Dermal Necrosis Research Articles

Geotrichum candidum as a possible cause of bovine abortion

Geotrichum spp. are ubiquitous, saprotrophic fungi found in soil, organic matter, and silage, as a contaminant in food products and in the digestive tracts of mammals. The current study reports a case of Geotrichum candidum infection with dermatitis in an aborted bovine fetus with skin and lung lesions. A 6-month-old aborted male Holstein Friesian fetus displayed unusual lesions on the skin of the abdomen, thorax, and head, which was excessively thickened and wrinkled. These changes corresponded to orthokeratotic hyperkeratosis, neutrophil accumulation in the stratum corneum, a pyogranulomatous inflammatory infiltrate, and superficial dermal necrosis. Moderate suppurative multifocal pneumonia was observed. Large numbers of mononuclear cells and occasional fibrin thrombi within blood vessels were found in the lungs, brain, and cerebellum. Gridley staining revealed fungal structures within the skin lesions. The mycological exam demonstrated the growth of G. candidum, and phase contrast microscopy conducted on the abomasal fluid revealed hyphae compatible with this agent. The skin lesions observed, in association with the fungus isolated, indicated that the abortion was due to G. candidum infection of the bovine fetus.

Resolvin D2 prevents secondary thrombosis and necrosis in a mouse burn wound model

Deep partial thickness burns are subject to delayed necrosis of initially viable tissues surrounding the primary zone of thermally induced coagulation, which results in an expansion of the burn wound, both in area and depth, within 48 hours postburn. Neutrophil sequestration and activation leading to microvascular damage is thought to mediate this secondary tissue damage. Resolvins, a class of endogenous mediators derived from omega-3 polyunsaturated fatty acids, have been shown to regulate the resolution of inflammation. We hypothesized that exogenous resolvins could mitigate the deleterious impact of the inflammatory response in burn wounds. Using two different mouse burn injury models involving significant partial thickness injuries, we found that a systemically administered single dose of resolvin D2 (RvD2) as low as 25 pg/g bw given within an interval of up to 4 hours postburn effectively prevented thrombosis of the deep dermal vascular network and subsequent dermal necrosis. By preserving the microvascular network, RvD2 enhanced neutrophil access to the dermis, but prevented neutrophil-mediated damage through other anti-inflammatory actions, including inhibition of tumor necrosis factor-α, interleukin-1β, and neutrophil platelet-endothelial cell adhesion molecule-1. In a clinical context, RvD2 may be therapeutically useful by reducing the need for surgical debridement and the area requiring skin grafting.

Necrotizing Cervical Fasciitis, Retrospective study of Cases and management

Total nine patients of Cervicofacial Necrotizing Fasciitis (CNF) were treated at ENT Department Al Ain Hospital between September 2007 and September 2009. The out come of their management studied retrospectively and presented. All patients were evaluated regarding clinical manifestations, etiology and site of infection and details of their management were discussed. Majorities of patients were diabetic male adults. All patients had odontogenic infection as the primary source of infection, except one who had parapharyngeal abscess.. The bacteriology showed streptococci on top of the list, but all of them had multibacterial infections. Gentamycin, metronidazol, benzyle Penicilline and clindamycin represent a combination thearapy covering all gram negative, gram positive and anaerobes for all cases. Histopathology showed extensive tissue necrosis with dermal vascular necrosis. Mortality was 1/9 (11.1%). One patient died from his illness and others recovered after proper surgical and medical management. Details of their presentation, site of infection, bacteriological causes and out come of the management are discussed and results compared with other articles. We emphasize early diagnosis and initiation of both aggressive surgical (repeated debridement) and medical treatment (combinations of antibiotics) and a multidisciplinary approach is essential to minimize mortality.

