Infectious Diseases of the Skin

145 Pages·2009·15.205 MB·French

by  Elston, Dirk

INFECTIOUS
DISEASES
OF THE
SKIN
Dirk M Elston,
MD
Director, Department of Dermatology
Geisinger Medical Center
Danville, Pennsylvania, USA
MANSON
PUBLISHING
DEDICATION
To my wife, Kathy, and my children, Carly and Nate. You are my source of inspiration.
Dirk M Elston, MD
Copyright © 2009 Manson Publishing Ltd
ISBN: 978-1-84076-107-8
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or
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Commissioning editor: Jill Northcott
Project manager: Paul Bennett
Copy-editor: Ruth Maxwell
Design and layout: Cathy Martin, Presspack Computing Ltd
Colour reproduction: Tenon & Polert Colour Scanning Ltd, Hong Kong
Printed by: Grafos SA, Barcelona, Spain
CONTENTS
PREFACE 6
CONTRIBUTORS 7
CHAPTER 1 BACTERIAL INFECTIONS 8
Introduction 8
Impetigo 8
Folliculitis 10
Furuncle/carbuncle 11
Abscess 12
Staphylococcal scalded skin syndrome 12
Scarlet fever 14
Erysipelas 14
Cellulitis 16
Necrotizing fasciitis 17
Peri-anal streptococcal disease 18
Cutaneous anthrax 19
Pitted keratolysis 19
Trichomycosis axillaris 20
Erythrasma 20
Ecthyma 20
Ecthyma gangrenosum 22
Meningococcemia 23
Cat-scratch disease 24
Chancroid 24
Granuloma inguinale (Donovanosis) 24
Gonorrhea 26
Typhus 27
Rocky Mountain spotted fever 28
Fish tank granuloma 29
Lyme disease 30
Syphilis (Lues) 30
4
CHAPTER 2 FUNGAL INFECTIONS 34
Introduction 34
SUPERFICIAL FUNGAL INFECTIONS 34
Dermatophytosis 34
Onychomycosis 44
Candidiasis 46
Pityriasis versicolor 48
Tinea nigra 48
DEEP FUNGAL INFECTIONS 50
Chromoblastomycosis 50
Sporotrichosis 50
Histoplasmosis 50
North American blastomycosis 52
Paracoccidioidomycosis (South American blastomycosis) 52
Coccidioidomycosis 52
Cryptococcosis 54
Lobomycosis 55
Hyalohyphomycosis (aspergillosis and fusariosis) 55
Mucormycosis 56
RELATED INFECTIONS 58
Rhinosporidiosis 58
Protothecosis 59
CHAPTER 3 VIRAL DISEASES 60
Introduction 60
Herpes simplex infection 60
Varicella zoster virus infection 65
Epstein–Barr virus infection 68
Gianotti–Crosti syndrome (papular acrodermatitis of childhood) 69
Unilateral laterothoracic exanthem 69
Cytomegalovirus infection 70
Exanthem subitum infection 71
Kaposi’s sarcoma infection 71
Erythema infectiosum (fifth disease) infection 73
Human papillomavirus infection 74
Measles infection 78
Rubella infection 80
Poxvirus infection 80
5
CHAPTER 4 TROPICAL AND EXOTIC INFECTIOUS DISEASES 84
Introduction 84
Rhinoscleroma 84
Bacillary angiomatosis 85
Cutaneous tuberculosis 86
Leprosy 88
MYCETOMA 90
Chromoblastomycosis 91
Lobomycosis 92
Paracoccidioidomycosis 93
Acanthamebiasis 94
Amebiasis 94
Leishmaniasis 96
Onchocerciasis 98
Schistosomiasis 99
Strongyloidiasis 100
Cutaneous larva migrans 101
CHAPTER 5 ARTHROPODS AND INFESTATIONS 102
Introduction 102
INSECTS 102
Pediculosis 102
Insect bites 104
Hymenopterids 106
Hemipterids 108
Lepidopterids 109
Coleopterids 110
Siphonapterids 110
ARACHNIDS 112
Mites 112
Ticks 116
Spiders 118
Scorpions 121
CENTIPEDES AND MILLIPEDES 123
REFERENCES 124
ILLUSTRATED GLOSSARY 136
INDEX 141
PREFACE
Despite the rise of modern medicine, infections remain clinical reference in the daily practice of medicine.
the leading cause of death worldwide. As we develop The skin is readily visible, and therefore visual
new antibiotics, organisms develop mechanisms of inspection remains the most important means of
resistance. The battle rages on. In this battle, the most accurate dermatologic diagnosis. Skin infections are no
critical determinant of successful treatment remains an exception. Morphology, symptoms, exposure, and time
accurate diagnosis. This atlas will serve as a pictorial course generally establish the diagnosis. Laboratory
guide to the diagnosis of common bacterial, fungal, and tests can provide confirmation, but therapy must
viral skin infections, as well as recognition of usually be initiated based on the initial clinical
