Garcia-Lara - UM1010 - Microbiology - Lecture - SSTIs 240125 - Core Slides Section - Lecture PDF

Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 MIcrobiota by : LECTURE 3 CORE Dr. GARCIA-LARA SLIDES Bitesize 1...

Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 MIcrobiota by : LECTURE 3 CORE Dr. GARCIA-LARA SLIDES Bitesize 1 1 1  Dr Jorge Garcia-Lara The skin: the first layer of defence nutrients competition Chen and Tsao. 2013. The skin microbiome: Current perspectives 2 and future challenges. J Am Acad Dermatol. 143-155.  Dr Jorge Garcia-Lara The skin (if healthy & intact) protects underlying tissues from infection is colonised with normal flora that plays an important role in preventing potential pathogens from colonising the skin bacteria present on the skin controlled by: moisture acid pH of the skin surface temperature – not optimum for all pathogens excreted sebum, fatty acids and urea microbiota competition besides bacteria the microbiota has fungi, mites and viruses (not everyone considers viruses part of the natural flora) Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 3  Dr Jorge Garcia-Lara The bacteriobiota ” Proteobacteria: Acinetobacter johnsonii, Klebsiella oxytoca, Enterobacter aerogenes, Moraxella, Pseudomonas aeruginosa, Serratia, Stenotrophomonas maltophilia, Haemophilus parainfluenzae, Escherichia coli, Neisseria spp. Firmicutes (G+; low G+C): Bacillus, Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lungdunensis, Streptococcus oralis, Veillonella spp. Actinobacteria (G+; high G+C): Corynebacterium (diphteroids) , Micrococcus luteus, Propionibacterium acnes 4  Dr Jorge Garcia-Lara Moisture and fat, keys to the distribution Chen and Tsao. 2013. The skin microbiome: Current perspectives and future challenges. J Am Acad Dermatol. 143-155. 5 5  Dr Jorge Garcia-Lara Activity Lecture : Skin and soft tissues infectious disease Can you please derive 3 key statements from the preceding slide? 3 minutes Submission : in class activty Contributors : Individual / Study group Output : verbal in class 6  Dr Jorge Garcia-Lara The mycobiome Malasezzi Candida a Staphylococci Corynebacteri a Micrococcus Aspergillu 7  Dr Jorge Garcia-Lara And you thought you could see everything on the skin ! nearly half of the bacteria in your skin microbiota cannot be cultured 8 OTU, Operational Taxonomic Unit – “16S RNA determined species”  Dr Jorge Garcia-Lara The ”healthy microflora” Staphylococcus aureus meningitis sinusitis stye boils furuncules sepsis pneumonia endocarditis nephritis emesis scalded skin CAI syndrome diarrhea cystitis UTI TSS impetigo osteomyelitis 9  Dr Jorge Garcia-Lara Carriage is a disease risk factor moist skin areas & higher pH (axilla, perineum, scalp, between toes) 1 in 3 in the population carry Staphylococcus aureus Like aureus, Corynebacterium spp. and Candida spp. are also after moist habitats To better competeS. epidermidis , who occupies drier areas of the skin 10  Dr Jorge Garcia-Lara The skin "normal flora" Exposed dry areas have relatively few resident organisms (e.g., Staphylococcus epidermidis) The hair follicles, sebaceous glands and sweat support anaerobic organisms e.g., Propionibacterium acnes and other diphteroids numbers increase during puberty with acne Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 11  Dr Jorge Garcia-Lara Dysbiosis of the skin acne, psoriasis, atopic dermatitis, and rosacea linked to skin dysbiosis dysbiosis in atopic dermatitis implicates Staphylococcus species, but also microbes such as Propionibacterium and Malassezia RegIIIg (C-type lectin) (See Figure in next slide): o not produced on the skin o highly expressed in skin wounds and the lesional skin of psoriasis patients o it is antimicrobial and it regulates the proliferation and differentiation of keratinocytes to promote wound healing after skin injury o its production is induced by gram-negative bacteria through peptidoglycan and flagellin through TLR-4 interactions o antibiotic treatment leads to a decrease in RegIIIg production 12  Dr Jorge Garcia-Lara The onset: hospitalized patients & antibiotic exposure Enterococci Anti-gram- positive bacteria (piperacillin, tazobactam) lectin 13  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 histological vaginal smears by : LECTURE 3 CORE Dr. GARCIA-LARA SLIDES Bitesize 2 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 14  Dr Jorge Garcia-Lara breach intact skin – Anatomy of the skin broken skin and paths to get through it remotely-produced toxin mediates skin damage system infections to the blood and then to the skin 15  Dr Jorge Garcia-Lara Sites of infection & infections folliculitis boils carbuncles abscess impetigo spreading inf. erysipelas (lymph nodes) cellulitis (fat tissue) necrotising inf. fasciitis (inflamm. resp. to infect.) gangrene (tissue death) (follow infection) myonecrosis (muscle ischemia) 16  Dr Jorge Garcia-Lara Skin infections: treatment overview Stevens et al. 2014. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America Clin Infect Dis. 15;59(2):e10-52. 17  Dr Jorge Garcia-Lara Skin wound infections: Treatment overview Stevens et al. 2014. Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections: 2014 Update by the Infectious Diseases Society of America 18 Clin Infect Dis. 15;59(2):e10-52.  Dr Jorge Garcia-Lara Skin infections: typical diagnosis history & physical examination culture ( laboratory ) Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 19  Dr Jorge Garcia-Lara Activity Lecture : Skin and soft tissues infectious disease Find out the meaning of the following statement: “ bacterial pathogens are typically chemoorganoheterotroph mesophilic neutrophiles that can be strict aerobes, anaerobes or facultative anaerobes with the possibility of being aerotolerant or aerosensitive ” Submission : Guided independent study Contributors : Individual / Study group Output : verbal in class 20  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 Taking advantage of Available spaces by : LECTURE 3 CORE Dr. GARCIA-LARA SLIDES Bitesize 3 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 21  Dr Jorge Garcia-Lara Bacterial skin infections - Folliculitis Infection and inflammation of hair follicles chronic folliculitis (sycosis barbae): deep folliculitis - occurs on bearded areas Staphylococcus aureus – the most common Other: Candida spp., Pseudomonas spp., and Enterobacteriaceae superficial Folliculitis on leg 2-4 days incubation of the boils emollient creams topical antibacterials oral antibiotics lesions (boils) – small 2-5mm red (erythematous) itchy (pruritic) often with central pustule (purulent) 22 22  Dr Jorge Garcia-Lara Bacterial skin infections - Acne hormonal changes in puberty increase sebum production and keratinisation - acne potential plugged pore enhances bacterial growth typically in teenagers because of hormonal changes, but also in adults (hormonal fluctuations Plugs of keratin of menstruation and pregnancy) blocking sebaceous it affects more than 1/5th of the USA population ducts leading to ‘Blackheads’ lesion in sebaceous follicles – keratin plugs Propionibacterium acnes , gram+ non-spore forming, anaerobic & produces acids (e.g., propionic) acid staphylococci & micrococci face (common); also other parts of the body although rare it may lead to systemic complications (post-operative infections, prostheses failures,...) potential adjuvant-type arthritis development Propionibacterium acnes Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 23  Dr Jorge Garcia-Lara Bullous impetigo Non-bullous impetigo commonly due to S. aureus exfoliating toxins (A and B) Bullous impetigo common in newborns Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 24  Dr Jorge Garcia-Lara Bacterial skin infections - Impetigo bacterial access through broken/damaged skin (2nd ARY) highly contagious with a few days incubation (especially non-bullous) superficial infection of the skin epidermis Non-bullous childhood impetigo Staphylococcus aureus & GAS (Groups A Streptococci i.e., Streptococcus pyogenes; GABHS, Group A b haemolytic streptococci) nose / throat microflora contact with infected