Extravasation injury due to dopamine infusion leading to dermal necrosis and gangrene

Extravasation injury due to dopamine infusion leading to dermal necrosis and gangrene

A case series of thermal scald injuries in dogs exposed to hot water from garden hoses (garden hose scalding syndrome)

In this report, we present a series of cases of thermal burns (scalds) in dogs resulting from exposure to hot water from a garden hose that had been lying in the sun. These dogs typically inhabited the southern and western regions of the USA, where the recorded high temperatures often exceed 32°C (90°F) during the warm summer months. Dogs with thermal scald injury in these cases presented with linear thermal burns along the dorsum, in addition to a variety of other macroscopic lesions that were dependent upon the degree of burn exposure and ranged from local erythema to ulcerated, necrotic and sloughing skin. Chronic, healed wounds were often alopecic, with markedly thickened skin and characteristically smooth and glassy scar tissue formation. Histologically, the lesions of thermal scald injury in these dogs were indistinguishable from any other second or third degree burn, and consisted of full-thickness dermal and epidermal necrosis with occasional fibrinoid necrosis of vessel walls, vasculitis and intravascular thrombosis. Here, we closely examine 10 cases of dogs with dorsal thermal burns collected from Texas, Arizona, California, Utah, Nevada, Indiana, Michigan and North Carolina and propose the term 'garden hose scalding syndrome (GHS)' to describe this unique type of scald injury.

Prognostic value of histologic features of toxic epidermal necrolysis

The prognosis of toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and SJS/TEN overlap syndrome has been assessed using a disease-specific severity score (SCORTEN) based on clinical and laboratory data. Histologic data may improve outcome prediction. We sought to evaluate whether dermal mononuclear infiltration and epidermal necrosis predict survival of patients with TEN, SJS, or SJS/TEN. We conducted a retrospective review of clinical records and skin biopsy specimens read without knowledge of clinical data. We identified 108 patients (SJS, n = 42; SJS/TEN, n = 36; TEN, n = 30). Overall mortality was 21.3%. Dermal infiltration and epidermal necrosis were not associated with time from disease onset to biopsy. Extensive dermal infiltrates were seen in 19 (18.5%) patients and full-thickness epidermal necrosis in 56 (52%) patients. Dermal infiltrate severity was not associated with day-1 (D1) SCORTEN or hospital death. Epidermal necrosis severity showed trends toward associations with D1 SCORTEN (P = .11) and hospital death (P = .06). In univariate analyses, full-thickness epidermal necrosis was significantly associated with hospital death (32.1% vs 11.4%, P = .017) and worse D1 SCORTEN values (1.98 ± 1.29 vs 1.55 ± 1.21; P = .04). In the bivariate analysis, however, D1 SCORTEN remained significantly associated with hospital death (odds ratio = 3.07, 95% confidence interval 1.83-5.16) but the association with full-thickness epidermal necrosis was no longer significant (odds ratio = 2.02, 95% confidence interval 0.65-7.12). Retrospective study design and indirect assessment of progression are limitations. Full-thickness epidermal necrosis was associated with mortality but did not independently predict hospital death after adjustment based on the SCORTEN value. Dermal infiltrate severity was not associated with hospital death.

Resistance of erythrocytes from Brown trout (Salmo trutta m. trutta L.) affected by ulcerative dermal necrosis syndrome

In the present work we evaluated the effect of ulcerative dermal necrosis (UDN) syndrome on resistance of erythrocytes to haemolytic agents and lipid peroxidation level in the blood from brown trout (Salmo trutta m. trutta L.). Results showed that lipid peroxidation increased in erythrocytes, as evidenced by high thiobarbituric acid reactive substance (TBARS) levels. Compared to control group, the resistance of erythrocytes to haemolytic agents was significantly lower in UDN-positive fish. Besides, UDN increased the percent of hemolysated erythrocytes subjected to the hydrochloric acid, urea and hydrogen peroxide. Results showed that UDN led to an oxidative stress in erythrocytes able to induce enhanced lipid peroxidation level, as suggested by TBARS level and decrease of erythrocytes resistance to haemolytic agents.