arthropods of medical importance. Drug names are assessment. This text will provide many images to assist
used as they are licensed in the United States. you in recognizing skin infections. We hope we have
The text is divided into chapters by class of provided you with a reference that will become one of
organism, and in each chapter by clinical entity. We have your favorites and will be useful in your daily practice.
found this approach to be the most useful for those
using the text. It can serve as both a tutorial and a handy Dirk M Elston
6
CONTRIBUTORS
CHAPTER 1 Stephen K Tyring, MD, PhD, MBA
Tammie Ferringer, MD Department of Dermatology
Department of Dermatology and Pathology Center for Clinical Studies
Geisinger Medical Center Houston School of Medicine, University of Texas
Danville, Pennsylvania, USA Houston, Texas, USA
CHAPTER 2 CHAPTER 4
Whitney A High, MD Omar P Sangüeza, MD
Assistant Professor, Departments of Dermatology Professor, Departments of Pathology and
& Dermatopathology Dermatology
University of Colorado School of Medicine Wake Forest University School of Medicine
Denver, Colorado, USA Winston-Salem, North Carolina, USA
CHAPTER 3 Daniel J Sheehan, MD
Anita Arora, MD Department of Pathology
Center for Clinical Studies Wake Forest University School of Medicine
Houston School of Medicine, University of Texas Winston-Salem, North Carolina, USA
Houston, Texas, USA
Gary Goldenberg, MD
Natalia Mendoza, MSc Department of Dermatology
Center for Clinical Studies Wake Forest University School of Medicine
Houston School of Medicine, University of Texas Winston-Salem, North Carolina, USA
Houston, Texas, USA
and Universidad El Bosque CHAPTER 5
Bogotá, Colombia Dirk M Elston, MD
Director, Department of Dermatology
Adriana Motta Geisinger Medical Center
Department of Dermatology Danville, Pennsylvania, USA
Universidad El Bosque
Bogotá, Colombia
Vandana Madkan, MD
Center for Clinical Studies
Houston School of Medicine, University of Texas
Houston, Texas, USA
7
CHAPTER 1
BACTERIAL
INFECTIONS
Tammie Ferringer
INTRODUCTION
organisms are also implicated. As with other skin
Bacterial infections remain the most common infections, clinical diagnosis is the most important
infectious cause of visits to a physician. Most step in the appropriate choice of therapy.
cutaneous infections are caused by staphylococci
IMPETIGO
and streptococci, but a wide range of other
Impetigo may be staphylococcal or streptococcal in
origin. In either case, it is a contagious, superficial
1
skin infection that occurs most frequently in early
childhood but all ages may be affected. Transmission
is by direct contact or fomites.
The non-bullous form of impetigo presents as
transient vesicles or pustules that rupture with
resultant erosions surmounted by a golden-yellow
crust (1–6). The crust can usually be removed easily,
leaving an eroded surface. The infection spreads to
contiguous and distal areas through inoculation
from scratching. Lesions tend to resolve within days
to weeks without scarring. The face (around the
mouth and the nose) and sites with an impaired
cutaneous barrier (e.g. insect bites, abrasions, burns,
1Honey-colored crust of impetigo in a common anatomic eczema) are most frequently involved (7–9).
location.
2 3
2Crusted impetigo in a patient with nasal staphylococcal 3Honey-colored crusts in impetigo represent coagulated
carriage. serum.
8
Bacterial Infections 9
4 5
4Secondary impetiginization in an area of impaired 5Close-up demonstrates soft adherent fibrinous material
cutaneous barrier. that is secondarily impetiginized.
6Impetiginized 6 7
dermatitis on the
face. Both anti -
staphylococcal
therapy and a
topical
corticosteroid
will be needed.
7Impetiginized eczema overlying a joint presents a risk of
septic arthritis.
8 9
8Impetiginized eczema evolves from vesicles to pustules. 9Impetiginized eczema. The image demonstrates
multilocular vesicles of dyshidrotic eczema with
superimposed impetiginized pustules.