Scabies pathogen, transmission route, prevention. Scabies: pathogen, how to recognize, typical manifestations, how to get rid of the mite, medications, prevention. Such places include

This disease was once described by Aristotle. Mention of it can also be found on the pages of the Old Testament. But it was only in the Middle Ages that the role of the tick in transmitting the disease was suggested. In different countries, the disease was called differently: psora (Ancient Greece), scabies (Ancient Rome). In Russia it is known as scabies.

Some researchers believe that the disease has a wave-like (periodic) nature. But a number of scientists do not support this view. They attribute some of the cyclicality to surges associated with natural disasters, wars, famines and other events involving overcrowding and unsanitary conditions.

According to statistics, in the last years of the last century, 5% of people on the entire planet suffered from scabies. People of all ages are infected, with more cases occurring among children and young people.

Meet the scabies mite

Methods of transmission

The main route of transmission of the pathogen is contact with the skin of a sick person. There have been cases of infection after using linen or a patient's bed, upholstered furniture and during sexual contact. Because of this, scabies is classified as a sexually transmitted disease (STD). Animals can also get scabies, but this variety is not transmitted to humans. Even if they get sick, they recover quickly. Ignoring hygiene rules increases the risk of disease.

How dangerous is infection with scabies?

The scabies mite is not a human-friendly organism. Its invasion of the skin does not go unnoticed. In addition to unpleasant symptoms, various complications may occur such as:

Typical symptoms of scabies

Another symptom of scabies is a rash. Although some people experience vague signs, the rash still appears sooner or later, and in certain places. For diagnosis, the location of the rash is even more important than its type.

Almost all patients observe small nodules in the interdigital spaces, as well as on the lateral surfaces of the fingers. Including the rash is found on:

After a few weeks, the nature of the rash changes: it becomes papulovesicular. This is the result of the vital activity of ticks, the manifestation of an allergic reaction to their excrement. Purulent rashes and bloody crusts may appear. Usually the rashes are located symmetrically.

Typical scabies manifests itself in a group pattern of itching. If all family members experience itching, which gets worse in the evening, then a visit to a specialist in skin diseases cannot be avoided.

How does scabies manifest itself in children?

Children's scabies has a number of features:

1. There is no clear symmetrical localization of the rash. The rash can be found on any part of the child’s body, even on the face and head.
2. Infants and children of kindergarten age may experience splitting of the nails. They thicken and cracks may even appear.
3. Children often experience general malaise: the temperature rises, tearfulness, irritability appear, loss of appetite occurs, the child becomes weak, and other diseases arise due to decreased immunity.

Video: photo gallery of scabies manifestations

How to diagnose scabies?

The basic principles of diagnosis include:

• Personal examination of the patient the presence of characteristic scabies.
• Microscopic examination of skin scraping.
• Specific laboratory diagnostics. For examination, the tick is removed using a needle. This is an older way.
• Express diagnostics. To brighten the epidermis, the drug uses lactic acid.
• Sometimes layer-by-layer scraping of the epidermis is performed. In this case, lactic acid is replaced with a mixture of glycerin and alkali.

Complications make diagnosis difficult.

Scabies is differentiated from diseases that also accompany itching. Such diseases include microbial eczema and nodular pruritus. However, unlike scabies, the itching of these ailments bothers the patient during the day. A sure sign of scabies is the passages of female mites.

Scabies also needs to be differentiated from scabies, since they have many common symptoms. The diagnosis is clarified using serological studies.

The symptoms of childhood pruritus and urticaria are also very similar to those of scabies. Other similar diseases are dermatitis, eczema, pityriasis rosea, inflamed insect bites (for example), allergic rashes.

Scabies can be considered an indicator of other STDs. This is explained by the inability of damaged skin to resist a new infection.

Types of scabies

Making diagnosis difficult, scabies can occur in several clinical forms at once; we will focus on the most well-known of them.

The best medications for ticks:

Rub the anti-scabies ointment into the skin for 10 minutes. Pay special attention to the main locations of the rash. Rub once a day (in the evening) for five days. After the course they wash and change clothes. You must try not to damage the delicate skin of the genital organs, femoral and inguinal folds, and the nipple areas.

If there are complications in the form of pustular rashes or ulcers, they must first be treated. For eczema, antihistamines and topical corticosteroids are used.

Sulfur preparations are very effective, but even the best drugs have their drawbacks:

1. Smell;
2. Long-term use;
3. Soiled laundry;
4. They are not prescribed to infants.

Benzyl benzoate emulsion

It is used to treat both adults and young children. It is recommended to rub into the skin for two days. After this, the patient must take a shower and change all underwear. For children, the product is rubbed into the scalp (the scalp) and face. But you have to be careful not to get it in your eyes.

If new rashes appear on the skin, and the patient is bothered by nighttime itching, then treatment must be continued for two more days.

Peruvian balsam

In its production, a legume plant is used, which contains the same benzyl benzoate, but of natural origin. Side effects include eczema and kidney intoxication.

Crotamiton

It not only has anti-itch properties, but also relieves itching. Nevertheless, there are still cases where this remedy did not help. The advantage of the drug is that it can even be applied to the skin of a child’s face.

It is important not to self-medicate, but to apply medical recommendations.

Features and Issues

Sometimes treatment does not reduce itching. The main causes of this condition:

• A mixture of sour cream and hunting powder in a ratio of 3:1. Leave the mixture in a warm place, stirring constantly, for two hours. The ointment is applied to the entire body. After complete absorption, rinse with water.
• Cream with celandine (2:1). You can use the product in the form of compresses. At the same time, the laundry does not get dirty. This ointment is odorless, which is important for some patients.
• Since ancient times, scabies was treated with heated lard, to which elecampane root and tar were added.

