Background

Bacteria have sometimes become the substitute for any infection. If someone has a cold, we think they should be prescribed antibiotics. In reality, most colds are caused by viruses and most antibiotics are ineffective against them. Recently, bacteria have made tabloid headlines with horrific cases of flesh eating bacteria. Yet, most of history has been manipulated by the bacteria. We read of leprosy in the biblical times, the plague during the middle ages, and cholera in modern times. The coming of antibiotic therapy in the 1940's appeared to promise eradication of most of earth's diseases. Unfortunately, the development of antibiotic resistance has stymied our best efforts at keeping these organisms in check.

Actinomycosis
Anthrax (Bacillus anthrax)
Bacillary Angiomatosis
Bartonella Infections (Bartonellosis, Carrion's Disease)
Chancroid (Haemophilus ducreyi)
Clostridium
E. coli
Ehrlichiosis
Enterococcus (VRE)
Erythrasma
Gonorrhea
Granuloma Inguinale
Hemophilus influenzae (H. flu)
Impetigo
Leprosy
Lyme Disease
Lymphogranuloma venereum
Mycetoma
Nanobacteria
Necrotizing Fasciitis (Flesh Eating Bacteria Disease)
Neisseria meningitidis
Pseudomonas
Rhinoscleroma
Rocky Mountain Spotted Fever
Shigella (Shigellosis)
Staphylococcus
Streptococcus
Syphilis
Tuberculosis (Mycobacterium tuberculosis)
Tuberculosis, Atypical (Atypical Mycobacterium, MAI, Swimming pool granuloma, Scrofuloderma)
Tularemia
Vibrio vulnificus
Yersinia

OUTLINE

Disease Associations
Treatment
Commonly Used Terms
Internet Links

DISEASE ASSOCIATIONS	CHARACTERIZATION
Tropical dermatology: bacterial tropical diseases. Lupi O, Madkan V, Tyring SK. Department of Medical Clinics, Dermatology, Federal University of Rio de Janeiro, Instituto de Dermatologia da Santa Casa da Misericordia do Rio de Janeiro, Brazil.	J Am Acad Dermatol. 2006 Apr;54(4):559-78; quiz 578-80. Abstract quote   Bacterial infections are common in tropical parts of the world and can include those species also seen regularly in temperate climates. Many tropical bacterial infections, however, are rarely diagnosed in temperate parts of the world and include bartonellosis, tropical ulcer, tropical pyomyositis, granuloma inguinale, lymphogranuloma venereum, yaws, pinta, melioidosis, and glanders. Some tropical bacterial diseases, eg, plague and anthrax, are associated with high mortality rates and are of potential use in bioterrorism. Some tropical bacterial diseases are closely associated with specific activities such as hunting (ie, tularemia) or eating raw seafood (Vibrio vulnificus infection). The bacterial diseases having the most severe medical impact in the tropics are those caused by members of the Mycobacterium genus. Millions of persons throughout the world suffer from tuberculosis and leprosy; Buruli ulcers are common causes of morbidity in many tropical countries. Because of the increasing frequency of travel to tropical parts of the world for tourism and work as well as the increasing number of immigrants and adoptees from these areas, it is imperative that physicians practicing in temperate climates be able to recognize the signs and symptoms of tropical bacterial diseases, carry out the proper diagnostic tests, and initiate appropriate therapy and prevention. LEARNING OBJECTIVE: At the completion of this learning activity, participants should be familiar with the clinical presentations, epidemiologies, diagnoses, therapies, and preventions of bacterial tropical diseases.
Gram-negative bacterial toe web infection: A survey of 123 cases from the district of Cagliari, Italy Nicola Aste, MD Laura Atzori, MD Miriam Zucca, MD Monica Pau, MD Pietro Biggio, MD Cagliari, Italy	J Am Acad Dermatol 2001;45:537-41 Abstract quote Background: Foot intertrigo is mostly caused by dermatophytes and yeasts, less frequently by gram-positive and gram-negative bacteria. Nevertheless, the importance of polymicrobial infections and especially colonizations of Pseudomonas aeruginosa can cause therapy problems in relation to antibiotic resistance and the risk of potentially lethal complications. Objective: The aim of this study was to evaluate the main epidemiologic and clinical features of intertrigo from gram-negative bacteria, the function of promoting factors, and the measures taken to treat and prevent this disorder. Methods: Between 1989 and 1998, 123 cases of intertrigo from gram-negative bacteria were observed at the Cagliari University Dermatology Department. Routine clinical and blood examinations, repeated bacterioscopic and mycologic examinations, cultures aimed at identifying the responsible bacteria, and antibiograms were performed. Results: P aeruginosa was found to be the prevailing pathogen, both alone and associated with other gram-negative bacteria (such as Escherichia coli, Proteus mirabilis, Morganella morganii) and gram-positive bacteria. Clinical manifestations were similar in the majority of patients: erythema, vesicopustules, erosions, and marked maceration caused by abundant, malodorous exudate. Lesions affected the interdigital spaces of both feet and frequently extended to the planta and the back of the toes. Patients complained of burning and pain. Successful therapies were achieved with combined topical and systemic treatment; to avoid the risk of antimicrobial resistance, the choice of the active antibiotic was guided by antibiograms. Conclusion: In all symptomatic toe web infections, the presence of gram-negative germs, such as P aeruginosa, should be investigated to avoid the risk of treatment failures and more severe local or systemic complications.

