K 10 Skin Infections

7/25/2019 K 10 Skin Infections.

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Mikroorganisme yang

menyebabkan penyakit di kulit

( bakteri & virus) Bakteri : Mybobacterium leprae

Virus DNA : HHV! dan HHV"

HHV# ( V$V) Variola virus

%arvovirus B!

HHV' & HHV

H%V Molluscum contagiosum virus

Virus NA : Measles virus

ubella virus


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MycobacteriaMycobacteria

(Acid *ast Bacilli)(Acid *ast Bacilli)

+bligate pat,ogens

Mycobacterium tuberculosis- TB Mycobacterium bovis- bovine TB Mycobacterium leprae- Hansen's disease,

(leprosy) ,Morbus Hansen


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Morbus Hansen ( -eprosy )Morbus Hansen ( -eprosy )

%enyebab : Mycobacterium leprae

Mengandug se.umla, besar mycolic acids di permukaan

selnya/ Berkembang biak lambat sekali/

Mengin0eksi kulit1 sara01dan selaput lendir/ Belum dapat dibiakkan di -aboratorium atau cell culture1

tapi suda, dapat dibiakkan di mouse 0oot pads danarmadillo/


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-eprosy-eprosy

-eprosy 2ara in0eksinya belum diketa,ui1 tapi mungkin melalui

respiratory droplets 3ebanyakan orang resisten ter,adap in0eksi dan tidak sampai

berkembang active disease

Kontak yang lama dan intim dengan pasien

lepromatous via :

Nasal secretion

Skin lesions

Inhalation

TransmisiTransmisi


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%er.alanan %enyakit :%er.alanan %enyakit :

Di kulit pasien timbul discolored patc,es yang tidak itc,

or ,urt

%atc,es seperti pada tinea (ring4ormlike patc,es)1dengan pinggir yang meninggi/

%asien mengelu, adanya loss o0 0eeling 4it,in t,e patc, o0

discolored skin


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LeprosyLeprosy


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-eprosy 5 ge.alage.ala lain:

loss o0 eyebro4s t,ick or lumpy earlobes loss o0 0eeling (burns or scars) painless ulcers on t,e 0eet drop 0eet de0ormities o0 ,ands and6or 0eet


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Facial appearance yang klasik pada advanced leprosy


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LeprosyLeprosy


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ulcers, resorption of boneulcers, resorption of bone

worsened from careless use of hands (nerve damageworsened from careless use of hands (nerve damage


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Diagnosis -epra:

%ada penyakit yang tela, lama1 pasien mengelu, adanyanumbness or tingling di tangan dan kaki ( ,ands and 0eet)

%embesaran syara0 di lengan dan le,er

Mycobacterium leprae di.umpai di lesi kulit/( skin lesions)

7lkus yang tidak nyeri (painless ulcers) terin0eksi1

8 kemudian ulkus yang terin0eksi ini akan mengalaminekrosis/

3arena tanpa nyeri1 in0eksinya tanda disadari pasien akanmenyerang .aingan lebi, dalam ( tulang)


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!da dua bentuk utama :

"# Tuberculoid leprosy (TT

$# %epromatous leprosy (%%

&entuk lain: &orderline leprosy

Low TT BT BB BL LL High

prognosis jejek

'anifestasi Klinis'anifestasi Klinis


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9uberculoid -eprosy (99)

Biasanya pada pasien dengan daya ta,an tubu, yang relati0tinggi/

%ada skin smear tidak di.umpai bakteri/

%asien tidak menularkan penykit ke orang lain/

kin patc,es sedikit1 bentuknya variabel 1 tapi sering bagianpinggr meninggi dan bagian central rata ( 0lat )


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9uberculoid -eprosy (99)

Biasanya pasien mengelu, adanya loss o0 0eeling inskin patc,es

;ika tangan atau kaki terlibat dan menyebabkan loss

o0 0eeling pada sala, satu tangan atau kaki sa.a/

espons ter,adap pengobatan biasanya cepat


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Borderline -eprosy

%ada skin smears di.umpai sedikit atau

banyak bakteri /

many skin patc,es1 some 0eeling loss1 patc,esabout t,e same on bot, sides o0 t,e body

severe nerve damage1 loss o0 0eeling and

strengt,1 de0ormities in bot, ,ands and bot, 0eet


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Borderline -eprosy

Borderline leprosy dibagi atas

Borderline tuberculoid (B9)