How to prevent the disease?

To prevent the spread of the disease, certain scabies prevention measures must be observed. Necessary:

While you can protect yourself from many STDs using a condom, this does not apply to scabies. The causative agent of the disease is transmitted through any contact of the skin of a patient with the skin of a healthy person.

Video: scabies in the program “Live Healthy!”

Characteristic signs of scabies are mite tunnels and itching. They can be found on the skin as small, sinuous lines. The most common location is the interdigital folds of skin on the hands, the back of the forearm. The passages may not be noticeable until a rash appears, which is accompanied by severe itching.

Common causes

Scabies is a fairly common skin disease and is transmitted through contact, both through household and sexual contact with a person with scabies or with objects (clothing, bedding) used by the patient. Infection can only occur from person to person.

Diagnosis of scabies in our clinic

To diagnose scabies, in most cases it is enough to correctly collect an anamnesis, thoroughly examine the patient and do a dermatoscopy of the rashes and scabies tracts. In some cases, microscopy of skin scrapings may be necessary to confirm the diagnosis. In the photographs you can see the microscopic picture of scabies. The first photo shows a scabies mite, and the second photo shows scabies mite eggs and excrement.

photographic materials from the daily practice of the clinical director of the clinic

How to treat scabies in the clinic

For effective scabies treatment drugs are used that are prescribed locally in the form of solutions, ointments and creams. These are drugs with acaricidal (i.e., tick-killing) action. One of the effective and safe drugs prescribed for scabies is Permethrin. In case of intolerance (in rare cases) or an allergic reaction to the drug, Spregal may be prescribed.

It is not recommended to self-medicate, as it may not produce results and lead to a long process. In addition, other family members living with the patient will become infected with scabies, and eventually the whole family will have to see a doctor.

The name of the pathogen comes from ancient Greek. σάρξ (meat, pulp), κόπτειν (gnaw, tear, cut) And lat. scaber (comb).

Characteristic signs of the disease are itching and papulovesicular rash, often with the addition of secondary pustular elements due to infection during scratching. The word “scabies” itself has the same root as the verb “to itch.”

History of the study of the disease

Reliable evidence of the role of scabies mites in the development of the disease appears only after the creation of an optical microscope. In 1687, the Italian physician Giovan Cosimo Bonomo and the pharmacist Giacinto Cestoni first described the connection between scabies mites and the typical skin symptoms that develop following infection. It was they who first established that the disease could be caused by a microscopic organism.

A complete and reliable description of the etiology and pathogenesis was given in 1844 by the German dermatologist Ferdinand Hebra. This manual was translated into Russian in 1876 by A. G. Polotebnev.

How is scabies transmitted?

Scabies almost always occurs through prolonged direct skin-to-skin contact. The predominant route of transmission is sexual. Children often become infected when they sleep in the same bed with sick parents. In crowded groups, other direct skin-to-skin contacts are also realized (contact sports, children fussing, frequent and strong handshakes, etc.). Although a number of manuals continue to reproduce outdated information about the transmission of scabies through household items (household items, bedding, etc.), experts agree that such a route of infection is extremely unlikely. The exception is cases of Norwegian scabies, when up to several million mites live on the patient’s body (in typical cases this is 10-20 mites).

The key experiment, which proved that direct contact with the patient’s skin plays a dominant role in the transmission of scabies, was performed in 1940 in Great Britain under the leadership of Mellanby. Of 272 attempts to infect volunteers by placing them in a bed from which patients with severe scabies had just risen, only 4 attempts led to illness.

Scabies infection through animals

Dogs, cats, ungulates, livestock, etc. may be infected by various variants of the Sarcoptes scabiei mite, which can be transmitted to humans. This produces a picture similar to localized cutaneous scabies caused by the human variant of scabies (Sarcoptes scabiei var. hominis). However, all other variants of the mite are not able to complete the full life cycle on human skin, so this scabies is short-lived and does not require treatment with scabicides.

Life cycle of scabies mite

Mite mating occurs on the surface of the skin. Immediately after mating, the males die. A fertilized female forms an itch tract in the stratum corneum of the skin, in which she lays 2-4 eggs per night. Ticks dissolve skin keratin using special proteolytic enzymes contained in their saliva (they feed on the resulting lysate). Males form short lateral branches in the female's scabies passage. The lifespan of a female does not exceed 4-6 weeks. The larvae hatch after 2-4 days and immediately begin to form burrows in the very top layer of the skin. After another 3-4 days, the larvae molt and turn into protonymphs, which in turn molt after 2-5 days into teleonymphs. Teleonympha develops into an adult male or female in 5-6 days. In total, the formation of an adult tick occurs in 10-14 days.

The mite can be infectious at any stage of development, but more often scabies is transmitted from person to person with fertilized adult females.

Ticks are not active during the daytime. The female begins to “dig” the tunnel (2-3 mm per day) in the evening; At the same time, itching intensifies in patients with typical forms of scabies. At night, females come to the surface of the skin to mate and move to other parts of the body (on the surface of warm skin, mites move at a speed of 2.5 cm per minute. The most favorable situation for infection then arises.

A characteristic, but not obligatory, clinical symptom of scabies is itchy skin, which gets worse in the evening. An erythematous papulovesicular rash forms on the skin; when scratched, pustular elements join and crusts form with the formation of polymorphic rashes. A pathognomonic sign is the presence of scabies.

