment must begin immediately.

High doses of antibiotics, typically penicillin and clindamycin, are given, and all dead and infected tissue
is removed surgically. About one of five people with gas gangrene in a limb requires amputation.

Treatment in a high-pressure oxygen (hyperbaric oxygen) chamber may also be helpful, but such
chambers are not always readily available.

PREVENTION: Doctors do the following to prevent gas gangrene:

Clean wounds thoroughly; Remove foreign objects and dead tissue from wounds; Give antibiotics
intravenously before, during, and after abdominal surgery to prevent infection.

No vaccine can prevent clostridial infection.

 6. BACILLUS ANTHRACIS
DISEASE: ANTHRAX

DEFINITION: Anthrax is a disease of herbivores. There are three forms of anthrax-cutaneous,

gastrointestinal, or pulmonary anthrax. The skin infection, cutaneous anthrax, is the most common
form.  Anthrax mostly affects animals that graze on land that has the bacteria.

ETIOLOGIC AGENT: Bacillus Anthracis: The bacteria are dormant, or inactive, in soil.

MODE OF TRANSMISSION: People can become infected through inhaled bacteria spores, contaminated
food or water, or skin wounds.

SIGNS AND SYMPTOMS: It is characterized by painless papules at the site of inoculation that become
ulcerative, and later develops necrotic eschar. This is also associated with painful lymphadenopathy and
edema.

Anthrax symptoms vary depending on the type. Symptoms typically appear within one week of
exposure. Sometimes, signs of inhalation anthrax aren’t noticeable for two months. Depending on the
type, symptoms include:

 Chest pain and trouble breathing.  Nausea and vomiting, abdominal

 Fatigue. pain and bloody diarrhea.
 Fever and profuse sweating.  Skin ulcer (sore) with a black center.
 Headache or muscle aches.  Swollen lymph nodes.
 Itchy blisters or bumps.

DIAGNOSIS:

Depending on your symptoms and the anthrax type, your healthcare provider may conduct one or more
of these tests:

 Biopsy of skin lesion.

 Blood tests.
 Chest X-ray.
 Computed tomography (CT) scan.
 Lab tests on stool or mucus.
 Lumbar puncture (spinal tap).

TREATMENT: Antibiotics like penicillin or doxycycline are the drugs of choice. In resistant cases,
ciprofloxacin is recommended.

PREVENTION: Prevention is through vaccination of animals and individuals at risk such as animal
handlers, veterinarians, military personnel, and those working in slaughterhouses.

The anthrax vaccine is 90% effective at preventing infection. The vaccine is only available to people
between the ages of 18 and 65 who work in high-risk professions. You receive five doses of the vaccine
over 18 months.

FUNGAL SKIN INFECTIONS

 1. SUPERFICIAL MYCOSES
DISEASE: TINEA VERSICOLOR (PITYRIASIS VERSICOLOR)

DEFINITION: Tinea versicolor is a fungal infection that causes small patches of discolored spots on your
skin. It results from a type of yeast that naturally lives on your skin. When the yeast grows out of
control, the skin disease, which appears as a rash, is the result. The infection is worldwide in distribution
but more common in tropical regions.

ETIOLOGIC AGENT: Malassezia Furfur (Pityrosporum Orbiculare): a normal flora of the skin particularly
in areas rich in sebaceous glands

MODE OF TRANSMISSION: It does not spread from person to person. Other things that increase your
chance of getting tinea versicolor include: Having an impaired immune system, which can occur during
pregnancy or from some illnesses.

SIGNS AND SYMPTOMS: The lesions are irregular, discrete hypo- or hyperpigmented macules depending
on the skin color of the affected individual. The lesions a scaly with a dry, chalky appearance, and usually
appear on the face, neck trunk, and arms.

DIAGNOSIS: Diagnosis is made by microscopic visualization of "spaghetti and meatballs" appearance of

M. furfur with an alkaline stain (10% KOH or NaOH). It can also be demonstrated with Periodic Acid
Schiff stain (PAS stain) or hematoxyllin-eosin stain (H&E stain). Your doctor can diagnose tinea versicolor
by looking at it. If there's any doubt, he or she may take skin scrapings from the infected area and view
them under a microscope.

TREATMENT: Treatment includes application of keratolytic agents containing selenium disulfide or

salicylic acid and topical antifungal drugs like ketoconazole.

Treatment of tinea versicolor can consist of creams, lotions, or shampoos that you put on your skin. It
can also include medication given as pills. The type of treatment will depend on the size, location, and
thickness of the infected area.

PREVENTION: It can be difficult to prevent a recurrence of this condition. If you’ve been diagnosed with
tinea versicolor and you’ve successfully treated it, there are steps you can take to prevent future
infections. These include: avoiding excessive heat; avoiding tanning or excessive sun exposure; avoiding
excessive sweating.

You can also help prevent tinea versicolor by using a prescription-strength skin treatment during times
of the year when you’re most susceptible to it.

DISEASE: TINEA NIGRA

DEFINITION: Tinea nigra is a very rare fungal infection. It causes brown or black patches to develop on
the soles of the feet, the palms of the hand, or, on rare occasions, the torso. The infection is common in
the tropical and subtropical regions, and is more frequently seen in adolescents, young adults, and
females.

ETIOLOGIC AGENT: caused by Hortaea werneckii (formerly Exophiala werneckii), a dematiaceous fungus
that produces melanin and grows as mold producing annelids or annelloconidia. Causes most tinea nigra
infections. 

MODE OF TRANSMISIION: A person can get the infection when the yeast gets into their body, often
through a small wound.

SIGNS AND SYMPTOMS: The lesions involve the palms and soles and are described as gray to black,
well-demarcated macules.

Tinea nigra is largely painless and harmless, but it does produce a few symptoms. They include:

 A brown or black patch resembling a stain that usually occurs on the palm of the hand or, more
rarely, on the sole of the foot. In one study published in Studies in Mycology,  19 of 22 Trusted
Source people with tinea nigra had the patches on their palms while only three had them on
their feet.

 The patch is generally flat, with defined borders.

 The darkest area of the patch is at the edges. Shading gets lighter as it extends inward. This
darker outside area may look like a halo.

 The lesion is slow-growing and usually appears on only one hand or foot.

DIAGNOSIS: Diagnosis is made by direct microscopic examination of skin scrapings with potassium
hydroxide and culture using Sabouraud's dextrose agar medium.

Tinea nigra can look like more serious skin conditions, such as malignant melanoma, a deadly form of
skin cancer that can present as dark patches. Because of this, your doctor may want to scrape a sample
of the lesion and send it to a lab for testing. In some cases, the lesion can be scraped entirely away and
not require any further treatment.

TREATMENT: Treatment is similar to the treatment for tinea versicolor.

PREVENTION: Since the fungus that causes tinea nigra is found in soil, sewage, and rotting vegetation,
the best way to prevent infection is to protect your skin. Wear shoes if you’ll be walking in the hot,
humid regions where the fungus is found. If there’s any risk you’ll be touching vegetation — for
instance, if you’ll be hiking, gardening, or planting — be sure to also wear gloves.

2. CUTANEOUS MYCOSES OR DERMATOPHYTOSIS

Dermatophytosis (tinea) infections are fungal infections caused by dermatophytes - a group of fungi that
invade and grow in dead keratin. Several species commonly invade human keratin and these belong to
the Epidermophyton, Microsporum and Trichophyton genera. They tend to grow outwards on skin,
producing a ring-like pattern - hence the term 'ringworm'. They are very common and affect different
parts of the body. They can usually be successfully treated but success depends on the site of infection
and on compliance with treatment.

DISEASE: TINEA PEDIS

DEFINITION: Athlete’s foot — also called tinea pedis — is a contagious fungal infection that affects the
skin on the feet. It can also spread to the toenails and the hands. The fungal infection is called athlete’s
foot because it’s commonly seen in athletes. It commonly occurs in people whose feet have become
very sweaty while confined within tightfitting shoes.

ETIOLOGIC AGENT: Dermatophytosis

MODE OF TRANSMISIION: Athlete's foot is contagious and can be spread via contaminated floors,
towels or clothing. The infection can affect one or both feet and can spread to your hand — especially if
you scratch or pick at the infected parts of your feet.

SIGNS AND SYMPTOMS: Athlete's foot usually causes a scaly red rash. The rash typically begins in
between the toes. Itching is often the worst right after you take off your shoes and socks.

Some types of athlete's foot feature blisters or ulcers. The moccasin variety of athlete's foot causes
chronic dryness and scaling on the soles that extends up the side of the foot. It can be mistaken for
eczema or dry skin.

DIAGNOSIS: A doctor may diagnose athlete’s foot by the symptoms. Or, a doctor may order a skin test if
they aren’t sure a fungal infection is causing your symptoms.

A skin lesion potassium hydroxide exam is the most common test for athlete’s foot. A doctor scrapes off
a small area of infected skin and places it in potassium hydroxide. The KOH destroys normal cells and
leaves the fungal cells untouched so they are easy to see under a microscope.

TREATMENT: If your athlete's foot is mild, your doctor may suggest using an over-the-counter antifungal
ointment, cream, powder or spray.

If your athlete's foot doesn't respond, you may need a prescription-strength medication to apply to your
feet. Severe infections may require antifungal pills that you take by mouth.

Your doctor may recommend that you soak your feet in salt water or diluted vinegar to help dry up
blisters.

PREVENTION: These tips can help you avoid athlete's foot or ease the symptoms if infection occurs:

 Keep your feet dry, especially between your toes. Go barefoot to let your feet air out as much
as possible when you're home. Dry between your toes after a bath or shower.

 Change socks regularly. If your feet get very sweaty, change your socks twice a day.

 Wear light, well-ventilated shoes. Avoid shoes made of synthetic material, such as vinyl or
rubber.

 Alternate pairs of shoes. Don't wear the same pair every day so that you give your shoes time to
dry after each use.

 Protect your feet in public places. Wear waterproof sandals or shoes around public pools,
showers and lockers rooms.

 Treat your feet. Use powder, preferably antifungal, on your feet daily.

  Don't share shoes. Sharing risks spreading a fungal infection.

DISEASE: TINEA CAPITIS

DEFINITION: Tinea capitis is the term for a ringworm infection that develops on the skin and inside the
hair follicles on the scalp. It is a dermatophytosis that mainly affects children, is contagious, and can be
epidemic.

ETIOLOGIC AGENT: Trichophyton Rubrum

MODE OF TRANSMISIION: The fungus is usually spread by coming in contact with infected hairs on
combs, brushes, hats or pillow cases. The fungus can also spread through the air.

SIGNS AND SYMPTOMS: Initially, tinea capitis causes small red bumps and pustules on the scalp, as well
as some scaling. Over time, these bumps may increase in number. The rash can also spread to cover a
wider area.

People who have tinea capitis may experience a localized area of scaling, itching, and pus filled bumps.
They may also notice some hair loss.

DIAGNOSIS: A visual exam is often enough for a doctor to diagnose ringworm of the scalp. Your doctor
may use a special light called a Wood’s lamp to illuminate your scalp and determine signs of infection.

Your doctor may also take a skin or hair sample to confirm the diagnosis. The sample is then sent to a
lab to determine the presence of fungi. This involves looking at your hair or a scraping from a scaly patch
of scalp under a microscope. This process may take up to three weeks.

TREATMENT: Antifungal medications that can be taken by mouth are used to treat ringworm of the
scalp. The medications most commonly prescribed include griseofulvin (Gris-Peg) and terbinafine
(Lamisil). Your child might need to take one of these medications for six weeks or more.

Your doctor might recommend that you also wash your hair with a prescription-strength medicated
shampoo. This may help remove fungus spores and prevent the spread of the infection to other people
or to other areas of your child's scalp or body.

PREVENTION:

 The dermatophytes that cause ringworm are common and contagious. This makes prevention
difficult. Because children are especially susceptible, tell your children about the risks of sharing
hairbrushes and other personal items. Regular shampooing, hand washing, and other normal
hygiene routines can help prevent the spread of infection. Be sure to teach your children proper
hygiene, and follow these practices yourself.

 It can be hard to tell if an animal has ringworm, but a common sign of infection is bald patches.
Avoid petting any animals that have patches of skin showing through their fur. Maintain regular
checkups for all pets and ask your veterinarian to check for ringworm.

DISEASE: TINEA UNGUIUM (ONYCHOMYCOSIS)

DEFINITION: The most common fungus infection of the nails, also called onychomycosis. Onychomycosis
is a fungal infection of the nail bed, nail plate or both. It is caused by dermatophytes, non-dermatophyte
molds and yeast. Onychomycosis makes the nails look white and opaque, thickened, and brittle. More
commonly affecting the toenails than the fingernails. It is usually asymptomatic.

It is suspected if there are changes in the 3rd or 5th toenail, involvement of the 1st and 5th toenails on
the same foot and unilateral nail changes.

ETIOLOGIC AGENT: Trichophyton Rubrum and Trichophyton Interdigitale

MODE OF TRANSMISIION: While the fungus must be obtained from someplace, it is not highly
contagious. Nail fungus is so common that finding more than one person in a household who has it is
hardly more than a coincidence. It can be transmitted from person to person but only with constant
intimate contact.

SIGNS AND SYMPTOMS: Patients may complain of numbness, pain, discomfort affecting manual
activities & may cause loss of self-esteem & diminished social interaction. May manifest as
erythematous swelling of the nail fold (paronychia), separation of the nail plate from its bed.
Onychomycosis is classified based on route of infection & clinical presentation.

DIAGNOSIS: Because other infections can affect the nail and mimic symptoms of a fungal nail infection,
the only way to confirm a diagnosis is to see a doctor. They’ll take a scraping of the nail and look under a
microscope for signs of fungus.

In some cases, your doctor may send the sample to a lab for analysis and identification.

TREATMENT: Over-the-counter products aren’t usually recommended to treat nail infections since they
don’t provide reliable results. Instead, your doctor may prescribe an oral antifungal medication, such as:

 terbinafine (Lamisil)
 itraconazole (Sporanox)
 fluconazole (Diflucan)
 griseofulvin (Gris-PEG)
Your doctor may prescribe other antifungal treatments, such as antifungal nail lacquer or topical
solutions. These treatments are brushed onto the nail in the same way that you’d apply nail polish.

PREVENTION: Making a few simple lifestyle changes can help prevent a fungal infection of the nails.
Taking good care of your nails by keeping them well trimmed and clean is a good way to prevent
infections.

Also avoid injuring the skin around your nails. If you’re going to have damp or wet hands for an
extended amount of time, you may want to wear rubber gloves.

Other ways to prevent fungal infections of the nails include: washing your hands after touching infected
nails; drying your feet well after showering, especially between your toes; getting manicures or
pedicures from trustworthy salons; avoiding being barefoot in public places; reducing your use of
artificial nails and nail polish.

DISEASE: TINEA CORPORIS

DEFINITION: Ringworm of the body looks like ring- or circular-shaped rashes with edges that are slightly
raised. The skin in the middle of these ring-shaped rashes appears healthy. Usually, the rashes are itchy.
They will spread over the course of the infection Symptoms of a more severe infection include rings that
multiply and merge together. You may also develop blisters and pus-filled sores near the rings.

