Integumentary system diseases

Diseases in the Integumentary System

VIRAL DISEASE

FUNGAL DISEASE

BACTERIAL DISEASE

DIFFERENT KINDS OF DISEASES

CHICKENPOX (also called as VARICELLA)

• also spelled as Chicken pox

•is a highly contagious illness caused by primary infection with varicella zoster virus (VZV).

•it is an airborne disease spread easily through coughing or sneezing of ill individuals or through direct contact with

secretions from the rash.

• usually starts with vesicular skin rash mainly on the body and head rather than at the periphery and becomes itchy, raw pockmarks, which mostly heal without scarring.

• It is often stated to be a modification of chickpeas (based on resemblance of the vesicles to chickpeas) or due to the rash

resembling chicken pecks.

•Other theories include the designation chicken for a child (i.e., literally 'child pox') or a corruption of

itching-pox.

•Samuel Johnson explained the designation as "from its being of no very great danger."

Continuation...

Chikenpox

CAUSATIVE AGENT of CHICKENPOX

•Varicella zoster virus (VZV) is one of eight herpes viruses known to infect humans and other vertebrates.

•It commonly causes chicken-pox in children and adults and Herpes zoster (shingles) in adults and rarely in children.

• Primary VZV infection results in chickenpox (varicella), which may rarely result in complications including encephalitis or

pneumonia.

A closer look to Varicella zoster virus (VZV)

Morphology

•VZV is closely related to the herpes simplex viruses (HSV), sharing much genome homology.

•VZV also fails to produce the LAT (latency-associated transcripts) that play an important role in establishing HSV

latency (herpes simplex virus).

•VZV virons are spherical and 150–200 nm in diameter.

• Their lipid envelope encloses the nucleocapsid of 162 capsomeres arranged in an icosahedral form.

•Its DNA is a single, linear, double-stranded molecule, 125,000 nt long.

MODE OF TRANSMISSION

• Chicken Pox is transmitted from person to person by droplet infection, and by droplet nuclei.

• Most patients are infected by “Face to face”, (personal) contact. The portal of entry of the virus is through the

respiratory tract. Since the virus is extremely labile, it is unlikely that fomites play a significant role in its transmission.

• Contact infection undoubtedly plays a role when an individual with Herpes Zoster is an index case.

• The virus can cross the placental barrier and infect the fetus, a condition known as Congenital Varicella.

INCUBATION PERIOD

• Usually, the incubation period is about 14 to 16 days, although extremes as wide as 21 days have been reported.

• It takes between 10 and 21 days after contact with an infected person for someone to develop chickenpox (this is known as

the chickenpox incubation period).

• The usual chickenpox incubation period averages between 14 and 16 days.

LABORATORY EXAMINATIONS REQUIRED

LABORATORY EXAM RATIONALE

CONFIRMATION RESULTS

NORMAL VS ABNORMAL

Enzyme-linked immunosorbent assay (ELISA) Immunoassay

to detect the presence of a

substance, usually an antigen, in a

liquid sample or wet sample.

NormalNegative for varicella-zoster

IgG or IgM antibodies by ELISA: nonimmune.

AbnormalPositive for varicella-zoster IgG antibody: indicates a current or

previous infection, in the absence of current clinical symptoms, may indicate

immunity.Positive for varicella-zoster IgM antibody, indicates a current or

recent infection.

LABORATORY EXAM

RATIONALECONFIRMATION RESULTS

NORMAL VS ABNORMAL

Chickenpox Blood Test

to check for immunity to the herpes

zoster virus, the virus responsible for chickenpox.

.

NormalA normal value means that no virus or other microorganisms grew in the laboratory dish.Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

AbnormalAn abnormal (positive) result usually means that you have Virus or other microorganisms in your blood. This is a sign of infection.However, contamination of the blood sample can lead to a false-positive result, which means you do not have a true infection. Your health care provider can help determine the difference.

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SIGNS AND SYMPTOMS

•in adolescents and adults are nausea, loss of appetite, aching muscles, and headache followed by the characteristic rash, malaise and a low-

grade fever that signal the presence of the disease.

•In children the illness is not usually preceded by prodromal symptoms and the first sign is the rash.

•Rashes begins as small red dots on the face, scalp, torso and upper arms and legs; progressing over 10-12 hours to small bumps, blisters

and pustules; followed by umbilication and the formation of scabs.

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• Blisters may also occur on the palms, soles and mucous membranes, and painful, shallow ulcers may appear in the

mouth, the top of the throat and the genital area.