Borderline (BB)

Borderline lepromatous (B-)


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%epromatous %eprosy (%%

ada pasien dengan daya tahan tubuhrendah

ada skin patches di)umpai se)umlah besar'ycobacterium leprae

asien adalah infectious sehingga diobati

Skin patches, sering disertai dengandaerah*daerah menebal atau raised lumps


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-epromatous -eprosy (--) *acial skin becomes t,ick1 lumpy1 reddis,1 terutama

diatas alis mata1 pipi1 ,idung dan telinga/

Bridge o0 t,e nose mungkin secara perla,anla,an

akan mencekung ( sink )

;ika tidak diobati maka akan ter.adi kerusakan sara0 danparalisis


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-epromatous -eprosy (--)

-oss o0 0eeling and strengt, a00ects bot, ,ands and

bot, 0eet e


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!cid fast, auramine*rhodamine stains

Skin lesions or nasal scraping

!naesthetic checks

+ranulomatous formation

%epromin skin test : not for %epromatous leprosy

DiagnosisDiagnosis


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Tuberculoid leprosy:

apsone combined with rifampin

%epromatous leprosy:

apsone, rifampin and clofa-imine

&orderline leprosy: with .N%(erythema nodusum leprosum

Thalidomine

9reatment9reatment


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H=%=V>>DA=H=%=V>>DA=


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H7MAN H=%= V>7H7MAN H=%= V>7

!/ Herpes simpleks virus type !/ ( HV!)

"/ Herpes simpleks virus type "/( HV")

#/ Varicella ?oster virus ( V$V)

@/ 2ytomegalovirus ( 2MV)

/ =pstein Barr virus ( =BV)

'/ Human Herpes virus '/( HHV ')

/ Human Herpes virus / (HHV )

/ Human Herpes virus (HHV ):

(3aposiCs arcoma Herpesvirus :3HV)/


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i0atsi0at Virus Herpesi0atsi0at Virus Herpes

Virion: sp,eris1 icosa,edral capsid

enom : linear1 DNA untai ganda

%rotein: E # .enis protein pada virion=nvelope: glikoprotein1 reseptor *c

eplikasi: nucleus bertunas dari membran nuclear/


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i0atsi0at Virus Herpesi0atsi0at Virus Herpes

2iri k,as in0eksi ole, virus ,erpes:

! Menyebabkan in0eksi laten

" Menetap secara inde0initi0 pada penderita

#/ Dapat direaktivasi terutama pada immuno

suppressed ,ost


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!/ Virus ,erpes simpleks tipe ! ,anya pada manusia1 tidak memiliki vektor6reservoir ,e4an

>n0eksi laten: 9rigeminal ganglia

7sia terin0eksi: anak balita

9ransmisi6 penularan: kontak langsung1 saliva

e.ala 3linis:

a/ >n0/ %rimer:gingingostomatitis1 p,aryngotonsilitis1

keratocon.uctivitis1 in0 neonatal/

b/ ecurent in0: 0ever1 keratitis/

c/ >n0 primer6 recurrent: Herpes kulit di atas pinggang1 pd tangan1

siku1 ,erpatic 4it,lo41 ec?ema ,erpeticum1 genital ,erpes1

,erpes encep,alitis1 ,erpes meningitis/


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Virus ,erpes simpleks tipe "Virus ,erpes simpleks tipe "

9idak memiliki vektor6 resevoir ,e4an/

7sia terin0eksi: de4asa muda

>n0eksi latent : acral ganglion

9ransmisi: seFual

e.ala klinis:

!/ >n0 primer: >n0 neonatal

"/ >n0 primer6 recurent: ,erpes kulit di ba4a, pinggang1 pd tangan1 siku1

,erpetic 4it,lo41 genital ,erpes1 ,erpes meningitis/


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#/ Varicella$oster Virus (V$V)#/ Varicella$oster Virus (V$V)

