Wednesday, April 23, 2008

Skin Lesions 3



Port wine stain birthmark usually present at birth



Psoriasis is a common, probably inherited skin condition probably related to an autoimmune inflammatory response



Seborrheic keartosis is a benign form of skin cancer ususally seen in those over age 40



Systemic lupus erythematosus is a chronic inflammatory autoimmune disorder



Actinic keratosis is a precancerous skin growth usually caused by sun exposure



Basal cell carcinoma is a slow growing skin cancer



Severe bedsore: an area of skin that breaks down due to the pressure caused by staying in one position too long (wheelchair, bedridden)



Early Lyme Disease lesion: an inflammatory disease caused by infection caused by the bacterium Borrelia burgdorferi (transmitted by tick bite)

Tuesday, April 22, 2008

Skin Lesions 2



Cutaneous candidiasis (fungus) yeast infection of the skin



Necrobiosis diabeticorum (flesh eating skin disease) caused by infection with a variety of bacteria



Swimmer's itch caused by infection with bird Schistosome (worm)



Flea bite



2nd Degree burn

Pictures obtained from Medline Plus Encyclopedia

Sunday, April 20, 2008

Skin Lesions

Pictures from Medline Plus Encyclopedia



Blackheads caused by a small plug in the opening of a follicle on the skin



Cellulitis due to staph, strep or other bacterial infection



Atopic dermatitis chronic skin disorder categorized by scaly and itching rashes. Commonly seen in people that suffer allergies



Athletes foot due to Tinea (fungus) infection



Acne vulgaris occurs when tiny holes on the surface of the skin called pores become clogged



Shingles caused by infection with Herpes Zoster (virus)



Ringworm caused by Tinea corporis infection (fungus)

Skin Lesions



Because the skin is so visible, there are more diseases described for the skin than for any other organ of the body. Most skin diseases are not life threatening but some are such as the flesh eating bacterial infection. Unfortunately there are many different types (names) of skin lesions. Just a few are:



Macule: a flat lesion that cannot be felt.



Papule: a bump smaller than 10 mm



Nodule: a bump larger than 10 mm



Vesicle: a fluid filled cavity under the skin smaller than 10 mm



Blister: a fluid filled cavity larger than 10 mm

Saturday, April 19, 2008

Skin Anatomy



Skin is made up of three layers, some of which contain more specialized cells:

1. Epidermis: is the outer layer of skin. It is made up of 5 layers. From bottom to top they are: stratum basale; stratum spinosum; stratum granulosum; stratum licidum and stratum corneum. The epidermis varies in thickness from .05 to 1.5 mm.



More information about each of these layers can be found here.

The epidermis contains 3 types of specialized cells. Melanocytes which are cells that produce the pigment melanin; Langerhans cells, a type of dendritic cell involved in immune function and Merkel's cells which are associate with sensory touch.

2. Dermis: consists of 3 types of tissue found in two layers; the upper papillary layer and the lower reticular layer . Collagen, elastic tissue and reticular tissue.



The reticular layer (RD) of the skin gives it strength and elasticity. It is also the home to glands and hair follicles. The papillary layer (PD) contains the vascular network important in regulating heat flow from the skin.

Specialized cells in the dermis include: hair follicles, sweat (sebaceous) and scent (apocrine) glands associated with hair follicles; sweat glands (eccrine) not associated with hair follicles, blood vessels and nerves and sensory nerve cells (touch) called Meissner's and Vater-Pacini corpuscles.

3. Subcutaneous tissue: a layer of fat and connective tissue containing blood vessels and nerves.

More articles and resources concerning skin anatomy can be found here.

Friday, April 18, 2008

Helminth Infection of the Skin



Swimmer's itch is Cercarial Dermatitis. It results when bird (usually ducks, geese) schistosome eggs hatch and the resulting larvae infect a particular type of snail. Cercaria, from infected snails, are released into the water waiting to infect an unsuspecting duck. When the cercaria infect humans (the wrong host) a skin eruption occurs because the bird schistosome cercaria cannot develop further.



Cercarial dermatitis in a swimmer.

Another type of helminth skin infection that can be found in the USA is cutaneous larval migrans.




Cutaneous larval migrans results when roundworms that normally infect dogs or cats infect a human instead. The roundworm cannot develop normally because it is in the wrong host. Thus it wanders around under the skin.

