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Cutaneous Infections (cutaneous + infections)

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Medical Sciences	92%

Selected Abstracts

Therapy of environmental mycobacterial infections

DERMATOLOGIC THERAPY, Issue 3 2008
Caterina Fabroni
ABSTRACT: Environmental mycobacteria are the causative factors of an increasing number of infections worldwide. Cutaneous infections as a result of environmental mycobacteria are often misdiagnosed, and their treatment is difficult because these agents can show in vivo and in vitro multidrug resistance. The most common environmental mycobacteria that can cause cutaneous infections are Mycobacterium fortuitum and Mycobacterium marinum. All mycobacteria are characterized by low pathogenicity and they can contaminate affected or traumatized skin only in immunocompetent subjects (mainly in fishermen, swimming-pool attendants, and aquarium owners) whereas medical and esthetic procedures are at risk for the infections because of the quick-growing mycobacteria. Immunocompromised subjects can instead easily develop environmental mycobacterial infections of differing degrees of severity. [source]

Cutaneous infections in the elderly: diagnosis and management

DERMATOLOGIC THERAPY, Issue 3 2003
Jeffrey M. Weinberg
ABSTRACT:, Over the past several years there have been many advances in the diagnosis and treatment of cutaneous infectious diseases. This review focuses on the three major topics of interest in the geriatric population: herpes zoster and postherpetic neuralgia (PHN), onychomycosis, and recent advances in antibacterial therapy. Herpes zoster in adults is caused by reactivation of the varicella-zoster virus (VZV) that causes chickenpox in children. For many years acyclovir was the gold standard of antiviral therapy for the treatment of patients with herpes zoster. Famciclovir and valacyclovir, newer antivirals for herpes zoster, offer less frequent dosing. PHN refers to pain lasting ,2 months after an acute attack of herpes zoster. The pain may be constant or intermittent and may occur spontaneously or be caused by seemingly innocuous stimuli such as a light touch. Treatment of established PHN through pharmacologic and nonpharmacologic therapy will be discussed. In addition, therapeutic strategies to prevent PHN will be reviewed. These include the use of oral corticosteroids, nerve blocks, and treatment with standard antiviral therapy. Onychomycosis, or tinea unguium, is caused by dermatophytes in the majority of cases, but can also be caused by Candida and nondermatophyte molds. Onychomycosis is found more frequently in the elderly and in more males than females. There are four types of onychomycosis: distal subungual onychomycosis, proximal subungual onychomycosis, white superficial onychomycosis, and candidal onychomycosis. Over the past several years, new treatments for this disorder have emerged which offer shorter courses of therapy and greater efficacy than previous therapies. The treatment of bacterial skin and skin structure infections in the elderly is an important issue. There has been an alarming increase in the incidence of gram-positive infections, including resistant bacteria such as methicillin-resistant Staphylococcus aureus (MRSA) and drug-resistant pneumococci. While vancomycin has been considered the drug of last defense against gram-positive multidrug-resistant bacteria, the late 1980s saw an increase in vancomycin-resistant bacteria, including vancomycin-resistant enterococci (VRE). More recently, strains of vancomycin-intermediate resistant S. aureus (VISA) have been isolated. Gram-positive bacteria, such as S. aureus and Streptococcus pyogenes are often the cause of skin and skin structure infections, ranging from mild pyodermas to complicated infections including postsurgical wound infections, severe carbunculosis, and erysipelas. With limited treatment options, it has become critical to identify antibiotics with novel mechanisms of activity. Several new drugs have emerged as possible therapeutic alternatives, including linezolid and quinupristin/dalfopristin. [source]

Cutaneous infections with Stenotrophomonas maltophilia in patients using immunosuppressive medication

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 9 2007
JGE Smeets
[source]

Extensive and deep dermatophytosis caused by Trichophyton mentagrophytes var. Interdigitalis in an HIV-1 positive patient

JOURNAL OF THE EUROPEAN ACADEMY OF DERMATOLOGY & VENEREOLOGY, Issue 1 2000
Ma Muñoz-Pèrez
Abstract Background,Cutaneous infections are common in HIV-1 positive patients and are usually severe, recurrent, and caused by microorganisms that are unusual in immunocompetent patients. Objective,We report a case of an HIV-1-positive 23-year-old male, with a history of intravenous drug use, in stage C-II (CDC ,86), with a CD4 lymphocyte count of 335 cells/mm3. He had multiple, large erythematous, circinate and pustular plaques on his abdomen, back, arms and legs. Results,We isolated Trichophyton mentagrophytes var. interdigitalis from the lesions. The biopsy showed suppurative deep dermatophytosis and folliculitis. The patient satisfactorily responded to itraconazole (100 mg/d for 14 days). Conclusion,This is the first reported case of deep dermatophytosis caused by T. mentagrophytes in an HIV-positive patient. [source]