A/ Varicella (c,ickenpoF)Gcacar air

angat menular1 terutama pada anak

Masa inkubasi : : !"! ,r1 transmisi: sal na0as1 con.unctiva

3linis: malaise1 demam1 dia4ali ras, pada badan kemudian pada 4a.a,1 kaki

& tangan1 "@ ,r kemudian muncul makula1 papul8a dan erupsi vesicular

pada kulit dan mukosa/ 3omplikasi: encep,alitis1 pneumonia/

B/ $oster ( Herpes $oster )

>n0eksi akut pada syara0 & dorsal root ganglion

>n0lamasi& nyeri ,ebat pd ganglia unilateral pada badan1 kepala & le,er/


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Human ,erpes virus 'Human ,erpes virus '

9 lymp,tropic HHV ': !'/

3linis:: eFant,ema subitum pd in0ant (roseola in0antum)

demam1 skin ras,/

Human Herpes Virus 9lyp,otropic HHV : ! >n0 pada anak/ Dekat dg si0at cytomegalovirus/

Human Herpes Virus Disebut .uga 3HV (3aposiCs arcoma asscociated Herpes

Virus)1 seFually transmitted/

Virus di.umpai pada I penderita arcoma 3aposi (tumor

vascular) pada penderita A>D/


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%+JV>>DA=%+JV>>DA=

-argest & most compleF o0 viruses

9,ree poF viruses o0 medical important:

mallpoF virus1 vaccinia virus1 and molluscum contagiosum/


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%+JV>>DA=%+JV>>DA=

tructure & composition: +val or brick s,aped1 @nm (lengt,) F "#nm ()

eFternal sur0ace s,o4s ridges1 contains core & lateral

bodies 2omposition: DNA (#I)1protein (I)1 lipid(I)

enome: linear double stranded DNA1 MK !F!'

ric, in adenine & t,ymine bases1 lo4guaninepluscytosine

2ontain E! polypeptides L many en?imes in core

=nvelope ()


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tructure & composition:

Very resistant to inactivation

%arapoFvirus: "'F!'nm1 smaller t,an

ort,opoFvirus

genomes: MK J!'1 ,ave a

,ig,er guaninepluscytosine

content ('#I)

7ni


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VA22>N>A & VA>+-AVA22>N>A & VA>+-A

(%oFvirus in0ection in ,umans)(%oFvirus in0ection in ,umans)

! : ;enner introduced vaccination 4it, live

virus

!' : KH+ 4orld4ide campaign to

eradicate smallpoF

! : smallpoF 4as o00icially declared

eliminated


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2omposition o0 vaccinia & variola viruses:2omposition o0 vaccinia & variola viruses:

O Host : variola : only ,umans & monkeys

vaccinia : broad ,ost range1 including

rabbits & miceO ro4 on c,orioallantoic membrane o0 !!" days

old c,ick embryo1 but variola produces muc,

smaller pocksO ro4 in several types o0 c,ick & primate cell

lines


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%at,ogenesis o0 smallpoF:%at,ogenesis o0 smallpoF:

%ortal o0 entry : mucous membranes o0 upper

respiratory tract

A0ter viral entry :

!/ primary multiplication in t,e lymp,oid tissue draining t,e site o0 entry

"/ transient viremia and in0ection o0 reticulo

endot,elial cells t,roug,out t,e body #/ secondary p,ase o0 multiplication in t,ose cells

@/ secondary1 more intense viremia

/ clinical disease


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2->N>2A- *>ND>N :2->N>2A- *>ND>N :

