One of our requirements in Microbiology&Parasitology. :)

1. Diseases in the
Integumentary System

2. DIFFERENT KINDS OF
DISEASES
VIRAL DISEASE
FUNGAL DISEASE
BACTERIAL DISEASE

3. 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.

4. Continuation...
• 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."

5. Chikenpox

6. 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.

7. A closer look to
Varicella zoster virus (VZV)

8. 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.

9. 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.

10. 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.

11. LABORATORY
EXAMINATIONS REQUIRED
LABORATORY CONFIRMATION RESULTS
RATIONALE
EXAM NORMAL VS ABNORMAL
Normal
Negative for varicella-zoster IgG
or IgM antibodies by ELISA:
nonimmune.
to detect the
Enzyme-linked Abnormal
presence of a
immunosorbent Positive for varicella-zoster IgG
substance, usually an
assay (ELISA) antibody: indicates a current or
antigen, in a liquid
Immunoassay previous infection, in the absence
sample or wet sample.
of current clinical symptoms, may
indicate immunity.
Positive for varicella-zoster IgM
antibody, indicates a current or
recent infection.

12. Continuation...
LABORATORY CONFIRMATION RESULTS
RATIONALE
EXAM NORMAL VS ABNORMAL
Normal
A 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
to check for immunity meaning of your specific test results.
to the herpes
zoster virus, the Abnormal
Chickenpox Blood
virus responsible An abnormal (positive) result usually
Test means that you have Virus or other
for chickenpox.
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.

13. 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.

14. Continuation...
• 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.

15. Continuation...
•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

16. INTERVENTION
Nursing Management
Management Rationale
Body substance isolation should be
used for all infectious patients
Provide isolation. with diseases transmitted through
air may also need airborne and
droplet precautions.
Encourage patient to cover mouth Prevents spread of infection via
and nose during coughs or sneezes. airborne droplet.
Monitor patient’s temperature, Fever pattern aids in the disease
degree and pattern. process and diagnosis.
Chills often precede temperature
Observe for chills and profuse
spikes in presence of generalized
diaphoresis.
infection.

17. INTERVENTION
Nursing Management
Management Rationale
Room temperature should be altered
Monitor environmental temperature. to maintain near-normal body
temperature.
Provide tepid sponge baths, avoid the
May help reduce the fever.
use of alcohol.
Encourage to use calamine lotion. To help reduce the itchiness.
Used to reduce the fever by its
Administer antipyretics as indicated.
central action on the hypothalamus.

18. INTERVENTION
Medical Management
Children
Acyclovir 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.

19. INTERVENTION
Medical Management
ADULTS
Treatment 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.

20. 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.
BACK

21. TINEA PEDIS
(Athlete’s Foot)
• 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.

22. Athlete’s Foot/Tinea Pedis

23. CAUSATIVE AGENT of
Athlete’s Foot
•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.

24. A closer look to Trichophyton
rubrum

25. 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

26. Morphology
Microscopic Morphology Phase Contrast
•few pyriform, lateral microconidia
•pencil shaped macroconidia uncommon
•microconidia form on macroconidia
•arthroconidia produced from hyphae and
macroconidia

27. MODE OF TRANSMISSION
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.

28. Continuation...
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).

29. INCUBATION PERIOD
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.

30. LABORATORY
EXAMINATIONS REQUIRED
LABORATORY CONFIRMATION RESULTS
RATIONALE
EXAM NORMAL VS ABNORMAL
Normal
No fungi are present in the nail,
skin or hair samples.
to find out whether a
Other tests may be done to find
KOH (Potassium fungal infection is
out the cause of the skin
Hydroxide) present on the
infection.
Preparation nails, skin, scalp, or
beard.
Abnormal
Fungi are present in the nail, skin
or hair samples.

31. LABORATORY
EXAMINATIONS REQUIRED
CONFIRMATION
LABORATOR RESULTS
RATIONALE
Y EXAM
NORMAL VS ABNORMAL
used to find out Normal
whether fungi are present No fungi are present in the
and, if so, what type of skin or nail scrapings. Other
fungus it is. skin tests may be done to
done to find out the cause of find out the cause of the skin
cracking, scaling, peeling, or or nail problems.
Fungal Culture blistered skin, or to find out
why there is an area of Abnormal
persistent irritation (and Fungi are present, and the
sometimes redness) on the type of fungus is identified.
feet. The presence of fungi Treatment may vary
suggests that the condition depending on the type of
is athlete's foot (tineapedis). fungus present.