Topical Antibacterial Agents for Wound Care: A Primer

DERMATOLOGIC SURGERY, Issue 6 2003
Candace Thornton Spann MD
Although often overlooked, topical antibiotic agents play an important role in dermatology. Their many uses include prophylaxis against cutaneous infections, treatment of minor wounds and infections, and elimination of nasal carriage of Stapylococcus aureus. For these indications, they are advantageous over their systemic counterparts because they deliver a higher concentration of medication directly to the desired area and are less frequently implicated in causing bacterial resistance. The ideal topical antibiotic has a broad spectrum of activity, has persistent antibacterial effects, and has minimal toxicity or incidence of allergy. [source]

Therapy of environmental mycobacterial infections

Antimicrobial therapy in Dermatology

JOURNAL DER DEUTSCHEN DERMATOLOGISCHEN GESELLSCHAFT, Issue 1 2006
Cord Sunderkötter
Antiseptika; Antibiotika; ,-Laktam-Resistenz; Weichteilinfektion Summary The extensive and sometimes indiscriminate use of antibiotics sometimes without strict indications has led to increases in both bacterial resistance and sensitization of patients. Systemic antibiotics in skin infections are indicated when a severe local infection occurs which spreads into the surrounding tissue or when there are signs of systemic infection. There are special indications in patients with peripheral arterial occlusive disease,diabetes or immunosuppression. Topical use of antibiotics should be abandoned and replaced by antiseptics. The ,-lactam antibiotics are the antibiotics of first choice for many skin infections. They are usually effective, have a well-defined profile of adverse events and most are affordable. Penicillin G or V are the first line treatment for erysipelas. Infections with Staphylococcus aureus are usually treated with isoxazolyl penicillins or second generation cephalosporins. In mixed infections in patients with diabetes or peripheral arterial occlusive disease,the treatment of choice is metronidazole plus ,-lactam-/,-lactamase inhibitor antibiotics, but quinolones or second generation cephalosporins can also be used, once again with metronidazole. The aim of this review is to define the indications for antibiotics in dermatology, to highlight their modes of action and adverse effects and to make suggestions for rational antibiotic therapy in cutaneous infections frequently encountered in the practice of dermatology. Zusammenfassung Der bisweilen unkritische Einsatz von Antibiotika hat die Resistenzentwicklung beschleunigt und die Sensibilisierungsrate bei Patienten erhöht. Systemische Antibiotika sind bei kutanen Superinfektionen in der Regel dann indiziert, wenn eine schwere lokale Infektion mit Ausbreitung in das umgebende Gewebe vorliegt oder wenn sich gleichzeitig Zeichen einer systemischen Infektion einstellen. Bei peripherer arterieller Verschlusskrankheit, Diabetes mellitus oder Immunsuppression kann die Indikation auch früher gestellt werden. Lokale Antibiotika sollten in der Regel gemieden und durch moderne Antiseptika ersetzt werden. ,-Laktam-Antibiotika stellen für viele bakterielle Infektionserkrankungen in der ambulanten und klinischen Dermatologie die Antibiotika der ersten Wahl dar. Sie sind häufig ausreichend wirksam, besitzen ein gut definiertes Nebenwir-kungsprofil und sind zumeist preisgünstig. So wird das klassische Streptokokken-Erysipel mit Penicillin G oder V therapiert, bei Infektionen durch S. aureus kommen primär Isoxazolyl-Penicilline oder Zweit-Generations-Cephalosporine zum Einsatz. Im Falle von Mischinfektionen bei Diabetes mellitus oder pAVK sind ,-Laktam/,-Laktamaseinhibitoren indiziert, alternativ auch Chinolone oder Zweitgenerations-Cephalosporine, jeweils in Kombination mit Metronidazol. Diese Übersicht möchte die Indikationen für Antibiotika in der Dermatologie aufzeigen, das Wichtigste zu deren Wirkungsweise und Nebenwirkungen aufzählen und Therapievorschläge für häufige Infektionen der Haut in der dermatologischen Praxis geben. [source]