ETIOLOGIC AGENT: Trichophyton Or Microsporum

MODE OF TRANSMISIION: A ringworm infection can be spread in many direct and indirect ways,
including:
 Person to person: This happens through direct contact with the skin of a person infected with
ringworm.
 Pet/animal to person: This occurs when you have direct contact with an infected pet. Both dogs
and cats can spread the infection to people. Ferrets, horses, rabbits, goats, and pigs can also
spread ringworm to people.
 Inanimate item to person: It’s possible to get ringworm through indirect contact with objects,
including hair of an infected person, bedding, clothing, shower stalls, and floors.
 Soil to person: Rarely, a ringworm infection can be spread through contact with highly infected
soil for an extended amount of time.

SIGNS AND SYMPTOMS: Symptoms of ringworm of the body usually start about 4 to 10 days after
contact with the fungus. Ringworm of the body looks like ring- or circular-shaped rashes with edges that
are slightly raised. The skin in the middle of these ring-shaped rashes appears healthy. Usually, the
rashes are itchy. They will spread over the course of the infection. Symptoms of a more severe infection
include rings that multiply and merge together. You may also develop blisters and pus-filled sores near
the rings.

DIAGNOSIS: If your doctor suspects that you may have ringworm, they’ll examine your skin and may do
some tests to rule out other skin conditions not caused by fungus, like atopic dermatitis or psoriasis.
Usually a skin examination will result in a diagnosis.

Your doctor may also observe skin scrapings from the affected area under a microscope to look for
fungus. A sample may be sent to a laboratory for confirmation. The laboratory may perform a culture
test to see if the fungus grows.

TREATMENT: Over-the-counter (OTC) topical fungicidal medications are usually enough to treat the
infection. The medication may be in the form of a powder, ointment, or cream. It’s applied directly to
the affected areas of the skin. These medications include OTC products like:
 clotrimazole (Lotrimin AF)
 miconazole (Micatin)
 terbinafine (Lamisil)
 tolfaftate (Tinactin)
Shop for OTC antifungal medication.
Your pharmacist can also help you choose which one is right for you.
If the ringworm of the body is widespread, severe, or does not respond to the above medications, your
doctor may prescribe a stronger topical medication or a fungicidal that you take by
mouth. Griseofulvin is a commonly prescribed oral treatment for fungal infections.

PREVENTION: Ringworm of the body can be prevented by avoiding contact with someone who has the
infection. This includes both indirect and direct contact with that person.
Take the following precautions:
 Avoid sharing towels, hats, hairbrushes, and clothing with someone who has the infection.
 Take your pet to see a vet if you suspect a ringworm infection.
 If you have ringworm of the body, be sure to maintain good personal hygiene around other
people and avoid scratching the affected areas of your skin.
 After a shower, dry your skin well — especially between the toes and where skin touches skin,
such as in the groin and armpits.

DISEASE: TINEA CRURIS

DEFINITION: Jock itch (tinea cruris) is a fungal infection that causes a red and itchy rash in warm and
moist areas of the body. The rash often affects the groin and inner thighs and may be shaped like a ring.
Jock itch gets its name because it's common in athletes. It's also common in people who sweat a lot or
who are overweight.

ETIOLOGIC AGENT: Trichophyton

MODE OF TRANSMISIION: The organisms that cause jock itch thrive in damp, close environments. Jock
itch is caused by a fungus that spreads from person to person or from sharing contaminated towels or
clothing. It's often caused by the same fungus that causes athlete's foot. The infection often spreads
from the feet to the groin because the fungus can travel on your hands or on a towel.

SIGNS AND SYMPTOMS: Jock itch usually begins with a reddened area of skin in the crease in the groin.
It often spreads to the upper thigh in a half-moon shape. The rash may be ring-shaped and bordered
with a line of small blisters. It may burn or feel itchy, and the skin may be flaky or scaly.

DIAGNOSIS: The diagnosis of tinea cruris is usually obvious to doctors based on a physical examination.

If the diagnosis is not obvious, doctors may do a skin scraping and examine it under a microscope to be
sure that the rash is caused by a fungus.

TREATMENT: Tinea cruris is usually treated with topical antifungal agents. Sometimes hydrocortisone is

added, for faster relief of itch. Topical steroids should not be used on their own. If the treatment is
unsuccessful, oral antifungal medicines may be considered, including terbinafine and itraconazole.

PREVENTION: Reduce your risk of jock itch by taking these steps:

 Stay dry. Keep your groin area dry. Dry your genital area and inner thighs thoroughly with a
clean towel after showering or exercising. Dry your feet last to avoid spreading athlete's foot
fungus to the groin area.

 Wear clean clothes. Change your underwear at least once a day or more often if you sweat a
lot. It helps to wear underwear made of cotton or other fabric that breathes and keeps the skin
drier. Wash workout clothes after each use.

 Find the correct fit. Make sure your clothes fit correctly, especially underwear, athletic
supporters and sports uniforms. Avoid tight-fitting clothes, which can rub and chafe your skin
and put you at increased risk of jock itch. Try wearing boxer shorts rather than briefs.

 Don't share personal items. Don't let others use your clothing, towels or other personal items.
Don't borrow such items from others.
  Treat or prevent athlete's foot. Control any athlete's foot infection to prevent its spread to the
groin. If you spend time in moist public areas, such as a gym shower, wearing sandals will help
prevent athlete's foot.

DISEASE: TINEA BARBAE

DEFINITION: Tinea barbae is a superficial dermatophyte infection that is limited to the bearded areas of
the face and neck and occurs almost exclusively in older adolescent and adult males.  A fungal infection
(known as ringworm) of the bearded area of the face and neck, with swelling and marked crusting, often
with itching. In the days when men went to the barber daily for a shave, tinea barbae was called
barber's itch. 

ETIOLOGIC AGENT: Trichophyton

MODE OF TRANSMISIION: The transmission of tinea barbae to humans occurs through contact of an

infected animal to the skin of a human. Infection can occasionally be transmitted through contact of
infected animal hair on human skin. Tinea barbae is very rarely transmitted through human-to-human
contact but is not completely impossible.

SIGNS AND SYMPTOMS: Problems may be:

 Red, swollen sores around hair follicles in the beard and moustache
 Sores filled with pus
 Crusting
STUDY

If the infection is superficial, beard ringworm appears as a pink-to-red scaly patch ranging in size from 1
to 5 cm. Alternatively, small pus-filled bumps (pustules) may be seen around hair follicles in the affected
skin.

In deeper forms of beard ringworm, you may see firm red nodules covered with pustules or scabs that
may ooze blood and pus.

Beard ringworm is usually itchy. Deeper forms of beard ringworm may be accompanied by fever and
swollen lymph glands.

DIAGNOSIS: Doctors diagnose tinea barbae by examining plucked hairs under a microscope or by doing
a culture (the process of growing an organism in a laboratory for identification) or biopsy.

Diagnosis of tinea barbae is by identifying the fungal element on potassium hydroxide wet mount of
plucked hairs, culture, or biopsy.

Differential diagnosis of follicular-based papules and pustules in the beard area includes bacterial
folliculitis.

TREATMENT: Treatment of tinea barbae is with an antifungal drug, such as griseofulvin, terbinafine,

or itraconazole, taken by mouth.

If the area is severely inflamed, doctors may add a corticosteroid such as prednisone taken by mouth to
lessen symptoms and perhaps reduce the chance of scarring.

PREVENTION: To lower the chance of this infection:

  People who work with farm animals should cover the bearded area of their face.
 Wash the hands and face after working with farm animals.
 Do not share razors.

DISEASE: TINEA MANUUM

DEFINITION: Tinea manuum is a fungal infection of the hands. Tinea is also called ringworm,

and manuum refers to it being on the hands. Tinea causes a red, scaly rash that usually has a border that
is slightly raised.

ETIOLOGIC AGENT: Trichophyton

MODE OF TRANSMISIION: Tinea manuum is a slightly less common form of tinea, and you often
contract it by touching your feet or groin if they are infected. In fact, tinea will usually be on your feet if
it’s on a hand. You can get tinea manuum from others who have the infection. Touching objects
contaminated with fungus can also result in infection.

SIGNS AND SYMPTOMS: There are several common symptoms of tinea manuum.

The infected area on your hand will normally start small and gradually become larger over time. The
infection will generally start on the palm of the hand and may or may not spread to your fingers and
the back of your hand. The area infected with tinea will be itchy, red, and have a scaly appearance.
The infected area may also peel and flake.

Tinea manuum tends to occur on just one hand and both feet. Depending on the fungus causing the
tinea, the area may also blister and contain a clear liquid.

DIAGNOSIS: A medical professional can diagnose tinea (including manuum) using several different
methods. One is by using a Wood’s lamp. When this lamp shines on certain fungi, the fungus shines a
different color or brightness than the rest of your skin.

Your doctor may examine scales from the infected area under a microscope to diagnose tinea. Another
way to diagnose the condition is to take a culture of a sample of the infected skin. A culture is usually
only done if your doctor thinks your tinea will require oral medication.

TREATMENT: You can usually treat your tinea at home using a number of OTC topical medications.
These include miconazole (Lotrimin), terbinafine (Lamisil), and others.

If the infection does not clear up after a month, your doctor may recommend a prescription topical
medication. In severe cases or special circumstances, your doctor may prescribe an oral medication to
resolve the problem.

PREVENTION: To prevent tinea manuum, keep your hands clean and dry, especially if you wear gloves
regularly. Avoid contact with those who have an active case of tinea on any part of their body.

If you have tinea on other parts of your own body, avoid scratching these areas with your hands. When
you treat other infected areas, it’s good to wear disposable gloves to avoid spreading tinea to your
hands.

3. SUBCUTANEOUS MYCOSES
DISEASE: SPOROTRICHOSIS
DEFINITION: Sporotrichosis (also known as “rose gardener’s disease”) is an infection caused by a fungus
called Sporothrix schenckii. The fungus lives throughout the world in soil, plants, and decaying
vegetation. Cutaneous (skin) infection is the most common form of infection, although pulmonary
infection can occur if a person inhales the microscopic, airborne fungal spores. Most cases of
sporotrichosis are sporadic and are associated with minor skin trauma like cuts and scrapes; however,
outbreaks have been linked to activities that involve handling contaminated vegetation such as moss,
hay, or wood.

TYPES OF SPOROTRICHOSIS

 Cutaneous (skin) sporotrichosis is the most common form of the infection. It usually occurs on a
person’s hand or the arm after touching contaminated plant matter.

 Pulmonary (lung) sporotrichosis is rare but can happen after someone breathes in fungal spores
from the environment.

 Disseminated sporotrichosis occurs when the infection spreads to another part of the body,
such as bones, joints, or central nervous system. This form of sporotrichosis usually affects
people with health problems or who take medicines that lower the body’s ability to fight germs
and sickness, such as people living with HIV.

ETIOLOGIC AGENT: Sporothrix Schenckii

MODE OF TRANSMISIION: People get sporotrichosis by coming in contact with the fungal spores in the
environment. It occurs when the fungus enters the skin through a small cut or scrape, usually after
someone touches contaminated plant matter. Skin on the hands or arms is most commonly affected.

SIGNS AND SYMPTOMS: The symptoms of sporotrichosis depend on where the fungus is growing in the
body. Contact your healthcare provider if you have symptoms that you think are related to
sporotrichosis.

Sporotrichosis usually affects the skin or tissues underneath the skin. The first symptom of cutaneous
(skin) sporotrichosis is usually a small, painless bump that can develop any time from 1 to 12 weeks
after exposure to the fungus. The bump can be red, pink, or purple, and usually appears on the finger,
hand, or arm where the fungus has entered through a break in the skin. The bump will eventually grow
larger and may look like an open sore or ulcer that is very slow to heal. Additional bumps or sores may
appear later near the original one.

Pulmonary (lung) sporotrichosis is rare. Symptoms include cough, shortness of breath, chest pain, and
fever.

Symptoms of disseminated sporotrichosis depend on the body part affected. For example, infection of
the joints can cause joint pain that may be confused with rheumatoid arthritis. Infections of the central
nervous system can involve difficulty thinking, headache, and seizures.

DIAGNOSIS: Sporotrichosis is typically diagnosed when your doctor obtains a swab or a biopsy of the
infected site and sends the sample to a laboratory for a fungal culture. Serological tests are not always
useful in the diagnosis of sporotrichosis due to limitations in sensitivity and specificity.

TREATMENT: Most cases of sporotrichosis only involve the skin and/or subcutaneous tissues and are
non-life-threatening, but the infection requires treatment with prescription antifungal medication for
several months. The most common treatment for this type of sporotrichosis is oral itraconazole for 3 to
6 months. Itraconazole may also be used to treat bone and joint infections, but treatment should
continue for at least 12 months.
PREVENTION: There is no vaccine to prevent sporotrichosis. You can reduce your risk of sporotrichosis
by wearing protective clothing such as gloves and long sleeves when handling wires, rose bushes, bales
of hay, pine seedlings, or other materials that may cause minor cuts or punctures in the skin. It is also
advisable to avoid skin contact with sphagnum moss.

DISEASE: CHROMOBLASTOMYCOSIS

DEFINITION: Chromoblastomycosis is a chronic fungal infection in which there are raised crusted lesions
affecting the skin and subcutaneous tissue. It usually affects the limbs.

Chromoblastomycosis is a cutaneous infection affecting normal, immunocompetent people mostly in

tropical or subtropical areas; it is characterized by formation of papillomatous nodules that tend to
ulcerate.

Chromoblastomycosis often occurs at the site of penetrating injury, particularly in farmers and other
agricultural workers without adequate protective footwear and clothing.

Chromoblastomycosis is caused by dark brown or black fungi that produce sclerotic bodies in tissue.

ETIOLOGIC AGENT: BOOK

MODE OF TRANSMISIION: The organism is inoculated into the skin by a minor injury, for example, a cut
with a splinter when barefoot.

SIGNS AND SYMPTOMS: Usually, chromoblastomycosis begins on the foot or leg, but other exposed
body parts may be infected, especially where the skin is broken. Early small, itchy, enlarging papules
may resemble dermatophytosis (ringworm). These papules extend to form dull red or violaceous,
sharply demarcated patches with indurated bases. Several weeks or months later, new lesions,
projecting 1 to 2 mm above the skin, may appear along paths of lymphatic drainage. Hard, dull red or
grayish cauliflower-shaped nodular projections may develop in the center of patches and, if the infection
is untreated, gradually extend to cover extremities over the course of many years. Lymphatics may be
obstructed, itching may persist, and secondary bacterial superinfections may develop, causing
ulcerations and occasionally septicemia.

DIAGNOSIS: Late chromoblastomycosis lesions have a characteristic appearance, but early lesions may
be mistaken for dermatophytoses.

Fontana-Masson staining for melanin helps confirm the presence of the sclerotic bodies (Medlar
bodies), which are pathognomonic. Culture is needed to identify the causative species.

TREATMENT: Itraconazole is the most effective drug for chromoblastomycosis, although not all patients
respond. Flucytosine is sometimes added to prevent relapse. Amphotericin B is ineffective. Anecdotal
reports suggest that posaconazole, voriconazole, or terbinafine may also be effective.

Adjunctive therapies such as cryotherapy are often helpful, although response is slow.

For localized lesions, surgical excision may be curative.