As soon as a female mite lands on human skin, she immediately begins to “dig” a passage in the stratum corneum of the skin at a speed of 0.5-5 mm per day. As a result, on the surface of the skin, upon careful examination, one can detect whitish-gray lines slightly rising above the surface of the skin, ranging in size from 1 mm to 1 cm. The anterior blind end of the passage is distinguishable by the presence of a mite in it, which is visible through the epidermis in the form of a dark dot. The scabies tracts become visible after a few days when the peritunnel reaction of the host body forms. Most often, scabies can be found in the spaces between the fingers, on the inside of the wrists and on the skin of the penis. Sometimes it is not possible to detect scabies burrows (scabies without burrows).

The rash is distributed most often (in descending order) in the interdigital spaces of the hands, on the flexor side of the wrists; in men, it quickly moves from the hands to the penis and scrotum. Then the elbows, feet, armpits, areas under the breasts in women, the umbilical area, the belt line, and buttocks are affected. As a result, the entire body can be involved, except for the face and scalp (although in children under 3 years of age, these areas are also affected).

The presence of itching, primary rash and scabies is the main clinical symptom complex of a typical form of scabies.

Papules and vesicles often develop into secondary itch elements: excoriations (scratching), secondary pustular rashes and crusts. Primary and secondary elements coexist in one patient.

In domestic dermatology, it is customary to identify characteristic eponymous symptoms that facilitate diagnosis:

- Ardi's symptom - pustules and purulent crusts on the elbows and in their circumference;
- Gorchakov's symptom - bloody crusts there;
- Michaelis symptom - bloody crusts and impetiginous rashes in the intergluteal fold with transition to the sacrum;
- Sezari's symptom - detection of scabies in the form of a slight elevation upon palpation.

Scratching often leads to severe bacterial infection of the primary elements with the development of pyoderma, which in rare cases can lead to post-streptococcal and possibly rheumatic heart disease. Sometimes pyoderma with scabies is accompanied by the appearance of boils, ecthyma and, accompanied by lymphadenitis and lymphangitis. A number of patients develop microbial eczema or allergic dermatitis, which, along with pyoderma, in domestic dermatology are classified as complicated forms of scabies.

Etiology and pathogenesis. The causative agent is the scabies mite (sarcoptes scabiei). Infection occurs through direct contact with a patient or through household items (usually underwear and bed linen, clothing), less often in baths. The incubation period lasts for the most part 7-10 days, rarely longer. Infection is facilitated by poor skin hygiene.

Symptoms Severe itching appears, intensifying at night when warming up in bed, and rashes on the skin of nodules, blisters, bloody crusts and linear scratches, as well as characteristic scabies in the form of zigzag lines of dirty gray color, consisting of black dots. Typical localization of rashes is the flexor surfaces of the upper and lower extremities, the anterior wall of the axillary cavities, the abdomen and lateral surfaces of the torso, elbows, as well as in men - the skin of the penis, in women - the skin of the mammary glands, in children - the palms, soles and buttocks. Scabies are localized mainly on the lateral surfaces of the fingers, in the area of ​​the flexor surface of the wrist joints, in the circumference of the nipples in women and on the penis in men.

There are erased scabies farms, when the disease is limited to single nodules located not in typical places with weakly expressed and the absence of typical scabies tracts.

As a result of scratching scabies often complicated by pyoderma.

Differential diagnosis may be difficult in cases of erased forms of the disease, the absence of typical scabies tracts and complications with pyoderma. The presence of severe itching, especially at night, scratching in the area of ​​the nipples in women, buttocks in children, and the localization of rashes mainly on the flexor surfaces of the limbs help make a diagnosis. Ticks and their eggs can be found in sections of the stratum corneum of the skin of the affected areas. Mites are also found at the very end of the scabies tract.

Treatment. Wilkinson's ointment or 33% sulfur ointment is prescribed for rubbing into the skin, especially carefully in the places where scabies is predominantly localized; rub the ointment 1 or 2 times a day (morning and evening) for 5-7 days; on the 6-8th day, wash with soap and change linen. After each rubbing, to avoid the development of dermatitis, the skin should be powdered with a mixture of talc and starch in equal parts. For children, 10-15% sulfur ointment is used.

Treatment according to the Demyanovich method consists of sequentially rubbing into the skin first a 60% hyposulfite solution (Natrii hyposulfurosi 120.0; Aq. destill. 80.0. MDS External. Solution No. 1), then a 6% hydrochloric acid solution (Ac. hydrochlorici concentrati 12 ,0; Aq. desilk 200.0. MDS. External. Solution No. 2).

Having undressed, the patient rubs solution No. 1 poured into a plate into the skin, successively into the right and left arm, torso, right and left leg for 2-3 minutes. After a break of several minutes, a second similar cycle of rubbing is carried out. Once dry, rub solution No. 2 into the skin in the same order, pouring it into a handful, also 2, and sometimes 3 times, for 15-20 minutes.

In cases of severe and widespread scabies, this treatment is repeated the next day. 3 days after the end of rubbing - washing and changing clothes. In young children, a 40% hyposulfite solution and a 4% hydrochloric acid solution should be used. For treatment, you can use Flemings solution (Sol. Vlemings), as well as soap K.

Benzyl benzoate in the form of a 20% suspension is very effective (in children under 3 years of age, a 10% suspension is used). The latter consists of 20 g of benzyl benzoate, 2 g of green soap and 78 ml. water. It is rubbed into the entire body, except the head and soles, 2 times with a 10-minute break for drying. Then the patient puts on clean underwear and changes the bed linen. This treatment is carried out for 2 days. After 3 days - shower and change of linen again.