>ncubation period o0 variola (smallpoF) G !" days

!) *ever & malaise : ! days

") =Fant,ems appear

papular (!@ days vesicular (!@ days)

pustular ("' days)

crusts 0ormed ("@ 4eeks a0ter !stsign o0 lesion)

and leaving pink t,at 0aded slo4ly


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-AB/ D>AN+>:-AB/ D>AN+>:

a/ >solation & identi0ication : skin lesions specimen (c,oice 0or viral isolation)

direct eFam (electron microscope) :

rapid identi0ication o0 viral particles (P ! ,r) di00erentiate poFvirus in0ection 0rom

c,ickenpoF

viral isolation is carried out by inoculation o0 vesicular 0luid onto t,e c,orioallantoic

membrane ( 2AM ) o0 c,ick embryos


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-AB/ D>AN+>-AB/ D>AN+>

>n "# days vaccinia pocks are large 4it, necrotic

centers1 4,ereas variola pocks are muc, smaller

2ell cultures also be used 0or viral isolation

(ort,opoF1 parapoFviruses)

Agar gel precipitation L detect viral antigen1

identi0ies ort,opoFviruses as a group

b/ erology : H>1 Nt1 =->A1 >A or

immuno0luorescence tests antibodies appear a0ter !st4eek in0ection

cannot distinguis, among ort,opoFviruses


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Molluscum contagiosum virus (M2V)Molluscum contagiosum virus (M2V)

M2V: transmitted by close personal

contact1 including seFually/

9,e disease is n immunocompetent patients1 t,e

lesions are sel0limited but may last 0ormont,/


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2linical *indings:

2auses small1 pink1 papular1 4artlike

benign tumors o0 t,e skin or mucous

membranes/9,e lesions ,ave a c,aracteristic cup

s,aped crater 4it, a 4,ite core/


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%apovaviridae%apovaviridae


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%apovaviridae%apovaviridae

Virion: >cosa,edral 2omposition: DNA (!I)1 protein ()I

enome: ds DNA1 circular1 MK # million

=nvelope: none

eplication: nucleus

+utstanding c,aracteristic:

timulate cell DNA synt,esis

%olyomaviruses are signi0icant causes o0 ,uman disease

Viral oncoprotein interact 4it, cellular tumor supressor proteins


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>mportant properties o0>mportant properties o0

%apovaviruses%apovaviruses

Oncogenic potential tumor in natural host

esult o! natural in!ection" Benign tumor (#art)

Target tissue" $ur!ace epithelia

Most signi0icant ,uman illness"$%in #arts, plantar #arts !lat #arts

Laryngeal papillomas,

&ervical carcinoma

enital condyloma

mportant animal isolates" apillomaviruses !rom

co#s and rabbits


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Human %apillomavirus ( H%V)Human %apillomavirus ( H%V)/

seFually transmitted genital lesions1

premalignant and malignant disease o0

vulva1 cerviF1 penis and anus/ genital condylomas1 dysplasia to

invasive cervical cancer (H%V type !'1 !1

and !!1 #!1 ##1 #)/ -aryngeal papilloma in c,ildren: H%V '1 !!


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Asosiasi H%V dengan lesi klinis

9ypes H%V 2linical -esions uspectedoncogenic potential

! %lantar 4arts Benign

" 2ommon 4arts Benign

#1 !1 " *lat 4arts1 epidermodysplaciaverruci0ormis

arelymalignant

1=pidermodysplasia verruci0ormisin patients 4it, 2M> de0iciency #I progressto malignancy

Hands 4arts o0 meat &

animal ,andlers

benign


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'1 !! Anogenital condylomas8laryngeal papillomas :dysplasia and intra epit,elial neoplasmas1grades > & >>

-o4

1 !"1 !@

!1 !

! 5 "

#'1 @

=pidermodysplasiaverruci0ormis

ome progress to2a (e/g/ H%V !"1!1"

!#1 #" +ral local eipt,elial,yperplasia

%ossible progressionto 2a


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!'1 !1 #!1 ##1#1 #

Hig, grade dysplasia andcarcinomas o0 genitalmucosa1laryngeal andesop,agealcarcinomas8Bo4en disease

Hig, correlation4it, genital andoral carcinoma

"'1 "1 " 2utaneous 4arts Q

#1 @ -aryngeal 2a Maligna

# 3eratoacant,oma Benign

@!1 @" enital 4arts Benign


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9,ank RouS9,ank RouS

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K 10 Skin Infections