PREVENTION: It is documented that walking barefoot in endemic areas has a correlation with the
occurrence of chromoblastomycosis on the foot. So, it is necessary to abstain walking barefoot to
reduce the incidence of infection.
DISEASE: MYCETOMA

DEFINITION: Mycetoma is a disease caused by certain types of bacteria and fungi found in soil and
water. These bacteria and fungi may enter the body through a break in the skin, often on a person’s
foot. The resulting infection causes firm, usually painless but debilitating masses under the skin that can
eventually affect the underlying bone.

Mycetoma affects people of all ages and is more common in men. This disease primarily affects poorer
people in rural regions of Africa, Latin America, and Asia that are located near the equator and have dry
climates. People affected by mycetoma often live in remote areas where they have limited access to
healthcare and medications. Mycetoma can cause severe physical disabilities that can force people to
stop working and cause stigma.

ETIOLOGIC AGENT:

If dark or black grains or white, pail or unstained grains: Eumycetoma

If white to yellow grains, brown grains, or red to pink grains: Actinomycetoma

MODE OF TRANSMISIION: The bacteria and fungi that cause mycetoma live in soil and water. These
germs can enter the body through wounds or other small skin injuries, like a thorn prick. It is not known
why some people develop mycetoma and others do not, but aspects of the environment and living
conditions are likely involved. Mycetoma does not spread between people. 

SIGNS AND SYMPTOMS: Symptoms are similar for bacterial and fungal mycetoma. Both appear as firm,
painless masses under the skin. These masses usually appear on a person’s foot but can form anywhere
on the body. The mycetoma masses start small, but over time they can grow larger, develop oozing
sores, and cause the affected limb to become deformed or unusable. If mycetoma is not treated or if
treatment fails, it can spread to other areas of the body. Long-term mycetoma can eventually destroy
the underlying muscle and bone.

DIAGNOSIS: A doctor can diagnose mycetoma by taking a small sample (biopsy) of the infected area of
the body and sending it to a laboratory. The laboratory may examine the sample under a microscope,
but this test may not always determine if the infection is caused by bacteria or fungi and cannot
determine what type of bacteria or fungi is the cause of the mycetoma. A culture (growing the bacteria
or fungi in the laboratory) can determine the specific type of bacteria or fungus causing the infection. A
doctor may also do an imaging test such as an X-ray or ultrasound to diagnose mycetoma and see how
much damage has taken place to muscle and bone. Patients can avoid long-term infection and
amputation by seeking care and detecting and treating mycetoma early.

TREATMENT: Therapies that work against mycetoma are limited, may have to be taken for a long time,
and can be expensive. The treatment for mycetoma depends on whether it is caused by bacteria
(actinomycetoma) or fungi (eumycetoma).

 Actinomycetoma is usually treatable with antibiotics, and surgery is usually not needed.

 Eumycetoma is usually treated with long-term antifungal medicine, but treatment may not be
completely effective. In this case, surgery or amputation are sometimes needed to cut away the
infected tissue.
PREVENTION: Health care providers and researchers believe that wearing shoes might prevent injuries
that can lead to mycetoma. Shoes protect the feet while someone is walking or working outside in areas
where the germs that cause mycetoma are common in water and soil. Early detection and treatment,
before symptoms cause serious effects, can reduce disabilities from mycetoma and may cure the
condition.

VIRAL INFECTIONS OF THE SKIN

1. WARTS
DISEASE: SKIN WARTS
DEFINITION: Warts are skin growths that are caused by the human papillomavirus (HPV). There are
more than 60 kinds of HPV, some of which tend to cause warts on the skin. HPV stimulates quick growth
of cells on the skin's outer layer. In most cases, common warts appear on the fingers, near the
fingernails, or on the hands. Certain types of HPV can also cause warts to appear in the genital area.

There are five major types of warts. Each type appears on a different part of the body and has a distinct
appearance.

Common warts: usually grow on your fingers and toes, but can appear elsewhere. They have a rough,
grainy appearance and a rounded top. Common warts are grayer than the surrounding skin.

Plantar warts:  grow on the soles of the feet. Unlike other warts, plantar warts grow into your skin, not
out of it. You can tell if you have a plantar wart if you notice what appears to be a small hole in the
bottom of your foot that is surrounded by hardened skin. Plantar warts can make walking
uncomfortable.

Flat warts: usually grow on the face, thighs, or arms. They are small and not immediately noticeable.
Flat warts have a flat top, as if they’ve been scraped. They can be pink, brownish, or slightly yellow.

Filiform warts: grow around your mouth or nose and sometimes on your neck or under your chin. They
are small and shaped like a tiny flap or tag of skin. Filiform warts are the same color as your skin.

Periungual warts: grow under and around the toenails and fingernails. They can be painful and affect
nail growth.
ETIOLOGIC AGENT: HUMAN PAPILLOMAVIRUS (HPV)

MODE OF TRANSMISIION: Warts are highly contagious and are mainly passed by direct skin contact,
such as when you pick at your warts and then touch another area of your body. You can also spread
them with things like towels or razors that have touched a wart on your body or on someone else's.
Warts like moist and soft or injured skin.

SIGNS AND SYMPTOMS: Common warts usually occur on your fingers or hands and may be:

 Small, fleshy, grainy bumps

 Flesh-colored, white, pink or tan
 Rough to the touch
 Sprinkled with black pinpoints, which are small, clotted blood vessels

DIAGNOSIS: In most cases, your doctor can diagnose a common wart with one or more of these
techniques:

 Examining the wart

 Scraping off the top layer of the wart to check for signs of dark, pinpoint dots — clotted blood
vessels — which are common with warts

 Removing a small section of the wart (shave biopsy) and sending it to a laboratory for analysis to
rule out other types of skin growths

TREATMENT:

 Freezing (Cryotherapy): can be done with over-the-counter freezing spray products or by your

doctor, who will use liquid nitrogen to freeze a wart. For the at home treatment, temperatures
can reach as low as a negative 100 degrees. The down side of this home treatment is that it may
not freeze the wart deep enough to be effective. It can also be painful because the spray needs
to be applied longer than if you were being treated in a doctor’s office. When it works,
a blister forms around the wart and the dead tissue falls off within one to two weeks.

 Cantharidin: This substance, an extract of a blister beetle and applied to the skin, forms a blister
around the wart. After cantharidin is applied, the area is covered with a bandage. The blister lifts
the wart off the skin.

 Other medications: These include bleomycin, which is injected into a wart to kill a virus,

and imiquimod (Aldara and Zyclara), an immunotherapy drug that stimulates your own immune
system to fight off the wart virus. It comes in the form of a prescription cream. Although
imiquimod is stated for genital warts, it is modestly effective on other types of warts.

 Salicylic acid: Over-the-counter wart treatments come in several forms (gel, ointments or pads)
and contain salicylic acid as the active ingredient. When applied on a regular basis, the acid
gradually dissolves the wart tissue. The process may take several weeks.

 Minor surgery: When warts cannot be removed by other therapies, surgery may be used to cut
away the wart. The base of the wart will be destroyed using an electric needle or
by cryosurgery (deep freezing).

 Laser surgery: This procedure utilizes an intense beam of light (laser) to burn and destroy wart
tissue.
  Over-the-counter medication: Usually this contains salicylic acid and is applied in gel, ointment
or lotion form. Applied regularly, the wart eventually peels off. This is not for use in genital
warts.

PREVENTION: If you already have warts, you can prevent them from spreading by not picking at them.
Consider covering warts with bandages. In addition, keep hands as dry as possible -- warts are harder to
control in moist environments. You should never brush, comb, or shave areas where warts are present
as this can cause the virus to spread. Wash hands thoroughly after touching any warts.

DISEASE: GENITAL WARTS

DEFINITION: Genital warts are soft growths that appear on the genitals. They can cause pain,
discomfort, and itching.

Genital warts a sexually transmitted infection (STI) caused by certain low-risk strains of the human
papillomavirus (HPV). These are different from the high-risk strains that can lead to cervical dysplasia
and cancer.

HPV is the most common of all STIs. Men and women who are sexually active are vulnerable to
complications of HPV, including genital warts. HPV infection is especially dangerous for women because
some types of HPV can also cause cancer of the cervix and vulva.

ETIOLOGIC AGENT: HUMAN PAPILLOMAVIRUS (HPV)

MODE OF TRANSMISSION: Genital warts can be passed on through vaginal or anal sex without a

condom and by sharing sex toys. The virus is transmitted through close genital contact, which means
that you can get and pass on warts if you touch genitals with someone, even if you don't have
penetrative sex or ejaculate (cum).

SIGNS AND SYMPTOMS: In women, genital warts can grow on the vulva, the walls of the vagina, the
area between the external genitals and the anus, the anal canal, and the cervix. In men, they may occur
on the tip or shaft of the penis, the scrotum, or the anus.

Genital warts can also develop in the mouth or throat of a person who has had oral sexual contact with
an infected person.

The signs and symptoms of genital warts include:

 Small, flesh-colored, brown or pink swellings in your genital area

 A cauliflower-like shape caused by several warts close together

 Itching or discomfort in your genital area

 Bleeding with intercourse

Genital warts can be so small and flat as to be invisible. Rarely, however, genital warts can multiply into
large clusters, in someone with a suppressed immune system.

DIAGNOSIS: Genital warts are often diagnosed by appearance. Sometimes a biopsy might be necessary.

Pap tests

For women, it's important to have regular pelvic exams and Pap tests, which can help detect vaginal and
cervical changes caused by genital warts or the early signs of cervical cancer.
During a Pap test, your doctor uses a device called a speculum to hold open your vagina and see the
passage between your vagina and your uterus (cervix). He or she will then use a long-handled tool to
collect a small sample of cells from the cervix. The cells are examined with a microscope for
abnormalities.

HPV test

Only a few types of genital HPV have been linked to cervical cancer. A sample of cervical cells, taken
during a Pap test, can be tested for these cancer-causing HPV strains.

This test is generally reserved for women ages 30 and older. It isn't as useful for younger women
because for them, HPV usually goes away without treatment.

TREATMENT: Treatments can remove genital warts, but they may return. There is no cure for the
infection that causes them, but the body may clear the infection over time. Creams and lotions can
eliminate the warts over time, and there are various procedures to remove them. People should not
apply treatments designed to eliminate warts on the hands or feet to their genitals.

Treatments for genital warts include:

 Topical medication: A person applies a cream or liquid directly to the warts for several days
each week for several weeks.

 Cryotherapy: A healthcare professional applies liquid nitrogen to the area, causing blisters to
form around the warts, which eventually fall off — sometimes after several sessions.

 Electrocautery: After administering a local anesthetic, a healthcare professional uses an electric

current to remove the wart.

 Laser treatment: A healthcare professional removes the warts with an intensive beam of light.

 Surgery: The person receives a local anesthetic before a surgeon removes the warts.

The treatments are not painful but may cause soreness or irritation for a few days, and over-the-counter
pain relief medications can help. It may take weeks or months for the treatments to work. For some
people, the treatments do not work. Others may find that the warts return. Also, a healthcare provider
may use more than one treatment at a time. They may warn against using soaps, creams, or lotions that
may irritate the skin.

PREVENTION: To prevent genital warts, some of the steps you can take include:

 Abstaining from sexual contact

 Using condoms during sexual activity

 Having sex only with a partner who is not having sex with other people

 Avoiding sex with anyone who has visible symptoms of genital warts

 Get the HPV vaccine, called Gardasil

STUDY

HPV vaccines called Gardasil and Gardasil 9 can protect men and women from the most common HPV
strains that cause genital warts, and can also protect against strains of HPV that are linked to cervical
cancer.

A vaccine called Cervarix is also available. This vaccine protects against cervical cancer, but not against
genital warts.

Individuals up to age 45 years can receive the HPV vaccine, as well as those as young as age 9. The
vaccine is administered in a series of two or three shots, depending on age. Both types of vaccine should
be given before the person becomes sexually active, as they’re most effective before a person is
exposed to HPV.

2. HERPES SIMPLEX INFECTIONS

DISEASE: GINGIVOSTOMATITIS

DEFINITION: Gingivostomatitis is a common infection of the mouth and gums. The main symptoms are
mouth or gum swelling. There may also be lesions in the mouth that resemble canker sores. This
infection may be the result of a viral or bacterial infection. It’s often associated with improper care of
your teeth and mouth.

Gingivostomatitis is especially common in children. Children with gingivostomatitis may drool and refuse
to eat or drink because of the discomfort (often severe) caused by the sores. They may also
develop fever and swollen lymph nodes.

ETIOLOGIC AGENT: HSV-1

MODE OF TRANSMISSION: It usually spreads through the saliva of an infected individual or by direct

contact with a lesion or sore. 

SIGNS AND SYMPTOMS: Gingivostomatitis can cause a variety of symptoms, including:

 Redness
 Sores
 Pain or burning
 Swelling
 Fever
DIAGNOSIS: Your doctor will check your mouth for sores, the main symptom of the condition. More
tests are not usually necessary. If other symptoms are also present (such as cough, fever, and muscle
pain), they may want to do more tests.

In some cases, your doctor may take a culture (swab) from the sore to check for bacteria (strep throat)
or viruses. Your doctor may also perform a biopsy by removing a piece of skin if they suspect other
mouth sores are present.

TREATMENTS: An infection from bacteria is treated with antibiotics. When the cause is a virus, the goal
is to relieve symptoms. Antibiotics do not kill viruses. A viral infection should go away within 7 to 10
days.

PREVENTION: Taking care of your teeth and gums may decrease your risk of getting gingivostomatitis.
Healthy gums are pink with no sores or lesions. Good oral hygiene basics include:

 brushing your teeth at least twice a day, especially after eating and before going to sleep

 flossing daily

 getting your teeth professionally examined and cleaned by a dentist every six months

 keeping mouth pieces (dentures, retainers, musical instruments) clean to prevent bacteria
growth

To avoid the HSV-1 virus that can cause gingivostomatitis, avoid kissing or touching the face of a person
who is infected. Do not share makeup, razors, or silverware with them.

Frequently washing your hands is the best way to avoid the coxsackievirus. This is especially important
after using public toilets or changing a baby’s diaper and before eating or preparing meals. It’s also
important to educate children about the importance of proper hand washing.

DISEASE: HERPES LABIALIS (FEVER BLISTER OR COLD SORE)

DEFINITION: Cold sores are red, fluid-filled blisters that form near the mouth or on other areas of the
face. In rare cases, cold sores may appear on the fingers, nose, or inside the mouth. They’re usually
clumped together in patches. Cold sores may persist for two weeks or longer.

A cold sore is a group of tiny, painful blisters caused by the herpes simplex virus (HSV). They’re also
called fever blisters or herpes simplex labialis.

Up to 90% of people around the world have at least one form of HSV.

The symptoms are usually the most severe the first you time you get cold sores. A first-time cold sore
can make a child seriously ill.

After the first outbreak, your body should make antibodies, and you may never have another infection.
But many people get cold sores that come back.

ETIOLOGIC AGENT: HSV-1 AND 2

MODE OF TRANSMISSION: They can spread from person to person through close contact, such as
kissing. The sores are contagious even when they’re not visible.

STUDY

The virus is spread from person to person by kissing, by close contact with herpes lesions, or from saliva
even when sores are not present. Infected saliva is a common means of virus transmission. The
contagious period is highest when people have active blisters or moist sores. Once the blisters have
dried and crusted over (within a few days), the risk of contagion is significantly lessened. HSV can also be
spread through personal items that are contaminated with the virus, such as lipstick, utensils, and
razors. Despite popular myth, catching herpes (cold sores) from surfaces, towels, or washcloths is a very
low risk, since the virus does not usually survive long on dry surfaces.