individuals Bullous impetigo Non-bullous impetigo (areas with skin breaks) red sores – quickly burst – to yellow crusts face, mouth and nose (coalescent) Bullous impetigo (less contagious) fluid filled blisters – burst – no crust – “scalded skin” between waist and neck, arms and legs sometimes systemic symptoms (e.g., adenopathy) 25 25  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 Going deeper Erysipela & Cellulitis by : LECTURE 3 CORE Dr. GARCIA-LARA SLIDES Bitesize 4 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 26  Dr Jorge Garcia-Lara Bacterial skin infections - Erysipela erythros = red; pella = skin similar to cellulitis (deeper dermis & subcut. fat) acute infection of the dermis layer (upper dermal & superficial lymphatics) GAS (Groups A Streptococci i.e., Streptococcus pyogenes) & Staphylococcus aureus occasionally spread from throat/nasal carriage access through cuts/sores on skin legs & face on affected area: skin diffused redness & blisters swollen, warmth & pain malaise & pain (less than cellulitis generally) enlargement of regional lymph nodes well-delimited erythema and oedema Face erysipelas fever and malaise showing butterfly-wing rash may develop into bacteraemia (if untreated) 27  Dr Jorge Garcia-Lara MTZ– Metronidazole What is it? 28  Dr Jorge Garcia-Lara Bacterial skin infections - Cellulitis skin cellulitis : non-necrotizing inflammation of the skin and subcutaneous tissues, usually from acute infection Staphylococcus aureus (CA-MRSA) Streptococcus pyogenes gram-negative o aerobes (faecal flora, e.g., Escherichia coli) Streptococcus o anaerobes (e.g., Bacteroides fragilis group, pyogenes Prevotella sp., Porphyromonas sp., Clostridium sp. spread from: trauma (maybe microscopic) skin ulcers/boils 29 Bachelor of Medicine and Bachelor of Surgery MBBS  Dr Jorge Garcia-Lara Bacterial skin infections - Cellulitis legs (typically, but other areas are possible) on affected area: o hot, red, swollen lesion o tenderness and/or pain o enlargement of regional lymph nodes o breaks on the skin (w/ pus/blisters) – not always noticeable erythema and oedema poorly delimited ! fever/chills and malaise Bacteroides fragilis Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 30  Dr Jorge Garcia-Lara Activity Lecture : Skin and soft tissues infectious disease What is this ? 1 31  Dr Jorge Garcia-Lara Activity Lecture : Skin and soft tissues infectious disease This is a leg 1 This is an inflammed leg 2 Still an inflammed 3 leg 32  Dr Jorge Garcia-Lara Activity Lecture : Skin and soft tissues infectious disease What can you see ? 33  Dr Jorge Garcia-Lara Activity Lecture : Skin and soft tissues infectious disease Can you see any differences ? This is a leg 1 Erysipela 2 Cellulitis 3 34  Dr Jorge Garcia-Lara Activity Lecture : Skin and soft tissues infectious disease So what is it erysipela or cellulitis ? 35  Dr Jorge Garcia-Lara The path to success; one way and return Local Systemic osteomyelitis Bacteraemia infection infection pneumonia meningitis Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 36  Dr Jorge Garcia-Lara Bacterial skin infections - Cellulitis can spread to the other parts of the body through bacteraemia in severe cases: o high temperature 38oC or above o fast heart beat o vigorous shaking (rigors) o nausea/vomiting o dizziness/confusion o cold, clammy, pale skin o lymphangitic spread can lead to osteomyelitis risk to progress to myonecrotic presentations (e.g., necrotizing fasciitis) 37 37  Dr Jorge Garcia-Lara Bacterial skin infections – “Cellulitis” emergent surgical evaluation o indication of necrotizing fasciitis/gangrene ❑ violaceous bullae ❑ gas in tissue ❑ hypotension ❑ cutaneous haemorrhage ❑ skin anaesthesia Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 38  Dr Jorge Garcia-Lara Cellulitis - ERON Classification (Cellulitis) Class I Class II Class III Class IV Systemic no may or not yes Co-morbid. no controlled unstable (e.g., peripheral vascular disease, obesity or venous insufficiency) System no toxicity (e.g., confusion, tachycardia, tachypnoea, hypotension) Sepsis