Prevention. Mandatory examination of all family members of the patient, all children and staff in the children's institution where the patient with scabies was found, and all persons in the dormitory who were in contact with the patient with scabies; simultaneous treatment of all identified patients. Clothing and bedding are disinfected in appropriate disinfection chambers, and linen is boiled. In children's institutions, immediate isolation of patients who are not allowed into nurseries, kindergartens, or schools is necessary until scabies is cured.

Clinical picture. The main symptom of scabies is widespread night itching, caused by the activity of mites at this time of day. In addition to scratching, there are small papulovesicles and “scabies ducts” pathognomonic for the disease in the form of small grayish, slightly elevated, straight or curved stripes with a vesicle at the end in which the female is located. Favorite localizations are areas with thin, delicate skin (interdigital folds of the hands, axillary cavities, radiocarpal folds, abdomen, penis, inner thighs, mammary glands). The skin of the face and scalp is not affected. Scabies is often complicated by pyoderma (boils, ecthyma, impetigo).

The diagnosis is based on typical symptoms, identification of scabies, and detection of scabies mites during laboratory testing.

Drug therapy

Drugs of choice:

Permethrin (nittifor). Thoroughly wipe the scalp with undiluted preparation, wait until the hair is dry (do not wipe or wash). After 2-3 weeks, the hair is washed, dried and, if necessary, re-processed.

–Reed shampoo is applied to the affected areas for 10 minutes, then washed with soap or regular shampoo. Hair treatment is carried out for 10 days.

–Anti-Bit shampoo. The hair is moistened with water, the preparation is applied and rubbed into the hair roots for 3 minutes, then washed and the procedure is repeated. A repeat course is carried out - just for 2 days.

-So. The lotion is applied to damp hair, rubbed in, then rinsed thoroughly, applied again, wait 5 minutes, then the hair is thoroughly washed and combed out with a fine comb. The next day the procedure is repeated. The aerosol is sprayed over the scalp 20-30 times, wait 30 minutes, then rinse thoroughly and comb out with a fine comb; the next day the procedure is repeated.

Precautionary measure: drugs that destroy lice are never used to treat eyelash lesions. Lice from eyelashes and eyebrows are usually removed with tweezers. Lice on eyelashes can be killed or weakened with simple Vaseline.

Course and prognosis. With adequate treatment, over 90% of patients are cured. Relapses are often observed with repeated infection and an incomplete course of treatment. Prevention - compliance with the rules of personal hygiene.

15. Dermatomycosis. General characteristics, classification, epidemiology. Conditionally pathogenic and pathogenic fungi. Malassezia (keratomycosis) - pityriasis versicolor, trichosporia. Clinic, diagnosis, treatment. Mycosis of the feet and hands. Clinic, diagnosis, epidemiology, treatment. Inguinal athlete's foot. Trichophytosis is superficial and infiltrative-suppurative. Epidemiology, clinic, diagnosis, treatment, prevention. Trichophytosis as an occupational disease of livestock breeders. Microsporia. Epidemiology, clinic, diagnosis, treatment. Favus. Epidemiology, clinic, diagnosis, treatment, prevention. Lesions of the skin and mucous membranes caused by yeast fungi (candidiasis). Epidemiology, pathogenetic factors. Clinic, diagnosis, prevention, treatment.

TRICHOPHYTIA (ringworm) is a fungal disease of the skin, hair and nails. There are superficial (anthroponotic) and infiltrative-suppurative trichophytosis.

Superficial trichophytosis is rare, usually in children. The causative agents are anthropophilic trichophytons (T. violaceum, Tr. tonsurans), affecting the stratum corneum of the epidermis and hair (of the “endothrix” type). The source is a sick person. Infection occurs through direct contact or through hats, brushes, combs, underwear and other objects. Numerous isolated lesions up to 1.5 cm in size appear on the scalp, having irregular outlines and blurred boundaries; the skin is slightly swollen and hyperemic, covered with scales. Many hairs in the lesions are broken off at a level of 2-3 mm above the surface of the skin (“stumps”) or immediately upon exiting the follicle (“black dots”); the preserved hair has a normal appearance or the appearance of thin twisted threads “running” under the scales.

On smooth skin there are swollen, sharply defined round spots with a sunken, pale yellow, flaky center and a raised juicy peripheral ridge of pink-red color, covered with blisters, nodules and crusts. The spots tend to grow centrifugally and merge with each other. Sometimes there is slight itching. Chronic trichophytosis usually occurs in women and is characterized by numerous “black spots”, foci of diffuse peeling and atrophic bald spots on the scalp; extensive erythematous-squamous spots with blurred boundaries on smooth skin; natural damage to vellus hair; changes in nails (usually on the hands), which become dirty gray in color, deformed, “eaten away” and sometimes even torn away from the bed.

Infiltrative-suppurative trichophytosis. The pathogens are zoophilic trichophytons (Tr. verrucosum, Tr. mentagrophytes var. gypseum), affecting the epidermis, dermis and hair (of the “ectotrix” type). Sources are sick animals (cattle, especially calves, as well as mice, etc.), less often a sick person. The disease occurs at any age, most often in adults. It is characterized by acute inflammatory phenomena (up to suppuration) and a cyclic course, ending with complete recovery without a tendency to relapse. Predominant localization is open areas of smooth skin, scalp, beard and mustache area. Initially, the disease is practically indistinguishable from superficial trichophytosis of smooth skin. Then, as a result of increasing infiltration, the lesions transform into succulent plaques and nodes, sharply demarcated from the surrounding skin. Accompanying suppuration leads to the formation of deep follicular abscesses, when opened, liquid pus is released from the gaping hair follicles, especially when pressed. Regional lymphadenitis is possible. The result is scarring.

