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MODULE
FERA IBRAHIM
DEPARTMENT OF MICROBIOLOGY,
FMUI
THE STRUCTURE OF THE SKIN
• Healthy intact skin protects underlying tissues and provides excellent defense
against invading microbes
• Factors controlling the skin’s microbial load
• Kulit pada umumnya kering, lingkungan asam yang tidak mendukung pertumbuhan
kebanyakan mikroorganisme.
• Namun, daerah lembab, terutama di sekitar kelenjar keringat, dijajah oleh bakteri gram
positif dan anggota lain dari flora normal kulit. Faktor lingkungan dan inang mempengaruhi
kuantitas dan kualitas mikroflora kulit normal.
Normal Microbial Flora of Skin
•
•
Flora normal kulit terdiri dari populasi mikroorganisme sementara atau residen.
Kulit terus diinokulasi dengan mikroorganisme sementara, hampir semuanya tidak dapat
•
berkembang biak dan biasanya mati.
Mikroorganisme residen dapat multipel, bukan hanya bertahan hidup, di kulit.
Normal Flora of Skin
• The transient flora: contact with the superficial aspects of the skin from the environment,
another person or from the person’s own alimentary tract
Dua jenis flora kulit:
• Flora penduduk: selalu hadir di seluruh permukaan kulit (S. epidermidis, mikrokoksi,
diphtheroid, sejumlah kecil cocci anaerobik, propionibacterium)
• Flora sementara: kontak dengan aspek permukaan kulit dari lingkungan, orang lain atau
dari saluran pencernaan orang itu sendiri
Microbial disease of the skin may result
from any of three lines of attack
MACULAR/MACULOPAPULAR
MEASLES, RUBELLA, ENTEROVIRUSES, PARVOVIRUS B-19,
MONONUCLEOSIS, CYTOMEGALOVIRUS, HEPATITIS B, ROSEOLA, HIV
VESICLES
HERPES SIMPLEX, VARICELLA-ZOSTER, ECZEMA HERPETICUM,
HAND-FOOT AND MOUTH DISEASE
Famili : HERPESVIRIDAE
SubFamili : ALPHAHERPESVIRINAE
Genus : SIMPLEX VIRUS
PROPERTIES OF VIRUS
Outstanding characteristics:
Establish latent infections
Persist indefinitely in infected hosts
Frequently reactivated in immunosuppressed hosts
some are cancer-causing
PATHOGENESIS
SITES OF EVENTS IN HERPESVIRUS INFECTIONS
HERPES SIMPLEX TYPE 1
Herpetic whitlow,
nurses and doctors
HISTOLOGI VESIKEL
A= VESIKEL INTRAEPIDERMAL
B= SEL RAKSASA BERINTI BANYAK
C= DERMIS
TREATMENT, PREVENTION & CONTROL
• penyakit ini bisa parah pada orang dewasa dan anak-anak yang mengalami gangguan sistem imun
• Zoster (shingles) adalah penyakit sporadis dan tidak mampu pada orang dewasa atau
• individu immunocompromised, ditandai dengan ruam yang terbatas
• distribusi ke kulit dipersarafi oleh ganglion sensorik tunggal
VARICELLA
The virus → inoculation of the mucosa of the upper respiratory
tract or conjuctiva → viral replication in regional nodes →
virus infected cells into capillaries → blood →
localizes in the skin
Close up of
Pustules
(zoster)
Close up of rash
on light skin, vary greatly Close up of rash on dark skin,
in size and shape a petechial element
Close up of vesicle
(zoster),
Scarring
the vesicles develop
in clusters on an
erythematous base
CLINICAL FINDINGS
VARICELLA
Subclinical varicella <<<
Incubation period : 10-21 days
The earliest symptoms : malaise, fever → The rash, 1st on the trunk
on face, the limbs, the buccal and pharyngeal mucosa in the mouth
→2-4 days, fresh vesicles appear in the crops, all stages of
macules,
→Papules, vesicles and crusts may be seen at one time
Chickenpox pneumonia
(miliary calcification)
Haemorrhagic
chickenpox
THORACIC
Early
In human (B=multi
amnion cells Nucleated
Giant cell)
Histology of Mature
Peripheral nerve (A=intra
Epidermal
Vesicle, B=
Dermis)
Histology of the dorsal root ganglion