 

CLINICAL VARIANTS	CHARACTERIZATION
KLUYVERA
Clinically significant kluyvera infections. Carter JE, Evans TN. Department of Pathology, University of South Alabama, Medical Center, Mobile.	Am J Clin Pathol. 2005 Mar;123(3):334-8 Abstract quote.   To determine the clinical significance of Kluyvera isolates at our institution, we retrospectively analyzed clinical microbiology data from January 1999 to September 2003. We identified 11 isolates classified as Kluyvera ascorbata, 7 of which were considered clinically significant pathogens: 3 cases represented urinary tract infections; 2, bacteremia; 1, a soft tissue infection of the finger; and 1, acute appendicitis with a subsequent intra-abdominal abscess. The age distribution of patients was wide, ranging from 2 months to 73 years. Antimicrobial susceptibility studies of the clinically significant and non-clinically significant Kluyvera isolates showed susceptibility patterns similar to those reported in the medical literature, namely trends of resistance to ampicillin and first- and second-generation cephalosporins. Of the 4 non-clinically significant isolates in our study, 1 was resistant to ciprofloxacin, a finding reported in only 1 other isolate of Kluyvera in the medical literature. Patient outcome after treatment with third-generation cephalosporins and aminoglycosides in the 7 clinically significant cases was good, with no long-term sequelae. The potential virulence of K ascorbata highlights the need for heightened scrutiny of its antimicrobial susceptibility patterns for adequate clinical treatment.
TSUTSUGAMUSHI
Diagnosis of scrub typhus by immunohistochemical staining of Orientia tsutsugamushi in cutaneous lesions. Kim DM, Park CJ, Lim SC, Park KH, Jang WJ, Lee SH. Division of Infectious Diseases, Department of Internal Medicine, Chosun University College of Medicine, Gwangju, Republic of Korea.	Am J Clin Pathol. 2008 Oct;130(4):543-51. Abstract quote We assessed the clinical usefulness of immunohistochemical staining on skin biopsy specimens for the diagnosis of scrub typhus compared with indirect immunofluorescent antibody assay (IFA), the definitive diagnostic method for scrub typhus, in a prospective study of 125 patients with possible scrub typhus in 2005 and 2006. Skin biopsy specimens were obtained from 63 patients. To minimize the effects caused by antibiotics on immunohistochemical results, 46 patients were assessed before antibiotic administration (4 patients received antibiotic therapy before admission; 13 underwent skin biopsy after antibiotic administration at our hospital). Compared with IFA results, immunohistochemical results on maculopapular skin lesions demonstrated a sensitivity of 0.65 and a specificity of 1. Immunohistochemical results on eschars demonstrated a sensitivity of 1 and a specificity of 1. For immunohistochemical staining performed on skin lesions within 3 or 4 days of administration of antibiotics that are effective for Rickettsia, the antibiotics did not greatly influence diagnostic sensitivity. Immunohistochemical staining of skin biopsy specimens, particularly that of eschars, is sensitive and specific, and this technique can be reliable for confirming the diagnosis of scrub typhus.

 

TREATMENT	CHARACTERIZATION
ANTIBIOTIC RESISTANCE
Use of antimicrobial agents in consumer products. Tan L, Nielsen NH, Young DC, Trizna Z.	Arch Dermatol 2002 Aug;138(8):1082-6 Abstract quote OBJECTIVES: To summarize available data on the effectiveness of antimicrobial ingredients in consumer products such as hand lotions and soaps and to discuss the implications of such use on antimicrobial resistance. DATA SOURCES: We searched the MEDLINE database, 1966 to 2001, using the search term resistance qualified with the terms consumer product(s), OR soap, OR lotion, OR triclosan, and LexisNexis and the World Wide Web using the search strategy antimicrobial resistance AND consumer product. DATA EXTRACTION: English-language articles were selected that provided information on the use of antimicrobial ingredients in consumer products and the effect of this use on antimicrobial resistance. DATA SYNTHESIS: Despite the recent substantial increase in the use of antimicrobial ingredients in consumer products, the effects of this practice have not been studied extensively. No data support the efficacy or necessity of antimicrobial agents in such products, and a growing number of studies suggest increasing acquired bacterial resistance to them. Studies also suggest that acquired resistance to the antimicrobial agents used in consumer products may predispose bacteria to resistance against therapeutic antibiotics, but further research is needed. Considering available data and the critical nature of the antibiotic-resistance problem, it is prudent to avoid the use of antimicrobial agents in consumer products. CONCLUSIONS: The use of common antimicrobials for which acquired bacterial resistance has been demonstrated should be discontinued in consumer products unless data emerge to conclusively show that such resistance has no effect on public health and that such products are effective at preventing infection. Ultimately, antibiotic resistance must be controlled through judicious use of antibiotics by health care professionals and the public.

Macpherson and Pincus. Clinical Diagnosis and Management by Laboratory Methods. Twentyfirst Edition. WB Saunders. 2006.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 6th Edition. McGraw-Hill. 2003.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fifth Edition. Mosby Elesevier 2008

Gram stain-This is one of most common stains used in microbiology. By applying this stain to a slide of bacteria, most bacteria can be divided into gram positive and negative forms. This distinction has led to basic classification systems of bacteria which in turn leads to treatment.

Flagella-These whiplike appendages at one end of the organisms aid in movement. For the pathologist they aid in speciation.

Spores-Some bacteria form spores during periods that are unfavorable for growth. These spores are resistant to most disinfectants and temperature variations. When conditions are favorable, the spores can give rise to rapidly growing bacteria.

Basic Principles of Disease
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Commonly Used Terms
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Diagnostic Process
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Surgical Pathology Report
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Special Stains
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Last Updated October 13, 2008

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