SIGNS AND SYMPTOMS: Cold sores are most likely to show up on the outside of your mouth and lips,
but you can also get them on your nose and cheeks.

You may get cold sores as late as 20 days after you’re infected. The sore might appear near where the
virus entered your body.

Cold sores happen in stages:

1. You have a tingling, burning, or itching feeling.

2. About 12 to 24 hours later, blisters form. The area becomes red, swollen, and painful.
3. The blisters break open, and fluid comes out. This usually lasts 2 or 3 days.
4. A scab forms on the sore. It might crack or bleed.
5. The scab falls off.
You might also have red or swollen gums, swollen glands in your neck, fever, or muscle aches.

DIAGNOSIS: Your doctor might diagnose a cold sore just by looking at the blisters. They can also swab
the blister and test the fluid for HSV.

TREATMENTS: Although it may take a while to get rid of a cold sore, some medicines can shorten the
healing time and make the symptoms less painful. Cold sore treatments include:

 Over-the-counter medications: You can buy without a prescription creams or ointments that

you apply directly to the cold sore. If you start using these creams when you first notice tingling
or itching — before the cold sore forms — you may be able to prevent the cold sore from
appearing.

 Oral antiviral medicine: Your doctor may prescribe an antiviral medication that you take orally
(by mouth).
  Intravenous (IV) antiviral medicine: If other medications aren’t working, your doctor may need
to prescribe an antiviral medication that will be administered through an IV. In this case, your
doctor will monitor you closely throughout treatment.

PREVENTION: To avoid being infected with HSV-1, you should take the following precautions around
people who have cold sores:

 Avoid kissing, intimate contact and oral sex with someone who has a cold sore.

 Don’t share towels, razors, dishes, cutlery, straws, lip balm or lipstick.

 Wash your hands before touching your lips, eyes or genitals.

If you’ve already come into contact with HSV-1, do these to reduce risk of a cold sore outbreak:

 Try to stay healthy: A fever can trigger a cold sore, which is why people sometimes call them
fever blisters.

 Get enough rest: Fatigue weakens your immune system and makes you more likely to get sick.

 Wear lip balm with SPF: Protecting your lips from sunburn can help you avoid an outbreak.

If you have a cold sore, be careful around babies. Always wash your hands, and do not kiss a baby until
the cold sore has healed completely.

DISEASE: HERPETIC WHITLOW

DEFINITION: Herpetic whitlow—also called digital herpes simplex, finger herpes, or hand herpes—is a
painful viral infection occurring on the fingers or around the fingernails. Herpetic whitlow is caused by
infection with the herpes simplex virus (HSV).

ETIOLOGIC AGENT: HSV-1 AND 2

MODE OF TRANSMISSION: A person can develop herpetic whitlow through direct contact with skin
containing the virus, which might be on the genitals, face, or hands. The transmission might involve:
touching these areas of someone with active oral or genital sores. a person touching their own cold or
genital sores.

SIGNS AND SYMPTOMS: Symptoms of herpetic whitlow include swelling, reddening and tenderness of

the skin of infected finger. This may be accompanied by fever and swollen lymph nodes. Small, clear
vesicles initially form individually, then merge and become cloudy, unlike in bacterial whitlow when
there is pus.

DIAGNOSIS: The diagnosis of herpetic whitlow is readily confirmed by Tzanck test and culture. It is

important to distinguish herpetic whitlow from bacterial felon or paronychia, as herpetic whitlow is a
self-limited infection for which surgical incision is not indicated.

Doctors can usually identify viral conditions based on the appearance of sores or lesions. If your doctor
suspects a virus, a skin swab or blood test can confirm or rule out herpetic whitlow.

TREATMENTS: Herpetic whitlow doesn’t require treatment. The condition usually heals within a few
weeks without medication, but a prescription antiviral drug can shorten the duration of an outbreak.
Antivirals are only effective when taken within 24 hours of developing symptoms. Antivirals also help
lower the risk of transmitting the virus to other people. If a blister ruptures and an infection develops,
your doctor can prescribe an antibiotic.

You can treat herpetic whitlow at home by:

  taking a pain reliever — such as acetaminophen or ibuprofen — to help reduce pain and fever

 applying a cold compress several times a day to help reduce swelling

 cleaning the affected area daily and covering it with gauze

PREVENTION: Due to the contagious nature of this condition, you should keep the blistered area
covered until it heals. Not covering the area means it could spread to other parts of your body or be
transmitted to other people. Wearing gloves while cleaning an affected area also prevents spreading the
condition to other parts of your body. As a precaution, don’t wear contact lenses if you have herpetic
whitlow. If you touch your eye with the finger containing the affected area, the virus could spread to
your eye.

DISEASE: ECZEMA HERPETICUM

DEFINITION: Eczema herpeticum is a bad skin infection that occurs in people who already have eczema.
The herpes virus (the same one that causes cold sores) invades the skin and causes painful red spots.
The rash can spread very quickly over the body and needs to be treated quickly.

Usually the virus is caught from somebody who has an infection such as a cold sore. It takes 5-12 days
after contact with the infected person for the rash to develop.

ETIOLOGIC AGENT: HERPES SIMPLEX TYPE 1 OR 2

MODE OF TRANSMISSION: It can be transmitted through skin-to-skin contact.

SIGNS AND SYMPTOMS: A child or person with eczema herpeticum develops a skin rash which looks like
lots of little blisters. These are usually in areas where there has been a skin condition (usually atopic
eczema). The spots are usually quite painful. The spots then spread to other areas of skin. Eczema
herpeticum can develop on any part of the body but is most common on the face or neck.

The blisters are all around the same size. They are filled with fluid. It may be a clear fluid or a yellowish
fluid called pus. They may bleed or ooze or weep. They then become crusted over.

If you have eczema herpeticum, you feel unwell. You may have a high temperature. You may be able to
feel lumps called lymph nodes in your neck, armpits or groin. These come up in response to the
infection, to help fight it.

DIAGNOSIS: Eczema herpeticum can be diagnosed clinically when a patient with known

atopic dermatitis presents with an acute eruption of painful, monomorphic clustered vesicles associated
with fever and malaise. Viral infection can be confirmed by viral swabs taken by scraping the base of a
fresh blister.

TREATMENTS: The main treatment of eczema herpeticum is acyclovir, which is also approved for oral
use in patients younger than 18 years of age. For patients with severe disease and immunocompromised
patients, systemic antivirus medications and hospitalization are recommended.

PREVENTION: People with atopic dermatitis, contact dermatitis and other types of eczema should avoid
contact with anyone who has a cold sore. This includes not sharing silverware, lipstick, glassware, or any
other item that has touched the mouth of someone who has the herpes virus.

DISEASE: HERPES GLADIATORUM

DEFINITION: Herpes gladiatorum is a communicable viral infection. Sometimes called mat herpes, it is
common among people who play high-contact sports, such as wrestling.

Once the herpes simplex virus 1 (HSV-1) enters the body, it resides there for life.

While there is no cure for an HSV-1 infection such as herpes gladiatorum, the virus often lies dormant,
so there are periods when the person has no symptoms.

ETIOLOGIC AGENT: HSV-1 and HSV-2

MODE OF TRANSMISSION: When the virus reactivates and symptoms flare, the virus is more likely to
transmit to another person via skin-to-skin contact.

SIGNS AND SYMPTOMS: Herpes gladiatorum can affect any part of the body. If your eyes become
affected, it should be treated as a medical emergency.

Symptoms usually appear about a week after exposure to HSV-1. You may notice a fever and swollen
glands before the appearance of sores or blisters on your skin. You may also feel a tingling sensation in
the area affected by the virus.

A collection of lesions or blisters will appear on your skin for up to 10 days or so before healing. They
may or may not be painful.

You’ll likely have periods where you have no obvious symptoms. Even when there are no open sores or
blisters, you’re still able to transmit the virus.

DIAGNOSIS: A doctor can examine your sores and often diagnose your condition without any testing.
However, your doctor will likely take a small sample from one of the sores to be analyzed in a lab. Your
doctor can test the sample to confirm a diagnosis.

You may be advised to take a blood test in cases where it’s difficult to distinguish an HSV-1 infection
from another skin condition. The test will look for certain antibodies that appear.

A blood test can also be useful if you don’t have any obvious symptoms but are concerned that you may
have been exposed to the virus.

TREATMENTS: Mild cases of herpes gladiatorum may not need any treatment. You should, however,
avoid irritating the sores if they’re still visible. Even if your lesions are dry and fading, you may need to
avoid wrestling or any contact that could cause them to flare up.

For more serious cases, prescription antiviral medications can help speed up your recovery time.
Medications often prescribed for HSV-1 are acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir
(Famvir).

The drugs may be prescribed as a preventive measure. Even when you’re not having a flare-up, taking an
oral antiviral medication may help prevent outbreaks.

PREVENTION: Good personal hygiene is essential for preventing the spread of Herpes gladiatorum and

other skin infections. This is especially important for athletes who participate in direct contact sports.
Athletes should shower immediately after practice and use their own soap, towels, and razors.

CHAPTER 17: INFECTIONS OF THE

REPIRATORY TRACT
DISEASES OF THE UPPER RESPIRATORY TRACT
DISEASE: COMMON COLD

DEFINITION: A common cold is a contagious upper respiratory infection that affects your nose, throat,
sinuses and trachea (windpipe).

The common cold is a viral infection of your nose and throat (upper respiratory tract). It's usually
harmless, although it might not feel that way. Many types of viruses can cause a common cold.

Children younger than 6 are at greatest risk of colds, but healthy adults can also expect to have two or
three colds annually.

ETIOLOGIC AGENT: Rhinoviruses cause up to 50% of common colds.

MODE OF TRANSMISSION: A cold virus enters your body through your mouth, eyes or nose. The virus
can spread through droplets in the air when someone who is sick coughs, sneezes or talks.

It also spreads by hand-to-hand contact with someone who has a cold or by sharing contaminated
objects, such as utensils, towels, toys or telephones. If you touch your eyes, nose or mouth after such
contact or exposure, you're likely to catch a cold.

SIGNS AND SYMPTOMS: Within one to three days of picking up a cold virus, you’ll get symptoms like:

 Sneezing.  Headache.
 Runny nose.  Nasal congestion.
 Cough.  Fever (most common in children).
 Sore throat.

The signs and symptoms of the common cold in infants and children are similar to those seen in adults.
The cold may begin with a runny nose with clear nasal discharge, which later may become yellowish or
greenish in color. Infants and children may also become fussy and have decreased appetite.

DIAGNOSIS: A doctor or health care professional will generally diagnose the common cold based on the
description of the symptoms and the findings during the physical exam. Laboratory testing and imaging
studies are generally not necessary unless there are concerns about another underlying medical
condition, such as a bacterial disease or potential complications of the common cold.

TREATMENT: There is no cure for the common cold. The common cold is a self-limiting illness that will
resolve spontaneously with time and expectant management. Home remedies and medical treatments
are directed at alleviating the symptoms associated with the common cold while the body fights off the
infection.

PREVENTION: There's no vaccine for the common cold, but you can take commonsense precautions to
slow the spread of cold viruses:

 Wash your hands. Clean your hands thoroughly and often with soap and water, and teach
your children the importance of hand-washing. If soap and water aren't available, use an
alcohol-based hand sanitizer.

 Disinfect your stuff. Clean kitchen and bathroom countertops with disinfectant, especially
when someone in your family has a cold. Wash children's toys periodically.
  Use tissues. Sneeze and cough into tissues. Discard used tissues right away, then wash
your hands carefully.

Teach children to sneeze or cough into the bend of their elbow when they don't have a
tissue. That way they cover their mouths without using their hands.

 Don't share. Don't share drinking glasses or utensils with other family members. Use your
own glass or disposable cups when you or someone else is sick. Label the cup or glass with
the name of the person with the cold.

 Steer clear of colds. Avoid close contact with anyone who has a cold.

 Choose your child care center wisely. Look for a child care setting with good hygiene
practices and clear policies about keeping sick children at home.

 Take care of yourself. Eating well, getting exercise and enough sleep, and managing stress
might help you keep colds at bay.

DISEASE: PHARYNGITIS

DEFINITION: Pharyngitis is inflammation of the pharynx, which is in the back of the throat. It’s most
often referred to simply as “sore throat.” Pharyngitis can also cause scratchiness in the throat and
difficulty swallowing.

According to the American Osteopathic Association (AOA), pharyngitis-induced sore throat is one of the

most common reasons for doctor visits. More cases of pharyngitis occur during the colder months of the
year. It’s also one of the most common reasons why people stay home from work. In order to properly
treat a sore throat, it’s important to identify its cause. Pharyngitis may be caused by bacterial or viral
infections.

ETIOLOGIC AGENT:

MODE OF TRANSMISSION: Both viral and bacterial forms of pharyngitis are contagious. The germs that
cause pharyngitis tend to live in the nose and throat.

When a person with the condition coughs or sneezes, they release tiny droplets that contain the virus or
bacteria into the air. A person can become infected by:

 breathing these tiny droplets in

 touching contaminated objects and then touching their face

 consuming contaminated food and beverages

SIGNS AND SYMPTOMS:

DIAGNOSIS: Sore throats can result from a variety of underlying medical conditions. While viral
infections are the most common cause of pharyngitis, it is still important to correctly diagnose the cause
in order to treat the condition successfully.

A doctor will usually begin diagnosing pharyngitis by performing a physical examination. They will review
the person’s current symptoms and check their throat, ears, and nose for signs of infection.
When an individual has clear signs of a viral infection, the doctor will likely not perform further testing.

If the doctor suspects a bacterial infection, they may order a throat culture to confirm the diagnosis. This
involves taking a swab of a person’s throat and sending it to a lab for analysis.

TREATMENT:

PREVENTION: Maintaining proper hygiene can prevent many cases of pharyngitis.

To prevent pharyngitis:

 avoid sharing food, drinks, and eating utensils

 avoid individuals who are sick
 wash your hands often, especially before eating and after coughing or sneezing
 use alcohol-based hand sanitizers when soap and water aren’t available
 avoid smoking and inhaling secondhand smoke

DISEASE: NASOPHARYNGITIS

DEFINITION: Nasopharyngitis is commonly known as a cold. Doctors use the

term nasopharyngitis specifically to refer to swelling of the nasal passages and the back of the throat.
Your doctor may also refer to this as an upper respiratory infection or rhinitis.

Nasopharyngitis is caused by an infection, mainly the nasopharyngeal mucosa is inflamed. The disease
has another name. It is often referred to as epipharyngitis and rhinonasopharyngitis.

Nasopharyngitis is an inflammatory attack of the pharynx and nasal cavities. It is a minor and common
contagious throat disease. It is mainly caused by a virus. Contagion is air-borne and operates between
humans only. The disease is frequent amongst pre-school children, where it ranks first as infectious
disease. 

ETIOLOGIC AGENT:

 ADENOVIRUS (most common)

 INFLUENZA
 PARAINFLUENZA

MODE OF TRANSMISSION: It can spread through tiny air droplets that are expelled when a person
infected with the virus: sneezes. coughs. blows their nose.

