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Comprehensive Approach to Infections in Dermatology
Archana Singal, Chander Grover
SECTION 1: NORMAL FLORA
CHAPTER 1:
Normal Flora of Skin
INTRODUCTION
MICROBIAL SKIN FLORA
Bacterial Flora
Micrococcaceae
Coryneform Organisms
Propionibacteria
Gram-Negative Rods
Bacterial Interference and Competition
Fungal Flora
Pityrosporum
Candida
Viral Flora
Parasites
NORMAL ORAL FLORA
FACTORS AFFECTING THE SKIN FLORA
Endogenous
Body Site
Effect of Disease
Age
Sex
Exogenous (Environmental)
Temperature
Hospitalization
Occupation
Soaps and Disinfectants
Effect of Cosmetics
Effect of Medications
SKIN FLORA IN DISEASE (FIG. 2)
Skin Flora in Atopic Dermatitis
Skin Flora in Acne
Skin Flora in Psoriasis
Skin Flora in Seborrheic Dermatitis
ROLE OF SKIN FLORA IN DEVELOPING IMMUNITY
ROLE OF SKIN FLORA IN CANCER IMMUNOLOGY
MEASUREMENT OF SKIN FLORA
CONCLUSION
SECTION 2: BACTERIAL INFECTIONS
CHAPTER 2:
Gram Positive Bacterial Infections
INTRODUCTION
Staphylococcus
Streptococcus
IMPETIGO
Etiology
Epidemiology
Clinical Features
Course and Complications
Differential Diagnosis
Investigations
Treatment
Supportive Care
Medications
Topical Therapy
Systemic Therapy
Management of Difficult/Recurrent Cases and Prevention
STAPHYLOCOCCAL SCALDED SKIN SYNDROME (RITTER’S DISEASE)
Epidemiology
Clinical Features
Course and Complications
Differential Diagnosis
Diagnosis and Investigations
Management
Supportive Care
Medication
ECTHYMA
Etiology
Epidemiology
Clinical Features
Diagnosis and Investigations
Treatment
ERYSIPELAS (ST ANTHONY’S FIRE)
Etiology
Epidemiology
Clinical Features
Prognosis and Complications
Differential Diagnosis
Investigations
Management
Prevention of Recurrences
CELLULITIS
Etiology
Epidemiology
Clinical Features
Course and Complications
Differential Diagnosis
Investigations
Management
Local Care
Antibiotics
Adjuvant Treatment
Prevention of Recurrence
CUTANEOUS ABSCESS
Etiology
Epidemiology
Clinical Features
Differential Diagnosis
Investigations
Management
Management of Recurrent Cases and Prevention
FOLLICULITIS
Superficial Folliculitis (Bockhart’s impetigo)
Epidemiology
Clinical Features
Differential Diagnosis
Diagnosis
Investigations
Treatment
Management of Recurrent Infections and Prevention
Dermatitis Cruris Pustulosa Et Atrophicans
Epidemiology
Clinical Features
Management
Deep Folliculitis (Sycosis)
Epidemiology
Clinical Features
Differential Diagnosis
Investigations
Management
FURUNCLES
Etiology
Epidemiology
Clinical Features
Course and Complications
Differential Diagnosis
Investigations
Management
Prevention and Management of Recurrent Cases
CARBUNCLE
Etiology
Epidemiology
Clinical Features
Differential Diagnosis
Investigations
Management
OTHER INFECTIONS CAUSED BY STAPHYLOCOCCI AND STREPTOCOCCI
Periporitis Staphylogenes
Acute Paronychia
Botryomycosis
Perineal Streptococcal Dermatitis/Disease
Blistering Distal Dactylitis
Streptococcal Intertrigo
TOXIN-MEDIATED DISEASES
Bullous Impetigo
Staphylococcal Scalded Skin Syndrome
Toxic Shock Syndrome
Recurrent Toxin-Mediated Perineal Erythema
Scarlet Fever
DISEASES CAUSED BY CORYNEFORM BACTERIA
Erythrasma
Etiology
Epidemiology
Clinical Features
Differential Diagnosis
Investigations
Treatment
TRICHOBACTERIOSIS (AKA TRICHOMYCOSIS AXILLARIS)1,94
Etiology
Epidemiology
Clinical Features
Differential Diagnosis
Investigations
Treatment
PITTED KERATOLYSIS
Etiology
Epidemiology
Clinical Features
Differential Diagnosis
Investigations
Treatment
ACTINOMYCETE INFECTIONS
Actinomycosis
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Differential Diagnosis
Diagnosis
Treatment
Prevention
Complications
Nocardiosis
Introduction
Etiology and Pathogenesis
Epidemiology
Clinical Features
Differential Diagnoses
Diagnosis
Treatment
Prevention
CONCLUSION
CHAPTER 3:
Gram Negative Bacterial Infections
INTRODUCTION
GRAM-NEGATIVE COCCAL INFECTIONS
Neisserial Infections
Gonococcal Infections
Epidemiology
Etiological Agent and Pathogenesis
Clinical Features
Uncomplicated Gonococcal Infections
Gonococcal Dermatitis
Complicated Gonococcal Infections
Disseminated Gonococcal Infection
Gonococcal Ophthalmia Neonatorum
Diagnosis of Gonococcal Infections
Treatment
Prevention
Meningococcal Infections
