Diseases Due to Bacteria

Diseases Due to Bacteria

Erysipelas: A Streptococcal Infection
This is an acute infection and is highly contagious. It follows small scratches, abrasions or wounds, by the penetration of strepto-coccal bacteria into the deeper layers of the skin. Infection is favoured by debilitated states, and lack of skin care, and the out-breaks are most common in the spring.

The eruption most often occurs on the face, after an incubation period of about two to five days, and is preceded by malaise, head-ache, fever, dry tongue, rigors, and vomiting. The infected area is of a bright red color with a hot shiny surface, and usually starts with a single patch with definite raised edges and irregular outline, which spreads rapidly with small vesicles at the edge. There is much swelling and if the disease affects the face the patient may be almost unrecognizable, while the disease may spread into the mouth. On the limbs red streaks of lymphangitis may be visible.

The rash lasts about a week and then abates, unless the infection extends into underlying structures. Such a condition used to lead to severe complications but the cur-rent infection is much milder and responds quickly to treatment.

Treatment requires isolation with rest in bed. The case should be treated by a physician. A light or fluid diet is required.

Given immediately the disease is diagnosed, antibiotics rapidly control the infection so that skin treatment is seldom needed. For recurrent attacks, for babies, and for elderly patients penicillin is often preferred. Calamine lotion, or simple hot fomentations may be used to relieve the pain and oedema.

Impetigo: A Mixed Infection
Impetigo contagious is an infective nflammation of the skin, often staphylococcal in origin, with vesicles which suppurate, and when they break yield a serous or honey-like exudate which forms characteristic yellow crusts. The infection enters through an excoriation or scratch, and generally affects children, especially in the region of the mouth or scalp. It is often secondarily affected by streptococci, spreads rapidly, and is very contagious.

Treatment consists in careful bathing off of the crusts with 1 per cent cetrimide solution and removal of any hair. An application of 1 per cent crystal violet (gentian violet) in 25 per cent spirit is effective. A better application is an antibiotic cream put on freely after removal of the crusts; the skin should be clear in about a week. Hibitane (chlorhexidine) cream, 1 per cent, is often very useful.

In extensive eruptions, warm starch poul-tices may be used to assist separation of the spirit, the skin being then swabbed with scabs, The patient's towels, brushes, and clothes should be segregated, and school children should be kept from school. Gloves may be required to be worn to prevent scratching.

Sycosis: A Staphylococcal Infection (Barber's Itch)
Sycosis is a pustular eruption with crusts, which somewhat resembles impetigo contagious. The crusts occur in the hair follicles of the beard region; it is often very intractable and is highly contagious. As the pustules dry and heal new foci appear, so that the infection spreads, and the hairs gradually drop out of their infected follicles. Sometimes secondary infection with boils, eczema, or impetigo develops, while the condition occasionally affects the scalp, eyelids, armpits, or pubes.

Treatment is similar to that used for impetigo but is often protracted, since the infection is deeper and is less easily destroyed. The hairs should be pulled out with forceps, and any deep pustules may be opened. It is generally advisable to discontinue shaving, since this may cause reinfection of abrasions; in any case the shaving brush should be kept disinfected. Alternatively the hair of the affected area may be clipped short.

Vioform and Quinolor ointments are recommended. Antibiotic creams may be ordered by a doctor. When the skin is much inflamed fomentation's of 1 in 4,000 mercury per-chloride solution may be used before more active treatment is started.

Boils (Furuncles)
A boil is a localized infection of the skin, arising in a hair follicle or sebaceous gland. It usually proceeds to abscess formation. At first a tender nodule or hardness is felt just under the skin, which soon begins to look red. A painful tumour now begins to show, of a dusky red or purple color, which increases to the size of a pea, a hazel-nut or a walnut. Some time between the fourth and eighth day it becomes pointed and white at the top, when the skin breaks and lets out a little pus mixed with blood, and exposes a core or slough. In two or three more days this core comes away, leaving a cup-like cavity which gradually fills up, and the boil then gradually heals in two or three weeks.