or NF Antibiotics oral i.v. Admission community hospital 39  Dr Jorge Garcia-Lara cellulitis of the leg with excoriation and blistering 40  Dr Jorge Garcia-Lara debridement in progress 41  Dr Jorge Garcia-Lara debridement completed 42  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 Abscesses by : LECTURE 3 CORE Dr. GARCIA-LARA SLIDES Bitesize 5 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 43  Dr Jorge Garcia-Lara Bacterial skin infections Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 44  Dr Jorge Garcia-Lara Bacterial skin infections - Abscesses folliculitis can lead to abscesses (furuncles, carbuncles) microorganisms in hair follicle - "protected" from immune system = rapid local spread leads to inflammatory response (neutrophil infiltration, fibrin deposition,...) Furuncles – apparent small abscess exuding purulent materials from a single opening Carbuncles – multiple furuncles extending to subcutaneous fat (multiple openings) Staphylococcus aureus – the most common; MRSA swelling under skin – typically with pus (necrotic white blood cells –PMNs- and microorganisms) tenderness & pain on the area warmth & redness on the area Abscess may lead to high fever and chills (side of neck) drainage & washing out antibiotics meningitis & peritonitis (e.g.) if natural inward drainage 45  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 Scarlet Strawberry tongue by : LECTURE 3 CORE Dr. GARCIA-LARA SLIDES Bitesize 6 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 46  Strawberry tongue Dr Jorge Garcia-Lara Scarlet fever (scarlatina) Group A Streptococci GAS Streptococcus pyogenes 47 Bachelor of Medicine and Bachelor of Surgery MBBS  Dr Jorge Garcia-Lara Bacterial skin infections: toxin-mediated damage Scarlet fever (7 days) high fever pharyngitis / sore throat like strep-throat 2 days later bright red exanthem ‘sandpaper’ (body-wide) skin pigmentation potential complications - strawberry tongue unusual… unless GAS have spread in children it may elsewhere headache rheumatic fever nausea, vomiting, chills abdominal pain, and loss of appetite in secretions (nose discharge, ears, throat, & skin) may follow wounds, burns or respiratory tract infections leading cause of death in children before antibiotics 48 Dr Jorge Garcia-Lara 49  Dr Jorge Garcia-Lara Scarlet fever– toxin-mediated damage Scarlet fever Scalded Skin Syndrome Toxic Shock Syndrome Staphylococcus aureus Staphylococcus aureus Exfoliating toxin TSST Superantigen Superantigen epidermis top layer skin manifestation separation systemic Streptococcal Toxic Shock Syndrome Streptococcus pyogenes Streptococcus pyogenes SpeA SpeA (pyrogenic exotoxin) (pyrogenic exotoxin influence immune toxic shock-like system & skin blood syndrome vessels 50  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 Candida auris MYCOSES by : LECTURE 3 CORE Dr. GARCIA-LARA SLIDES Bitesize 7 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 51  Dr Jorge Garcia-Lara common skin manifestations common in immunocompromised Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 52  Dr Jorge Garcia-Lara Pathogenic fungi (cutaneous, subcutaneous, systemic) surface of skin or hair, and nails deeper skin layers mild (usually) involve internal organs life threatening other species leading species leading to non-skin infections to skin infections to remember to remember 53  Dr Jorge Garcia-Lara Let's talk about candida now (candidiasis) Candida Malasezzia "it is dry here" "it is wet/moist here (and likely more easy to get nutrients)" 54  Dr Jorge Garcia-Lara Trichophyton rubrum (ringworm) Malassezzia furfur Pityriasis versicolor tinea capitis 55  Dr Jorge Garcia-Lara Pityriasis/Tinea versicolor Malasezia furfur (basidiomycota, septate hyphae, conidia) typical skin microbiota scaly and discoloured skin patches sometimes itchy (pruritic) Pityriasis versicolor chest, abdomen, back & neck on the back M. furfur M. furfur Electron lactophenol micrograph cotton blue stain Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 56  Dr Jorge Garcia-Lara Dermatophytosis (tinea infections / ringworm) typical soil (geophilic) & animal (zoophilic) transmission; but also human (anthropophilic) spread through skin scales with arthrospores watch your step (carpets & showers) Trycophyton spp. (e.g., Trycophyton rubrum ), Microsporum spp. (ascomycota, arthrodermataceae ) Tinea pedis rash (red, silver or darker than surrounding skin, (athlete's foot) depending on your skin tone) e.g., may be scaly, dry, swollen or itchy Trycophyton rubrum, tinea capitis (skin and hair of the scalp) T. interdigitale tinea corporis (the body) tinea cruris (the crotch; ‘jock itch’ ) tinea manuum (the hands) tinea unguium (the nails) tinea pedis (the feet) – flaky, scaly, dry and itchy skin 57  Dr Jorge Garcia-Lara Dermatophytosis (tinea infections / ringworm) dermatophytes – keratin lovers arthroconidia for spore transmission 58  Dr Jorge Garcia-Lara Dermatophytosis (tinea infections/ ringworm) 59  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2021-2022 Cutaneous Candidiasis by : LECTURE 2 CORE Dr. GARCIA-LARA SLIDES Bitesize 8 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 60  Dr Jorge Garcia-Lara Let's talk about candida now (candidiasis) Candida Malasezzia "it is dry here" "it is wet/moist here (and likely more easy to get nutrients)" 61  Dr Jorge Garcia-Lara Candida albicans and Candida spp. 62 62  Dr Jorge Garcia-Lara Oral candidiasis 63  Dr Jorge Garcia-Lara Cutaneous candidiasis common in people with diabetes and in those who are obese (oral in adults) consider sign of an HIV infection, cancer or weakened immune system disorders warm, moist, creased areas such as the armpits and groin microbiota in low numbers in areas of high moisture (e.g., skin folds & mucosa) pruritic red rash (spreads) (candidiasis, thrush) diaper rash Candida infection under the arm it can disseminate into all major organs Gram stain image of C. albicans 64  Dr Jorge Garcia-Lara dimorphic fungi hyphae are the preferred invasive form Candida Scanning albicansmicrograph electron Candida Dimorphism invading theofepithelium C. albicans germ tube penetrating living tissue (arrowed) (Electron micrograph) Candida albicans (Light microscopy) 65  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 Cercarial Dermatitis by : LECTURE 2 CORE Dr. GARCIA-LARA SLIDES Bitesize 8 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 66  Dr Jorge Garcia-Lara Activity Lecture : Skin and soft tissues infectious disease See if you can identify what this are at the end of the session. 67  Dr Jorge Garcia-Lara Parasitic infections of the skin some parasites leave the skin, others remain trapped not common in the UK skin – major route of entry for parasites: direct penetration (schistosomes) injected into the bloodstream (blood-feeding vectors, e.g., Leishmania) diseases range from mild...... to life-threatening (typically in immunosuppressed patients) Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 68  Dr Jorge Garcia-Lara Cercarial dermatitis ("swimmer's itch") needs 2 hosts to complete its life cycle parasitic flatworms (trematodes) or flukes the larvae form = cercaria - useful in diagnosis/classif. preferrred host : aquatic birds and other mammals humans are an accidental host frequent in North American lakes Austrobilharzia variglandis (avian schistosome) ‘swimmer’s itch’ freshwater settings normally not medical attention needed; anti- inflammatories, e.g., topical corticosteroids 69  Dr Jorge Garcia-Lara Cercarial dermatitis ("swimmer's itch") skin rash (allergic reaction to the parasites) tingling, burning or itching of the skin small red pimples that may develop into blisters... to life-threatening (typically in immunosuppressed patients) normally not medical attention needed; anti- inflammatories, e.g., topical corticosteroids 70 70  Dr Jorge Garcia-Lara Cercarial dermatitis ("swimmer's itch") intermediate host S. mansoni egg 71  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 Viral Herpes Simplex (HSV) by : LECTURE 2 CORE Dr. GARCIA-LARA SLIDES Bitesize 9 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 