• symptoms appear from 10 to 21 days after infection, and the infected person is typically infectious from one to two

days prior to the appearance of the rash and remains infectious until four or five days after its appearance

• Adults may have a more widespread rash, and longer fever; and are more likely to experience complications, such as

varicella pneumonia.

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•Chickenpox is rarely fatal.

•It is generally more severe in adult males than in adult females or children.

•Chickenpox is believed to be the cause of one third of stroke cases in children.

•The most common late complication of chickenpox is shingles (herpes zoster), caused by reactivation of the varicella zoster

virus decades after the initial episode of chickenpox

Nursing ManagementINTERVENTION

Management Rationale

Provide isolation.

Body substance isolation should be used for all infectious patients with diseases transmitted through air may also need airborne and droplet precautions.

Encourage patient to cover mouth and nose during coughs or sneezes.

Prevents spread of infection via airborne droplet.

Monitor patient’s temperature, degree and pattern.

Fever pattern aids in the disease process and diagnosis.

Observe for chills and profuse diaphoresis.

Chills often precede temperature spikes in presence of generalized infection.

Nursing ManagementINTERVENTION

Management Rationale

Monitor environmental temperature.

Room temperature should be altered to maintain near-normal body temperature.

Provide tepid sponge baths, avoid the use of alcohol. May help reduce the fever.

Encourage to use calamine lotion. To help reduce the itchiness.

Administer antipyretics as indicated.

Used to reduce the fever by its central action on the hypothalamus.

Medical Management

ChildrenAcyclovir decreases symptoms by one day but has no

effect on complication rates. Use of acyclovir therefore is not currently recommended for immunocompetent individuals (i.e., otherwise healthy persons without known immunodeficiency or on immunosuppressive medication).

Children younger than 12 years old and older than one month are not meant to receive antiviral medication if they are not suffering from another medical condition which would put them at risk of developing complications.

Aspirin is highly contraindicated in children younger than 16 years as it has been related with a potentially fatal condition known as Reye's syndrome.

INTERVENTION

Medical Management

ADULTSTreatment with antiviral drugs (e.g. acyclovir or

valacyclovir) is generally advised, as long as it is started within 24–48 hours from rash onset.

Adults are more often prescribed antiviral medication as it is effective in reducing the severity of the condition and the likelihood of developing complications.

Adults are also advised to increase water intake to reduce dehydration and to relieve headaches. Painkillers such as paracetamol (acetaminophen) are also recommended as they are effective in relieving itching and other symptoms such as fever or pains. Antihistamines relieve itch and may be used in cases where the itch prevents sleep, because they are also sedative.

INTERVENTION

Medical Management

ADULTS

As with children, antiviral medication is considered more useful for those adults who are more prone to develop complications. These include pregnant women or people who have a weakened immune system.

Sorivudine, a nucleoside analogue has been reported to be effective in the treatment of primary varicella in healthy adults (case reports only), but large-scale clinical trials are still needed to demonstrate its efficacy.

INTERVENTION

BACK

• Athlete's foot, also called tinea pedis, is a fungal infection of the foot. It causes peeling, redness, itching, burning, and

sometimes blisters and sores.

• Athlete's foot is a very common infection.

•The fungus grows best in a warm, moist environment such as shoes, socks, swimming pools, locker rooms, and the floors of

public showers. It is most common in the summer and in warm, humid climates.

• It occurs more often in people who wear tight shoes and who use community baths and pools.

TINEA PEDIS(Athlete’s Foot)

Athlete’s Foot/Tinea Pedis

•Athlete's foot is caused by a microscopic fungus that lives on dead tissue of the hair, toenails, and outer skin layers.

•There are at least four kinds of fungus that can cause athlete's foot. The most common of these fungi is trichophyton rubrum.

•Trichophyton rubrum is a fungus that is the most common cause of athlete's foot, jock itch and ringworm.

•This fungus was first described by Malmsten in 1845.

CAUSATIVE AGENT of Athlete’s Foot

A closer look to Trichophyton rubrum

Morphology Colonial Morphology

• Growth rate: slow to moderately rapid• Texture: downy to cottony• Thallus color: white to pale pink• Reverse: blood red (PDA) to reddish brown (SDA,

Mycosel)• Variants:

– yellow, may produce red pigment on PDA– coffee brown soluble pigment– unpigmented– deeply red, heaped up, folded– yellow orange reverse

MorphologyMicroscopic Morphology Phase Contrast

•few pyriform, lateral microconidia

•pencil shaped macroconidia uncommon

•microconidia form on macroconidia

•arthroconidia produced from hyphae and macroconidia

From person to person•Athlete's foot is a communicable disease caused by a parasitic fungus in the genus Trichophyton, either Trichophyton rubrum or Trichophyton mentagrophytes.

