Cause Of Skin Ulceration Research Articles

Passive protection of Japanese pufferfish (Takifugu rubripes) against Vibrio harveyi infection using chicken egg yolk immunoglobulins (IgY)

In recent years, Vibrio harveyi has become a significant cause of skin ulceration of Japanese pufferfish (Takifugu rubripes), and the outbreaks have been responsible for mass mortalities and high economic losses. Thus, the main purpose of this study was to evaluate the protective effect of chicken egg yolk immunoglobulins (IgY) against V. harveyi infection in the T. rubripes. In the present study, hyperimmune anti-V. harveyi IgY was extracted from eggs laid by Hy-Line Brown hens immunized with formaldehyde-inactivated whole V. harveyi cells. The purity of the IgY after separation from egg yolk was approximately 82.4% as assessed by SDS-PAGE. The maximum IgY titer (ELISA) in water-soluble fractions was up to 1:130000 at week 12th of immunization of hens. In-vitro experiment revealed that the IgY inhibited the growth of V. harveyi in liquid medium by a concentration-dependent manner in the range of 1 to 10 mg/mL and on agar plates (P < 0.05). The effect of 10 mg/mL of IgY was similar to the 0.1 mg/mL of streptomycin within 7 h (P > 0.05). Confocal laser scanning microscope (CLSM) assays revealed that anti-V. harveyi IgY caused bacterial agglutination. The T. rubripes intramuscularly injected with 100 μL of V. harveyi (5.4 × 107 CFU/mL) and the IgY (10 mg/mL) showed a survival rate of 80% (P < 0.001). Dietary supplementation of 10% egg yolk powder significantly enhanced the resistance to V. harveyi infection with a survival rate of 50.0% (P < 0.001), as against 100% death in the positive control group. Immersing in 0.5 g/L aqueous IgY resulted in a 60.0% survival in challenged fish (P < 0.001), along with increase in the levels of non-specific immune-related enzymes (SOD, POD, NOS, ACP and LYZ) (p < 0.05). While 1 mg/mL of IgY significantly enhanced the phagocytosis of V. harveyi by macrophages (p < 0.05). These results revealed that IgY has great prospects in protecting T. rubripes against V. harveyi infection.

Diagnosis and treatment of vasculitic ulcerations

Vasculitis is arare cause of skin ulceration. Depending on the size of the affected vessel, the patient's comorbidities and the pathophysiology present, different clinical morphologies can be seen, which can often give preliminary indications of the type of underlying vasculitis. There may be systemic or cutaneous manifestations; thus, a targeted diagnostic workup should be initiated at an early stage. Treatment should be interdisciplinary if there is systemic participation. Vasculopathies (e.g., livedoid vasculopathy), in which occlusion of the vascular lumen is the main pathophysiological feature, should be delimitated from vasculitis. If vasculitic or vasculopathic ulceration is present, stage-appropriate wound management is recommended.

Mass Treatment with Single-Dose Azithromycin for Yaws

BackgroundMass treatment with azithromycin is a central component of the new World Health Organization (WHO) strategy to eradicate yaws. Empirical data on the effectiveness of the strategy are required as a prerequisite for worldwide implementation of the plan.MethodsWe performed repeated clinical surveys for active yaws, serologic surveys for latent yaws, and molecular analyses to determine the cause of skin ulcers and identify macrolide-resistant mutations before and 6 and 12 months after mass treatment with azithromycin on a Papua New Guinean island on which yaws was endemic. Primary-outcome indicators were the prevalence of serologically confirmed active infectious yaws in the entire population and the prevalence of latent yaws with high-titer seroreactivity in a subgroup of children 1 to 15 years of age.ResultsAt baseline, 13,302 of 16,092 residents (82.7%) received one oral dose of azithromycin. The prevalence of active infectious yaws was reduced from 2.4% before mass treatment to 0.3% at 12 months (difference, 2.1 percentage points; P<0.001). The prevalence of high-titer latent yaws among children was reduced from 18.3% to 6.5% (difference, 11.8 percentage points; P<0.001) with a near-absence of high-titer seroreactivity in children 1 to 5 years of age. Adverse events identified within 1 week after administration of the medication occurred in approximately 17% of the participants, included nausea, diarrhea, and vomiting, and were mild in severity. No evidence of emergence of resistance to macrolides against Treponema pallidum subspecies pertenue was seen.ConclusionsThe prevalence of active and latent yaws infection fell rapidly and substantially 12 months after high-coverage mass treatment with azithromycin, with the reduction perhaps aided by subsequent activities to identify and treat new cases of yaws. Our results support the WHO strategy for the eradication of yaws. (Funded by Newcrest Mining and International SOS; YESA-13 ClinicalTrials.gov number, NCT01955252.)