The diagnosis of trichophytosis should always be confirmed by microscopy and culture.

Treatment is carried out in a hospital setting. Orally - griseofulvin, nizoral; local iodine ointment therapy. In case of chronic trichophytosis, correction of general abnormalities is mandatory; with infiltrative-suppurative trichophytosis, acute inflammatory phenomena are first eliminated. The prognosis is usually favorable.

Prevention. Isolation of sick children. Thorough examination of all persons who were in contact with the patient. Use only individual skin, nail and hair care products. Prevention of infiltrative-suppurative trichophytosis is carried out jointly with the veterinary service.

FAVUS (scab) is a fungal disease of the skin, hair and nails, characterized by a long course; in the USSR it was practically eliminated. Pathogen - Tg. Schonleinii, affects the epidermis (usually the stratum corneum), can penetrate the dermis, and hematogenous spread is possible. Contagiousness is low. The source is a sick person. Transmission of mycosis occurs more often in childhood, with close and long-term family contact. The predisposing factor is weakening of the body as a result of chronic diseases, various types of intoxication, malnutrition and insufficient nutrition. Occurs at any age.

Clinical picture. The most typical form is scuticular. The affected hair becomes thin, dry, dull and dusty, but it does not break off and retains its length. A pathognomonic feature is the scutula (scutellum) - a peculiar crust of yellow-gray color with raised edges, which gives it a resemblance to a saucer; hair will stand out from the center. The scutulae increase in size and merge, forming extensive lesions with scalloped contours. They consist of accumulations of fungal elements, epidermal cells and fatty detritus. A “mouse” (“barn”) smell emanating from patients is characteristic. As the scutulae fall off, an atrophic surface is exposed, easily gathering into small thin folds like tissue paper. - Sometimes regional lymphadenitis occurs.

The squamous form of the favus of the scalp is characterized by diffuse peeling, and the impetiginoid form is characterized by layering of crusts resembling impetiginous ones. Hair damage and outcome are the same as with scuticular favus.

On smooth skin, lesions of which are rare and usually combined with lesions of the head, there are clearly demarcated erythematous-squamous, slightly inflamed spots, usually of irregular shape, against which small scutulae can form. A purely scuticular form of damage to smooth skin is possible. Scar atrophy does not occur. Damage to internal organs is known, leading to death. The diagnosis of the scuticular form is simple. In other forms, it requires laboratory confirmation.

Treatment is carried out in a hospital setting; orally-grise-ofulvin, nizoral; local - iodine-ointment therapy: correction of concomitant diseases, nonspecific immunotherapy.

Forecast. Without treatment, the process can last indefinitely; if internal organs are affected, it is usually bad. Prevention. Thorough repeated examinations of all members of the patient’s family and his entourage.

MICROSPORIA is a fungal disease of the skin and hair that mainly affects children. There are anthroponotic and ceanthroponotic microsporia. Anthroponotic microsporia is very rare in our country. Pathogens - anthropophilic 1crooporum (Microsporon ferrugineum) - affect the horny part of the epidermis and hair; are highly contagious. The source is a sick person. Routes of transmission: direct and indirect (through hats, brushes, combs, clothing, toys and other items).

Zooanthroponotic microsporia is a common mycosis. Pathogens - zoophilic microsporum (in our country M. nis) - affect the stratum corneum and hair; In terms of contagiousness, they are inferior to anthropophilic ones. Sources are cats (especially gyata), less often dogs. Transmission routes are direct (main) and indirect (through objects contaminated with hair and scales containing M. canis). Relatively rarely, infection occurs from a sick person. Clinical picture. Manifestations of anthroponotic ooanthroponotic microsporia are of the same type and are similar to podiatric trichophytosis, in contrast to which it has characteristics: clearer boundaries, rounded outlines, larger sizes of lesions on the scalp; Tamping (usually continuous) hair at a level of 6-8 mm; 1 there are whitish sheaths around the “stumps”; absence of black dots; on smooth skin - multiple lesions; almost constant involvement of vellus hair, frequent enlargement of the neck, occipital and cervical lymph nodes. Changes in the type of infiltrative-suppurative hophytosis may occur.

The diagnosis of microsporia should always be confirmed by legal studies (microscopy, culture of affected hair or skin flakes). Fluorescent diagnostics (examination under a Wood's lamp) is important. Treatment is carried out in a hospital. The prognosis is favorable.

Prevention. Isolation of sick children; examination of those in contact with the patient (including pets) using a Wood's lamp; catching stray cats and dogs.

MALASSESIOSIS

Pityriasis versicolor (lichen versicolor) is a fungal skin disease.

Clinical picture. On the skin of the chest, back, neck, less often the shoulder girdle and scalp, small (3-5 mm in diameter) non-inflammatory yellowish-brown spots with clear, uneven boundaries appear, when scraped, slight pityriasis-like peeling is revealed. As a result of peripheral growth, the spots increase in size and merge into large foci of so-called geographical outlines. There are no subjective sensations. A diagnostic iodine test is used, for which the affected skin is smeared with iodine tincture and immediately wiped with alcohol: the stratum corneum, loosened by the fungus, quickly absorbs iodine and pityriasis versicolor spots stand out sharply, turning dark brown against the background of slightly yellowed unaffected skin. Under the influence of ultraviolet rays (in particular, during tanning), as a result of peeling, untanned spots remain at the sites of former rashes - pseudoleukoderma.