Epidemiology
Etiological Agent and Pathogenesis
Clinical Features
Diagnosis
Treatment of Meningococcal Infections
Prevention
Moraxella Infections
GRAM-NEGATIVE BACILLARY INFECTIONS
Pseudomonal Infections
Epidemiology
Etiological Agent and Pathogenesis
Clinical Features
Diagnosis
Treatment of Pseudomonal Infections
Prevention
Klebsiella Infections
Epidemiology
Etiological Factors and Pathogenesis
Clinical Features
Bartonella Infections
Epidemiology
Etiological Agents and Pathogenesis
Cat Scratch Disease
Bacillary Angiomatosis
Oroya Fever and Verruga Peruana
Acinetobacter Infections
Yersinia Infections
Plague
Yersinia enterocolitica Infections
Bacteroidaceae Infections
Tropical Ulcer (Tropical Phagedena, Aden Ulcer, Malabar Ulcer, Jungle Rot)
Salmonella Infections
Enteric Fever
Burkholderia Infections
Glanders
Melioidosis
INFECTIONS CAUSED BY PLEOMORPHIC GRAM-NEGATIVE COCCOBACILLI
Haemophilus Infections
Haemophilus Influenzae Cellulitis
Chancroid (Soft Sore, Ulcus Molle)
Tularemia
Pasteurella Infections
Chlamydia Infections
Lymphogranuloma Venereum
Rickettsial Infections
Epidemiology
Typhus Group
Spotted Fever Group
Rickettsial Pox
Diagnosis and Treatment of Rickettsial Infections
CONDITIONS ASSOCIATED WITH GRAM-NEGATIVE BACTERIAL INFECTIONS
Gram-Negative Folliculitis
Gram-Negative Toe-Web Infection
Cutaneous Malakoplakia
Pyoderma Vegetans (Blastomycosis-Like Pyoderma)
Botryomycosis (Bacterial Pseudomycosis, Granular Bacteriosis, Actinophytosis)
Necrotizing Subcutaneous Infections
Introduction
Epidemiology
Etiological Agent and Pathogenesis
Clinical Features
Diagnosis
Treatment
Concluding Remarks
Mycoplasma Infections
Introduction
Epidemiology
Etiological Agent and Pathogenesis
Clinical Features
Investigations
Treatment
Concluding Remarks
Vibrio Infections
Brucellosis
Introduction
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
Nonvenereal Treponematoses
Endemic Syphilis
Yaws
Pinta
Diagnosis of Endemic Treponematoses
Treatment
Borrelia
Lyme Disease
Relapsing Fever
Leptospirosis
ACKNOWLEDGMENTS
SECTION 3: FUNGAL INFECTIONS
CHAPTER 4:
Superficial Fungal Infections
INTRODUCTION
LABORATORY DIAGNOSIS OF SUPERFICIAL FUNGAL INFECTIONS
Sampling Technique
Wood’s Lamp Examination
Direct Microscopic Examination
Fungal Culture
DERMATOPHYTOSIS
Introduction
Etiology
Epidemiology
Pathogenesis
Clinical Features
Tinea Corporis
Tinea Cruris or Dhobi Itch
Tinea Barbae
Tinea Capitis or Tinea Tonsurans
Tinea Unguium (Onychomycosis Caused by Dermatophytic Molds)
Tinea Pedis or Athlete’s Foot
Tinea Manuum
Dermatophytid Reactions
Investigations
Direct Microscopy
Fungal Culture
Histopathology
Treatment
Tinea Capitis
Tinea Corporis/Cruris/Faciei
Tinea Barbae
Tinea Pedis and Manuum
Tinea Unguium
NONDERMATOPHYTIC MOLD INFECTIONS
Etiopathogenesis
Clinical Features
Treatment
CANDIDIASIS OR CANDIDOSIS
Introduction
Etiology and Pathogenesis
Epidemiology
Clinical Manifestations
Oral Candidiasis
Vaginal and Vulvovaginal Candidiasis
Candidal Balanitis and Balanoposthitis
Candidal Intertrigo
Perianal Candidiasis
Candidal Paronychia
Onychomycosis Caused by Candida
Diaper Candidiasis or Candidal Diaper Dermatitis
Disseminated Candidiasis
Congenital Candidiasis
Chronic Mucocutaneous Candidiasis
Diagnosis
Treatment
Specific Therapy
Oral Candidiasis
Genital Candidiasis
Candidal Intertrigo
Candidal Paronychia and Onychomycosis
Chronic Mucocutaneous Candidiasis
PITYRIASIS VERSICOLOR (TINEA VERSICOLOR)
Introduction
Epidemiology
Etiological Agent and Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
Prevention
Other Cutaneous Disorders Associated with Malassezia
TINEA NIGRA PALMARIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
PIEDRA OR TRICHOMYCOSIS NODULARIS
Introduction
Etiology
Epidemiology
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
SUMMARY
CHAPTER 5:
Subcutaneous Mycoses
INTRODUCTION
CUTANEOUS SPOROTRICHOSIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Differential Diagnosis
Diagnosis
Direct Microscopy
Culture of Causative Fungus
Histology
Intradermal Test
Serodiagnosis/Molecular Diagnosis
Treatment
CHROMOBLASTOMYCOSIS/CHROMOMYCOSIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Differential Diagnosis
Diagnosis
Direct Microscopy
Histopathology
Culture