Haemophilus ducreyi as a cause of skin ulcers

In a yaws-endemic area, Oriol Mitjà and colleagues1 show that Haemophilus ducreyi causes skin ulcers in about 7% of children. In the context of empirical therapy, this important work underscores the need to periodically assess assumptions about epidemiology. H ducreyi was thought to be exclusively transmitted by abrasions that occur during sexual intercourse. In human inoculation experiments, 106 H ducreyi cells did not infect intact skin, but as few as one bacterium delivered by a puncture wound caused infection.

A phoenix of clinical toxinology: White-tailed spider (Lampona spp.) bites. A case report and review of medical significance

The Australian white-tailed spiders (“WTS”; Lamponidae: notably Lampona cylindrata &Lampona murina) have a continuing reputation on Internet sites as a cause of skin ulceration, labelled “necrotic arachnidism”, despite an increasing number of peer-reviewed publications debunking this reputation, with >135 confirmed cases now reported without any evidence of necrosis. We present here a case of confirmed WTS bite in a 42-year old male, followed for over a month, with photos of bite site signs and no development of skin ulceration/necrosis. The patient was initially alarmed by information on the Internet suggesting local necrosis would result from the bite. We discuss the evolution of knowledge about bites by the WTS, and the persistence of misconceptions about their factually mild medical significance.

Haemophilus ducreyi as a cause of skin ulcers in children from a yaws-endemic area of Papua New Guinea: a prospective cohort study.

Skin infections with ulceration are a major health problem in countries of the south Pacific region. Yaws, caused by Treponema pallidum subspecies pertenue and diagnosed by the presence of skin ulcers and a reactive syphilis serology, is one major cause, but this infection can be confused clinically with ulcers due to other causative agents. We investigated T pallidum pertenue and another bacterium known to cause skin infections in the Pacific islands-Haemophilus ducreyi-as causes of skin ulceration in a yaws-endemic region. Additionally, we identified specific signs and symptoms associated with these causative agents of cutaneous ulcers and compared these findings with laboratory-based diagnoses. We did a prospective cohort study of five yaws-endemic villages (total population 3117 people) during a yaws elimination campaign in Papua New Guinea in April, 2013. We enrolled all consenting patients with chronic moist or exudative skin ulcers. We undertook a detailed dermatological assessment, syphilis serology, and PCR on lesional swabs to detect the presence of T pallidum pertenue and H ducreyi. Patients with PCR-confirmed bacterial infections were included in a comparative analysis of demographics and clinical features. Full outcome data were available for 90 people with skin ulcers. Of these patients, 17 (19%) had negative results in all molecular tests and were therefore excluded from the comparative analyses. A bacterial cause was identified in 73 (81%) participants-either H ducreyi (n=42), T pallidum pertenue (yaws; n=19), or coinfection with both organisms (dual infection; n=12). The demographic characteristics of the patients infected with yaws and with H ducreyi were similar. Skin lesions in patients with yaws and in those with dual infection were larger than those in patients infected with H ducreyi (p=0·071). The lesions in patients with yaws and dual infection were more circular in shape (79% and 67%) than in those infected with H ducreyi (21%; p<0·0001); more likely to have central granulating tissue (90% and 67% vs 14%; p<0·0001); and more likely to have indurated edges (74% and 83% vs 31%; p=0·0003). The prevalence of reactive combined serology (positive T pallidum haemagglutination test and rapid plasmin reagin titre of ≥1:8) was higher in cases of yaws (63%) and dual infections (92%) than in H ducreyi infections (29%; p<0·0001). In this yaws-endemic community, H ducreyi is an important and previously unrecognised cause of chronic skin ulceration. Reactive syphilis serology caused by latent yaws can occur in ulcers with the presence of H ducreyi alone. The introduction of PCR for ulcer surveillance could improve the accuracy of diagnosis in countries with yaws eradication campaigns. Newcrest Mining Company.

Pyoderma Gangrenosum in Two Successive Pregnancies Complicating Caesarean Wound

Pyoderma gangrenosum (PG) is a rare ulcerative cutaneous disorder with tendency to recur in the injured area. Though most of the time is associated with chronic systemic conditions, it can occur in isolation and can be a diagnostic dilemma. The aetiology is poorly understood. The diagnosis is based on clinical features and excluding other causes of skin ulcers, as it does not have characteristic histopathology or laboratory findings. Lesions can develop after surgery, after trauma or de novo. We are reporting a 32-year-old pregnant lady with two previous instances of pyoderma gangrenosum in the previous pregnancy, who in postoperative period following caesarean section developed the same condition for the third time. She responded well to local wound care, oral Prednisolone, and Dapsone and made a good recovery. Pregnancy being an immunologically altered status can play a role in development of pyoderma gangrenosum and one should always rule out its possibility when there is a delayed wound healing.

Drug cutaneous side effect: focus on skin ulceration.

