EVALUATION OF BACTERIAL SPECIES IN PATIENTS WITH SKIN INFECTION AND THEIR ANTIBIOGRAM

ABSTRACT

Evaluation of bacterial species in patients with skin infection and their antibiogram were evaluated for the presence of inhabiting microorganism. Four (4) bacteria species were isolated which includes Staphylococcus aureus, Escherichia coli, Klebsiella sp and Pseudomonas aeruginosa. The percentage occurrence of the bacteria isolates showed that Staphylococcus aureus 33.03% had the highest percentage occurrence while Pseudomonas aeruginosa 13.76% had the lowest percentage occurrence. Other bacteria have percentage occurrence which includes Klebsiella sp., (25.67%) and Escherichia coli (27.52%) The antibiotic sensitivity test showed that Klebsiella sp. and Staphylococcus aureus were sensitive to all the antibiotics, while Pseudomonas aeruginosa had 30% activity for the antibiotics used in this study. From this study, it can be said that Staphylococcus aureus, Escherichia coli , Klebsiella sp and Pseudomonas aeruginosa are implicated in the skin infections in human and their presence if not treated will lead to longterm disease in humans affected.

TABLE OF CONTENTS

Certification                                                                                                                            i

Dedication                                                                                                                              ii

Acknowledgements                                                                                                                iii

Table of Contents                                                                                                                   iv

List of Tables                                                                                                                          v

Abstract                                                                                                                                  vi

CHAPTER ONE

1.0

            Introduction                                                                                                                1

1.1       Aims and objectives                                                                                                    3

CHAPTER TWO

2.0       Literature review                                                                                                         4

2.1       Normal flora of the skin                                                                                              5

2.1.1    Diphtheroids                                                                                                               6

2.1.2    Acne                                                                                                                            6

2.2       Principal members of the normal skin flora                                                                7

2.2.1    Fungi                                                                                                                           8

2.2       Bacterial skin diseases                                                                                    8

2.2.1    Furuncles, carbuncles and folliculitis                                                              8

2.2.2    Scalded skin syndrome                                                                                               10

2.2.3    Streptococcal impetigo                                                                                               11

2.2.4    Rocky mountain spotted fever                                                                                   13

2.2.5    Agent rocky mountain spotted fever: is caused by rickettsia rickettsia, an obligate 14

2.2.6    Lyme disease                                                                                                              15

2.2.7    Chickenpox (varicella)                                                                                                17

2.2.8    Measles (rubeola)                                                                                                        19

2.3       Skin diseases caused by fungi                                                                                    20

2.3.1    Tinea versicolor:  is a fungi causing mild skin diseases.                                             20

2.3.2    Superficial cutaneous mycoses                                                                                   21

2.3.3    Other gram-positive bacterial skin infections                                                             22

2.3.4    Gram-negative bacterial skin infections                                                                      23

2.4       Epidemiology of skin infection                                                                                  24

2.4.1    Staphylococcus aureus skin mediated infections                                                        24

2.4.2    Scalded skin syndrome                                                                                               25

2.4.3    Streptococcal impetigo                                                                                               25

2.4.4    Rocky mountain spotted fever                                                                                   25

2.4.5    Rocky mountain spotted fever:                                                                                  26

2.4.6    Lyme disease                                                                                                              26

2.4.7    Chickenpox (varicella)                                                                                                27

2.4.8    Measles (rubeola)                                                                                                        28

2.5       Prevention and treatment of skin infection                                                                29

2.5.1    Staphylococcus aureus skin mediated infection                                                         29

2.5.2    Scalded skin syndrome                                                                                               29

2.5.3    Streptococcal impetigo                                                                                               29

2.5.4    Rocky mountain spotted fever                                                                                   30

2.5.5    Agent rocky mountain spotted fever:                                                                         30

2.5.6    Lyme disease                                                                                                              31

2.5.7    Chickenpox (Varicella)                                                                                               31

2.5.8    Measles (Rubeola)                                                                                                       32

CHAPTER THREE

3.0       Materials and methods                                                                                                33

3.1       Study location /population                                                                                          33

3.2       Sterilization of materials                                                                                             33

3.3       Media used                                                                                                                 33

3.4       Sample collection                                                                                                        34

3.5       Microbiological analysis                                                                                              34

3.5.1    Inoculation                                                                                                                  34

3.5.2    Characterization of bacteria                                                                                        34

3.5.3      Sub-culture and purification of isolates                                                                    34

3.6       Gram staining reaction                                                                                                35

3.7       Biochemical identification of bacterial isolates                                                         35

3.7.1    Catalase test                                                                                                                35

3.7.2    Coagulase test                                                                                                             35

3.7.3    Citrate test                                                                                                                  36

3.7.4    Indole test                                                                                                                   36

3.7.5        Carbohydrate (sugar) utilization test                                                                          36

3.8       Antibiotic sensitivity testing                                                                                       37

CHAPTER FOUR

4.0       Results                                                                                                                        38

CHAPTER FIVE                

5.0       Discussion, Conclusion and Recommendation                                                           47

5.1       Discussion                                                                                                                   47

5.2       Conclusion                                                                                                                  49

5.3       Recommendation                                                                                                        49        References