SIGNS AND SYMPTOMS: A burning sensation appears in the nasopharynx, the patient is constantly
under the influence of unpleasant sensations. Dryness is felt in the nose, breathing through the nose is
significantly difficult. The sense of smell is impaired, a person cannot distinguish between smells.
Headaches can be felt in the back of the head. The patient's appearance has characteristic signs: the
nose becomes red and swollen, the lips dry out, the skin becomes pale, the eyes are in a wet place,
breathing is through the mouth. As for body temperature, it can be normal - 36.6.

There are three phases of acute nasopharyngitis:

 the first phase is characterized by dryness in the nose, there is a strong burning sensation;
  the sense of smell worsens. Sputum is released;

 a certain kind of discharge appears. This phase begins seven days after the onset of the first
phase.

DIAGNOSIS: The otolaryngologist, after listening to the patient, sends him for a blood test. It is possible
to refer the patient to allergy tests. A person recovers mainly after two weeks. However, the disease
must be treated, as complications can be very dangerous to health. Nasopharyngitis is treated
depending on the origin. An allergic disease is treated by directly eliminating the allergen and drug
therapy - antihistamines.

TREATMENT: In the event that the disease is infectious in nature, antibiotic therapy is prescribed. In this
case, the doctor takes into account the pathogen itself. When the body temperature rises, antipyretics
are used. Vasoconstrictor drops are used for difficult nasal breathing. Nevertheless, do not abuse them,
perhaps addiction or the mucous membrane may dry out. If the disease is infectious, the doctor may
prescribe physical therapy and drink plenty of fluids.

PREVENTION: In order to rid yourself of nasophringitis, it is necessary to strengthen the body. Lead a
healthy lifestyle, if you smoke, then it is better to give up this habit, do not abuse strong drinks. If you
have friends who suffer from infectious diseases, then try not to contact them. Drink vitamins and follow
a healthy diet.

Wash your hands frequently. Cover your mouth with your forearm when you cough. If you have been
around someone who is sick, washing your hands may help prevent you from catching the virus. You
should also avoid touching your eyes, nose, or mouth.

DISEASE: TONSILLOPHARYNGITIS

DEFINITION:

 Tonsillopharyngitis is the acute infection of the pharynx, tonsils, or both

 Also called strep throat, acute tonsillitis, pharyngitis or adenotonsillitis

 One of the most common diseases seen in primary care

ETIOLOGIC AGENT: The most common bacterium causing tonsillitis is Streptococcus pyogenes (group A
streptococcus), the bacterium that causes strep throat.

A virus or bacteria causes tonsillitis. The two types of tonsillitis are:

 Viral tonsillitis: Most cases (up to 70 percent) of tonsillitis are caused by a virus such as cold or
flu (influenza).

 Bacterial tonsillitis (strep throat): Other cases of tonsillitis are caused by group

A Streptococcus bacteria. Bacterial tonsillitis is commonly called strep throat.

MODE OF TRANSMISSION: Spreads through person-to-person contact, usually through saliva or nasal
secretions from an infected person

 The primary reservoir of group A streptococcus are the humans

 The disease is easily transmitted in the following places:

o Schools

o Day care centers

 o Military training facilities

 Transmission via food is rare and if transmission happens, it is most of the time due to improper
handling of food

 Pets and the use of household items such as plates and toys cannot transmit the disease or
bacteria

Tonsillitis can be spread through inhaling respiratory droplets that are generated when someone with
the infection coughs or sneezes. You can also develop tonsillitis if you come into contact with a
contaminated object. An example of this is if you touch a contaminated doorknob and then touch your
face, nose, or mouth.

SIGNS AND SYMPTOMS: Most Classic Symptoms

 Tonsillar swelling/exudates  Absence of cough

 Tender anterior cervical  Fever >38°C

lymphadenopathy

Common signs and symptoms of tonsillitis include:

 Red, swollen tonsils.  Fever.

 White or yellow coating or patches on  Enlarged, tender glands (lymph nodes)

the tonsils. in the neck.

 Sore throat.  A scratchy, muffled or throaty voice.

 Difficult or painful swallowing.  Bad breath.

DIAGNOSIS: Diagnosis is clinical, supplemented by culture or rapid antigen test.

To diagnosis tonsillitis, your doctor will:

1. Examine your throat for redness, swelling or white spots on the tonsils.

2. Ask about other symptoms you've had, such as a fever, cough, runny nose, rash or
stomachache.

3. Look in your ears and your nose for other signs of infection.

TREATMENT: Antibiotics. If tonsillitis is caused by a bacterial infection, your doctor will prescribe a
course of antibiotics. Penicillin taken by mouth for 10 days is the most common
antibiotic treatment prescribed for tonsillitis caused by group A streptococcus.

PREVENTION: To reduce your risk of developing tonsillitis, you should:

 Wash your hands often, especially before touching your nose or mouth.

 Avoid sharing food, drink, or utensils with someone who is sick.

 Replace your toothbrush regularly.

DISEASE: SCARLET FEVER

DEFINITION: Scarlet fever is a bacterial illness that develops in some people who have strep throat. Also
known as scarlatina, scarlet fever features a bright red rash that covers most of the body. Scarlet fever is
almost always accompanied by a sore throat and a high fever.
Scarlet fever is most common in children 5 to 15 years of age. Although scarlet fever was once
considered a serious childhood illness, antibiotic treatments have made it less threatening. Still, if left
untreated, scarlet fever can result in more-serious conditions that affect the heart, kidneys and other
parts of the body.

ETIOLOGIC AGENT: Bacteria called group A Streptococcus or group A strep cause scarlet fever. The
bacteria sometimes make a poison (toxin), which causes a rash — the “scarlet” of scarlet fever.

MODE OF TRANSMISSION: Group A strep live in the nose and throat and can easily spread to other
people. It is important to know that all infected people do not have symptoms or seem sick. People who
are infected spread the bacteria by coughing or sneezing, which creates small respiratory droplets that
contain the bacteria.

People can get sick if they:

 Breathe in those droplets

 Touch something with droplets on it and then touch their mouth or nose

 Drink from the same glass or eat from the same plate as a sick person

 Touch sores on the skin caused by group A strep (impetigo)

Rarely, people can spread group A strep through food that is not handled properly (visit CDC’s food
safety page). Experts do not believe pets or household items, like toys, spread these bacteria.

SIGNS AND SYMPTOMS: In general, scarlet fever is a mild infection. It usually takes two to five days for
someone exposed to group A strep to become sick. Illness usually begins with a fever and sore throat.
There may also be chills, vomiting, or abdominal pain. The tongue may have a whitish coating and
appear swollen. It may also have a “strawberry”-like (red and bumpy) appearance. The throat and
tonsils may be very red and sore, and swallowing may be painful.

One or two days after the illness begins, a red rash usually appears. However, the rash can appear
before illness or up to 7 days later. The rash may first appear on the neck, underarm, and groin (the area
where your stomach meets your thighs). Over time, the rash spreads over the body. The rash usually
begins as small, flat blotches that slowly become fine bumps that feel like sandpaper.

Although the cheeks might look flushed (rosy), there may be a pale area around the mouth. Underarm,
elbow, and groin skin creases may become brighter red than the rest of the rash. The rash from scarlet
fever fades in about 7 days. As the rash fades, the skin may peel around the fingertips, toes, and groin
area. This peeling can last up to several weeks.

DIAGNOSIS: Many viruses and bacteria can cause an illness that includes a red rash and sore throat.
Only a rapid strep test or a throat culture can determine if group A strep are the cause.

A rapid strep test involves swabbing the throat and testing the swab. The test quickly shows if group A
strep are causing the illness. If the test is positive, doctors can prescribe antibiotics. If the test is
negative, but a doctor still suspects scarlet fever, then the doctor can take a throat culture swab. A
throat culture takes time to see if group A strep bacteria grow from the swab. While it takes more time,
a throat culture sometimes finds infections that the rapid strep test misses. Culture is important to use
in children and teens since they can get rheumatic fever from an untreated scarlet fever infection. For
adults, it is usually not necessary to do a throat culture following a negative rapid strep test. Adults are
generally not at risk of getting rheumatic fever following scarlet fever.

TREATMENT: Doctors treat scarlet fever with antibiotics. Either penicillin or amoxicillin are

recommended as a first choice for people who are not allergic to penicillin. Doctors can use other
antibiotics to treat scarlet fever in people who are allergic to penicillin.

Benefits of antibiotics include:

 Decreasing how long someone is sick  Preventing the bacteria from spreading
to others
 Decreasing symptoms (feeling better)
 Preventing serious complications like
rheumatic fever
PREVENTION: While there is no vaccine to prevent scarlet fever, there are things people can do to
protect themselves and others. The best way to keep from getting or spreading group A strep is to wash
your hands often. This is especially important after coughing or sneezing and before preparing foods or
eating.

People can get scarlet fever more than once. Having scarlet fever does not protect someone from
getting it again in the future. While there is no vaccine to prevent scarlet fever, there are things people
can do to protect themselves and others.

Good Hygiene Helps Prevent Group A Strep Infections

The best way to keep from getting or spreading group A strep is to wash your hands often. This is
especially important after coughing or sneezing and before preparing foods or eating. To practice good
hygiene, you should:

 Cover your mouth and nose with a tissue when you cough or sneeze

 Put your used tissue in the waste basket

 Cough or sneeze into your upper sleeve or elbow, not your hands, if you don’t have a tissue

 Wash your hands often with soap and water for at least 20 seconds

 Use an alcohol-based hand rub if soap and water are not available

You should also wash glasses, utensils, and plates after someone who is sick uses them. These items are
safe for others to use once washed.

Antibiotics Help Prevent Spreading the Infection to Others

People with scarlet fever should stay home from work, school, or daycare until they:

 No longer have a fever

AND

 Have taken antibiotics for at least 12 hours

Take the prescription exactly as the doctor says to. Don’t stop taking the medicine, even if you or your
child feel better, unless the doctor says to stop.

DISEASE: SINUSITIS

DEFINITION: Sinusitis is an inflammation or swelling of the tissue lining the sinuses. Sinuses are hollow
spaces within the bones between your eyes, behind your cheekbones, and in your forehead. They make
mucus, which keeps the inside of your nose moist. That, in turn, helps protect against dust, allergens,
and pollutants.

Healthy sinuses are filled with air. But when they become blocked and filled with fluid, germs can grow
and cause an infection.

Doctors often refer to sinusitis as rhinosinusitis because inflammation of the sinuses nearly always
occurs with rhinitis, which is an inflammation of the nose.

What are the types of sinus infections?

Acute sinusitis
Acute sinusitis has the shortest duration. A viral infection brought on by the common cold can cause
symptoms that typically last between 1and 2 weeks. In the case of a bacterial infection, acute sinusitis
may last for up to 4 weeksTrusted Source. Seasonal allergies can also cause acute sinusitis.

Subacute sinusitis

Subacute sinusitis symptoms can last for up to 3 months. This condition commonly occurs with bacterial
infections or seasonal allergies.

Chronic sinusitis

Chronic sinusitis symptoms last for more than 3 months. They’re often less severe. Bacterial infection
may be to blame in these cases. Additionally, chronic sinusitis commonly occurs alongside persistent
allergies or structural nasal problems.

ETIOLOGIC AGENT: If the infection is of bacterial origin, the most common three causative agents are
Streptococcus pneumoniae (38%), Haemophilus influenzae (36%), and Moraxella catarrhalis (16%). Until
recently, H. influenzae was the most common bacterial agent to cause sinus infections.

MODE OF TRANSMISSION: You can spread the virus responsible for your sinus infection to another
person through the air when you sneeze or cough. Covering your nose and mouth when you cough or
sneeze can help reduce the risk of spreading infection.

SIGNS AND SYMPTOMS: The symptoms of sinusitis are similar to those of a common cold. They may
include:

 a decreased sense of smell  headache from sinus pressure

 fever  fatigue

 stuffy or runny nose  cough

It may be difficult for parents to detect a sinus infection in their children. Signs of an infection include:

 cold or allergy symptoms that don’t  thick, dark mucus coming from the nose
improve within 14 days
 a cough that lasts longer than 10 days
 a high fever (above 102°F or 39°C)

Symptoms of acute, subacute, and chronic sinus infections are similar. However, the severity and length
of your symptoms will vary.

DIAGNOSIS: A doctor may make a diagnosis by:

 asking about symptoms  ordering an MRI or CT scan to check for

structural problems, in some cases
 carrying out a physical examination
 carrying out an allergy test to identify
 using an endoscope to see inside the
possible triggers
nasal passages

TREATMENT:

Congestion

Nasal congestion is amongst the most common symptoms of a sinus infection. To help reduce the
feeling of pain from sinus pressure, apply a warm, damp cloth to your face and forehead several times a
day. Nasal saline rinses may help to clear the sticky and thick mucus from your nose.

Drink water and juice to stay hydrated and help thin the mucus. You can use an over-the-counter (OTC)
medication, such as guaifenesin, that thins mucus.

Use a humidifier in your bedroom to add moisture to the air. Turn on the shower and sit in the
bathroom with the door closed to surround yourself with steam.

Consider using OTC nasal corticosteroid spray. There are decongestants available OTC, but you may
want to consider asking your doctor about these before trying one.

Pain remedies
A sinus infection can trigger a sinus headache or pressure in your forehead and cheeks. If you’re in pain,
OTC medications such as acetaminophen and ibuprofen can help.

Antibiotics

If your symptoms don’t improve within a few weeks, you likely have a bacterial infection and should see
your doctor. You may need antibiotic therapy if you have symptoms that don’t improve within a couple
of weeks, including a runny nose, congestion, cough, continued facial pain or headaches, eye swelling, or
a fever.

If you receive an antibiotic, you must take it for 3 to 14 days, depending on your doctor’s instructions.
Don’t stop taking your medication earlier than directed, as this can allow the bacterial infection to fester
and possibly not fully resolve.

Your doctor may have you schedule another visit to monitor your condition. If your sinus infection
doesn’t improve or gets worse by your next visit, your doctor may refer you to an ear, nose, and throat
specialist.

The doctor may also order additional tests to determine whether allergies are triggering your sinusitis.

Surgery

Surgery to clear the sinuses, repair a deviated septum, or remove polyps may help if your chronic
sinusitis doesn’t improve with time and medication.

PREVENTION: Because sinus infections can develop after a cold, flu, or allergic reaction, a healthy
lifestyle and reducing your exposure to germs and allergens can help prevent an infection. To reduce
your risk, you can:

 Get a flu vaccine shot every year.  Take antihistamine medication to treat
allergies and colds.
 Eat healthy foods, such as fruits and
vegetables.  Avoid exposure to those with active
respiratory infection, such as a cold or
 Wash your hands regularly.
the flu.
 Limit your exposure to smoke,
chemicals, pollen, and other allergens
or irritants.

DISEASE: OTITIS EXTERNA

DEFINITION: Otitis externa is a condition that causes inflammation (redness and swelling) of the external
ear canal, which is the tube between the outer ear and eardrum. Otitis externa is often referred to as
"swimmer's ear" because repeated exposure to water can make the ear canal more vulnerable to
inflammation.
Swimmer's ear (also called otitis externa) is a type of ear infection. The infection occurs in the ear canal.
Because the ear canal is dark, warm, and can hold water, it makes a perfect environment for water-
loving bacteria and fungus to grow.

