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Skin Infection Lima
Leprosy, Actinomyces, Pseudomonas
31
Microbiology
Professional
04/03/2013

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Term
Types of Mycobacterium
Definition
Most important: M. Tubercleprae ulosis and M.
1)M. Tuberculosis (chronic pulmonary diseas) and
2)M. Leprae (skin and connective disease)
3)Atypical Mycobacteria (contain species that may cause infection of the lungs)
Term
Mycobacteria Morphology and Characteristics
Definition
1) aerobic
2) slender straight,curved, or rod shaped bacteia
3) usually resistant to dying, most disinfectants, acids, alkalis
4) heat sensitive
5) don't take up Gram stain well (mycolic acid), use Ziehl Nielsen or Kinyoun
Term
Acid Fast Stain: Ziehl-Nielson
Definition
1) Apply primary stain: carbol fuchsin
2) Decolorize with acid alcohol
3) counterstin with methylene blue
4) Mycobacteria retain primary stain, Acid Fast or Acid fast bacilli
Term
Virulens Factors for Mycobacterium
Definition
1) Cord Factor (sugar trehalose 6,6,dimycolate: stacking, inhibitor, epithelial metaplasia and giant cell
2) sulfatides or sulfalipids (inhibit fusion of phagosome and lysosome
3) LAM (inhibits macrophage activation and scavenges oxidative radicals)
Term
LAM (Lipoarabinomannan)
Definition
1) inhibits macrohpage activation and scavenges ocidative radicals
2) PPDs are derived from these proteins
Term
Mycobacterium Leprae
Definition
1) causes Leprosy
2) Acid Fast
3) Obligate Intracellular
4) Transmitted by respiratory droplets in association with prolonged (years) of close contact with a diseased person (lepromatous)
Term
Leprosy Characteristics
Definition
1)Long incubation period (2-10 years)
2) 2 Phases: Tuberculoid and Lepromatous
Term
Tuberculoid Phase
Definition
Paucibacillary (pauci=few) disease- tuberculoid phase; mostly do not transmit in this phase
Term
Lepromatous Ohase
Definition
multibacillary (many) disease- most infections stage and organism found in upper respiratory tract
Term
Prodromal Stage of Leprosy
Definition
1)First sign is feeling of numbness
2) Temperature is first sensation lost, then light touch, pain and deep pressure in order
3)Hypopigmentation

Sensory loss usually beins in extremities
Term
Tuberculoid Characteristics
Definition
1) benign, non progressive
2) Paucibacillary
3) Palbale nerves (sever peripheral nerve damage)
4) Positive lepromin test
5) Common in those with vigorous response**
Term
Lepromatous Phase Characteristics
Definition
1) Malignant, progressive
2) nodular skin lesions
3) negative lepromin test
4) down regulated or wrong type of T-cell activation (th2)
Term
Lepra Cells
Definition
modified mononuclear or epithelioid cells
Term
Lepromarous Stage Manifestations?
Definition
1) *leonine faces
2) loss of eyebros
3) *edem of legs is a late finding
4) eye involvement
5) few more things but starred importnat two
Term
Immunity (T cells involved with which stages)
Definition
PB/tuberculoid: Th1
MB/lepromatous: Th2

*Th2 suppress Th1 leading to less activation of macrophages
Term
Lab Diagnosis
Definition
1)Cannot be cultivated from tissue
2) rely on biopsy of tissue- acid fast stain (SNET: Skin, Nasal Scraping, Ear Lobes, Tissue Secretions)
3) organisms seen in lepra cell
If not clear rely on presentation of lesions
Term
Lepromin Test
Definition
1) inject heat kill M. leprae from armadillos

*2) no diagnostic value

*3) prognostic for the immune status of patient
Term
Treatment (only high yield)
Definition
1) MDT (multidrug therapy); Dapsone, rifampin, clofazimine,
2) Stage dependent; Pb/Tuberculoid:6-12 month of dapsone and rifampcin
MB/lepromatous: 12-24 month of dapson rifampcin, clofazimine
3) Patients no longer infections after first dose of MDT
4) Patients who complete therapy are considered cured
5) Thalidomide approved for treating leprosy as immune modulator (controversial
6) Irreversible nerve damge leading to loss of sensation may result
Term
Non-tuberculous Mycobacteria
Definition
1) Mycobacterium Marinum
2) Source is fresh, salt water, swimming pools
3) Clinical infection is granulomatous ulcerations of the skin
4) 2-8 week incubation (papules that enlarge and supporate)
Term
You are cleaning somebodies aquarium over the qeekend and scrape hand in the aquarium then have lesion that becomes infected what is the organism?
Definition
Mycobacetrium marinum
Term
Actinomyces
Definition
1) Faculatative intracellular
2) Facultative to strict anaerobic
3) gram positive
4) Bacteria with fungi like structure (mycleia or hyphae)
5) Non acid fast
Term
Is Actinomyces exogenous or endogenous?
Definition
Endogenous- no person to person contact
Term
Actinomyces species that cause disease?
Definition
A. Isrealii
A. naeslundii
Term
Are actinyces fast or slow growing?
Definition
Slow Growth, produce chronic slowyly developing disease
Term
Where is Actinomycosis normally found?
Definition
skin; only cause disease when normal mucosal barriers are disrupted; pathogenic proliferation after 1) trauma, 2) surgery (tooth extraction), 3) infection
Term
What diseases does Actinomycosis cause
Definition
1) Chronic granulomatous lesions
2) Become suppurative
3) Form Abscesses connected by sinus tracts
4)** Form microscopic colonies- sulfur granules- fibrotic walling of lesion
Term
What are the Risk factors for Actinomycosis?
Definition
1) Trauma or inusr to oral cavit
2) Aspiration of organism into long
3) injust to GIT
4) Pelvic infection
5)CNS hematogenous spread fro other site
Term
What is the most common site for actinomycosis?
Definition
1) Cervicofacial area (face and mandible)
2) associated wiht poor oral hygiene
3) lumpy jaw
4) draining sinus tract along jaw line
Term
What are other presentation of Actinmycoses?
Definition
Thoracic, Abdominal, Cerebral
Term
Colony growth IUD
Definition
1) can lead to extensive tissue destruction
2) Abscesses
3) Obstruction
4) and causes PID
Term
Laboratory ID
Definition
1)
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