LIST OF TABLES

Table                                                           Title of tables                                                    Page

1          The biochemical characteristics of the bacteria isolates                                              40

2          Percentage occurrence of bacterial isolates                                                                 41

3a        Diameter zones of inhibition (mm) of Klebsiella sp                                                   42       

3b        Diameter zones of inhibition (mm) of Escherichia coli                                                             43

3c        Diameter zones of inhibition (mm) of Pseudomonas aeruginosa                               44

  3d        Diameter zones of inhibition (mm) of Staphylococcus aureus                                   45

4          Antimicrobial susceptibility pattern of the bacterial isolates                                      46

CHAPTER ONE

1.0       INTRODUCTION

The skin is a barrier that limits invasion and growth of pathogenic bacteria. The cutaneous antimicrobial defense mechanisms include the mechanical rigidity of the stratum corneum and its low moisture content, stratum corneum lipids, production of lysozyme, acidity (pH 5), and defensins (Yoto et al., 2006). Specifically, most areas of skin are dry, creating an unfavorable environment for bacterial replication. Dead keratinocytes slough and physically remove colonizing bacteria. Skin is cooler than normal body temperature and slightly acidic; most bacteria grow best at a neutral pH and at 37°C. If organisms can evade cutaneous host defenses, the next line of protection involves the inunune system, or skin associated lymphoid tissue (SALT) (Ku et al., 2005).

The skin is an intricate habitat for many bacteria. A sterile milieu prenatally, human skin soon becomes host to resident bacteria after birth. The type and density of bacteria are determined by anatomic location, local humidity, the amount of sebum and sweat production, and the host's hormonal status and age (Bosnjak et al., 2005). Bacterial skin flora are commensal, symbiotic, or parasitic relative to the host; although alterations in host immune status are known to have a significant impact, the type of relationship established is often inherent to the bacteria. Persistent colonization is the result of the ability of bacteria to adhere to skin epithelium, grow in a relatively dry and acidic milieu, and rapidly re-adhere during the normal process of desquamation (Holten, 2006).

Skin supports the growth of commensal bacteria, which protect the host from pathogenic bacteria both directly and indirectly. Direct effects include bacteriocin production, production of toxic

metabolites, induction of a low reduction oxidation potential, depletion of essential nutrients, prevention of adherence of competing bacteria, inhibition of translocation, and degradation of toxins. Commensal bacteria compete for nutrients, niches, and receptors. For example, Staphylococcus epidermidis bind keratinocyte receptors and inhibit adherence of virulent S. aureus. Commensals can release species-specific antibiotic substances known as bacteriocins. For example, S. aureus strain 502A release bacteriocins that inhibit other virulent staphylococcal organisms (Holten, 2006).

Thus, infections with a bacterial etiology associated with an inflammatory process limited to the hair follicle are classified as folliculitis. They are characterized clinically by the presence of abscesses and the formation of typical papules or pustules. Impetigo, erysipelas, and cellulitis are widespread infections. Impetigo is an infection limited to the epidermis and characterized by a bullous rash that evolves in crusts and pustules. Erysipelas is an acute erythematous infection that spreads rapidly and is usually associated with systemic symptoms. If the lesion is located in the subcutaneous fat and mainly involves the derma, it is called cellulitis. Both infections are associated with an intense inflammatory process. Infections characterized by rapidly progressive cellulitis that causes extensive damage to the tissue below the derma, in particular to the muscular tissue, and impairs the blood flow are known as necrotizing infections, subsequent to which necrotizing fasciitis and gas gangrene (infections not considered of dermatological competence) arise. The microorganisms most commonly involved in skin infections of a bacterial etiology includes (Kuhne et al., 2006); S. epidermidis found in upper trunk produce slime, S. hominis  found in glabrous skin, S. haemolyticus, S. capitis, S. midis, S. warneri, S. saprophyticus, S. cohnii, S. xylosus, S. simulans, S. saccharolyticus found in forehead/antecubital anaerobic, Micrococcus, M. luteus, M. varians, M. lylae found in children/cold temperature, M. kristinae found in children, M. nishinomiyacnsis, M. roseus, M. sedentarius found  in pitted keratolysis, M. agieis, Corynebacterium, C. minutissimum found in intertriginous lipophilic/porphyrin erythrasma, C. tenuis found  in intertriginous lipophilic trichomycosis, C. xerosis found in conjunctiva lipophilic conjunctivitis, C. jeikeium found  in intertriginous lipophilic/antibiotic resistant, Rhodococcus found  in lipophilic granuloma in HIV, Propionibacterium found  in acnes sebaceous gland lipophilic/anaerobic acne, P. granulosum found  in sebaceous gland lipophilic/anaerobic severe acne, P. avidum found  in axilla lipophilic/anaerobic, Brevibacterium found  in toe webs nonlipophilic (large-colony) foot odor, white piedra found in Dermabacter nonlipophilic (large-colony) pitted keratolysis, while Acinetobacter found  in dry areas gram-negative burn wounds (Ho et al., 2006; Grieco et al., 2005).

1.1       AIMS AND OBJECTIVES

i. To isolate, identify and characterize bacteria associated with skin infections

ii. To determine the antibiotics susceptibility pattern for the bacteria isolated

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