Serodiagnosis/Molecular Diagnosis
Treatment
PHAEOHYPHOMYCOSIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Differential Diagnosis
Diagnosis
Histopathology
Fungal Culture
Serodiagnosis/Molecular Diagnosis
Treatment
MYCETOMA (SYN: MADURA FOOT, MADUROMYCOSIS)
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Differential Diagnosis
Diagnosis
Radiological Investigations
Direct Microscopy and Culture
Histopathology
Serodiagnosis/Molecular Diagnosis
Treatment
Eumycetoma
Actinomycetoma
SUBCUTANEOUS ZYGOMYCOSIS
Introduction
Entomophthoromycosis
Basidiobolomycosis
Introduction
Epidemiology
Etiology
Clinical Features
Differential Diagnosis
Rhinofacial Conidiobolomycosis (Rhinoentomophthoramycosis)
Introduction
Epidemiology
Etiology
Clinical Features
Differential Diagnosis
Diagnosis
Histology
Culture of Causative Fungus
Serodiagnosis/Molecular Diagnosis
Treatment
MUCORMYCOSIS
Epidemiology
Etiology and Pathogenesis
Clinical Features
Differential Diagnosis
Diagnosis
Histology
Culture of Causative Fungus
Serodiagnosis/Molecular Diagnosis
Treatment
LOBOMYCOSIS
Introduction
Etiology and Pathogenesis
Epidemiology
Clinical Features
Differential Diagnosis
Diagnosis
Direct Smears
Histopathology
Culture
Serodiagnosis/Molecular Diagnosis
Treatment
RHINOSPORIDIOSIS
Etiology and Pathogenesis
Epidemiology
Clinical Features
Differential Diagnosis
Diagnosis
Cytodiagnosis
Histology
Culture
Serology and Molecular Techniques
Treatment
HYALOHYPHOMYCOSIS
Etiology and Pathogenesis
Clinical Features, Diagnosis and Treatment
Diagnosis
Treatment
FUSARIOSIS
Clinical Features
Diagnosis
Treatment and Prognosis
PAECILOMYCOSIS
Clinical Features
Diagnosis
Treatment and Prognosis
MISCELLANEOUS FUNGI
Treatment and Prognosis
PREVENTION
CHAPTER 6:
Deep Fungal Infections
INTRODUCTION
LABORATORY DIAGNOSIS
Specimen Collection
Transport of Specimens
Direct Microscopy
Histopathology
Culture
Serology and Molecular Methods
HISTOPLASMOSIS (DARLING'S DISEASE)
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Direct Microscopy
Histopathology
Culture
Serology
Antigen Detection
Skin Testing
Differential Diagnosis
Treatment
Prevention
BLASTOMYCOSIS (NORTH AMERICAN BLASTOMYCOSIS, GILCHRIST'S DISEASE)
Introduction
Epidemiology
Etiology and pathogenesis
Clinical features
Diagnosis
Direct microscopy
Histopathology
Culture
Serology
Differential Diagnosis
Treatment
Prevention
COCCIDIOIDOMYCOSIS (COCCIDIOIDAL GRANULOMA, VALLEY FEVER, SAN JOAQUIN VALLEY FEVER, DESERT RHEUMATISM)
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Specimen Collection
Microscopy
Histopathology
Culture
Serology
Molecular Methods
Coccidioidin or spherulin skin tests
Differential Diagnosis
Treatment
Prevention
PARACOCCIDIOIDOMYCOSIS (SOUTH AMERICAN BLASTOMYCOSIS, PARACOCCIDIOIDAL GRANULOMA)
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Specimen Collection
Microscopy
Histopathology
Culture
Serology
Differential Diagnosis
Treatment
Prevention
CRYPTOCOCCOSIS (TORULOSIS, EUROPEAN BLASTOMYCOSIS)
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Pulmonary Cryptococcosis
CNS cryptococcosis
Ocular cryptococcosis
Cutaneous cryptococcosis
Other Organs
Diagnosis57
Specimen Collection
Direct Microscopy
Histopathology
Cultures
Serology
Molecular Techniques
Differential Diagnosis
Treatment
Prevention
PENICILLIOSIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Specimen collection
Cultures
Histopathology
Other Tests
Differential Diagnosis
Treatment
Prevention
FUNGAL INFECTIONS IN NEUTROPENIA
ASPERGILLUS
Introduction
Etiology
Clinical features
Diagnosis
Treatment
SYSTEMIC CANDIDIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
MUCORMYCOSIS
Introduction
Epidemiology
Etiology and pathogenesis
Clinical features
Diagnosis
Treatment
FUSARIOSIS
Introduction
Epidemiology
Etiology and pathogenesis
Clinical features
Diagnosis
Treatment
TRICHOSPORONOSIS
Introduction
Epidemiology
Etiology and pathogenesis
Clinical features
Diagnosis
Treatment
PROTOTHECOSIS
Introduction
Epidemiology
Etiology and pathogenesis
Clinical features
Diagnosis
Treatment
PYTHIUM
Introduction
Epidemiology
Etiology and pathogenesis
Clinical features
Diagnosis
Treatment
PNEUMOCYSTIS JIROVECI
CONCLUSION
SECTION 4: VIRAL INFECTIONS
CHAPTER 7:
Overview of Dermatologic Viral Infections
