Dr.

Chitra Pai
Professor, Microbiology,
AUA.
 Purpura: Red –purple lesions
due to extravasation of blood
into the skin or mucus
membrane.
 Palpable /
Nonpalpable(Macular)
 Macular purpura—Petechiae (<
3mm) or Ecchymoses (>3mm)

Imp Causes:
 Meningococcemia Petechia Ecchymosis
 Rocky mountain spotted fever
 Leptospirosis
 Viral hemorrhagic fevers:
Dengue, Hanta virus
 Complication of meningococcal
infection
 Abrupt onset of petechial
eruptions along with fever, chills,
prostration, cyanosis,
hypotension, profound shock.
 Waterhouse Friderichsen
syndrome.

Gram negative cocci in pairs, capsule +

Oxidase postive
Ferments glucose and maltose
Cefotaxime
Endotoxic activity: LOS
Vaccine: A,C,Y,W135.
IgA protease
Rifampicin
Fever, Jaundice, hemorrhagic
lesions in skin and eyes, Muscle
pain
 Leptospirosis/ Weil’s disease: Leptospira interrogans

Silver stain:
spirochete with
hooked end

• High incidence: Hawaii

• Exposure to water
sources contaminated
with rat, dog or livestock
urine.
• Recreational water sports
• Sewer workers,
Treatment: Penicillin/ Doxycycline/ cephalosporins Swineherds, farmers.
 DENGUE FEVER
• Transmitted through Aedes
mosquito
• Break bone fever with
rash(maculopapular and
hemorrhagic),retro orbital pain,
muscle and joint pain.
• Reinfection with another serotype
causes dengue hemorrhagic shock
• Enveloped, icosahedral
• + ss RNA (Flavivirus)
HANTA VIRUS
 Fever, Cough, myalgia,
pulmonary edema,
hypotension
 Inhalation of rodent excreta
 (-)ss, segmented, RNA,
enveloped(Bunyavirus)
Other Viral Hemorrhagic fevers
TREPONEMA PALLIDUM HEMOPHILUS DUCREYI

 Painless ulcer Superficial, necrotic, painful

 Gummas ulcers
 Maculopapular rash:
coppery red rashes

Commonest tick borne disease in the USA
Vector: Ixodes tick-deer tick.
I.scapularis in Northeast (Connecticut) and
midwest (Wisconsin);
Ixodes pacificus on West coast(California)
Late spring/ early summer
Annular skin lesion, fever, chills,
headaches, arthritis, muscle aches
and joint pains, Bell’s palsy,
meningitis, myocarditis.
Nature lovers, dog lovers,
camping , hiking etc.
Rash features: concentric red,
erythematous rash
Called Bull’s eye rash or target rash.
Doxycycline, Amoxycillin/ azithromycin
 concentric red,
erythematous rash
 Called Bull’s eye rash or
target rash
 Pediculus humanus
Borrelia
recurrentis

Ornithodoros spp.
Borrelia spp.

Ixodes spp.
Borrelia
burgdorferi
 Influenza like illness along
with maculopapular rash wich
becomes petechial. Starts
from ankles and wrists,
spreading to palms, soles and
then trunk and face.
Pathology: Involvement of
vascular endothelium.
 Usually not seen in Rocky
mountains areas.
 Highest incidence in east
coast
• Transmitted by vector: Dermacentor
andersonii (wood tick); D.variabilis(dog tick)
• Reservoir: Ticks, rodents, dogs
• Common in warmer months April-June
• Lab diagnosis:
Immunofluorescent test
WEIL FELIX test: Heterophile
agglutination test using nonmotile P.vulgaris
strains)
• Doxycycline.
MACULAR VESICULAR RASHES

 Measles  HSV
 Rubella  Pox virus
 Parvovirus  Chicken pox and herpes
 Human herpes virus 6 zoster
 Coxsackie virus
 Others: EBV, CMV, HIV etc.
MEASLES (RUBEOLA)
 Fevere, Cough, coryza and
conjunctivitis, Koplik’s spots.
 Rash is confluent, erythematous,
maculopapular, appears on face,
back and extremities
 Starts in the head area and spreads
to entire body.
 ss, RNA,enveloped,
paramyxovirus
 Complications: Giant cell pneumonia
(Warthin-Finkledey cells)
 Subacute sclerosing Panencephalitis
(SSPE)
GERMAN MEASLES (RUBELLA))
 Minor pyrexia, malaise and
lymphadenopathy with
suboccipital, postauricular lymph
nodes most commonly enlarged
and tender
 Erythematous macular rash
begins on face and forehead and
spreads caudally.
 Rash lasts for 3 days.
 ssRNA virus with an envelope,
Togavirus
 Complications: Congenital
rubella syndrome
MEASLES RASH AND KOPLIK’S
SPOTS GERMAN MEASLES

Post auricular lymphadenopathy and

rash of Rubella
FIFTH DISEASE/ ERYTHEMA SIXTH DISEASE/ ROSEOLA
INFECTIOSUM INFANTUM/ EXANTHEMA SUBITUM

 Parvoviruses: B 19  Human Herpes virus 6

 ‘Slapped cheek appearance’
 Erythematous rash on the cheeks,  Fever for few days; fever
followed by a reticulate or lacy rash goes down and rash
on trunk and extremities(extensor appears.
surfaces)
 Other features: arthralgia and  Rash appears indurated
lymphadenopathy
 SS, nonenveloped DNA virus
Affects erythroid progenitor cells

 In pregnant women,
Parvovirus B19 infection
causes :
 Hydrops fetalis: severe
anemia; congestive heart
failure in fetus resulting in
1.Rubeola still birth/ abortion
2.Scarlet fever  Patients’ with sickle cell
3.German measles anemia may have
4.Duke’s disease APLASTIC CRISIS
5.Parvo B19
6.Human herpesvirus 6
 Coxsackie A 16: Hand  Ss Nonenveloped, RNA
foot and mouth virus
disease.
 Enteroviral rash
 EBV
 CMV Rash with
pharyngitis
 HIV
Coxsackie virus, Herpes virus, Chicken pox and shingles.
Hand -Foot –Mouth disease

SS RNA, NONENVELOPED
VIRUS
ENTEROVIRUS: A 16

Coxsackie virus A 16
Symptoms:
Mild fever, vesicular exanthems on
hands, feet, mouth and tongue.
Illness subsides in a few days.
HERPES VIRUS
 Types of
manifestations:Herpetic
whitlow, Eczema herpeticum,
Herpes gladiatorum
 Typical herpetic lesion: Vesicles
in clusters on an erythematous
base—Dew drop on Rose Petal
appearance
 Tzanck smear: ballooning and
multinucleate giant cell
 Treatment
HERPES ZOSTER
 Reactivation of latent VZV
infection. Zoster is associated
with decreased T cell function:
 Old age
 Pre-AIDS phase
 Organ transplant recipients
Dermatomal distribution of
vesicles with severe pain.
SMALL POX CHICKEN POX

• Synchronous;  Transmission: through

centrifugal in respiratory route.
distribution  Rashes are usually seen as
• Ds enveloped asynchronous and
DNA virus centripetal
 Ds enveloped DNA virus
MOLLUSCUM CONTAGIOSUM HUMAN PAPILLOMA VIRUS

 Pearly white umbilicated

lesions with central
caseation
 Sites: hands, mouth, legs
etc.

Plantar and Palmar warts:

Non enveloped viruses
with icosahedral
symmetry.
Supercoiled double