•It is typically transmitted in moist environments where people walk barefoot, such as showers, bath houses, and locker rooms.

•It can also be transmitted by sharing footwear with an infected person, or less commonly, by sharing towels with an infected person.


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To other parts of the body• The various parasitic fungi that cause athlete's foot can

also cause skin infections on other areas of the body, most often under toenails (onychomycosis) or on the groin (tinea cruris).

The incubation period differs:

1. tinea corporis has an incubation period of four to ten days

2. tinea capitis has an incubation period of 10–14 days

3. the incubation period of tinea pedis and tinea unguium is probably weeks but exact limits are unknown.

INCUBATION PERIOD




NORMAL VS ABNORMAL

KOH (Potassium Hydroxide) Preparation

to find out whether a fungal infection is

present on the nails, skin, scalp, or

beard.

NormalNo fungi are present in the nail,

skin or hair samples.Other tests may be done to find

out the cause of the skin infection.

AbnormalFungi are present in the nail,

skin or hair samples.


LABORATORY EXAM

RATIONALE


NORMAL VS ABNORMAL

Fungal Culture

used to find out whether fungi are present

and, if so, what type of fungus it is.

done to find out the cause of cracking, scaling,

peeling, or blistered skin, or to find out why there is an area of persistent irritation (and sometimes redness)

on the feet. The presence of fungi suggests that the condition is athlete's

foot (tineapedis).

NormalNo fungi are present in the

skin or nail scrapings. Other skin tests may be

done to find out the cause of the skin or nail

problems.

AbnormalFungi are present, and the type of fungus is identified.

Treatment may vary depending on the type of

fungus present.




NORMAL VS ABNORMAL

Skin Biopsy

performed to exclude a chronic

skin infection, non-cancerous tumors, skin cancers and

other skin diseases that may mimic athlete’s foot.

NormalNo fungi are present in the skin

or nail scrapings. Other skin tests may be done to find out the cause of the skin or nail

problems.

AbnormalFungi are present, and the type

of fungus is identified.Treatment may vary depending on the type of fungus present.

As the infection progresses, the skin grows soft and the center of the infection becomes inflamed and sensitive to the touch. Gradually, the edges of the infected area become milky white and the skin begins to peel. A slight watery discharge also may be present.

1. Itching, stinging and burning between your toes2. Itching, stinging and burning on the soles of your feet3. Itchy blisters4. Cracking and peeling skin, especially between your toes and on the soles of your feet5. Excessive dryness of the skin on the bottoms or sides of the feet6. Toenails that are thick, crumbly, ragged, discolored or pulling away from the nail bed

SIGNS AND SYMPTOMS

1. Keep your feet clean, dry, and cool.

2. Whenever possible, take off your shoes to "air out" your feet.

3. Clean your feet daily with soap and water.

4. Always dry well between your toes.

INTERVENTIONNursing Management

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5. Use an absorbent powder such as talcum powder or aluminum chloride powder.

6. Wear absorbent socks (e.g., made out of cotton or wool).

7. Avoid tight-fitting footwear, since sweaty feet provide ideal conditions for fungal growth.

8. Change your socks after exercising or after any excess sweating.

INTERVENTIONMedical Management

•By examining the feet for scaling, itchiness, and strong foot odor, doctors can easily diagnose athlete's foot.

•Doctor can confirm the diagnosis and exclude other possible skin conditions such as eczema, ringworm, and psoriasis by taking a

scraping of lesions from the feet and sending it to the lab for testing.

•Athlete's foot that's soggy, inflamed, and foul-smelling requires quick medical attention.

•If the foot is inflamed and your doctor has confirmed that there's a bacterial infection, the infection and inflammation must first be

treated before anti-fungals are used.


•Topical anti-fungals (creams, solutions, gel, and lotions), either over-the-counter or prescription, are usually effective

for uncomplicated cases of athlete's foot. When these topical agents don't work, antifungal pills are often prescribed.

•Some medications used to treat athlete's foot contain both an antifungal and antibacterial ingredient to help speed up

healing. In addition, special aluminum acetate wet dressings may be helpful when applied to vesiculated or macerated

lesions. Shoes may also be treated with antifungal powders.

•A foot condition that doesn't clear up after appropriate treatment may not be due to a fungal or bacterial

infection. The symptoms may be caused by some other type of skin disease. That's why it's important to see your doctor to

confirm the presence of athlete's foot.

ONYCHOMYCOSIS(TINEA UNGUIUM)

•Onychomycosis (also known as "dermatophytic onychomycosis,“ "ringworm of the nail,“ and "tinea unguium”)

means fungal infection of the nail.

