a macule is like a rash and is flat and discolored

a papule is erythemous swelling of the skin; can be raised and indurated meaning hardened.  collection of cells giving rise to these features is known as a nodule

acute:  erythematous papules, macules, vesicles, tissue necrosis, ulcers

chronic:  granulomas, hair loss

lyme disease:

-pathogen

-lesion stages

pathogen: Borreliaburgdorferi; B. garinii; B. afzelii

lesion stages: 1)Erythema migrans (EM), 2) Multiple EMs of Borreliallymphocytoma (BL, may be found in ear lobe of child) – a rare, stage 2 lesion, (smaller, smoother redder, further away from initial site) 3) Acrodermatitischronicaatrophicans (ACA) – a rare, and very unusual, well defined plaques seen in the elderly

dx'd by seriology bc it's difficult to grow

Lesion(s) are usually flat or slightly elevated but rare vesicular 

         forms have been reported.

●     EM lesions appear an average of 9 days (range of 1-36 days) 

         from tick attachment and resolve spontaneously within 3 to 5

         weeks; they resolve quicker if pt

given antibiotics.

usually DO NOT itch

west, southwest, virigin islands, africa, ethiopia, sudan

spread by several boriella including the ornitodoros "soft tick"

flu-like symtoms with recurrent episodes of fever

small puritic rash is less than half of those bitten (other lesions may appear as papules of petechial hemorrhages)

found in southwest in USA and is linked to the aerosolation of the infected tissue through the preparation of animals having been trapped and slaughtered

clinical forms:

cutaneous; small and painful, will enlarge and ulcerate and will turn from eschar to scar

  ulceroglandular; oculoglandular

  pneumonic;

  oropharyngeal;

  typhoidal

● erythema nodosum &

● erythema multiforme

Anthrax, ecthyma, animal bite infection, cat scratch disease, plague, sporotrichosis

-rock mountin spotted fever

-erlichiosis (mid-west) and anaplasmosis (north eastern)

-q-fever, but not really a tick diease because it first affects the animal which then affects us

all these diseases is caused by obligate intracellular pathogens

-dog tick bite

-pink, discrete macules-> progress of papules, petichials, then ecchymoses (blue/black discoloration)

-prefers extremities

these rods will be found intracellulary

because they are Ricketsia ricketsii

can be detected by serology, but patient is usually pretty bad off my this point.  non-penicillin ABs need to be used because cell wall cannot be accessed

what is a tache noire

Cutaneous manifestations:  a unique eschar

    ● a few days after the onset of “flu-like” symptoms, lesion begins as

       an erythematous macule, progressing to papular, vesicular, and

       necrotic stages to form a painless small ulcer with a black, crusted

       necrotic center having an erythematous halo.

seen in a few other spotted fevers

Ehrlichiosis

     ● found mostly in the southeastern & mid-western USA;

     ● rash occurs in about 20-88% of cases;

     ● rash can appear as petechial, macular, papular and

         erythematous;  ● found mostly on the extremities.

dx'd by intracellular ricketsial forms called "morullas"

HGE: ● recently re-named as anaplasmosis;

     ● occurs mostly in the northeast & upper midwest

     ● caused by Anaplasmaphagocytophilum;

     ● transmitted mostly by deer ticks the rash is less prominent than that seen in Lyme(I. scapularis);

     ● rash not a prominent feature (appears in <16% of cases)

dx'd by intracellular ricketsial forms called "morullas"

southeast, central midwest

lone-star tick

aka master's disease

rash is identical to EM caused by Lyme

Leishmaniasis

Leishmaniapromastigotes are injected into the skin; these “transform” into amastigotes from SAND-FLIES which enter and grow inside macrophages; can be dx'd by touch prep using Giemsa

likely found in middle east, asia, or south america

the organism could also be histoplasmosis if it is not Leishmaniasis

"sleeping sickness" from tsetse fly

a chancre soon appears after the fly bite (a hard red painful nodule)

disipitates in two weeks, but then comes back larger two weeks after that

---------------

a similar disease could happpen in the united states through a vector that is a blood-sucking reduviid bug

-25% of patients develop a CHAGOMA lesion (localized) and 50% develop a ROMANA sign (swelling of eeye)

flea bites, yersina pestis, gram neg rod

initial nodular lesions but spreads quickly through lymphatics (causing overlying skin to turn red with the nodes become so inflammed)

blue-black cutaneous hemorrhaging gives it the name "the black death"

because it has a CO₂ requirement

spore forming, may also be pneumonic and gastrointestinal

black eschars form

exposed skin to marina water, fish tanks

begins with erythmatous to blue papules

usually pretty localized with low morbitity except in immunocompromised patients, however, it could infiltrate the lymphatics

cultured at 33 degrees on lowenstein (just like TB)

acid fast bacilli

can be surrounded by granuloma