Why is this ear infection called "swimmer's ear"?

Otitis externa was given the nickname swimmer's ear because it most commonly affects individuals who
spend a lot of time in water, such as swimmers.

ETIOLOGIC AGENT: Pseudomonas aeruginosa or Staphylococcus aureus

MODE OF TRANSMISSION: Swimmer's ear can occur when water stays in the ear canal for long periods
of time, providing the perfect environment for germs to grow and infect the skin. Germs found in pools
and at other recreational water venues are one of the most common causes of swimmer's ear.

SIGNS AND SYMPTOMS: Symptoms you may get are:

 Itchiness in the ear  Trouble hearing (sound may seem

muffled as your ear canal swells)
 Pain, which can become severe
 Fluid or pus draining out of the ear

Here's one way to tell which type of ear infection you have. If it hurts when you tug or press your ear,
you may have swimmer's ear.

 Ear pain: pain that often gets worse  Blocked ear

when the outer ear is tugged or pressed
 Redness and swelling in the outer ear
on; pain can become intense and
spread across the side of the face of the  Temporary hearing loss or decreased
affected ear hearing
 Itching inside the ear canal  Slight fever
 Bad-smelling or colored (yellow,
yellow/green) pus oozing from the ear

DIAGNOSIS: If you have ear pain, don't wait -- see your doctor right away. Getting treatment quickly can
stop an infection from getting worse.

During your appointment, your doctor will look in your ear and may gently clean it out. This will help
treatments work better.

Then, you'll probably get eardrops that may have antibiotics, steroids, or other ingredients to fight the
infection and help with swelling. In some cases, you may need to take antibiotic pills, too.

TREATMENT: Primary treatment of otitis externa (OE) involves management of pain, removal of debris

from the external auditory canal (EAC), administration of topical medications to control edema and
infection, and avoidance of contributing factors. Most cases can be treated with over-the-counter
analgesics and topical eardrops.

PREVENTION:

 Keep ears as dry as possible. Place a shower cap over your head to help prevent water or hair
shampoo from getting into your ears. Place a cotton ball in the ear but do not push it in far. Use
a dry towel to dry your ears after bathing or swimming. Use ear plugs if you play water sports or
are frequently in water.

 Turn your head from side to side after getting out of water. This helps water drain from your
ears.

 Don't stick anything into your ear canal. This includes pens/pencils, fingers, bobby clips or
cotton-tipped swabs. (Swabs should only be used to dry the outer ear.)

 Don't swim in polluted water.

  Do not swallow the water you swim in.

 Use a simple, homemade solution to help prevent bacteria from growing inside the ear. Mix one
drop of vinegar with one drop of isopropyl (rubbing) alcohol and put one drop in each ear after
bathing or swimming. Be sure to check with your doctor first before making and using this
homemade solution.

DISEASE: OTITIS MEDIA

DEFINITION: A middle ear infection, also called otitis media, occurs when a virus or bacteria cause the
area behind the eardrum to become inflamed. The condition is most common in children. According to
the Lucile Packard Children’s Hospital at Stanford, middle ear infections occur in 80 percent of children
by the time they reach age 3.

Most middle ear infections occur during the winter and early spring. Often, middle ear infections go
away without any medication. However, you should seek medical treatment if pain persists or you have
a fever.

Otitis media is inflammation located in the middle ear. Otitis media can occur as a result of a cold, sore
throat, or respiratory infection.

What are the different types of otitis media?

Different types of otitis media include the following:

 Acute otitis media (AOM). The middle ear infection occurs abruptly causing swelling and
redness. Fluid and mucus become trapped inside the ear, causing the child to have a fever, ear
pain, and hearing loss.

 Otitis media with effusion (OME.) Fluid (effusion) and mucus continue to accumulate in the
middle ear after an initial infection subsides. The child may experience a feeling of fullness in the
ear and hearing loss.

 Chronic otitis media with effusion (COME). Fluid remains in the middle ear for a prolonged
period or returns again and again, even though there is no infection. May result in difficulty
fighting new infection and hearing loss.

ETIOLOGIC AGENT:

MODE OF TRANSMISSION: AOM is transmitted by airborne spread of the causative infectious agents in
droplets, sprayed into the air when a sick person coughs or sneezes. The infection in the new host
usually begins with a common cold, sore throat or measles.

SIGNS AND SYMPTOMS: The following are the most common symptoms of otitis media. However, each
child may experience symptoms differently. Symptoms may include:

 Unusual irritability  Fluid draining from ear(s)

 Difficulty sleeping or staying asleep  Loss of balance

 Tugging or pulling at one or both ears  Hearing difficulties

 Fever  Ear pain

The symptoms of otitis media may resemble other conditions or medical problems. Always consult your
child's physician for a diagnosis.

DIAGNOSIS: Your doctor will make sure they have your child’s medical history and will do a physical
examination. During the exam, your doctor will look at the outer ear and eardrum using a lighted
instrument called an otoscope to check for redness, swelling, pus, and fluid.

Your doctor might also conduct a test called tympanometry to determine whether the middle ear is
working properly. For this test, a device is put inside your ear canal, changing the pressure and making
the eardrum vibrate. The test measures changes in vibration and records them on a graph. Your doctor
will interpret the results.

TREATMENT: There are a number of ways to treat middle ear infections. Your doctor will base
treatment on your child’s age, health, and medical history. Doctors will also consider the following:

 the severity of the infection

 the ability of your child to tolerate antibiotics

 opinion or preference of the parents

Depending on the severity of the infection, your doctor may tell you that the best option is to treat the
pain and wait to see if symptoms go away. Ibuprofen or another fever and pain reducer is a common
treatment.

Symptoms lasting more than three days usually mean your doctor will recommend antibiotics. However,
antibiotics won’t cure an infection if its caused by a virus.

PREVENTION: There are ways to lower your child’s risk of getting ear infections:

 Wash your hands and your child’s hands  Avoid smoky environments.
frequently.
 Keep your child’s immunizations up-to-
 If you bottle feed, always hold your date.
baby’s bottle yourself and feed them
 Wean your child from the pacifier by
while they’re sitting up or semi-upright.
the time they are 1 year old.
Wean them off the bottle when they
turn 1 year old.

The American Osteopathic Association also recommends breastfeeding your baby if possible, as it can

help to reduce the incidence of middle ear infections.

DISEASE: CROUP

DEFINITION: Croup is a viral condition that causes swelling around the vocal cords.

It’s characterized by breathing difficulties and a bad cough that sounds like a barking seal. Many of the
viruses responsible for croup also cause the common cold. Most active in the fall and winter months,
croup usually targets children under the age of 5.

ETIOLOGIC AGENT: There are several viruses that can cause croup. Many cases come from
parainfluenza viruses (the common cold). Other viruses that may cause croup include adenovirus
(another group of common cold viruses), respiratory syncytial virus (RSV), the most common germ
affecting young children, and measles. Croup may also be caused by allergies, exposure to inhaled
irritants, or bacterial infections. But these are rare.

MODE OF TRANSMISSION: Your child may contract a virus by breathing infected respiratory droplets
coughed or sneezed into the air. Virus particles in these droplets may also survive on toys and other
surfaces. If your child touches a contaminated surface and then touches his or her eyes, nose or mouth,
an infection may follow.

SIGNS AND SYMPTOMS: Croup often begins as a typical cold. If there's enough inflammation and
coughing, a child will develop:

 Loud barking cough that's further aggravated by crying and coughing, as well as anxiety and
agitation, setting up a cycle of worsening signs and symptoms
 Fever
 Hoarse voice
 Breathing that may be noisy or labored
Symptoms of croup are typically worse at night and usually last for three to five days.

DIAGNOSIS: Croup is generally diagnosed during a physical exam.

Your doctor will likely listen to the cough, observe breathing, and ask for a description of symptoms.
Even when an office visit is not necessary, doctors and nurses may diagnose croup by attentively
listening to the characteristic cough over the phone. If croup symptoms are persistent, your doctor may
order a throat exam or X-ray to rule out other respiratory conditions.

TREATMENT: The majority of children with croup can be treated at home. Still croup can be scary,
especially if it lands your child in the doctor's office, emergency room or hospital. Treatment is typically
based on the severity of symptoms.

Comfort measures

Comforting your child and keeping him or her calm are important, because crying and agitation worsen
airway obstruction. Hold your child, sing lullabies or read quiet stories. Offer a favorite blanket or toy.
Speak in a soothing voice.

Medication

If your child's symptoms persist beyond three to five days or worsen, your child's doctor may prescribe
these medications:

 A type of steroid (glucocorticoid) may be given to reduce inflammation in the airway. Benefits
will typically be felt within a few hours. A single dose of dexamethasone is usually
recommended because of its long-lasting effects.

 Epinephrine also is effective in reducing airway inflammation and may be given in an inhaled
form using a nebulizer for more-severe symptoms. It's fast acting, but its effects wear off
quickly. Your child likely will need to be observed in the emergency room for several hours
before going home to determine if a second dose is needed.

Hospitalization

For severe croup, your child may need to spend time in a hospital to be monitored and receive
additional treatments.

PREVENTION: Most cases of croup are caused by the same viruses that cause the common cold or
influenza. Prevention strategies are similar for all these viruses. They include frequent hand-washing,
keeping hands and objects out of the mouth, and avoiding people who are not feeling well.

Some of the most serious cases of croup are caused by conditions such as measles. To avoid dangerous
ailments such as this, parents should keep their children on schedule for appropriate vaccinations.

DISEASE: INFLUENZA
DEFINITION: The flu (or influenza) is a highly contagious viral infection of the respiratory tract that can
cause severe illness and life-threatening complications (including pneumonia). It affects people of all
ages. The flu is spread by contact with fluids from coughs and sneezes that contain the flu virus.

It is estimated that flu contributes to more than 3,300 deaths in Australia each year.

Even healthy people can sometimes die from the flu. For vulnerable Victorians, like young children, the
elderly, pregnant women and people with a weakened immune system or chronic medical condition, the
flu can have serious and devastating outcomes. 

Influenza is caused by infection of the respiratory tract with influenza viruses, RNA viruses of the
Orthomyxovirus genus. Influenza viruses are classified into 4 types: A, B, C, and D. Only virus types A and
B commonly cause illness in humans.

ETIOLOGIC AGENT: There are three serotypes - A, B and C[2]. Influenza A and B viruses cause most clinical
disease:

 A is the more frequent and the cause of major influenza outbreaks.

 B tends to circulate with A in yearly outbreaks and causes less severe illness.

 C tends to cause a mild or asymptomatic illness akin to the common cold.

There are four types of influenza virus, termed influenza viruses A, B, C, and D. Aquatic birds are the
primary reservoir of Influenza A virus (IAV), which is also widespread in various mammals, including
humans and pigs. Influenza B virus (IBV) and Influenza C virus (ICV) primarily infect humans,
and Influenza D virus (IDV) is found in cattle and pigs. IAV and IBV circulate in humans and cause
seasonal epidemics, and ICV causes a mild infection, primarily in children. IDV can infect humans but is
not known to cause illness. 

MODE OF TRANSMISSION: Influenza viruses travel through the air in droplets when someone with the
infection coughs, sneezes or talks. You can inhale the droplets directly, or you can pick up the germs
from an object — such as a telephone or computer keyboard — and then transfer them to your eyes,
nose or mouth.

A person can develop flu symptoms if droplets that contain the virus and come from the breath of
another person enter their mouth, nose, or lungs.

This transmission can happenTrusted Source if:

 Someone without the virus is near a person with flu.

 Someone who is virus free handles an object a person with the virus has touched and then
touches their mouth, nose, or eyes.

SIGNS AND SYMPTOMS: Influenza (flu) can cause mild to severe illness, and at times can lead to death.
Flu is different from a cold. Flu usually comes on suddenly. People who have flu often feel some or all of
these symptoms:

 fever* or feeling feverish/chills  runny or stuffy nose

 cough  muscle or body aches

 sore throat  headaches

  fatigue (tiredness)  some people may have vomiting and
diarrhea, though this is more common
in children than adults.

*It’s important to note that not everyone with flu will have a fever.

DIAGNOSIS: Flu, and other kinds of viruses, can only be confirmed by a doctor after a nose or throat
swab has returned positive results.  Treatment is similar for any ‘flu-like’ illness, but a diagnosis is useful
in helping health officials track disease patterns and frequency. It is also required where complications
have developed.

TREATMENT: Antiviral drugs can treat flu illness. Antiviral drugs are different from antibiotics. Flu
antivirals are prescription medicines (pills, liquid, intravenous solution, or an inhaled powder) and are
not available over the counter. Antiviral drugs can make illness milder and shorten the time you are sick.

PREVENTION: The first and most important step in preventing flu is to get a flu vaccine each year. Flu
vaccine has been shown to reduce flu related illnesses and the risk of serious flu complications that can
result in hospitalization or even death. CDC also recommends everyday preventive actions (like staying
away from people who are sick, covering coughs and sneezes and frequent handwashing) to help slow
the spread of germs that cause respiratory (nose, throat, and lungs) illnesses, like flu.

DISEASE: REYE’S SYNDROME

DEFINITION: Reye's syndrome is a very rare disorder that can cause serious liver and brain damage. If it's
not treated promptly, it may lead to permanent brain injury or death. Reye's syndrome mainly affects
children and young adults under 20 years of age.

Reye’s syndrome usually occurs in children who have had a recent viral infection, such as chickenpox or
the flu. Taking aspirin to treat such an infection greatly increases the risk of Reye’s.

ETIOLOGIC AGENT: Influenza virus types A and B and varicella-zoster virus are the pathogens most
commonly associated with Reye syndrome.

The exact cause of Reye's syndrome is unknown, although several factors may play a role in its
development. Reye's syndrome seems to be triggered by using aspirin to treat a viral illness or infection
— particularly flu (influenza) and chickenpox — in children and teenagers who have an underlying fatty
acid oxidation disorder.

MODE OF TRANSMISSION: If you use aspirin to treat symptoms of your child or teenager’s viral
infection, they are at high risk for developing Reye’s syndrome.

SIGNS AND SYMPTOMS: In Reye's syndrome, a child's blood sugar level typically drops while the levels
of ammonia and acidity in his or her blood rise. At the same time, the liver may swell and develop fatty
deposits. Swelling may also occur in the brain, which can cause seizures, convulsions or loss of
consciousness.

The signs and symptoms of Reye's syndrome typically appear about three to five days after the onset of
a viral infection, such as the flu (influenza) or chickenpox, or an upper respiratory infection, such as a
cold.

DIAGNOSIS: As Reye's syndrome is so rare, other conditions that can cause similar symptoms need to be
ruled out. These include:

 meningitis – inflammation of the protective membranes surrounding the brain and spinal cord
  encephalitis – inflammation of the brain

 inherited metabolic disorders  – conditions, such as medium-chain acyl-CoA dehydrogenase

deficiency (MCADD), that affect the chemical reactions that occur in your body

Blood tests and urine tests can help detect if there's a build-up of toxins or bacteria in the blood, and
they can also be used to check if the liver is functioning normally.

Tests may also be carried out to check for the presence or absence of certain chemicals that could
indicate an inherited metabolic disorder.