INTRODUCTION
PATHOGENESIS OF VIRAL INFECTIONS
Viral Replication
Pathogenesis of Viral Infections in Skin
VIRAL EXANTHEMS
DIAGNOSIS
PARVOVIRUS
Parvovirus B19 (Erythema Infectiosum or Fifth Disease)
Pathogenesis
Clinical Features
Papular Purpuric Glove and Socks Syndrome
Diagnosis
Differential Diagnosis
Complications
Prognosis
Treatment
Prevention
VIRAL INSECT-BORNE AND VIRAL HEMORRHAGIC FEVERS
Chikungunya Virus
Clinical Course
Differential Diagnosis
Investigations
Treatment
Rubella
Pathogenesis
Clinical Features
Diagnosis
Congenital Rubella Syndrome
Prevention
Dengue
Pathogenesis of Dengue Hemorrhagic Fever/Dengue Shock Syndrome
Clinical Features
Cutaneous Features
Differential Diagnoses
Diagnosis
Treatment
Kyasanur Forest Disease
Clinical Features
Ebola Virus
Pathogenesis
Human Transmission of Ebola Viruses
Clinical Features
Diagnosis
Treatment
PICORNAVIRUSES
Coxsackieviruses
Herpangina
Echoviruses
Diagnosis
Foot and Mouth Disease
Clinical Features
Diagnosis
Treatment
MYXOVIRUSES AND RELATED RNA VIRUSES
Measles (Syn: Morbilli, Rubeola)
Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Complications
Course
Treatment
Prevention
Respiratory Syncytial Virus
Pathogenesis
Clinical Features
Diagnosis
CONCLUSION
CHAPTER 8:
Herpes Viruses
INTRODUCTION
CLASSIFICATION OF HERPES VIRUS
Phenotypic Structure of Herpes Virus
Genomic Structure of Herpes Virus
HUMAN HERPES SIMPLEX VIRUS
Introduction
Epidemiology
Etiological Agent
Pathogenesis
Clinical Features
Herpes Gingivostomatitis
Genital Herpes
Genital Herpes in Pregnancy
Other Herpes Simplex Virus Cutaneous Infections
Eczema Herpeticum
Herpetic Whitlow
Herpes Gladiatorum
Herpetic sycosis
Herpetic Keratoconjunctivitis
Neonatal Herpes Simplex Infections
Complications
Herpes Simplex Infection in Immunocompromised
Diagnosis
Detection of Virus/Viral Antigen
Serology
Treatment
General Measures
Systemic Antiviral Therapy
Topical Antiviral Therapy
Newer Antiviral Treatments
Vaccines
Prevention
Prevention of Orolabial and Genital Herpes
Prevention of Neonatal Herpes
VARICELLA-ZOSTER VIRUS
Introduction
VARICELLA
Epidemiology
Etiological Agent and Pathogenesis
Clinical Features
Varicella in Adults
Complications
Varicella in Immunocompromised Children
Varicella in Immunocompromised Adults
Varicella Among Immunized
Varicella in Pregnancy
Diagnosis
Differential Diagnosis
Treatment
General Measures
Antiviral Therapy
Prevention
Vaccination
Passive Antibody Prophylaxis
Antiviral Chemoprophylaxis
Conclusion
HERPES ZOSTER
Introduction
Epidemiology
Etiological Agent
Pathogenesis
Clinical Features
Complications
Herpes Zoster in Immunocompromised
Diagnosis
Differential Diagnosis
General Measures
Treatment
Treatment of Postherpetic Neuralgia
Prevention
Conclusion
CYTOMEGALOVIRUS
Introduction
Epidemiology
Etiological Agent
Pathogenesis
Clinical Features
Cytomegalovirus in the Immunocompromised
Cytomegalovirus Infection in Newborn
Complications
Diagnosis
Treatment
Prevention
Conclusion
EPSTEIN-BARR VIRUS
Introduction
Epidemiology
Etiological Agent and Pathogenesis
Clinical Features
Diagnosis
Treatment
Prevention
HUMAN HERPES VIRUS 6
Introduction
Epidemiology
Etiological Agent and Pathogenesis
Clinical Features
Diagnosis
Treatment
HUMAN HERPES VIRUS 7
Introduction
Epidemiology
Pathogenesis
Clinical Features
Diagnosis
Treatment
HUMAN HERPES VIRUS 8
Introduction
Epidemiology
Etiological Agent and Pathogenesis
Clinical Features
Classic Kaposi’s Sarcoma
Endemic Kaposi’s Sarcoma
AIDS-Associated Kaposi’s Sarcoma
Iatrogenic Kaposi’s Sarcoma
Complications
Differential Diagnosis
Diagnosis
Treatment
Prevention
Conclusion
CONCLUSION
CHAPTER 9:
Human Papillomavirus and Hepatitis A, B, and C Infections
INTRODUCTION AND BRIEF HISTORY
EPIDEMIOLOGY
ETIOLOGICAL AGENT
TRANSMISSION
Incubation Period
Anogenital Warts
PATHOGENESIS5
Viral Latency
IMMUNE RESPONSES TO PAPILLOMA VIRUS INFECTION
Cell-mediated Immunity in HPV Infections
CLINICAL MANIFESTATIONS OF HPV INFECTION
Benign Cutaneous Lesions
Common Warts (Figs 3A and B)
Plantar Warts (Figs 5A and B)
Flat Warts (Plane Warts) (Fig. 6)
Filiform Warts (Fig. 7)
Pigmented Warts
Epidermodysplasia Verruciformis (Figs 9A and B)
Benign Mucosal Lesions
Condylomata Acuminata (Figs 10A and B)