72  Dr Jorge Garcia-Lara Herpeviridae : Herpes Simplex (HSV) clinical diagnosis 1 in 5 adolescents (USA) (HSV2) neurotrophic mainly subclinical pharyngeal/anogenital infection primary oral infection (e.g., sore throat) gingivostomatitis herpes labialis (e.g., cold sores, fever blisters) vesicles to pustules to ulceration cervical lymph node enlargement supportive care fluids becomes latent in sensory trigeminal ganglia antipyretics reactivation b/c immunosuppression analgesics systemic infection oral hygiene sunlight trauma stress small molecule therapy menstruation aciclovir oncogenic potential (problem = resistance) zinc (local) 73 73  Dr Jorge Garcia-Lara Herpeviridae : Herpes Simplex (HSV) saliva fatal in infants (C-section) HSV1 HSV2 sexual Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 74  Dr Jorge Garcia-Lara Herpes viruses : taxonomy and structure rotavirus papilloma hepatitis B adenoviruses smallpox herpes simplex influenza rabies varicella-zoster cytomegalovirus Epstein-Barr Japanese encephalitis human herpes Ebola RSV yellow fever mumps hepatitis C measles dengue MERS West Nile HIV SARS polio hepatitis A rubella rhinovirus coxsakie Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) enterovirus 75  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 Viral Coxsackie A virus by : LECTURE 2 CORE Dr. GARCIA-LARA SLIDES Bitesize 10 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 76  Dr Jorge Garcia-Lara Picornaviridae : Coxsackie A Virus faecal-oral route clinical diagnosis mainly in the summer mucosal multiplication Coxsackie A virus generic features (GF) self-limited (lasts 1 week) malaise mouth ulcers to painful stomatitis fever (mild) loss of apetite hand foot mouth disease (hand & foot papules) rarely complications painkillers; mouth wash Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 77  Dr Jorge Garcia-Lara Picornaviridae : Coxsackie A Virus Coxsackie A virus Human hand, foot and mouth disease Coxsackie is an Enterovirus; relatives: HAV & polio different from animal FMD (Aphtovirus) FMD sensitive to stomach acid FMD rare in humans 78  Dr Jorge Garcia-Lara MICROBIOLOGY Unit: ISCM Module: UM1010 Yr. 2023-2024 Viral Measles & Mumps by : LECTURE 2 CORE Dr. GARCIA-LARA SLIDES Bitesize 11 Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 79  Dr Jorge Garcia-Lara Paramyxoviridae: Measles viruses droplets (nose, mouth, throat); highly contagious worldwide typically children' asymptomatic buccal mucosa white spots (Koplik's spots) high fever conjunctivitis; blood shot eyes maculopapular rash (starts face/neck; maybe confluent) respiratory symptoms Measles rash complications: bronchitis, pneumonia, otitis Koplik’s spots Genus: Morbillivrus vaccine MMR live attenuated Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 80  Dr Jorge Garcia-Lara Paramyxoviridae: Mumps and Measles viruses Mumps virus Measles virus (Paramyxovirus - genus) (Morbillivirus - genus) droplets typically children swelling of salivary glands (parotids) asymptomatic oedema and erythema buccal mucosa white spots high fever conjunctivitis maculopapular rash respiratory symptoms rarely complications complications: bronchitis, pneumonia, otitis vaccine vaccine MMR live attenuated MMR live attenuated 81 81  Dr Jorge Garcia-Lara Paramyxoviridae: Mumps and Measles viruses Mumps virus Measles virus (Paramyxovirus - genus) (Morbillivirus - genus) neuraminidase and hemaglutinin Hemaglutinin no neuraminidase 15kb genome 15kb genome protein identity within the Paramyxoviridae 40-50% Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 82  Dr Jorge Garcia-Lara Learning outcomes M1.I.MSK.MIC4: List and explain the main skin, muscle, joint and bone infections M1.I.MSK.MIC3: Define common infectious diseases of the skin explaining their basic pathophysiology, prevalence, aetiology, signs and symptoms, diagnoses & treatments Medicinae Baccalaureus Baccalaureaus Chirurgiae (MBBS) Physician Associate Studies (MPAS) 83  Dr Jorge Garcia-Lara School of Medicine Questions? [email protected] @GarciaLaraClan #UCLanMicrobiology 84 84