The diagnosis is based on characteristic clinical symptoms and a positive iodine test. In doubtful cases, a microscopic examination of skin flakes is performed to detect the pathogen. Differential diagnosis is carried out in some cases with syphilitic roseola, which does not peel off, does not merge into solid foci, the iodine test is negative, and serological reactions to syphilis are positive; there may be other manifestations of syphilis. Pseudo-leukoderma must be differentiated from true syphilitic leukoderma, in which small round (0.5-1 cm) or marbled hypopigmented spots without clear boundaries are located on the slightly pigmented skin of the posterior-lateral surfaces of the neck, sometimes spreading to the skin of the back; positive serological reactions and other signs of syphilis make it possible to distinguish it from pseudoleukoderma.

Treatment. Rubbing in Andriasyan's liquid (urotropine - 5 g, 8% acetic acid solution - 35 ml, glycerin -10 ml), 2-5% salicylic-resorcinol alcohol, Wilkinson ointment, 10% sulfur ointment, mycozolon, treatment using the Dem-method Yanovich (see Scabies) and other antifungal agents for 3-7 days, after which a general hygienic bath with soap and a washcloth is prescribed. To prevent relapse of the disease, it is advisable to treat the entire skin. For cosmetic purposes, ultraviolet irradiation is indicated to eliminate pseudoleukoderma after antifungal treatment.

TRICHOSPORY (from the Greek thríx, gender trichos - hair and spora - sowing, seed), piedra (from the Spanish piedra - stone), a fungal hair disease caused by many varieties of fungi of the genus Trichosporon; belongs to the group of keratomycosis.

It is manifested by the formation along the length of the hair of multiple, barely noticeable, spindle-shaped hard nodules, from whitish to dark brown in color, with a peculiar pungent odor; consist of fungal spores. The integrity of the hair is not damaged, there are no inflammatory phenomena on the skin. With the American variety of Trichosporia, predominantly women are affected: the hair on the head is affected. The European form of Trichosporia is usually observed in men (in the area of ​​the beard and mustache). The contagiousness of Trichosporia is low: infection is possible through sharing a towel, hat, comb, etc. with the patient. The development of Trichosporia is promoted by washing the hair with a decoction of flaxseed and lubricating the hair with burdock oil, which is a breeding ground for the pathogen.

Treatment: after shaving the hair, the affected areas are washed with hot water and soap, wiped with a 0.1-0.2% solution of sublimate. Prevention: compliance with personal hygiene rules.

CANDIDOSES

This is a lesion of the mucous membranes, internal organs, and nails, caused by the exogenous introduction of fungi of the genus Candida. Candida does not form spores or true mycelium. Pseudomycelium consists of cells tightly adjacent to each other. They reproduce by budding and germination. Aerobes. Optimal conditions: t=30-37, pH=7.0-7.4, Sabouraud medium, MPA + glucose, beer wort. They withstand drying, freezing and thawing well. Sensitive to the action of phenol, formaldehyde, lysol, chloramine, iodites, borates, sulfates, aniline dyes. They live on the surface of the skin and mucous membranes, most of them are not pathogenic.

The source of infection is a patient with an acute form of candidiasis. Infection by direct and indirect contact. Factors contributing to the disease: virulence of the pathogen, the state of the macroorganism (integrity of the skin and mucous membranes, skin contamination, the presence of chronic pathology, disruption of the central nervous system, edocrine and other systems), long-term use of antibiotics, cytostatics, glucocorticoids.

Classification:

Surface:

– mucous membranes; – skin; – nail folds and plates;

Chronic granulomatous candidiasis;

Visceral;

Secondary candidiasis;

5. Candidomylides;

CLINICAL FORMS:

Candidiasis of large skin folds- more often in childhood, combined with damage to the mucous membranes. The skin of the inguinal, femoral, intergluteal, and axillary folds is affected. The skin is hyperemic, the boundaries are clear, flabby gray blisters appear on the surface, after their opening smooth, shiny, moist surfaces of erosions are exposed. With a prolonged course, infiltration increases and deep, painful cracks form.

Candidiasis of small skin folds- neck, navel, interdigital spaces. Neck - clinical forms are easier to treat, the inflammatory process and infiltration are reduced.

Candidiasis of the toes- erythema with a clear border, accompanied by itching, blistering elements and erosions appear. Wearing shoes aggravates the process and cracks form. Sometimes the process begins with diaper rash - the lesion is covered with gray-white films and does not extend to the back surface.

Interdigital candidal erosion of the hands- the process is asymmetrical in nature, most often localized on the right hand between 3-4 fingers. The erythema is bright red, the epithelium is exfoliated along the periphery, and pain appears.

Differential diagnosis with herpetic infection. With herpetic infection: - deeper damage; - the edges of the lesions are polycyclic; - occurs after hypothermia.

Superficial candidiasis of the skin of the trunk (in children)- there is no clear clinical picture, it may resemble a scarlet fever rash, eczematous erythroderma. Damage to the palms and feet - against the background of erythema, scaly patches appear in the form of garlands. The skin is yellow-brown, deepening skin folds, hyperkeratosis.

Candidiasis of the nipple- more often in nursing mothers if the child has thrush. The skin is pink-red to dark red in color, and the skin peels off in small scales.

Nail damage- begins from the posterior edge of the nail fold, when pressed, liquid pus is released, shine is lost, destroyed, resulting in sharply painful swelling.

Damage to the skin of the head of the penis and foreskin- in persons suffering from diabetes mellitus. Skin - red with convoluted scaly patches, white-gray coating; a shiny eroded surface is exposed, itching develops.

Chronic generalized granulomatous candidiasis- begins in early childhood with damage to the oral mucosa, then the red border, corners of the mouth, and nail folds are involved; the skin in large areas is erythematous with scaly lesions, nodular elements appear, turning into infiltrated plaques, and the nodules into tumor-like formations. Their surface is covered with a gray-yellow crust, after removing which the vegetation opens.