Other tests that may be recommended include a:

 CT scan to check for brain swelling

 lumbar puncture – where a sample of fluid is removed from the spine using a needle to check
for bacteria or viruses

 liver biopsy – where a small sample of liver tissue is removed and examined to look for
distinctive cell changes associated with Reye's syndrome

TREATMENT: If Reye's syndrome is diagnosed, your child will need to be immediately admitted to
an intensive care unit. Treatment aims to minimise the symptoms and support the body's vital functions,
such as breathing and blood circulation. It's also essential to protect the brain against permanent
damage that can be caused by the brain swelling.

Medicines may be given directly into a vein (intravenously), such as:

 electrolytes and fluids – to correct the level of salts, minerals and nutrients, such as glucose
(sugar), in the blood

 diuretics – medicines to help rid the body of excess fluid and reduce swelling in the brain

 ammonia detoxicants – medicines to reduce the level of ammonia

 anticonvulsants – medicines to control seizures

A ventilator (breathing machine) may be used if your child needs help with breathing.

PREVENTION: Use caution when giving aspirin to children or teenagers. Though aspirin is approved for
use in children older than age 3, children and teenagers recovering from chickenpox or flu-like
symptoms should never take aspirin. This includes plain aspirin and medications that contain aspirin.

DISEASE: DIPHTHERIA

DEFINITION: Diphtheria (dif-THEER-e-uh) is a serious bacterial infection that usually affects the mucous
membranes of your nose and throat. Diphtheria is extremely rare in the United States and other
developed countries, thanks to widespread vaccination against the disease.
Diphtheria can be treated with medications. But in advanced stages, diphtheria can damage your heart,
kidneys and nervous system. Even with treatment, diphtheria can be deadly, especially in children.

ETIOLOGIC AGENT: Diphtheria is a serious infection caused by strains of bacteria

called Corynebacterium diphtheriae  that make a toxin (poison). It is the toxin that can cause people to
get very sick.

MODE OF TRANSMISSION: Diphtheria bacteria spread from person to person, usually through
respiratory droplets, like from coughing or sneezing.  People can also get sick from touching infected
open sores or ulcers.

SIGNS AND SYMPTOMS: Diphtheria can infect the respiratory tract (parts of the body involved in
breathing) and skin. In the respiratory tract, it causes a thick, gray coating to build up in the throat or
nose. This coating can make it hard to breathe and swallow. Diphtheria skin infections can cause open
sores or shallow ulcers.

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Respiratory Diphtheria

The bacteria most commonly infect the respiratory system, which includes parts of the body involved in
breathing. When the bacteria get into and attach to the lining of the respiratory system, it can cause:

 Weakness  Mild fever

 Sore throat  Swollen glands in the neck

The bacteria make a toxin (poison) that kills healthy tissues in the respiratory system. Within two to
three days, the dead tissue forms a thick, gray coating that can build up in the throat or nose. Medical
experts call this thick, gray coating a “pseudomembrane.” It can cover tissues in the nose, tonsils, voice
box, and throat, making it very hard to breathe and swallow.

If the toxin gets into the blood stream, it can cause heart, nerve, and kidney damage.

Diphtheria Skin Infection

The bacteria can also infect the skin, causing open sores or ulcers. However, diphtheria skin infections
rarely result in any other severe disease.

DIAGNOSIS: Doctors usually decide if a person has diphtheria by looking for common signs
and symptoms. They can swab the back of the throat or nose and test it for the bacteria that cause
diphtheria. A doctor can also take a sample from an open sore or ulcer and try and grow the bacteria. If
the bacteria grow and make a toxin (poison), the doctor can be sure a patient has diphtheria. However,
it takes time to grow the bacteria, so it is important to start treatment right away if a doctor suspects
respiratory diphtheria.

TREATMENT: Diphtheria treatment today involves:

 Using diphtheria antitoxin to stop the toxin made by the bacteria from damaging the body. This
treatment is very important for respiratory diphtheria infections, but it is rarely used for
diphtheria skin infections.

 Using antibiotics to kill and get rid of the bacteria. This is important for both diphtheria
infections in the respiratory system and on the skin.

Even with treatment, about 1 in 10 people with respiratory diphtheria will die.

People with diphtheria are usually no longer able to infect others 48 hours after they begin taking
antibiotics. However, it is important to finish taking the full course of antibiotics to make sure the
bacteria are completely removed from the body. After the patient finishes the full treatment, the doctor
will run tests to make sure the bacteria are not in the patient’s body anymore.

PREVENTION:

Vaccination
Keeping up to date with recommended vaccines is the best way to prevent diphtheria.

In the United States, there are four vaccines used to prevent diphtheria: DTaP, Tdap, DT, and Td. Each of
these vaccines prevents diphtheria and tetanus; DTaP and Tdap also help prevent pertussis (whooping
cough).

Antibiotics

CDC recommends that close contacts of someone with diphtheria receive antibiotics to prevent them
from getting sick. Experts call this prophylaxis. This is important for people with diphtheria infecting the
respiratory system (parts of the body involved in breathing) and skin.

DISEASES OF THE LOWER REPIRATORY TRACT

DISEASE: CHRONIC BRONCHIOLITIS

DEFINITION: Chronic bronchitis is long-term inflammation of the bronchi. It is common among smokers.
People with chronic bronchitis tend to get lung infections more easily. They also have episodes of acute
bronchitis, when symptoms are worse.

People with chronic bronchitis have chronic obstructive pulmonary disease (COPD). This is a large group
of lung diseases that includes chronic bronchitis. These diseases can block air flow in the lungs and cause
breathing problems. The 2 most common conditions of COPD are chronic bronchitis and emphysema.

ETIOLOGIC AGENT: Streptococcus pneumoniae (Pneumococci) and Haemophilus influenzae

MODE OF TRANSMISSION: It's often caused by smoking cigarettes, but can also be due to prolonged
exposure to other noxious irritants. It's usually not contagious, so you typically can't get it from another
person or pass it onto someone else.

SIGNS AND SYMPTOMS: At first, you may have no symptoms or only mild symptoms. As the disease
gets worse, your symptoms usually become more severe. They can include

 Frequent coughing or a cough that  Shortness of breath, especially with

produces a lot mucus physical activity

 Wheezing  Tightness in your chest

 A whistling or squeaky sound when you

breathe

Some people with chronic bronchitis get frequent respiratory infections such as colds and the flu. In
severe cases, chronic bronchitis can cause weight loss, weakness in your lower muscles, and swelling in
your ankles, feet, or legs.

DIAGNOSIS: To make a diagnosis, your health care provider

 Will ask about your medical history and  May do lab tests, such as lung function
family history tests, a chest x-ray or CT scan, and
blood tests
 Will ask about your symptoms
TREATMENT: There is no cure for chronic bronchitis. However, treatments can help with symptoms,
slow the progress of the disease, and improve your ability to stay active. It may include:

 Quitting smoking  Getting oxygen from portable

 Staying away from secondhand smoke
and other lung irritants
 Taking medicines by mouth (oral) to
open airways and help clear away
mucus
 Taking inhaled medicines, such as
bronchodilators and steroids
containers
 Having lung reduction surgery to take
out damaged areas of the lung
 Getting a lung transplant, in rare cases
 Humidifying the air
 Pulmonary rehab to help you learn how
to live with your breathing problems
and stay active

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. There are also treatments to prevent or treat complications of the disease. Treatments include

 Lifestyle changes, such as

 Quitting smoking if you are a smoker. This is the most important step you can take to
treat chronic bronchitis.

 Avoiding secondhand smoke and places where you might breathe in other lung irritants

 Ask your health care provider for an eating plan that will meet your nutritional needs.
Also ask about how much physical activity you can do. Physical activity can strengthen
the muscles that help you breathe and improve your overall wellness.

 Medicines, such as

 Bronchodilators, which relax the muscles around your airways. This helps open your
airways and makes breathing easier. Most bronchodilators are taken through an inhaler.
In more severe cases, the inhaler may also contain steroids to reduce inflammation.

 Vaccines for the flu and pneumococcal pneumonia, since people with chronic bronchitis
are at higher risk for serious problems from these diseases.

 Antibiotics if you get a bacterial or viral lung infection

 Oxygen therapy, if you have severe chronic bronchitis and low levels of oxygen in your blood.
Oxygen therapy can help you breathe better. You may need extra oxygen all the time or only at
certain times.

 Pulmonary rehabilitation, which is a program that helps improve the well-being of people who
have chronic breathing problems. It may include

 An exercise program  Nutritional counseling

 Disease management training  Psychological counseling

 A lung transplant, as a last resort for people who have severe symptoms that have not gotten
better with medicines

If you have chronic bronchitis, it's important to know when and where to get help for your symptoms.
You should get emergency care if you have severe symptoms, such as trouble catching your breath or
talking. Call your health care provider if your symptoms are getting worse or if you have signs of an
infection, such as a fever.

PREVENTION: Since smoking causes most cases of chronic bronchitis, the best way to prevent it is to not
smoke. It's also important to try to avoid lung irritants such as secondhand smoke, air pollution,
chemical fumes, and dusts.
What’s the difference between bronchiolitis and bronchitis?
These two conditions not only sound similar, but they are similar in some ways. Both can be caused by a
virus. Both affect the airways in the lungs, but bronchitis affects the larger airways (the bronchi).
Bronchiolitis affects the smaller airways (bronchioles). Bronchitis usually affects older children and
adults, while bronchiolitis is more common in younger children.

DISEASE: BRONCHIOLITIS

DEFINITION: Bronchiolitis is an inflammatory respiratory condition. It’s caused by a virus that affects the
smallest air passages in the lungs (bronchioles). The job of the bronchioles is to control airflow in your
lungs. When they become infected or damaged, they can swell or become clogged. This blocks the flow
of oxygen. Although it’s generally a childhood condition, bronchiolitis can also affect adults.

There are two main types of bronchiolitis:

Viral bronchiolitis appears in infants. Most cases of viral bronchiolitis are due to respiratory syncytial
virus (RSV). Viral outbreaks occur every winter and affect children under the age of 1 year old.

Bronchiolitis obliterans is a rare and dangerous condition seen in adults. This disease causes scarring in
the bronchioles. This blocks the air passages creating an airway obstruction that can’t be reversed.

ETIOLOGIC AGENT: The viruses that cause most cases of bronchiolitis are the respiratory syncytial
virus (RSV), the rhinovirus and the influenza (flu) virus. These viruses are very contagious and are spread
from person to person by touching secretions from the mouth or nose or by respiratory droplets in the
air. The droplets get into the air when someone sneezes or coughs.

MODE OF TRANSMISSION: Bronchiolitis is transmitted by spreading pathogens from one person to

another. Usually, pathogens spread when infected people cough, sneeze, or even talk, releasing tiny
saliva droplets in the air. These droplets can then infect another person when they land on that person's
mouth, nose, or eyes.

SIGNS AND SYMPTOMS: The first signs look a lot like a cold. Your child may have the following
symptoms:

 Runny nose  Fever

 Cough  Stuffy nose

 Less appetite

The symptoms may get worse over the next few days, including faster breathing. If you see signs that
your child is having trouble breathing, call their doctor at once or seek medical care if your call isn’t
answered. Otherwise, here are some other things to watch for:

 Wheezing (a high-pitched, whistling  Signs of dehydration such as dry mouth,

sound when exhaling) crying without tears, not peeing as
often
 Fast breathing (more than 60 breaths a
minute)  Vomiting

 Labored breathing and grunting  Sluggish or tired appearance

 Trouble drinking, sucking, swallowing  Constant coughing

  Pause in breathing for more than 15
seconds (called apnea)

DIAGNOSIS: Your provider is probably very familiar with bronchiolitis. They will ask you questions like
how long your child has been sick, if your child has a fever, and if your child has been around anyone
else who has been sick.

The provider will examine your child and listen to their lungs. A pulse oximeter, an electronic device that
can be placed painlessly on fingertips or toes, can find out how much oxygen there is in your child’s
blood.

It’s not likely that more tests will be needed. If they are, they might include having a chest X-ray or
sending a sample of mucus for testing. Your provider might order a urine test if it seems like your child
might have a urinary tract infection.

TREATMENT: In most cases, bronchiolitis is not treated. Antibiotics will not help because this is a viral
infection. You will be advised to keep your child hydrated as best you can.

Are there drugs to treat bronchiolitis?

Some doctors have used steroids, while others used inhaled bronchodilators to treat bronchiolitis. There
is no hard evidence to show that these are useful. However, it is likely that research will continue to find
ways to improve treatment. For instance, oxygen therapy is also being studied and is sometimes used.

A small percentage of children may need oxygen therapy or intravenous (IV) fluids, which would be
given in the hospital. Bronchiolitis is the main reason that infants are hospitalized in the U.S., with about
100,000 hospital admissions per year. While bronchiolitis is manageable, it can also be life-threatening
in rare cases, such as when it causes respiratory failure.

PREVENTION: Bronchiolitis can be spread by small children through close contact, saliva and mucus. The
best way to prevent infection is to avoid others who are sick, and practice good hand washing. Until your
child is better, keep him or her home from daycare and be sure to wash toys between uses. Do not
share cups, forks or spoons.

In some cases, children may be given the RSV antibody palivizumab (Synagis®) to prevent RSV infections.
This might happen if your healthcare provider thinks that your child is at a higher risk of having serious
complications. Your child might be one of these if they have congenital heart defects or were very
premature.

DISEASE: RESPIRATORY SYNCYNTIAL VIRUS (RSV)

DEFINITION: Respiratory syncytial virus (RSV) is a highly contagious, seasonal lung infection. It affects
the lungs and its bronchioles (smaller passageways that carry air to the lung). It’s a common childhood
illness that can affect adults too. Most cases are mild, with cold-like symptoms. Severe infection leads to
pneumonia and bronchiolitis.

ETIOLOGIC AGENT: RESPIRATORY SYNCYNTIAL VIRUS (RSV)

MODE OF TRANSMISSION: Respiratory syncytial virus enters the body through the eyes, nose or
mouth. It spreads easily through the air on infected respiratory droplets. You or your child can become
infected if someone with RSV coughs or sneezes near you. The virus also passes to others through direct
contact, such as shaking hands.

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People infected with RSV are usually contagious for 3 to 8 days. However, some infants, and people with
weakened immune systems, can continue to spread the virus even after they stop showing symptoms,
for as long as 4 weeks. Children are often exposed to and infected with RSV outside the home, such as in
school or child-care centers. They can then transmit the virus to other members of the family.

RSV can survive for many hours on hard surfaces such as tables and crib rails. It typically lives on soft
surfaces such as tissues and hands for shorter amounts of time.

SIGNS AND SYMPTOMS: People infected with RSV usually show symptoms within 4 to 6 days after
getting infected. Patients develop fever and other symptoms such as runny nose, cough, headache,
decreased appetite, body ache or weakness, and occasionally otitis media.

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Common symptoms of RSV in infants include:

 Runny nose.  Fever (temperature above 100 degrees

Fahrenheit). Fever may not always be
 Decrease in appetite.
present.
 Sneezing and coughing.

Symptoms in the youngest infants include:

 Fussiness/irritability.  Decreased appetite.

 Decreased activity/more tired than  Pauses in breathing.

usual.