Oxalosis Involving the Skin

The primary hyperoxalurias are a group of rare autosomal recessive metabolic disorders associated with abnormal overproduction of serum oxalate and subsequent deposition in tissue. Most patients present at an early age with recurrent urolithiasis and renal failure. Vascular deposition of oxalate-producing skin manifestations, such as livedo reticularis, acrocyanosis, peripheral gangrene, and ulcerations, is typical of the primary hyperoxalurias. We present the case of a 38-year-old woman with end-stage renal disease receiving hemodialysis with progressive skin changes, including livedo reticularis, superficial eschars, and brawny, woody fibrosis of her extremities, who was clinically suspected to have calciphylaxis or nephrogenic systemic fibrosis. Cutaneous biopsy specimens revealed rectangular, birefringent, yellowish-brown, polarizable crystalline material suggestive of oxalate within the dermis, subcutis, and medium-size vessels along with areas of focal epidermal and superficial dermal necrosis. Her subsequent medical history was obtained and was suggestive of a diagnosis of primary hyperoxaluria. This case highlights the variability of clinical presentations in primary hyperoxaluria and that the disease can be diagnosed in adulthood. In addition, this case demonstrates that hyperoxaluria should be included in the differential diagnosis of calciphylaxis and nephrogenic systemic fibrosis.

Detection of feline herpes virus 1 via polymerase chain reaction and immunohistochemistry in cats with ulcerative facial dermatitis, eosinophilic granuloma complex reaction patterns and mosquito bite hypersensitivity

Ulcerative dermatitis caused by feline herpes virus 1 (FHV-1) is an uncommon disease characterized by cutaneous ulcers secondary to epidermal, adnexal and dermal necrosis. Differential diagnoses for FHV-1 lesions include, but are not limited to, mosquito bite hypersensitivity and eosinophilic granuloma complex. Histopathological diagnosis of FHV-1 dermatitis is based on the detection of the intranuclear inclusion bodies. In cases where intranuclear inclusions are missing but clinical and histological findings are compatible with FHV-1 dermatitis, immunohistochemistry (IHC) and PCRs have been used. In this retrospective study, we evaluated the presence of FHV-1 by IHC and PCR in skin biopsies and compared the results of the two tests. Sixty-four skin biopsy specimens from cats with compatible lesions were reviewed and tested via PCR and IHC for evidence of FHV-1. Polymerase chain reaction was positive in 12 of 64 biopsies; PCR and IHC were positive only in two of 64 biopsies, and these cases were considered true positive cases. The higher number of PCR-positive cases was possibly attributed to amplification of viral DNA from a live attenuated vaccination, but a previous FHV-1 infection with subsequent amplification of latently inserted FHV-1 could not be excluded. If clinical signs and histopathology suggest FHV-1 infection in the absence of typical inclusion bodies, IHC is the preferred diagnostic test; PCR may be useful for initial screening, but due to false positives is not sufficient for a definitive diagnosis.

Cutaneous Peripheral T-Cell Lymphoma of Cytotoxic Phenotype Mimicking Extranodal NK/T-Cell Lymphoma

Cutaneous peripheral T-cell lymphoma unspecified is a rare neoplasm that is infrequently associated with Epstein-Barr virus (EBV) infection. In contrast, extranodal natural killer (NK)/T-cell lymphoma, although also rare, is known to be strongly associated with EBV and occurs most commonly in the nasal region. We report the case of a 55-year-old male who presented with fever and an indurated cutaneous plaque with ulceration. This cutaneous neoplasm showed diffuse dermal lymphomatous infiltration and tumor necrosis, with neoplastic cells expressing CD2, cytoplasmic CD3 (CD3ε), CD8, CD16, CD30, T-cell intracellular antigen-1, and granzyme B but not CD56, BF1, or T-cell receptor (TCR) δ1. Furthermore, the tumor cells were noted to be diffusely positive for EBV by in situ hybridization. A monoclonal TCR gene rearrangement was demonstrated. The disease showed an aggressive clinical course, and the patient died within 3 weeks of diagnosis without complete staging or chemotherapy. According to the 2005 World Health Organization/European Organization for Research and Treatment of Cancer scheme for cutaneous lymphoma and the 2008 WHO classification for lymphoid neoplasms, our case would have been classified as a nasal type extranodal NK/T-cell lymphoma with T-cell lineage. However, the expressions of CD8 and CD16, in addition to a monoclonal TCR gene rearrangement, are unusual findings in NK/T-cell lymphoma, and we believe such a phenotype/genotype should be more appropriately classified as an EBV-positive peripheral T-cell lymphoma, unspecified with a cytotoxic phenotype. Detailed clinicopathologic and molecular studies of similar cases may shed light on the prognostic impact of NK vs. T-cell lineage on extranodal NK/T-cell lymphomas.