Boils are liable to occur in parts exposed to friction, such as the neck and buttocks. Very often crops of boils occur over a period of some weeks or months. In the passage of the ear, boils are exceedingly painful, while on the nose or upper lip a boil may cause infection of a vein leading to the brain and may prove fatal.

A 'blind boil' is slow in pointing, and may persist for some weeks.

There are various causes of boils, but they are commonly associated with debilitated conditions, dirt, or irritation of the skin by friction. Diabetes mellitus is often associated with recurrent attacks of boils and carbuncles.

Treatment
General cleanliness by use of antiseptic soaps is indicated, coal-tar soap or carbolic soap being suitable. Any sources of irritation, such as frayed collars, should be avoided when boils occur on the neck.

Locally, apply glycerin and ichthammol (10 per cent) on lint until the boil points, and then incise gently to allow drainage. Regions such as the axilla should not be shaved and not fomented, since the surrounding hair follicles tend to become infected.

A paint of 1 per cent solution of crystal violet or brilliant green should be used daily (these solutions dye the skin). After the boil has opened, apply small dressings of glycerin and magnesium sulphate paste, or use glycerin and ichthammol as above.

Paint the surroundings of the boil with iodine, which will prevent a crop of pustules appearing round the boil. General tonic treatment, with an iron mixture, is usually required.

Antibiotics may be given if the boil is in a dangerous situation, as on the upper lip, or if there are signs of general spread.

An open-air holiday is often beneficial, and the diet should contain plenty of green vegetables and fruit, with restriction of sugar.

Carbuncles
A carbuncle is somewhat like a boil, only much larger and more painful. Instead of one hair follicle being inflamed, as in the case of a boil, a carbuncle is a confluent mass of boils in several follicles. The surface is flatter than that of a boil, the inflammation is more severe and the constitutional symptoms are more acute.

Like boils, a carbuncle develops most often upon the nape of the neck, the shoulders, the back, the buttocks or the thighs.

The diameter may be two or three inches, and the surface is dusky red and painful for about seven to ten days until the centre softens and perforates, often at several points. Pus is discharged, and a large slough eventually separates. The central cavity heals slowly, leaving a large scar.

Carbuncles most often occur in men over middle age, and diabetes mellitus, alcoholism and albuminuria are often predisposing causes. They cause much pain especially in old or debilitated people. Upon the head or neck they are more dangerous than in other situations.

Treatment
To avoid any further spread of the infection, the carbuncle and the skin around it should be smeared with an anti-septic cream such as Hibitane, or the physician may prefer to use a topical antibiotic such as Neobactrin ointment. The whole body should be washed daily with an antiseptic soap.

Antibiotics such as penicillin or cloxacillin are prescribed when the carbuncle is large or on the face and the patient has some associated fever.

Where pus has already formed and it is too late for antibiotic treatment, or where the carbuncle does not discharge naturally, an incision will be made to release the pus.

Ultraviolet light therapy may be beneficial. The general health requires great care, with rest, fresh air, and a nourishing diet.

Leprosy
Leprosy is a general disease with extensive skin manifestations; it is caused by the Mycobacterium leprce, but the mode of invasion remains obscure. The disease may be contracted by contagion from leprous sores or discharges from the mouth or nose of a leper. It is associated with dirt and squalor.

The incubation period may be several years; after a long interval there may be vague malaise, drowsiness, pains and pricking sensations. In the lepromatous nodular skin affection, fever occurs in bouts and there are nodules in the skin and mucous membranes.

In tuberculoid leprosy an erythematous rash appears with patches on the arms, hands, feet, and face; later these may become numb, lose sensation, and form ulcers. The eyes are generally involved also, and in the last stages the toes, fingers and indeed the whole limb may undergo dry gangrene and drop off. The disease is very chronic.

Treatment
Sulphone drugs, dapsone (D.D.S.) and solapsone (Sulphetrone), have revolutionised the treatment of leprosy. Although treatment may have to be continued for up to five years, a number of cures have been effected. Treatment always requires the care of a physician. See also Fevers and Infectious Diseases.

In developing countries, BCG vaccination is given to prevent leprosy.

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