Symptoms of severe RSV in infants include:

 Short, shallow and rapid breathing.  Bluish coloring of lips, mouth and
fingernails.
 Flaring (spreading out) of nostrils with
every breath.  Wheezing (This can be a sign of
pneumonia or bronchiolitis.)
 Belly breathing (look for a “caving in” of
the chest in the form of an upside-down  Poor appetite.
“V” starting under the neck).

DIAGNOSIS: Your healthcare provider will take your or your child’s medical history and ask about
symptoms. The physical exam will include listening to your or your child’s lungs and checking oxygen
level in a simple finger monitoring test (pulse oximetry). They may order blood testing to check for signs
of infection (such as a higher than normal white blood cell count) or take a nose swab to test for viruses.

If more severe illness is suspected, your healthcare provider will order imaging tests (X-rays, CT scan) to
check your or your child’s lungs.

TREATMENT: The infection usually subsides in about 1 – 2 weeks. Most cases are mild and patients can
be managed with supportive treatment. Severe cases may need oxygen therapy and tube feeding.
Antiviral agent may be considered for patients with congenital heart or lung diseases. Antibiotics may be
needed only if there are bacterial complications such as pneumonia, sinusitis or otitis media.

PREVENTION: There are steps you can take to help prevent the spread of RSV. Specifically, if you have
cold-like symptoms you should

 Cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands

 Wash your hands often with soap and water for at least 20 seconds

 Avoid close contact, such as kissing, shaking hands, and sharing cups and eating utensils, with
others

 Clean frequently touched surfaces such as doorknobs and mobile devices

Researchers are working to develop RSV vaccines, but none are available yet. A drug called palivizumab
(pah-lih-VIH-zu-mahb) is available to prevent severe RSV illness in certain infants and children who are
at high risk for severe disease. This could include, for example, infants born prematurely or with
congenital (present from birth) heart disease or chronic lung disease. The drug can help prevent serious
RSV disease, but it cannot help cure or treat children already suffering from serious RSV disease, and it
cannot prevent infection with RSV. If your child is at high risk for severe RSV disease, talk to your
healthcare provider to see if palivizumab can be used as a preventive measure.

DISEASE: PNEUMONIA

DEFINITION: Pneumonia is an infection that inflames your lungs' air sacs (alveoli). The air sacs may fill up
with fluid or pus, causing symptoms such as a cough, fever, chills and trouble breathing.

Bacterial pneumonia, which is the most common form, tends to be more serious than other types of
pneumonia, with symptoms that require medical care.

Types of pneumonia

Pneumonia can also be classified according to where or how it was acquired.

Hospital-acquired pneumonia (HAP)

This type of bacterial pneumonia is acquired during a hospital stay. It can be more serious than other
types, as the bacteria involved may be more resistant to antibiotics.

Community-acquired pneumonia (CAP)

Community-acquired pneumonia (CAP) refers to pneumonia that’s acquired outside of a medical or

institutional setting.

Ventilator-associated pneumonia (VAP)

When people who are using a ventilator get pneumonia, it’s called VAP.

Aspiration pneumonia

Aspiration pneumonia happens when you inhale bacteria into your lungs from food, drink, or saliva. This
type is more likely to occur if you have a swallowing problem or if you’re too sedate from the use of
medications, alcohol, or other drugs.

ETIOLOGIC AGENT:

Other bacteria that can cause pneumonia include:

 Staphylococcus aureus

 Moraxella catarrhalis

 Streptococcus pyogenes

 Neisseria meningitidis

 Klebsiella pneumoniae

MODE OF TRANSMISSION: Pneumonia is spread when droplets of fluid containing the pneumonia
bacteria or virus are launched in the air when someone coughs or sneezes and then inhaled by others.
You can also get pneumonia from touching an object previously touched by the person with pneumonia
(transferring the germs) or touching a tissue used by the infected person and then touching your mouth
or nose.

SIGNS AND SYMPTOMS: People with pneumonia experience a cough along with other symptoms such
as fever or breathlessness without an obvious cause.

Pneumonia symptoms can vary from so mild you barely notice them, to so severe that hospitalization is
required. How your body responds to pneumonia depends on the type germ causing the infection, your
age and your overall health.

The signs and symptoms of pneumonia may include:

 Cough, which may produce greenish,  Sharp or stabbing chest pain that gets
yellow or even bloody mucus worse when you breathe deeply or
cough
 Fever, sweating and shaking chills
 Loss of appetite, low energy, and
 Shortness of breath
fatigue
 Rapid, shallow breathing
 Nausea and vomiting, especially in small
children

 Confusion, especially in older people

The symptoms of bacterial pneumonia can develop gradually or suddenly. Fever may rise as high as a
dangerous 105 degrees F, with profuse sweating and rapidly increased breathing and pulse rate. Lips
and nailbeds may have a bluish color due to lack of oxygen in the blood. A patient's mental state may be
confused or delirious.

The symptoms of viral pneumonia usually develop over a period of several days. Early symptoms are
similar to influenza symptoms: fever, a dry cough, headache, muscle pain, and weakness. Within a day
or two, the symptoms typically get worse, with increasing cough, shortness of breath and muscle pain.
There may be a high fever and there may be blueness of the lips.

DIAGNOSIS: Sometimes pneumonia can be difficult to diagnose because the symptoms are so variable,
and are often very similar to those seen in a cold or influenza. To diagnose pneumonia, and to try to
identify the germ that is causing the illness, your doctor will ask questions about your medical history,
do a physical exam, and run some tests.

TREATMENT: Treatment for pneumonia depends on the type of pneumonia, which germ is causing it,
and how severe it is:

 Antibiotics treat bacterial pneumonia and some types of fungal pneumonia. They do not work
for viral pneumonia.

 In some cases, your provider may prescribe antiviral medicines for viral pneumonia

 Antifungal medicines treat other types of fungal pneumonia

You may need to be treated in a hospital if your symptoms are severe or if you are at risk for
complications. While there, you may get additional treatments. For example, if your blood oxygen level
is low, you may receive oxygen therapy.

It may take time to recover from pneumonia. Some people feel better within a week. For other people,
it can take a month or more.

PREVENTION: Vaccines can help prevent pneumonia caused by pneumococcal bacteria or the flu virus.
Having good hygiene, not smoking, and having a healthy lifestyle may also help prevent pneumonia.

DISEASE: ACUTE BACTERIAL PNEUMONIA

DEFINITION: Bacterial pneumonia is an infection of your lungs caused by certain bacteria. The most
common one is Streptococcus  (pneumococcus),  but other bacteria can cause it too. If you’re young and
basically healthy, these bacteria can live in your throat without causing any trouble. But if your body’s
defenses (immune system) become weak for some reason, the bacteria can go down into your lungs.
When this happens, the air sacs in your lungs get infected and inflamed. They fill up with fluid, and that
causes pneumonia.

ETIOLOGIC AGENT:

 Streptococcus pneumoniae

 Legionella pneumophila; this pneumonia is often called Legionnaires' disease

 Mycoplasma pneumoniae

 Chlamydia pneumoniae

 Haemophilus influenzae

MODE OF TRANSMISSION: The pneumococcal bacterium usually enters the lungs after a person

breathes in particles or droplets from a sneeze or cough from another individual who has the infection.

SIGNS AND SYMPTOMS: Symptoms of bacterial pneumonia can develop gradually or suddenly.
Symptoms include:

 High fever (up to 105° F)  Cough with mucus (might be greenish in

color or contain a small amount of
 Tiredness (fatigue)
blood)
 Trouble breathing: rapid breathing or
 Chest pain and/or abdominal pain,
shortness of breath
especially with coughing or deep
 Sweating breathing

 Chills  Loss of appetite

 Confused mental state or changes in

awareness (especially in older adults)

DIAGNOSIS: To diagnose bacterial pneumonia, your doctor will:

 Listen for abnormal chest sounds that indicate a heavy secretion of mucus.
 Take a blood sample to determine if your white blood cell count is high, which usually indicates
infection.
 Take a blood culture, which can help determine if the bacteria have spread to your bloodstream
and also help identify the bacterium causing the infection.
 Take a sample of mucus, or a sputum culture, to identify the bacterium causing the infection.
 Order chest X-rays to confirm the presence and extent of the infection.
TREATMENT: Bacterial pneumonia is usually treated with antibiotics. The specific antibiotic choice
depends on such factors as your general health, other health conditions you may have, the type of
medications you are currently taking (if any), your recent (if any) use of antibiotics, any evidence of
antibiotic resistance in the local community and your age. Medicines to relieve pain and lower fever may
also be helpful. Ask your doctor if you should take a cough suppressant. It’s important to be able to
cough to clear your lungs.

PREVENTION: Bacterial pneumonia itself is not contagious, but the infection that caused bacterial
pneumonia is contagious. It can spread through coughs, sneezes, and contamination on objects.
Practicing good hygiene can help prevent the spread of pneumonia or the risk of catching it.

There are two kinds of shots for bacterial pneumonia:

PCV13 (Prevnar 13) is for: PPSV23 (Pneumovax) is for:

 People 65 or older  People 65 or older

 Kids under 5 years  Children older than 2 who have a high

risk of bacterial pneumonia
 People who have a high risk of bacterial
pneumonia  People between 19 and 64 who smoke
or have asthma

Besides getting shots, you can lower your risk of getting bacterial pneumonia by doing these things:

 Wash your hands regularly, especially after you go to the bathroom and before you eat.
 Eat right, with plenty of fruits and vegetables.
 Exercise.
 Get enough sleep.
 Quit smoking.
 Stay away from sick people, if possible.

Bacterial vs. viral pneumonia: What’s the difference?

The two most common causes of pneumonia are bacteria and viruses. The flu is one of the most
common causes of viral pneumonia in adults, though post-flu complications can also cause
bacterial pneumonia.

Viral pneumonia Bacterial pneumonia

most likely to affect healthy more likely to affect someone with a lowered
Who? people with strong immune immune system, or someone who is
systems recovering from a respiratory infection

Treatment antibiotics don’t work antibiotics may be prescribed

Outlook can be severe and fatal may be more aggressive and difficult to treat

In bacterial pneumonia, there will likely be a much more visible presence of fluid in the lungs
than viral pneumonia. Bacterial pneumonia is also more likely to enter the blood stream and
infect other parts of the body.
DISEASE: VIRAL PNEUMONIA

DEFINITION: Viral pneumonia is an infection of your lungs caused by a virus. The most common cause is

the flu, but you can also get viral pneumonia from the common cold and other viruses. These nasty
germs usually stick to the upper part of your respiratory system. But the trouble starts when they get
down into your lungs. Then the air sacs in your lungs get infected and inflamed, and they fill up with
fluid.

Anything that weakens your body’s defenses (immune system) can raise your chances of getting
pneumonia.

ETIOLOGIC AGENT:

 Respiratory syncytial virus (RSV)

 Some common cold and flu viruses

 SARS-CoV-2, the virus that causes COVID-19

MODE OF TRANSMISSION: Viruses that cause pneumonia travel through the air in droplets of fluid after
someone sneezes or coughs. These fluids can get into your body through your nose or mouth. You can
also get viral pneumonia after touching a virus-covered doorknob or keyboard and then touching
your mouth or nose.

SIGNS AND SYMPTOMS: Symptoms usually develop over a period of several days. Early symptoms are
similar to flu symptoms, which include:

 Fever  Loss of appetite

 Dry cough  Muscle pain

 Headache  Weakness

 Sore throat

Additional symptoms appearing about a day later include:

 Higher fever

 Cough with mucus

 Shortness of breath

DIAGNOSIS: Your doctor’s diagnosis will depend on how severe your infection is. If you have mild
symptoms, your doctor may suggest blood tests or a chest X-ray.

If your symptoms are serious, and you are 65 or older (or an infant or young child), your doctor might
want to test some of your fluids. They may also put a camera down your throat to check your airways.
TREATMENT:  Antibiotics are not used to fight viruses. (In some cases antibiotics may be given to fight a
bacterial infection that is also present.) There are no treatments for most viral causes of pneumonia.
However, if the flu virus is thought to be the cause, antiviral drugs might be prescribed, such
as oseltamivir (Tamiflu®), zanamivir (Relenza®), or peramivir (Rapivab®), to decrease the length and
severity of the illness. Over-the-counter medicines to relieve pain and lower fever are usually
recommended. Other medicines and therapies such as breathing treatments and exercises to loosen
mucus may be prescribed by your doctor.

PREVENTION: Get a flu vaccine (shot) once every year. Flu vaccines are prepared to protect against that
year’s virus strain. Having the flu can make it easier to get bacterial pneumonia.

The same steps you would take to try to prevent the flu also help lower your chance of pneumonia.

 Wash your hands often. Scrub them with soap and water for at least 20 seconds before you eat or
prepare food. When you are in public places, use sanitizer.
 Get a flu vaccination each year at the beginning of flu season.
 Stay away from people who are coughing or sneezing.
 Try not to touch your eyes, ears, nose, and mouth.

DISEASE: FUNGAL PNEUMONIA

DEFINITION: Fungal pneumonia is an infection of the lungs by fungi. It can be caused by

either endemic or opportunistic fungi or a combination of both. Case mortality in fungal pneumonias
can be as high as 90% in immunocompromised patients, though immunocompetent patients generally
respond well to anti-fungal therapy. Fungal pneumonia is more common in people who have chronic
health problems or weakened immune systems. 

ETIOLOGIC AGENT:

 Pneumocystis pneumonia (PCP)  Histoplasmosis

 Coccidioidomycosis, which causes valley  Cryptococcus

fever

MODE OF TRANSMISSION: Fungal pneumonia passes from the environment to a person, but it's not
contagious from person to person.

SIGNS AND SYMPTOMS: Because the most common symptoms of fungal pneumonia are similar to those
of viral or bacterial lung infections, diagnosis—and proper treatment—can be delayed. Those symptoms
are:

 Fever  Pain while breathing or coughing

 Chills  Nausea and/or vomiting

 Cough with thick, colored phlegm  Diarrhea4

 Shortness of breath

Age can play a part in the type and severity of symptoms in people with fungal pneumonia, including:
  In older adults, fungal pneumonia symptoms tend to be mild, but the condition can also lead to
mental confusion, which requires immediate medical attention.

 Infants and toddlers with the condition may have difficulty feeding, pale-colored skin, breathing
difficulties (grunts or rattles while breathing), a limp appearance, less urine production, and
fussiness.5

DIAGNOSIS: Fungal pneumonia can be diagnosed in a number of ways. The simplest and cheapest
method is to culture the fungus from a patient's respiratory fluids. However, such tests are not only
insensitive but take time to develop which is a major drawback because studies have shown that slow
diagnosis of fungal pneumonia is linked to high mortality. [4] Microscopy is another method but is also
slow and imprecise. Supplementing these classical methods is the detection of antigens. This technique
is significantly faster but can be less sensitive and specific than the classical methods. [5]

TREATMENT:  Antifungal medication is prescribed if a fungus is the cause of your pneumonia.

Therapy for fungal pneumonias must include antifungal agents. The type of antifungal drug employed
must be selected based on the particular pathogen that is isolated or that is clinically suspected. Many
classes of antifungal agents are now available, including the classic antibiotics; first-, second-, and third-
generation triazoles; and the echinocandins. Amphotericin B is less frequently used and, when used, is
often given as a liposomal formulation to decrease toxicity.  

PREVENTION:

DISEASE: STREPTOCOCCUS PNEUMONIAE

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