Bowenoid Papulosis (Fig. 12)
Focal Epithelial Hyperplasia
Human Papilloma Virus in Malignant Lesions
Bowen’s Disease of the Genitalia (Fig. 13)
Extragenital Bowen’s Disease (Fig. 14)
Basal and Squamous Cell Carcinomas
Penile Cancer (Figs 15A and B)
Cervical Cancer (Figs 16A and B)
DIFFERENTIAL DIAGNOSIS (BOX 1)
LABORATORY DIAGNOSIS
Polymerase Chain Reaction
In situ hybridization
Southern blot analysis
Histopathology
MANAGEMENT
Destructive Modalities
Salicylic Acid
Cantharidin
Caustics
Formic Acid
Cryotherapy
Radiofrequency Ablation
Laser Ablation
Carbon Dioxide Laser (CO2 Laser)
Erbium: Yttrium/Aluminum/Garnet Laser
Pulsed Dye Laser
Surgery
Antimitotic Therapy
Podophyllin
Podophyllotoxin
Bleomycin
5-Fluorouracil
Immunotherapy
Imiquimod
Interferon Alpha
Contact Sensitizers
Intralesional Immunotherapy
Autoimplantation Therapy
Oral Immunomodulators
Photodynamic Therapy
Virucidal Therapy
Alternative Modalities
Human Papillomavirus Vaccine
Treatment for Special Consideration like Pregnancy, Small Children and Immunosuppressed Patients
HEPATITIS VIRUSES
Hepatitis A
Introduction
Epidemiology42
Transmission
Pathogenesis
Clinical Feature
Diagnosis
Treatment
Prevention43
Pre-exposure Prophylaxis
Post-exposure Prophylaxis
Hepatitis B
Introduction
Epidemiology1
Transmission
Pathogenesis
Clinical Features
Diagnosis
Treatment
Prevention
Precautions
Hepatitis C
Introduction
Epidemiology42
Transmission
Clinical Features
Diagnosis
Treatment
Prevention
CHAPTER 10:
Poxviruses, Rubella, Coxsackie, and Other Viruses
INTRODUCTION
POXVIRUSES (TABLE 2)
General Introduction
GENUS: ORTHOPOXVIRUSES
Genus: parapoxviruses
Orf
Milker’s Nodule/Pseudocowpox/Paravaccinia
Genus: Yatapox
Tanapox
Genus: molluscipox
Molluscum Contagiosum
RIBONUCLEIC ACID VIRUS AND SKIN DISEASE
Introduction
Genus: Paramyxoviruses
Measles
Genus: Togavirus
Rubella (German Measles)
Introduction
Epidemiology
Clinical features
Complications
Diagnosis
Congenital Rubella syndrome
Genus: Picornavirus
Coxsackieviruses: Exanthem
Introduction
Hand-foot-and-mouth Disease
Epidemiology
Etiological agent and pathogenesis
Clinical features
Differential diagnosis
Diagnosis
Treatment
Prevention
CONCLUSION
SECTION 5: MYCOBACTERIAL INFECTIONS
CHAPTER 11:
Leprosy
INTRODUCTION
HISTORY OF LEPROSY
EPIDEMIOLOGY
Global Scenario
Indian Scenario
CHILDHOOD LEPROSY
ETIOPATHOGENESIS
Organism
SOURCE OF INFECTION
CULTURE CHARACTERISTICS
Genome
Structure
Capsule
Cell Wall
Cell Membrane
Cytoplasm
Incubation Period
Transmission
ETIOPATHOGENESIS
CLINICAL COURSE
CLINICAL FEATURES
Indeterminate Leprosy
Tuberculoid Leprosy
Borderline Leprosy (Borderline Tuberculoid, Borderline Borderline, and Borderline Lepromatous)
Lepromatous Leprosy
Pure Neuritic Leprosy
Uncommon Variants
Histoid Leprosy
Lucio Leprosy
Lazarine Leprosy
Systemic Manifestations in Leprosy
Eye
Upper Respiratory Tract
Reproductive System
Lower Respiratory Tract
Lymph Nodes
Gastrointestinal Tract
DIAGNOSIS OF LEPROSY
Laboratory Diagnosis
Slit-skin Smear
Skin Biopsy
Indeterminate Leprosy
Tuberculoid Leprosy
Borderline Tuberculoid
Mid borderline or Borderline Borderline
Borderline Lepromatous
Lepromatous Leprosy
Immunochemical Staining Procedures
Nerve Biopsies
Nerve Ultrasonography
Histamine Test
Other Tests Include
MANAGEMENT OF LEPROSY
REACTIONS IN LEPROSY
Management of Leprosy Reactions
DRUG RESISTANCE IN LEPROSY
Magnitude of Problem
When to Suspect
Methods of Detection
Mouse Footpad Method
Mutation Detection by Sequencing
Mutation Detection by deoxyribonucleic acid Microarray
Buddemeyer Method
Management of Drugs Resistant Leprosy
LEPROSY AND HUMAN IMMUNODEFICIENCY VIRUS INFECTION
LEPROSY IN PREGNANCY
LEPROSY IN CHILDREN
DEFORMITIES IN LEPROSY
MANAGEMENT OF DEFORMITIES
Medical
Physiotherapy
Health Education
Surgical
Ulcer Management (self-care)
LEPROSY VACCINES AND IMMUNOTHERAPY
WHAT IS NEW IN LEPROSY
Uniform Multidrug Therapy
Newer Chemotherapeutic Agents in Leprosy
Rifampicin-Ofloxacin Therapy
Rifampicin-Ofloxacin Minocycline Therapy
PREVENTION
CONCLUSION
CHAPTER 12:
Cutaneos Tuberculosis
INTRODUCTION
EPIDEMIOLOGY
Global Epidemiology of Tuberculosis
Global Epidemiology of Cutaneous Tuberculosis
Epidemiology of Cutaneous Tuberculosis in Indian Subcontinent