Thursday, April 17, 2008

Ectoparasites



Top to bottom: human flea (Pulex), eyelash mite (Demodex) and a louse (Pediculus)

Here is a great medical entomology website. An ectoparasite is a parasite that lives on or in the skin rather than inside the body. Humans can become infested with many different ectoparasites. Some are pretty much harmless (head lice) and others can transmit disease (ticks, fleas, mites). Some ectoparasites live in the skin. For instance the scabies mite.



Learn more about scabies (mites) here, it's something you could possibly see. You can visit these websites to learn about head lice, ticks that spread Lyme Disease, body lice, and dust mites (not an ectoparasite but a cause of allergy). Here is a paper that discusses eyelash mites (demodex) and rosacea.

Some diseases spread by ectoparasites include: Babesiosis (ticks), Plague (fleas) and scrub typhus (mites).

Helminths




Helminths are multicellular worms. The parasitic worms are found in several classes. The trematodes (flukes) and cestodes (tapeworms) contain the flatworms. The nematodes are the roundworms.

A good introduction to helminths can be found here. You can find plenty of pictures of helminths at this website if you click around.

Some important helminth diseases of man include Schistosomiasis, Oncocerciasis, Lymphatic Filariasis, Echinococcosis and Taeniasis. Some roundworm infections found in the USA include Pinworm (Enterobius), Whipworm (Trichuris), Ascariasis, Hookworm and Strongyliasis.

Tuesday, April 15, 2008

Protozoa



A selection of parasitic protozoa from the UK Natural History Collection. From left to right: Entamoeba histolytica which cause amoebic dysentary; Trypanosoma brucei transmitted by Tetsi flies and causes sleeping sickness; Babesia sp in Red Blood Cells transmitted by ticks; Balantidium coli a very large protozoan of pigs that rarely causes disease; and then two ciliates of cattle both of which are symbionts and cause no disease.

Protozoa are unicellular, eukaryotic,usually motile organisms that are more "animal-like" than "plant-like". More than you need to know about parasitic protozoa can be found here and here.

Protozoa have complex life cycles, some requiring two different hosts for reproduction and/or transmission. You can see some animations of protozoan life cycles at this WHO website. Below is a dipiction of the malaria life cycle which takes place in a mosquito and a human.





Malaria parasites in red blood cells.

You can find out more about protozoa and parasites in general at this CDC website.

The most important protozoan diseases include: Malaria, Leishmaniasis, Trypanosomiasis (African and American), and Amoebiasis. Protozoal infections in the USA are more likely to be Toxoplasmosis, Giardiasis, Babesiosis and Trichomonas.

Bacteria



Bacteria are unicellular, prokaryotic, microscopic organisms. They are found in many different shapes including rods, spheres and spirals.

For a short introduction to bacteria go here.

There is lots of information about bacteria, bacterial pathogenesis, bacterial genetics etc at this great website.

Everything you want to know about bacterial infections can be found at this CDC website.



LMT's should be aware of this website concerning skin diseases. Just click on the links to see pictures.

Viruses


Rabies virus.

Viruses are small infectious particles that can only replicate inside of cells. The particle is made up of a protein capsid coat containing either RNA or DNA. Viruses are generally considered to be non-living.

There are many good websites that provide all the information you need to know about viruses. All the Virology on the WWW is a great place to start. Then visit The Big Picture Book of Viruses. Want to learn more about specific viral infections...then go here.


Influenza virus

Prion Diseases



Prions are small proteinaceous infectious particles. They are non-living and lack DNA. Prion diseases are often called Spongiform encephalopathies because diseased brains often appear with large vacuoles. Prion diseases are usually rapidly progressive and are always fatal.

I highly recommend looking at this single page for more information about prions.

A free, full-text review on prions by Stanley Prusiner can be found here.

More about Creutzfieldt-Jacob disease here.

Go here for the CDC Prion Disease page.

Some info on Alzheimer disease here.

Monday, April 14, 2008

Genetic Disorders



The University of Utah has provided an excellent website on genetics. There are animations and interactive projects to reinforce your learning. Make use of them!

Injured (mutated)DNA or abnormal chromosomes can result in genetic disease.
First, refresh your memory on mutations.
What is a mutation?
How do mutations occur?
How do mutations cause genetic disorders?

To learn more about genetic disorders go to this University of Utah website. Notice the distinction between single gene disorders, chromosome abnormalities and multifactorial disorders.