•It is the most common disease of the nails and constitutes about a half of all nail abnormalities.

•This condition may affect toenails or fingernails, but toenail infections are particularly common.

•The prevalence of onychomycosis is about 6-8% in the adult population.

Onychomycosis

CAUSATIVE AGENT

•The causative pathogens of onychomycosis include: dermatophytes, Candida, and nondermatophytic molds.

•Dermatophytes are the fungi most commonly responsible for onychomycosis in the temperate western countries;

•Candida and nondermatophytic molds are more frequently involved in the tropics and subtropics with a hot

and humid climate. •Another type of onychomycosis is caused by yeast (Candida albicans or Candida parapsilosis). These infections are less

common and produce similar symptoms.

A closer look to Dermatophytes

Candida albicans


•Dermatophytes are transmitted by direct contact with infected host (human or animal) or by direct or indirect contact with infected exfoliated skin or hair in clothing, combs, hair brushes, theatre seats, caps, furniture, bed

linens, shoes, socks, towels, hotel rugs, sauna, bathhouse, and locker room floors.

•may be viable in the environment for up to 15 months.

•There is an increased susceptibility to infection when there is a preexisting injury to the skin such as scars, burns, excessive temperature and humidity. Adaptation to growth on humans

by most geophilic species resulted in diminished loss of sporulation, sexuality, and other soil-associated

characteristics.

INCUBATION PERIOD

•the incubation period of tinea pedis and tinea unguium is probably weeks but exact limits are unknown.

LAB EXAMS REQUIRED



NORMAL VS ABNORMAL

KOH (Potassium Hydroxide) Preparation

to find out whether a fungal infection is

present on the nails, skin, scalp, or

beard.

NormalNo fungi are present in the nail,

skin or hair samples.Other tests may be done to find

out the cause of the skin infection.

AbnormalFungi are present in the nail,

skin or hair samples.

LAB EXAM REQUIRED

LABORATORY EXAM

RATIONALE


NORMAL VS ABNORMAL

Fungal Culture

used to find out whether fungi are present

and, if so, what type of fungus it is.

done to find out the cause of cracking, scaling,

peeling, or blistered skin, or to find out why there is

an area of persistent irritation (and sometimes redness) on the feet. The

presence of fungi suggests that the

condition is athlete's foot (tinea pedis).

NormalNo fungi are present in the

skin or nail scrapings. Other skin tests may be

done to find out the cause of the skin or nail

problems.



fungus present.

LAB EXAMS REQUIRED



NORMAL VS ABNORMAL

Skin Biopsy

performed to exclude a chronic

skin infection, non-cancerous tumors, skin

cancers and other skin diseases that

may mimic athlete’s foot.

NormalNo fungi are present in the skin or nail scrapings. Other skin tests may be done to find out the cause of the

skin or nail problems.



fungus present.

SIGNS AND SYMPTOMS

•the nail thickened and discoloured: white, black, yellow or green.

•the nail can become brittle, with pieces breaking off or coming away from the toe or finger completely.

•the skin can become inflamed and painful underneath and around the nail If left untreated.

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•There may also be white or yellow patches on the nailbed or scaly skin next to the nail.

•There is usually no pain or other bodily symptoms, unless the disease is severe.

•People with onychomycosis may experience significant psychosocial problems due to the appearance of the nail,

particularly when fingers – which are always visible – rather than toenails are affected


•Keep your nails clipped. Cut the nails straight and make sure they do not extend beyond the tips of your toes (or your fingers). (If you have one or more infected nails, use a separate pair of clippers for infected nails and another for healthy nails. If you have diabetes, consult your physician before cutting your toenails.)

•Disinfect. After each use, disinfect any manicure and pedicure tools by wiping them with cotton balls saturated with alcohol. Let them air dry for 60 to 90 minutes before using them again.

•Be careful at the nail salon. Make sure the salon has an autoclave (a special heating device for disinfecting instruments) and that it is used after each treatment.


•Keep clean and dry. Wash your hands and feet daily with soap and water and dry them well. Be sure to dry between your toes.

•Use an antifungal foot powder. Avoid cornstarch because it encourages fungal growth.

•Make sure your footwear breathes. Choose leather shoes with plenty of toe room. Have more than one pair and alternate your shoes to make sure they air out at least 24 hours before they are worn again. Also, avoid socks made from nylon or polyester because they don’t absorb perspiration as well as cotton or wool. In warm weather, wearing sandals may help prevent infections


• Your doctor will take scrapings from under the nail to discover what type of infection is present. Once the

condition is diagnosed, your doctor may prescribe one of the newer oral antifungal medication agents, itraconazole

(Sporanox) or terbinafine (Lamisil).