Epidemiology of Childhood Cutaneous Tuberculosis Across the Globe and in India
ETIOPATHOGENESIS
Etiological Agent
Host-Pathogen Interaction in Tuberculosis
Predisposing Factors
Route of Infection
Bacillary Virulence and Drug Resistance
Host Constitution
Environmental Factors
CLINICAL CLASSIFICATION IN CUTANEOUS TUBERCULOSIS
TUBERCULOUS CHANCRE (PRIMARY INOCULATION TUBERCULOSIS)
Pathogenesis
Clinical Features
Histopathology
Course
TUBERCULOSIS VERRUCOSA CUTIS (SYN: “WARTY TUBERCULOSIS”)
Pathogenesis
Clinical Features
Differential Diagnosis (Box 5)
Histopathology
Course
BY CONTINUITY OR AUTOINOCULATION
Scrofuloderma
Pathogenesis
Clinical Features
Histopathology and Diagnosis
Course
Orificial Tuberculosis (Syn: Tuberculosis Cutis Orificialis)
Pathogenesis
Clinical Features
Diagnosis
Course
BY HEMATOGENOUS/LYMPHATIC DISSEMINATION
Lupus Vulgaris
Pathogenesis
Clinical Features
Differential Diagnosis
Course
Tuberculous Gumma (Syn: Metastatic Tuberculous Abscess)
Pathogenesis
Clinical Features
Histopathology
Course
Acute Miliary Tuberculosis
Pathogenesis
Clinical Features
Differential Diagnosis
Histopathology
Course
PAPULONECROTIC TUBERCULID
Clinical Features
Differential Diagnosis
Histopathology
Course
Erythema Induratum of Bazin
Clinical Features
Differential Diagnosis
Erythema Induratum of Bazin versus Nodular Vasculitis
Histopathology
LICHEN SCROFULOSORUM
Clinical Features
Differential Diagnosis
Histopathology
SUPERFICIAL THROMBOPHLEBITIC TUBERCULID
BACILLUS CALMETTE-GUERIN AND CUTANEOUS TUBERCULOSIS
HIV AND CUTANEOUS TUBERCULOSIS
DIAGNOSIS
Mantoux Test
Quantiferon TB Gold Tests and T-SPOT TB Test
Histopathology
Demonstration of Acid-Fast Bacillus in the Stained Smear
Mycobacterial Culture
Radiometric Technology
Serological Diagnosis of Tuberculosis
Antigen Detection
Polymerase Chain Reaction
Antitubercular Drug Trial (Therapeutic Trial)
Systemic Screening for Tubercular Focus
TREATMENT
DRUG RESISTANCE IN CUTANEOUS TUBERCULOSIS
PREVENTION
CONCLUSION
CHAPTER 13:
Nontuberculous Mycobacterial Infections
INTRODUCTION
EPIDEMIOLOGY
ETIOLOGICAL AGENT AND PATHOGENESIS
CLINICAL DISEASE
LOCALIZED CUTANEOUS AND SOFT TISSUE INFECTIONS
ENVIRONMENTAL SOURCE OF NTM
SLOWLY GROWING MYCOBACTERIA
M. marinum
Epidemiology
Clinical Findings
Differential Diagnosis
Diagnosis
Treatment
M. ulcerans (Buruli Ulcer, Bairnsdale Ulcer)
Epidemiology
Clinical Findings
Differential Diagnosis
Diagnosis
Treatment
M. kansasii
M. hemophilum
OTHER SLOW GROWERS
M. scrofulaceum
M. szulgai
M. avium complex or M. avium-intracellulare
Incidence
Epidemiology
Clinical Findings
Differential Diagnosis
Diagnosis
RAPIDLY GROWING MYCOBACTERIA1,16
M. fortuitum, M. chelonae and M. abscessus
Epidemiology
Clinical Findings
Differential Diagnosis
Diagnosis
Treatment (Table 3)
IATROGENIC NTM
Treatment of NTM
Prevention
SUMMARY
SECTION 6: PARASITIC AND PROTOZOAL DISEASES
CHAPTER 14:
Human Helminthic Infections (Nematodes, Cestodes, and Trematodes)
INTRODUCTION
NEMATODES
Introduction
Life Cycle
GUINEA WORM DISEASE (DRACUNCULIASIS)
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
Prevention
ONCHOCERCIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
STREPTOCERCIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
LYMPHATIC FILARIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Tests for Detection of Circulating Filarial Antigens
Differential Diagnosis
Treatment
Therapy for Filariasis
Prognosis of Lymphedema
LOIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
ENTEROBIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
HOOKWORM DISEASE
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
STRONGYLOIDIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
CUTANEOUS LARVA MIGRANS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
VISCERAL LARVA MIGRANS: TOXOCARIASIS
Introduction
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
GNATHOSTOMIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Differential Diagnosis
Treatment
DIROFILARIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
TRICHINOSIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
TREMATODE INFECTIONS
SCHISTOSOMIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Complications
Diagnosis
Treatment
CERCARIAL DERMATITIS
Introduction
Etiology and Pathogenesis