Distribution of mycobacteria in clinically healthy ornamental fish and their aquarium environment

JOURNAL OF FISH DISEASES, Issue 7 2006
V Beran
Abstract Some mycobacterial species (particularly Mycobacterium marinum) found in aquarium environments may cause chronic diseases in fish and cutaneous infections in humans, the so-called ,fish tank granuloma'. The presence and distribution of mycobacterial species in clinically healthy aquarium fish and their environment has not been adequately explored. The present study analysed the occurrence of mycobacteria in a decorative aquarium (Brno, South Moravia) and in five aquaria of a professional fish breeder (Bohumin, North Moravia). After Ziehl,Neelsen staining, acid-fast rods (AFR) were observed in six (14.3%) and mycobacteria were detected by culture in 18 (42.9%) of 42 tissue samples from 19 fish. Sixty-five samples of the aqueous environment from all six aquaria were examined; AFR were found in 16 (24.6%) and mycobacteria were detected by culture in 49 (75.4%) samples. Forty-one (70.7%) of 58 selected mycobacterial isolates were identified biochemically as follows: M. fortuitum, M. flavescens, M. chelonae, M. gordonae, M. terrae, M. triviale, M. diernhoferi, M. celatum, M. kansasii and M. intracellulare. The clinically important species for humans and fish, M. marinum, was not detected. Mycobacterium kansasii was isolated from one sample of the aquarium environment from North Moravia, which is a region of the Czech Republic with endemic incidence of M. kansasii in water. The incidence of other conditionally pathogenic mycobacterial species in healthy fish and in all investigated constituents of the aquarium environment including snails and crustaceans used for fish feeding, was quite high. Accordingly, mycobacterial species from aquarium environments may serve as a possible source of infection for both aquarium fish and immunodeficient fish handlers. [source]

Incidence of benign upper respiratory tract infections, HSV and HPV cutaneous infections in inflammatory bowel disease patients treated with azathioprine

ALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 10 2009
P. SEKSIK
Summary Background, There are few data on the incidence of benign infections (upper respiratory tract infections, herpes lesions and viral warts) during exposure to azathioprine. Aims, To determine the incidence of benign infections in IBD out-patients receiving azathioprine (AZA+) and to look at the influence of leucocyte counts in the onset of these events. Methods, A total of 230 patients were included in a prospective cohort and observed during 207 patient-years. Episodes of benign infections were collected and incidences of benign infections were compared between the AZA+ group and patients without AZA (AZA,). Results, The incidence of upper respiratory tract infections in the cohort was 2.1 ± 2.2 per observation-year. There was no difference between the AZA+ (n = 169) and AZA, (n = 61) groups (2.2 ± 2.3 vs. 2.1 ± 2.1, P = 0.77). The incidence of herpes flares was significantly increased in the AZA+ group compared to the AZA, group (1.0 ± 2.6 vs. 0.2 ± 0.8 per year, P = 0.04). Similarly, there were significantly more patients with appearance or worsening viral warts in the AZA+ group (17.2% (AZA+) vs. 3.3% (AZA,), P = 0.004). Conclusion, This study suggests that the incidence of herpes flares and the appearance or worsening of viral warts are increased in IBD patients receiving AZA. [source]

Herpetic Infection in Epidermolysis Bullosa

PEDIATRIC DERMATOLOGY, Issue 4 2006
Adam I. Rubin M.D.
Standard wound care practices advocate the use of special dressings on open erosions as well as antibiotic topical medications to treat and prevent cutaneous infections. We report a child with recessive dystrophic epidermolysis bullosa admitted to our institution because of fevers at home. She was treated with multiple antibiotics for a cutaneous infection of the right hand. During her hospital stay, she sustained persistent fevers, and oral erosions developed, with progressive hemorrhagic crusting. Viral culture of the lip grew herpes simplex virus type 1, consistent with a diagnosis of herpetic gingivostomatitis. We present this patient to illustrate the importance of investigating wounds of epidermolysis bullosa patients for viral agents when faced with managing a child with an unclear source of fever. To the best of our knowledge, although this is the first report of herpetic gingivostomatitis in association with epidermolysis bullosa, it is likely to be more prevalent than the literature could suggest. [source]