Skin ulcers are defined as tissue loss interesting the deeper layers of the dermis and hypodermis, with low tendency to spontaneous healing. They cause disability related to pain, risk of infection and amputation, chronic management, requiring working absence with notably economic burden. The major cause is often related to underlying vascular disease, infections, tumors, autoimmunity, trauma, even if literature occasionally reported several cases of drug inducing skin ulceration. Most of drugs involved are chemotherapy agents and more recently molecular target therapies. Evidences supporting these drugs as the major cause of skin ulcers include delay of onset after therapy initiation, improvement after withdrawal of the drug, recurrence after its reintroduction and, sometimes, simultaneous occurrence of other skin lesions that have previously been reported to be associated with these agents. Attention should be reserved to patients undergoing antineoplastic agents, especially if previously affected by predisposing comorbidities, considering such side effect as possible differential diagnosis for skin ulceration in neoplastic patients.

Factor V Leiden Mutation–Related Chronic Skin Ulcers

Chronic skin ulcers require extensive, systemic differential diagnosis; thus, they are difficult to diagnose and treat. Transient or persistent hypercoagulable states are among the rare causes of skin ulcers. Here, we present the case of a 27-year-old woman patient with recurrent, nonhealing skin ulcers of 8 years' duration, who had been treated unsuccessfully with various medications under different diagnoses at different clinics. On admission, a skin biopsy demonstrated occlusive vasculopathy, and the search for an inherited hypercoagulable state revealed a heterozygous factor V Leiden mutation. The patient was treated with anticoagulants and hyperbaric oxygen. On treatment, the skin lesions healed and did not recur.

An Unusual Cause of Skin Ulceration in a Very Long-Term Peritoneal Dialysis Patient

An Unusual Cause of Skin Ulceration in a Very Long-Term Peritoneal Dialysis Patient

膠原病における皮膚潰瘍治療

The causes of skin ulcers in collagen vascular diseases are complicated, and involve peripheral vascular complications, vasculitis, and thrombosis. It is necessary to determine the treatment, such as oral medication, infusion, ointment and surgery after careful consideration of its causes. This review shows skin manifestations of various collagen vascular diseases and the causes of skin ulcers in these diseases.

Pyoderma gangrenosum after caesarean section: a case report

BackgroundPyoderma gangrenosum is a rare ulcerative skin disease. The diagnosis is based on clinical features and excluding other causes of skin ulcers, as it does not have characteristic histopathology or laboratory findings. The etiology is poorly understood. Lesions can develop spontaneously, after surgery or after trauma.Case presentationWe present the case of a 32-year-old woman with ulcerative wound defect after caesarean section. The wound was not healing despite standard wound care and antibiotic treatment. Pyoderma gangrenosum was diagnosed and after high dose corticosteroids wound healing started.ConclusionEarly diagnosis and subsequent treatment of pyoderma gangrenosum are crucial for limiting scar tissue. Diagnosis of pyoderma gangrenosum could easily be missed since gynaecologists are rarely confronted with this disorder.

65-Year-Old Woman With Painful Leg Ulcers

65-Year-Old Woman With Painful Leg Ulcers

Sequelae of Mycobacterium ulcerans infections (Buruli ulcer)

Buruli ulcer, a type of mycobacterial infection, has recently emerged as an increasingly common and major cause of skin ulceration and associated morbidity, especially in the West African sub-region. In 1993, there was an outbreak of the disease in the Amansie West District of Ghana. From 1994 to 1998, 360 ulcers (already healed or active disease) were seen. Some of them were managed surgically at the Komfo Anokye Teaching Hospital (KATH), Kumasi and at two district hospitals all in the Ashanti Region. Many of the victims lost limbs (amputated), sight, breast, genitalia or they developed contractures of the toes, ankle joints, knee joints, wrists, fingers, elbows, etc. with subsequent lymphedema. Surgical excision of the ulcers with skin grafting resulted in wound closure. Secondary problems such as contractures were corrected by standard reconstructive methods.

Uncommon Causes of Ulcers

Skin ulcers are a commonly encountered problem in clinical practice. Failure of an ulcer to respond to therapy might suggest less common causes of skin ulcers. This article reviews clinical aspects of uncommon skin ulcers.

Deposits of paraprotein in small vessels as a cause of skin ulcers in Waldenstr�m's macroglobulinemia

A 71-year-old man presented with epistaxis and large ulcers on arms and legs. A monoclonal IgM-kappa gammopathy and high levels of cryoglobulins were found. Histology of the affected skin showed deposits of paraprotein in the small vessels, causing luminal obstruction. This in turn caused ischemic skin lesions, which were successfully treated with cortisone (fluocortolone 100 mg/day every second day) and cyclophosphamide (100 mg/day).

Prolidase deficiency: an inborn error of metabolism with major dermatological manifestations.

Prolidase deficiency is a very rarely reported inborn error of metabolism. It has important and severe dermatological manifestations, especially ulcers of the lower extremities. It has been reported from seven different countries. It is suspected that the disease is more common than presently acknowledged. It is suggested that this disease should be included on the list of causes of skin ulcers in order to have a higher index of suspicion for diagnosis.