• Another option is an FDA-approved topical medication, ciclopirox, sold under the name Penlac Nail Lacquer. You

apply it daily to the affected nail and adjacent skin for up to 48 weeks and trim the nail weekly. It may cause skin

irritation, but is otherwise safe; it costs less than the oral drugs.

• In rare cases, if the infection is extremely painful, your physician may recommend removing the nail (though this alone

will not resolve the infection).


BACK

IMPETIGO

•Impetigo is a highly contagious bacterial skin infection most common among pre-school

children. People who play close contact sports are also susceptible, regardless of age.

•Impetigo is not as common in adults. The name derives from the Latin impetere ("assail"). It is

also known as school sores.

Impetigo

CAUSATIVE AGENT

• It is primarily caused by Staphylococcus aureus, and sometimes by Streptococcus

pyogenes.

•According to the American Academy of Family Physicians, both bullous and nonbullous are primarily caused by Staphylococcus aureus,

with Streptococcus also commonly being involved in the nonbullous form.

a closer look to Staphylococcus aureus

Streptococcus pyogenes


•Bacteria can enter the skin through a cut, scrape, insect bite, or other breaks in the skin. A person can also get impetigo

without a break in the skin. This usually happens because of dried Streptococcus bacteria in the air.

•People can transmit bacteria from one person to another or within the same infected person. Impetigo sores have a large

amount of bacteria in them.

•Skin-to-skin contact is the most common method of impetigo transmission.


•If you scratch or touch an active sore contaminated with bacteria and then touch another part of the body, you can spread infection to that area. The infection can also spread

from one person to another in the same manner.

•The bacteria that cause impetigo may also spread by touching shared items or surfaces that have come into contact with

someone else's infection. This includes things such as towels, bedding, uniforms, razors, washcloths, and sporting equipment.

•Finally, bacteria can be transmitted through discharge from the nose of a person colonized with bacteria.

The incubation period is the time between being exposed to the bacteria and the development of signs and symptoms. The incubation period is usually one to three days for Streptococcal and four to 10 days for Staphylococcal infections.

INCUBATION PERIOD

LAB EXAMS REQUIRED



NORMAL VS ABNORMAL

BLOOD CULTURE

is a test to find an infection in the blood. A blood

culture can show what bacteria or

fungi are in the blood.

NormalA normal value means that no bacteria or other microorganisms grew in the laboratory dish.Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

AbnormalAn abnormal (positive) result usually means that you have bacteria or other microorganisms in your blood. This is a sign of infection.However, contamination of the blood sample can lead to a false-positive result, which means you do not have a true infection. Your health care provider can help determine the difference..

LAB EXAMS REQUIRED



NORMAL VS ABNORMAL

SKIN LESION BIOPSY

performed to exclude a chronic skin infection, non-cancerous tumors, skin cancers and other skin diseases that may

mimic athlete’s foot

NormalNo fungi are present in the skin

or nail scrapings. Other skin tests may be done to find out the cause of the skin or nail

problems.

AbnormalFungi are present, and the type

of fungus is identified.Treatment may vary depending on the type of fungus present.

.

The following are signs and symptoms of impetigo:

1. Red sores that quickly rupture, ooze for a few days and then form a yellowish-brown crust

2. Itching

3. Painless, fluid-filled blisters

4. In the more serious form, painful fluid- or pus-filled sores that turn into deep ulcers

SIGNS AND SYMPTOMS

1. Penicillin or Erythromycin orally administered.2. Application of mupirocin (Bactroban) ointment for 7 to 10 days.3. Wash the crusts daily with soap and water for the lesions to heal quickly.4. Contact precautions should be implemented.5. Instruct the patient to stay indoors for a few days to stop any bacteria from getting into the blisters and making the infections worse. 6. The infected person’s bed linens, towels, and clothing should be separated from those of other family members.7. The infected person should use separate towels for bathing and hand washing.


• Agents for nonbullous impetigo: benzathine penicillin or oral penicillin or erythromycin.

• Agents for bullous impetigo: penicillinase-resistant penicillin or erythromycin

• Topical antibacterial therapy Is the usual treatment for disease that is limited to a small area. The topical preparation is applied to lesions several times daily for 1 week. Lesions are soaked or washed with soap solution to remove central site of bacterial growth and to give the topical antibiotic an opportunity to reach the infected site.


BACK

VIRAL DISEASE

FUNGAL DISEASE

BACTERIAL DISEASE

DIFFERENT KINDS OF DISEASES

Prepared by:

GROUP 3

BSN II-B

Education

Integumentary system diseases