Cutaneous alternariosis in a cardiac transplant recipient

AUSTRALASIAN JOURNAL OF DERMATOLOGY, Issue 1 2001
Tanya K Gilmour
SUMMARY A 55-year-old male cardiac transplant recipient presented with cutaneous nodules on the limbs caused by Alternaria alternata. Oral fluconazole 200 mg daily for 3 weeks was ineffective. Itraconazole 100 mg oral daily was ceased when hyperglycaemia developed. Individual lesions were successfully treated with either curettage and cautery or double freeze-thaw cryotherapy. Alternaria spp. are ubiquitous fungal saprophytes which may cause cutaneous infections particularly in immunocompromised patients. [source]

Darier's disease in Singapore

BRITISH JOURNAL OF DERMATOLOGY, Issue 2 2005
B.K. Goh
Summary Background, Darier's disease is a rare, dominantly inherited genodermatosis. Although it has been well studied in caucasians, very little is known about the clinical spectrum of this disorder among Asians. Objectives, To determine the demographic and clinical profile of Asian patients with Darier's disease. Methods, This is a retrospective study of all new cases of Darier's disease seen in our centre over a 20-year period (1982,2002). Results, Twenty-four nonrelated cases of Darier's disease were studied. The incidence rate was 3·1 per million per decade. The gender distribution was 19 males and five females, and the ethnic origin was 21 Chinese, two Malays and one Nepalese. The peak age of onset was between 11 and 20 years. Sun exposure exacerbated the disease in 13 of the patients, and three had neuropsychiatric disorders. The disease affected predominantly seborrhoeic areas in 19 patients, flexural in three, acral in one and was segmental in one patient. Hand involvement was common and included palmar pits in nine patients, acrokeratosis verruciformis in four and nail changes in 12 patients. Haemorrhagic macules were not seen. Rare features included oral mucosal lesions (two patients) and guttate leucoderma (three patients). Pathogens involved in cutaneous infections included herpes simplex virus, Staphylococcus aureus, Streptococcus species and Morganella morgani. All patients treated with oral retinoids had improvement of clinical signs. In contrast, the response to topical retinoids was poor. Conclusions, Compared with western studies, our results show a similar incidence rate, age of onset, distribution of disease patterns and association with neuropsychiatric disorders. Features that differ include co-occurrence of guttate leucoderma, rarity of acrokeratosis, absence of haemorrhagic macules and poor response to topical retinoids. [source]

Dermatological signs in South Asian women induced by sari and petticoat drawstrings

CLINICAL & EXPERIMENTAL DERMATOLOGY, Issue 5 2010
S. B. Verma
Summary The sari, the elegant garment worn by Indian and many South Asian women, is associated with many cutaneous signs. With millions of South Asians settled all over the world, it is important for clinicians to be aware of the cutaneous associations of wearing a sari that is tied tightly around the waist with a drawstring. Lichenified linear hyperpigmented grooves, vitiligo, postinflammatory depigmentation, lichen planus and superficial cutaneous infections are some of the conditions seen in women wearing this garment. This review is one of the very few detailed reports of this widely worn garment and its dermatological associations. [source]

Cutaneous Community-associated Methicillin-resistant Staphylococcus aureus among All Skin and Soft-tissue Infections in Two Geographically Distant Pediatric Emergency Departments

ACADEMIC EMERGENCY MEDICINE, Issue 1 2007
Molly B. Hasty MD
Abstract Objectives To describe the culture results of cutaneous infections affecting otherwise healthy children presenting to two pediatric emergency departments (EDs) in the southeastern United States and southern California. Methods Medical records of 920 children who presented to the pediatric EDs with skin infections and abscesses (International Classification of Diseases, Ninth Revision codes 680.0,686.9) during 2003 were reviewed. Chronically ill children with previously described risk factors for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) were excluded. Data abstracted included the type of infection; the site of infection; and, if a culture was obtained, the organism grown, along with their corresponding sensitivities. Results Of the 270 children who had bacterial cultures obtained, 60 (22%) were CA-MRSA,positive cultures, most cultured from abscesses (80%). Of all abscesses cultured, CA-MRSA grew in more than half (53%). All CA-MRSA isolates tested were sensitive to vancomycin, trimethoprim-sulfamethoxazole, rifampin, and gentamicin. One isolate at each center was resistant to clindamycin. The sensitivities at both institutions were similar. Conclusions The authors conclude that CA-MRSA is responsible for most abscesses and that the pattern of CA-MRSA infections in these geographically distant pediatric EDs is similar. These data suggest that optimal diagnostic and management strategies for CA-MRSA will likely be widely applicable if results from a larger, more collaborative study yield similar findings. [source]