Clinical Features
Treatment
PARAGONIMIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
CESTODES
ECHINOCOCCOSIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
CYSTICERCOSIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
SPARGANOSIS
Introduction
Epidemiology
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
CONCLUSION
CHAPTER 15:
Protozoal Diseases
INTRODUCTION
LEISHMANIASIS
Introduction
Epidemiology
Etiology and Pathogenesis
Disease Immunology
Localized Cutaneous Leishmaniasis
Diffuse Cutaneous Leishmaniasis
Clinical Features
Cutaneous Leishmaniasis
Old World Cutaneous Leishmaniasis (Oriental Sore/Baghdad Boil/Delhi Boil/Aleppo Boil/Rose of Jericho)
Diffuse Cutaneous Leishmaniasis (Anergic, Lepromatous or Pseudolepromatous Leishmaniasis)
Mucosal Leishmaniasis
Chronic Cutaneous Leishmaniasis/Leishmaniasis Recidivans Cutis (Lupoid/Tuberculoid Leishmaniasis)
Post-Kala-Azar Dermal Leishmaniasis
Grade 1
Grade 2
Grade 3
Diagnosis
Direct Demonstration of Organism
Direct Smears
Histopathology (Fig. 11)
Culture
Biphasic Blood-Based Media
Serological Tests
Molecular Techniques
Monoclonal Antibodies
Differential Diagnosis
Treatment
Pentavalent Antimonials21-23
Amphotericin B Deoxycholate21,24
Lipid Formulations of Amphotericin B
Paromomycin21,25
Pentamidine Isethionate21,26,27
Miltefosine7,21
Azoles Medicines: Ketoconazole, Fluconazole, Itraconazole28,29
Approach to Therapy
Miltefosine31,32
Duration of Treatment
Amphotericin B33
Duration of Treatment
Definitions of Cure
Clinical Cure
Parasitological Cure
Prevention
Vector Control Methods34-37
Prophylactic Leishmaniasis Vaccines38-40
First-Generation Candidate Vaccines
Second-Generation Vaccines
Immunochemotherapy and Therapeutic Vaccines
CONCLUSION
CUTANEOUS AMEBIASIS41,42
Introduction
Etiology and Pathogenesis
Clinical Features
Diagnosis
Treatment
Prevention
Conclusion
CUTANEOUS TOXOPLASMOSIS43
Introduction
Etiology and Pathogenesis
Clinical Features
Diagnosis
Histopathology
Serology
Treatment
Prevention
Conclusion
TRYPANOSOMIASIS
Introduction
Etiology and Pathogenesis
Clinical Features
Chagoma or Inoculation Chagoma
Romana’s Sign
Schizotripanides
Diagnosis
Treatment
Prevention
Conclusion
MALARIA
CONCLUSION
SECTION 7: INFESTATIONS, BITES, AND STINGS
CHAPTER 16:
Infestations
INTRODUCTION1
SCABIES
Epidemiology
Etiological Agent and Pathogenesis
Causative Organism
Transmission
Life Cycle (Fig. 2)
Host Immune Response (Fig. 3)
Clinical Features4,9
Scabies in Infant and Children
Scabies in Elderly
Nodular Scabies (Fig. 8)
Bullous Scabies
Scabies Incognito
Subungual Scabies
Crusted Scabies (Norwegian Scabies)
Scabies of the Scalp
Genital Scabies
Animal Scabies
Complications
Diagnosis
Skin Scrapings
Skin Biopsy
Dermatoscopy
Reflectance-mode Confocal Microscopy
Differential Diagnosis
Treatment
Scabicidal Drugs
Technique of Topical Antiscabietic Application
Resistance to Treatment
Prevention and Control
Conclusion
PEDICULOSIS
Introduction
Epidemiology
Etiological Agent and Pathogenesis
Causative Organism
Life Cycle (Fig. 17)
Clinical Features25,31,33
Head Louse
Body Louse
Pubic Louse
Diagnosis
Differential Diagnosis25,31,33
Louse-borne Pathogens27
Treatment25,27,31,33
Topical Pediculicides
Oral Pediculicides24
Nonpharmacological and Herbal Pediculicides24,37
Prevention and Control
Conclusion
FLEA (SIPHONAPTERA) INFESTATIONS
Tungiasis
Introduction
Epidemiology1,40-42
Etiological Agent and Pathogenesis40,41
Life Cycle41 (Fig. 24)
Clinical Manifestations40,44,45
Diagnosis40,46-48
Differential Diagnosis40,45,49
Treatment40,41,44,49
Prevention41,45,49
Summary
Human Flea Infestation (Pulex Irritans)
DEMODICIDOSIS
Introduction
Epidemiology
Sites of involvement
Etiology and Pathogenesis
Causative Organism
Life Cycle4,58
Pathogenesis
Clinical Manifestations
Primary Demodicosis52
Secondary Demodicidosis52
Diagnosis
Prevention and Treatment52,58
Conclusion
CHAPTER 17:
Bites and Stings
INTRODUCTION
ANIMAL BITES
Introduction
Epidemiology
Dog Bites
Epidemiology
Clinical Features
Management
Rabies
Cat Bites
Introduction
Epidemiology
Clinical Features
Human Bites
SNAKE BITES
Introduction
Epidemiology
Etiology
Clinical Features
Diagnosis
Treatment
Dos
Don’ts
Prevention
ARTHROPOD BITES AND STINGS
Introduction