Damage to the oral mucosa - candidal stomatitis.

Clinical forms:

1) limited damage to the tongue - candidal glossitis: the mucous membrane of the tongue is pink-red, longitudinal and transverse stripes appear, the tongue is covered with a white-yellow coating (at first easily, then difficult to remove with the opening of erosions), atrophy of the papillae.

2) on the mucous membrane of the gums - gingivitis, may be covered with a white coating.

3) mucous membrane of the tonsils - candidal tonsillitis, the color is natural, then pockets of white plaque appear, which are at first easily removed.

Thrush- on the affected areas there is a white coating, reminiscent of milk or semolina porridge.

Candidal cheilitis - the skin of the red border of the lips swells, deep radial folds appear, accompanied by dryness and discomfort.

Damage to the corners of the mouth- candidiasis - the corners are covered with a gray-white film, after peeling - erosion. Damage to the mucous membranes of the urogenital tract - vulvovaginitis: - more often during menopause; - those employed in the production of antibiotics; - with hormonal disorders. Severe itching appears, the mucous membranes are bright red, infiltrated, dry; the areas are shiny, smooth, a gray-white coating appears, liquid discharge with crumbly flakes appears.

DIAGNOSTICS. Material + 1-2 drops of 10% alkali solution. Under microscopy, yeast cells, pseudomycelium, budding cells. There is no natural post-infectious immunity.

TREATMENT.

1) prescription of anti-candidiasis antibiotics: nystatin 500,000 units 6-8 times a day, levorin 500,000 units 3 times a day, amphoglucomide 200,000 units 2 times a day, mycoheptin 250,000 units 2 times a day, course 12-14 days, amphotericin B 0.2- 1 mg/kg every other day IV on 5% glucose, nizoral 200 mg 2 times a day for 10-14 days.

2) external therapy:

for skin lesions:

a) alcohol solutions of aniline dyes; b) Castellani liquid; c) ointments: levorin, nystatin, amphotericin, octateonic; d) nitrofungin with water 1:1; e) clotrimazole (cream, solution);

in case of damage to the mucous membranes:

a) rinsing with 5% solution of baking soda, furacillin; b) treatment with aqueous solutions of aniline dyes;

c) ointments; d) Decamine cheek tablets every 2 hours; e) 10% borax on glycerin;

for vulvovaginitis:

a) douching with KMpO4, furatsilin; b) ointments containing nystatin, levorin; c) clotrimazole (vaginal tablets). Feature: mainly internal organs, the central nervous system, and the musculoskeletal system are affected. Distributed in the subtropics and tropics.

Contributing factors:

respiratory pathology pathways; – gastrointestinal pathology; – hypovitaminosis.

1.Coccidioidomycosis- internal organs, bones, skin are affected. Pathogen: coccidioides imitis. Infection occurs by airborne droplets, through damaged skin and mucous membranes of the respiratory tract. After the disease - stable immunity. The incubation period is 1-6 weeks. At first it occurs like ARVI. X-ray: foci of pneumonia, abscess formation, frequent pulmonary hemorrhages. After 2-3 weeks, various rashes appear on the skin. Around large joints, nodes appear in the subcutaneous fat, which then disintegrate, forming ulcers with undermined edges, with a bottom covered with vegetation. After resolution - rough star-shaped scars. With a long course - increased ESR, leukocytosis, hypochromic anemia.

DIAGNOSTICS: 1) find spherules; 2) obtaining a pure culture on Sabouraud medium; 3) obtaining an experimental model (mouse); 4) skin allergy test (iv coccidioidin).

TREATMENT: 1) amphotericin B IV drip every other day, course - 30 injections; 2)a/b wide spectrum; 3) external therapy; 4) stimulation of healing; 5) iodine preparations; 6) antihistamines.

2. Histoplasmosis (Darling's disease)- damage to the reticuloendothelial system. Pathogen: Histoplasma capsulata. Infection is aerogenic, the reservoir of infection is soil. They begin with damage to the lungs and lymph nodes, every second person has skin damage: spots, nodules, nodes, erythematous-flaky patches, uniting into large infiltrates.

DIAGNOSTICS.

1) isolation of the pathogen; 2) obtaining a pure culture; 3) intravenous test with histplasmin.

3. Chromomycosis. Epidemiology has not been studied; burns, congestion, and mechanical injuries contribute; localized on the lower extremities, the incubation period is from 3 weeks to several months. At the site of penetration there is a pink-red tubercle with a bluish tint, prone to peripheral growth; numerous tubercles form a single infiltrate. If rejected, it results in an ulcer that heals very slowly and leaves a rough scar.

16. Tuberculous lupus. Scrofuloderma. Warty tuberculosis. Papulo-necrotic tuberculosis. Erythema induratum of Bazin. Disseminated miliary lupus of the face. Epidemiology, clinical manifestations. Lupozoria. Treatment and prevention.

Tuberculous lupus(lupus vulgaris) is the most common form of skin tuberculosis.