Therapie der Netz(-Implantat)-Infektion

Infections of an implanted hernia mesh are a major challenge. The incidence of mesh infections after incisional hernia repair is about 1% for endoscopic techniques and can be more than 15% in open techniques. Intraoperative mesh contamination is considered to be the primary cause. All woven or knitted hernia meshes have recesses where bacteria may adhere and establish colonies. The bacterial spectrum for mesh infection includes skin pathogens, such as Staphylococcus aureus (including MRSA), Streptococcus spp., as well as E. coli, Enterococcus and Mycobacteria. The therapy approach needs to be tailored to the morphological findings and the treatment for uncomplicated phlegmon is broad spectrum antibiotic therapy. If there is encapsulated fluid accumulation, CT-controlled drainage and daily infusion of antiseptics via the drain is a good option. For dermal necrosis, mesh fistula, exposed mesh or enterocutaneous fistula, a precise CT evaluation is necessary to tailor the operation. Vacuum systems are gaining increased acceptance in conditioning the local findings. For most patients the therapeutic concept will be based on individual decisions. If parts of a formerly infected mesh remain in the patient, a lifelong follow-up is necessary.

Induction of oxidative stress and antioxidant defenses in the livers of sea trout, Salmo trutta L., with ulcerative dermal necrosis

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Bacterial Etiology of Necrotic Arachnidism in Black Widow Spider Bites

Spider bites are a common challenge for physicians and veterinarians worldwide. Envenomation by the Western Black Widow (Latrodectus hesperus) is frequently associated with a necrotic cutaneous reaction at the bite site; a condition known as necrotic arachnidism. Although the composition of venom is known to be almost entirely neurotoxic, and thus, presumably not damaging to skin, varying degrees of dermal necrosis are commonly encountered at the site of envenomation. The underlying mechanism is unknown, prompting our investigation of the possibility for a bacterial etiology of the local lesions associated with the bite. This descriptive study reports the presence of 5 uncommon, highly pathogenic; multiple antibiotic resistant, bacterial species cultured from 220 pairs of sterilely extracted black widow spider fangs. This finding is consistent with the known unresponsiveness of cutaneous spider bite lesions to steroids and first-line antibiotic treatment; which has led to the misconception that the venom is the causative agent. This discovery supports our hypothesis that bacterial strains have adapted to life on the fangs of certain spiders; providing them with an excellent mode of infection by not only being passed subcutaneously to the victim, but also protected from host defenses by the immunosuppressive effects of the venom. Since current treatment protocols for spider envenomations concentrate almost solely on the local and systemic effects of the venom itself, our findings suggest that the current diagnostic algorithm and treatment standards for spider bites in both human and animal medicine may be inadequate and should be re-assessed.

Histopathologic changes in the gills and skin of adult Clarias gariepinus exposed to ethanolic extract of Parkia biglobosa pods

ABSTRACT Background and aim: Fish live in direct contact with their immediate external environment and, therefore, are highly vulnerable to aquatic pollutants. We aimed to investigate histopathologic changes in the gills and skin of fish exposed to plant extracts. Methods: Clarias gariepinus adults were exposed to 0 mg/L, 85 mg/L, 100 mg/L, 115 mg/L, 130 mg/L and 145 mg/L concentrations of ethanolic extracts of Parkia biglobosa pods over a 96‐h period. Results: Gills from exposed fish showed hyperemia and severe edema with fusion of secondary lamellae. The skin from exposed fish showed hyperplasia of mucus producing cells, epidermal and dermal polymorphonuclear leukocytic infiltrations with areas of dermal necrosis and aggregation of melanin pigments. Fish from the control group showed no histopathologic changes. Conclusions: Ethanolic extract of P. biglobosa pods is toxic to adult C. gariepinus. Therefore, extensive use of this tree to harvest fish for human consumption should be discouraged pending further investigations to determine the safety of such practices to human health.