Epidemiology
Pathophysiology
Clinical Features
Treatment
Class Insecta
Family Culicidae (Mosquitoes)
Other Flies
Myiasis
Siphonaptera (Fleas)
Hymenoptera
Hemiptera
Lepidoptera (Caterpillars, Moths and Butterflies)
Coleoptera (Beetles)
Class Arachnida
Spiders
Scorpions
Mites
Ticks
Class Chilopoda and Diplopoda
AQUATIC BITES AND STINGS
Hirudinea (Leeches)
Cnidaria (Sea Anemones, Jellyfish and Corals)
Seabather’s Eruption
Echinoidea (Sea Urchins)
Introduction
Clinical Features
Treatment
Porifera (Sponges)
Mollusca
Fish Bites and Venoms
CONCLUSION
SECTION 8: SEXUALLY TRANSMITTED INFECTIONS
CHAPTER 18:
Sexually Transmitted Diseases
INTRODUCTION
ETIOLOGICAL AGENTS
EPIDEMIOLOGY
GENITAL DISCHARGES
Gonorrhea
Introduction
Epidemiology
Etiological Agent
Pathogenesis
Clinical Features
Asymptomatic Infection
Infections in Infants
Complications
Interaction with HIV
Laboratory Diagnosis
Case Classification (Effective January 1, 2014)33
Differential Diagnoses
Treatment25,34
Uncomplicated Gonococcal Infections of the Cervix, Urethra and Rectum
Uncomplicated Gonococcal Infections of the Pharynx
Gonococcal Conjunctivitis
Disseminated Gonococcal Infection
Gonococcal Meningitis and Endocarditis
Ophthalmia Neonatorum Caused By Neisseria Gonorrhoeae
Ophthalmia Neonatorum Prophylaxis
Recommended Regimen
Management of Sex Partners25
Follow-up25
Prevention
Gonococcal Drug Resistance
Chlamydia
Introduction
Epidemiology
Etiological Agent and Pathogenesis
Infections in Men
Littritis
Infections in Women
Other Infections (Both Men and Women)3
Interaction with HIV
Laboratory Diagnosis
Laboratory Criteria for Diagnosis (Revised 6/09)70 Case Classification
Differential Diagnoses
Treatment25
Uncomplicated Chlamydia Trachomatis Infections (Urethral, Endocervical, Rectal)
Chlamydia Trachomatis Infection in Pregnancy
Ophthalmia Neonatorum by Chlamydia Trachomatis
Follow-up25
Management of Sex Partner25
Prevention
Vaccines50
GENITAL ULCER DISEASE
Chancroid
Introduction
Epidemiology
Etiology
Pathogenesis
Clinical Features
Interaction with HIV
Diagnosis
Differential Diagnoses
Treatment
Follow-up
Lymphogranuloma Venereum
Introduction
Epidemiology
Etiology
Pathogenesis
Clinical Features
Interaction with HIV
Differential Diagnoses
Diagnosis
Treatment
Follow-up
Partner Treatment
Syphilis
Introduction
Epidemiology
Etiology
Pathogenesis
Clinical Features
Syphilis and HIV
Diagnosis
Direct Identification of Treponema Pallidum
Differential Diagnoses
Treatment
Primary and secondary syphilis
Neurosyphilis
Congenital Syphilis
Follow-up
Partner Treatment
Granuloma Inguinale (Donovanosis)
Introduction
Etiology and Pathogenesis
Epidemiology
Clinical Features
Differential Diagnoses
Diagnosis
Treatment
Management of Sex Partners
Special Considerations
Complications
CHAPTER 19:
Human Immunodeficiency Virus
INTRODUCTION
EPIDEMIOLOGY
Global
Indian Scenario
ETIOLOGIC AGENT AND PATHOGENESIS
CLINICAL FEATURES
DIAGNOSIS OF HIV INFECTION
Human Immunodeficiency Virus Antibody Tests
Antibody Tests: HIV EIA/ELISA (Microwell Format)
Viral Particle Detection
CD4 T Cell Count
Plasma HIV RNA Testing
Coreceptor Tropism Assays
TREATMENT15
Immune Reconstitution Inflammatory Syndrome17
DERMATOLOGIC INFECTIONS ASSOCIATED WITH HIV/AIDS
Bacterial Infections
Staphylococcal Skin and Soft Tissue Infections
Bacillary Angiomatosis
Mycobacterial Infections
Cutaneous Tuberculosis
Atypical Mycobacterial Infections
Leprosy
Viral Infections
Varicella Zoster Virus
Molluscum Contagiosum
Epstein-Barr Virus
Cytomegalovirus
Kaposi’s Sarcoma
Fungal Infections
Cryptococcosis
Coccidiomycosis
Histoplasmosis
Penicillium Marneffei
Pneumocystis Jiroveci
Candidiasis
Dermatophytosis
Leishmaniasis
Human Immunodeficiency Virus and Sexually Transmitted Diseases
Genital Herpes
Syphilis
Chancroid
Granuloma Inguinale
Lymphogranuloma Venereum
Human Papillomavirus Infections
Other Sexually Transmitted Diseases
Scabies
PREVENTION OF OPPORTUNISTIC INFECTION IN HIV
ACKNOWLEDGEMENTS
CONCLUSION
CHAPTER 20:
Human T-cell Lymphotropic Virus and Related Diseases
INTRODUCTION
EPIDEMIOLOGY
CLINICAL FEATURES
Infective Dermatitis
Scabies
Mycoses
Strongyloidiasis
Leprosy
DIAGNOSIS
PREVENTION
CONCLUSION
INDEX
TOC
Index
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