(A=undegenerate neurones,B= degenerate neurones
C=mononuclear cells)
EPIDEMIOLOGY
Molluscum contagiosum
Genus : Molluscipoxvirus
Sporadic, epidemic
FAMILY : PAPILLOMAVIRIDAE
Important properties of papillomavirus
Replication of virus
Schematic representation of a skin wart (papilloma)
TRANSMISSION :
DIRECT CONTACT ,
SEXUAL CONTACT
Immune Response
* Important, cell-mediated immunity
Clinical Manisfestation
Asymptomatic shedding
- Skin wart
- Epidermodysplasia Verruciformis
- Genital Infection
- Anogenital wart
- Cancer cervix
- Papilloma laringeal
- Papilloma nasal
- Focal epithelial hyperplasia
- Papilloma skuamosa
- Papilloma conjungtiva
- Other malignancies
CLASSIFICATION OF HPV TYPES BY
CERVICAL ONCOGENICITY
(data from Munoz et al 2003)
PLANTAR WARTS
FLAT WARTS
CONDYLOMA ACUMINATA
GENITAL WARTS
Epidemiology
Viruses are found worldwide, Virus persist in host and
asymptomatic shedding
Electron Microscopy
Fera Ibrahim, Department of Microbiology, Medical Faculty, University of Indonesia, Dec 2007
Serological assays are not recommended for diagnosis
in individual women due to low sensitivity, but they are
useful in comparisons of groups in epidemiological and
ecological studies (Dillner 1999).
Treatment And Prevention :
Warts spontaneously regress → take many months to years
No spesific treatment
- Antiproliferative agents : Podophyllin/podophyllotoxin, 5-Fluorouracil,
Cidofovir
- Destructive/excision therapies : Trichloracetic acid, currette or Surgery,
electrosurgical, laser therapy, photodynamic therapy (5-aminolevulinic
acid/haematoporphyrins –red light laser)
- Cryotherapy
- Immunomodulators (IFN alpha, imiquimod/imidazoquinolines)/Vaccines
Vaccines :
-Prophilaxis Vaccines are available → L1 & L2
-Vaccines are in clinical trial → Therapeutic Vaccines : E6 & E7
Measles rash on first day Rash on 3rd day, confluent over most body,
some discrete spot remain especially on the limbs
EXANTHEMATOUS DISEASE (ECHOVIRUS INFECTION)
Maculopapular rashes have been found in
infection with echovirus 4, 11, 16, and 19
Herpangina, is predominantly
a disease of children and is caused
by type A coxsackievirus,
fever, sore throat, dysphagia, headache,
myalgia, throat is inflamed and
small discrete vesicles, each surrounded
by a band of erythema
Herpex simplex-Herpangina,
similar lesions,tend to affect the anterior half of the buccal cavity,
herpangina is confined to the posterior
HAND, FOOT AND MOUTH DISEASE
is a mild illness caused by coxsackieviruses type A16, A10 and A5
fever, slight malaise, a sore mouth, characteristic lesion appears in the mouth, on the hands and feet
gonococcal rash,
a vesicular or
pustular eruption
herpetic lesions (a history of urethritis
are usually confined or vaginal discharge)
vesicle on heel to one finger,
rash on buttocks,
HFM is more widespread
a maculopapular
ROSEOLA INFANTUM
EXANTHEM SUBITUM
SIXTH DISEASE
is caused by HHV6 infection
fever, may have a convulsion,
throat inflamed but no exudate,
erythematous macular rash
(persists for 36 hours then fade)
Rash on trunk
ERYTHEMA INFECTIOSUM (SLAPPED-CHEEK SYNDROME)
→ FIFTH DISEASE
Rash on trunk,
morbilliform, annular, or confluent
RUBELLA (GERMAN MEASLES)VIRUS INFECTIONS
maculopapular, measles
Conjunctivitis
Cloudy cornea
Cataract
Purpura and
hepatosplenomegaly Glaucoma
HUMAN CYTOMEGALOVIRUS INFECTION
PRIMARY INFECTION →
INFECTIOUS MONONUCLEOSIS
Enanthem - petechiae
Anginose
inflamed throat
without exudate
Rash on upper limb, the rash tends
to patchy and is heavier on the limb
abnormal mononuclear cells (contrast with the rash of Rubella)