You should understand the genetic basis of sickle cell disease, PKUand cystic fibrosis.

Be sure to understand genetic traits characterized as:

Autosomal dominant

Autosomal recessive

Sex-linked (or X-linked)

To learn more about disorders caused by abnormal chromosomes go to another page at the same website.

You should understand the genetic basis of Down Syndrome, Turner Syndrome, and Klinefelter Syndrome.

Another great place to learn some genetics is at the Cold Spring Harbor DNA Learning Center. Here is the page for "Your Genes, Your Health".

There is also an excellent, easily understood, source of information on understanding genetic conditions at the National Library of Medicine. Your taxes paid for it, make use of it.

Thursday, March 13, 2008

Genetics Definitions

A locus is the specific place on a chromosome where a gene is located.

An allele is any one of an alternative forms of a given gene. Blood group antigens are an example. Blood types A, B and O are each alleles or slightly different version of genes that code for a blood surface antigen.

A gene is the portion of DNA that usually encodes a protein. Genes confer inheritable traits.

A genotype describes the genetic constitution of an individual.

A phenotype is the observed appearance or quality of an individual. Blue eyes, blond hair, six fingers. It is the product of the genotype and the environment.

A dominent allele (gene) expresses its phenotype even in the presence of a recessive allele. Thus genotype AA (two dominent alleles - homozygous) and Aa (one dominent and one recessive allele - heterozygous) have the same phenotype.

A recessive allele (gene) is expressed only if two copies of the recessive allele occurs.

A homozygous gene pair is an identical pair of alleles at the locus of each chromosome - eg. AA or aa but NOT Aa which is heterozygous.

A heterozygous gene pair has different alleles at the locus of each chromosome - eg. Aa

A gene mutation is a permanent change in the DNA sequence that makes up a gene.

A point mutation is single nucleotide base change in the DNA.

For more basics about chromosomes take this tour of the basics.

For more basics about genes take this tour of the basics.

Genetics Refresher

First, refresh your memory about the cell and basic cell biology.

Then review the genome.



DNA is found in the nucleus



And in the mitochondria. Mitochondrial DNA is circular and carries the information for 37 genes. Almost all (99.9%) of your mitochondrial DNA is inherited from your mother.



DNA is transcribed into mRNA in the nucleus, and translated into protein in the cytoplasm.

A gene is the functional unit of heredity in an organism. A gene's nucleotide sequence encodes an RNA or polypeptide.

A gene mutation is a heritable change in the DNA sequence that makes up a gene.

A point mutation are those mutations that affect a single base pair of DNA. It occurs when 1 base on a DNA strand is replaced with a different one. There are four types of point mutations:

(1) missense mutation is where the point mutation results in a wrong codon and a wrong amino acid.

(2) nonsense mutation is where the point mutation results in a stop codon where the protein would be terminated at that point.

(3) silent (or sense) mutation is where the point mutation results in a new codon that still encodes the same amino acid

(4) frameshift mutation results from the addition or deletion of a base pair in a gene. Such additions or deletions shift the mRNA's reading frame by one base so that incorrect amino acids are added to the protein chain.



A chromosomal mutation occurs when a long segment of DNA is deleted, inserted, inverted or translocated.

Much more can be learned about the human genome at this Wellcome Trust website.

Immune System Disorders - Immune Deficiency


Disorders related to defective immunity can be classified as follows:

1) Inadequate response to exposure to foreign antigen (congenital immunodeficiency).

2) An excessive or inappropriate immune response in response to foreign antigen (allergy).

3) The loss of the capacity to distinguish self from non-self (autoimmunity).

4) Cancer of the immune cells.

In this post we will deal with #1 above.

PRIMARY IMMUNE DEFICIENCY is a condition that results if one or more essential components of the immune system fails or is missing due to a congenital genetic defect.

Some examples of primary immune deficiency diseases include:

Reticular dysgenesis

Severe combined immune deficiency disease

Ataxia Telangiectasia

Wiskott-Aldrich Syndrome

DiGeorge Syndrome (affects primarily T cell function)

Bruton's congenital agammaglobulinemia (affects B cell function)

X-linked Hyper-IgM Syndrome

SECONDARY IMMUNE DEFICIENCY

Secondary immune deficiencies occur when damage is caused by an environmental factor.

Neoplastic disorder

Malnutrition

Iatrogenic

Infection