It is characterized by the formation of specific soft tubercles (lupas), located in the dermis, pink in color with clear boundaries, 2–3 mm in diameter. The main morphological element is a tubercle (lupoma), which is an infectious granuloma. The tubercles tend to grow peripherally and merge to form solid foci (flat shape). With vitropression (pressure with a glass slide), the color of the tubercle becomes yellowish (the “apple jelly” phenomenon), and when pressing on the tubercle, the button-shaped probe easily falls through, leaving a depression in the tubercle (Pospelov’s symptom). Gradually, the tubercles undergo fibrosis with the destruction of collagen and elastic fibers and the formation of scar atrophy. With the exudative nature of the process and under the influence of various injuries, the tubercles can ulcerate (ulcerative form) with the formation of superficial ulcers with soft, uneven edges and easily bleeding. Tumor-like, verrucous, mutilating and other forms of tuberculous lupus are also possible. The rash is usually localized on the face, but can also be on the torso and limbs. The mucous membrane of the nasal cavity, hard and soft palate, lips, and gums is often affected. The disease occurs more often in women. Lupus vulgaris is characterized by a sluggish, long-term course and can be complicated by the development of lupus carcinoma.

Scrofuloderma(colliquatic tuberculosis) - with hematogenous spread of mycobacteria into the skin, the disease is characterized by multiple lesions. When spreading per continuitatem, the process is most often localized in the neck, especially in the triangle under the lower jaw, on the cheeks, near the auricle, in the supra- and subclavian fossae; less often - on the limbs.

Scrofuloderma in children in 80% of cases is caused by mycobacteria of cattle (M. bovis), with which the child becomes infected primarily, as a rule, by consuming infected milk. Sometimes the primary site of tuberculosis is the lungs.

Scrofuloderma in adults and old people occurs due to hematogenous introduction of mycobacteria into the skin. Lesions in these cases can appear on any part of the body, most often on the neck, chest and abdomen, in the groin folds, on the buttocks and tongue. There are usually many lesions.

Clinically, the disease is characterized by the appearance in the subcutaneous fatty tissue of one or several dense, clearly defined nodes, the size of a large pea or hazelnut. Gradually increasing, the nodes can reach the size of a chicken egg and become fused with the surface layers of the skin, which turns bluish-red. Subsequently, the nodes soften and turn into cold abscesses, opening with one or more holes, from which liquid, crumbly pus with scraps of necrotic tissue is released. Enlargement of the perforation leads to the formation of ulcers with thinned, soft, overhanging edges of a bluish color and an uneven bottom with flaccid yellowish granulations that bleed easily. The ulcers heal slowly, leaving behind uneven scars with webs, verrucous and keloid protrusions. With secondary scrofuloderma associated with lymph nodes, the ulcers are deeper, penetrating into the tissue of the lymph node. After healing, a retracted, dense, uneven scar also remains. In some cases, scrofulodermal ulcers tend to grow peripherally and can reach a very large size.

Scrofuloderma is often combined with damage to bones and joints, as well as with active but benign pulmonary tuberculosis, sometimes with other forms of cutaneous tuberculosis (lupus, warty tuberculosis). Tuberculin reactions are usually positive.

The course of scrofuloderma varies; in some cases, the disease is limited to the formation of a single node and ends with recovery relatively quickly, in others, due to the appearance of new nodes, it can drag on for months.

Differential diagnosis should be made with syphilitic gummas, lymphogranuloma venereum, actinomycosis and deep mycoses.

Warty tuberculosis skin, as a rule, occurs as a result of exogenous infection in people who come into contact with the corpses of animals or people with tuberculosis (pathologists, medical workers, butchers, etc.); sometimes the disease occurs due to autoinoculation. The lesions are localized mainly on the back of the hands and fingers, less often on the feet. They can be single or multiple.

At the site where the pathogen invades the skin, a dense, painless, bluish-red papule appears, or less commonly a papulo-pustule, the size of a pea (“cadaveric tubercle”). The papule gradually grows and turns into a dense, flat plaque, on the surface of which, starting from the center, warty growths and massive horny layers are formed, as a result of which the surface of the plaque becomes uneven and rough. Only along the periphery does a violet-red border remain, not covered with horny layers. Sometimes new papules and plaques form near the main focus, gradually merging.

The process progresses very slowly (over years). Gradually, cicatricial atrophy forms in the center of the lesion, sometimes the lesion acquires a ring-shaped or even serpiginating shape. No tubercles characteristic of lupus vulgaris develop, and the “apple jelly” symptom is negative. There are no subjective sensations. Sometimes warty skin tuberculosis is complicated by lymphadenitis.

The cause of warty skin tuberculosis when infected from animals is M. bovis. The disease is usually occupational and is observed in slaughterhouse workers, butchers, farmers, and veterinarians. The skin lesion is localized; pronounced hyperkeratosis is observed on the surface of the lesion; the course of the disease is long.

Tubercular tuberculosis of the skin, caused by M. tuberculosis, is usually observed in medical workers who become infected during autopsies of the corpses of patients (“cadaveric tubercle”, “postmortem tubercle”, “verruca necrogenica”). The lesion on the skin develops quickly, is characterized by the severity of the inflammatory reaction and the rapid formation of a warty infiltrate. The skin process is often complicated by regional lymphadenitis; sometimes lymph nodes undergo caseous necrosis.

Warty skin tuberculosis should be differentiated from warts vulgaris, verrucous lupus vulgaris, bromoderma, pyoderma vegetans, keratoacanthoma, cancer and blastomycosis.

Papulo-necrotic tuberculosis occurs hematogenously in young people with tuberculosis, more often girls. On the extensor surface of the limbs and on the buttocks, small nodules with necrosis in the center appear, which leave behind a depressed scar. The nodules appear in spurts, in bursts, as a result of which one can simultaneously see rashes at different stages of development.

Indurative tuberculosis (erythema induratum of Bazin) is a hematogenous tuberculosis farm, more often affecting young women. Localization: flexor surfaces of the legs. Deeply located nodes emanating from the subcutaneous tissue are covered with purple-bluish skin, often located symmetrically. When opened, the nodes form flaccid, long-term non-healing ulcers.