32. LABORATORY
EXAMINATIONS REQUIRED
LABORATORY CONFIRMATION RESULTS
RATIONALE
EXAM NORMAL VS ABNORMAL
Normal
No fungi are present in the skin
performed to exclude
or nail scrapings. Other skin tests
a chronic skin
may be done to find out the cause
infection, non-
of the skin or nail problems.
cancerous tumors,
Skin Biopsy
skin cancers and
Abnormal
other skin diseases
Fungi are present, and the type of
that may mimic
fungus is identified.
athlete’s foot.
Treatment may vary depending on
the type of fungus present.

33. SIGNS AND SYMPTOMS
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 toes
2. Itching, stinging and burning on the soles of your feet
3. Itchy blisters
4. Cracking and peeling skin, especially between your toes and on the
soles of your feet
5. Excessive dryness of the skin on the bottoms or sides of the feet
6. Toenails that are thick, crumbly, ragged, discolored or pulling away
from the nail bed

34. INTERVENTION
Nursing Management
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.

35. Continuation...
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.

36. INTERVENTION
Medical 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.

37. INTERVENTION
Medical Management
•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.

38. 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.

39. Onychomycosis

40. 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.

41. A closer look to
Dermatophytes

42. Candida albicans

43. MODE OF TRANSMISSION
•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.

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

45. LAB EXAMS REQUIRED
LABORATORY CONFIRMATION RESULTS
RATIONALE
EXAM NORMAL VS ABNORMAL
Normal
No fungi are present in the nail,
skin or hair samples.
to find out whether a
Other tests may be done to find
KOH (Potassium fungal infection is
out the cause of the skin
Hydroxide) present on the
infection.
Preparation nails, skin, scalp, or
beard.
Abnormal
Fungi are present in the nail, skin
or hair samples.

46. LAB EXAM REQUIRED
CONFIRMATION
LABORATORY RESULTS
RATIONALE
EXAM
NORMAL VS ABNORMAL
used to find out
Normal
whether fungi are present
No fungi are present in the
and, if so, what type of
skin or nail scrapings. Other
fungus it is.
skin tests may be done to
done to find out the cause
find out the cause of the skin
of cracking, scaling, peeling,
or nail problems.
or blistered skin, or to find
Fungal Culture
out why there is an area of
Abnormal
persistent irritation (and
Fungi are present, and the
sometimes redness) on the
type of fungus is identified.
feet. The presence of fungi
Treatment may vary
suggests that the condition
depending on the type of
is athlete's foot (tinea
fungus present.
pedis).

47. LAB EXAMS REQUIRED
LABORATORY CONFIRMATION RESULTS
RATIONALE
EXAM NORMAL VS ABNORMAL
Normal
No fungi are present in the
performed to skin or nail scrapings. Other
exclude a chronic skin tests may be done to find
skin infection, non- out the cause of the skin or
cancerous tumors, nail problems.
Skin Biopsy
skin cancers and
other skin diseases Abnormal
that may mimic Fungi are present, and the
athlete’s foot. type of fungus is identified.
Treatment may vary depending
on the type of fungus present.

48. 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.

49. Continuation...
•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

50. INTERVENTION
Nursing Management
•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.

51. INTERVENTION
Nursing Management
•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

52. INTERVENTION
Medical Management
• 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.

53. INTERVENTION
Medical Management
• 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

54. 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.

55. Impetigo

56. 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.

57. a closer look to
Staphylococcus aureus

58. Streptococcus pyogenes

59. MODE OF TRANSMISSION
•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.

60. MODE OF 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.

61. INCUBATION PERIOD
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.

62. LAB EXAMS REQUIRED
LABORATORY CONFIRMATION RESULTS
RATIONALE
EXAM NORMAL VS ABNORMAL
Normal
A 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
is a test to find an test results.
infection in the blood.
BLOOD CULTURE A blood culture can Abnormal
An abnormal (positive) result usually means
show what bacteria or that you have bacteria or other
fungi are in the blood. 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..

63. LAB EXAMS REQUIRED
LABORATORY CONFIRMATION RESULTS
RATIONALE
EXAM NORMAL VS ABNORMAL
Normal
No fungi are present in the skin
or nail scrapings. Other skin tests
may be done to find out the cause
performed to exclude a of the skin or nail problems.
chronic skin infection,
SKIN LESION non-cancerous tumors,
BIOPSY skin cancers and other Abnormal
skin diseases that may Fungi are present, and the type of
mimic athlete’s foot fungus is identified.
Treatment may vary depending on
the type of fungus present.
.

64. SIGNS AND SYMPTOMS
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

65. INTERVENTION
Nursing Management
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.

66. INTERVENTION
Medical Management
• 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

67. DIFFERENT KINDS OF
DISEASES
VIRAL DISEASE
FUNGAL DISEASE
BACTERIAL DISEASE

68. Prepared by:
GROUP 3
BSN II-B