Demodex mites: Facts and controversies

Because Demodex mites are ubiquitous, their potential as human pathogens has often been ignored. This contribution focuses on the growing body of evidence linking Demodex mites with various skin disorders. Histologically, spongiosis and lymphoid inflammation are regularly seen in follicles containing Demodex mites. In animals, they are well established as a cause of mange, and a human counterpart–demodectic alopecia–appears to exist. There is also a statistical association between Demodex mite density and rosacea, facial itching, and chronic blepharitis. Papulovesicular rosacealike lesions and spiny blepharitis often respond to agents that reduce Demodex numbers. Although these observations are not sufficient to fulfill Koch's postulates, Koch's postulates are also not fulfilled for the association between brown recluse spiders and dermal necrosis or the association between streptococci and guttate psoriasis. The evidence linking Demodex mites to human disease has implications regarding treatment.

Phytotherapy of Aeromonas hydrophila-infected Goldfish, Carassius auratus

Etiological investigations have often implicated Aeromonas hydrophila, a heterotrophic Gram-negative pathogenic aquatic bacterium, in a variety of systemic and localized fish diseases. The aim of this study was to test the efficacy of a herbal concoction against A. hydrophila-infected goldfish (Carassius auratus). After the pathogen was intramuscularly injected, scales sloughed off on the site of administration, with the appearance of a muscular hemorrhagic protuberance that progressed into an extensive ulcerative dermatitis associated with focal hemorrhage, edema, and dermal necrosis exposing the underlying muscles. Progression of the disease affected the organs in the following order: muscle, gills, liver, and finally the heart tissue. The dip treatment with the concoction (1% herbal concoction dip treatment for 5 min/d daily at 1100 h) restored the histoarchitecture of the altered primary gill lamellae, liver, heart, and muscle. The recovery changes are reported.

What is your diagnosis? Leg ulcers in SLE

A 25-year-old female, known case of systemic lupus erythematosus (SLE) for 1 year presented with a 3 months history of painful ulcers over right leg and foot. The lesions were preceded by an injury and started as bullae which got ulcerated. There was no history of pain abdomen, bloody diarrhoea, jaundice, pain or swelling in joints, any bleeding tendency, cough, chest pain, polyuria, polydypsia or polyphagia. Also there was no history of any drug intake known to cause leg ulceration. General physical examination revealed pallor and oedema of right leg and foot. Cutaneous examination revealed malar rash, lupus hair, livido reticularis of trunk and limbs and multiple well-defined ulcers distributed on right leg and foot (Fig. 1) ranging in size from 2 × 2c m to 8 × 5 cm with purplish punched out borders and a necrotic base studded with small abscesses extending down to the deep fascia. Cutaneous tenderness was present. All peripheral pulses were normally palpable and sensations over both feet and legs were normal. Mucosae, palms and soles were free from any lesions. Investigations revealed a haemoglobin of 8 gm/dL, a positive direct coomb’s test, antinuclear antibody (ANA) and anti double stranded DNA (anti ds-DNA) was positive, anti-cardiolipin antibody and lupus anticoagulant and antineutrophilic cytoplasmic antibody (c ANCA) were negative, a blood urea of 77 mg/dL and serum creatinine of 3.5 mg/dL with a normal radiograph of right leg and foot. Venous and arterial duplex sonography of the right leg showed no evidence of reduced perfusion or arteriosclerosis. Edge biopsy of the lesion revealed epidermal and dermal necrosis with central intense neutrophilic infiltrate and a peripheral mixed inflammatory infiltrate. What is your diagnosis?

Erythromycin extravasation mimicking necrotising fasciitis in the infant

Erythromycin is a broad-spectrum antimicrobial drug that belongs to the macrolide family. Extravasation injuries with erythromycin can mimic necrotising fasciitis and are associated with extensive tissue loss. We present a case of erythromycin extravasation in a 1-year-old child with significant comorbidities. The presentation of blistering and deep dermal necrosis followed extravasation of an unknown volume of erythromycin and required urgent plastic surgery review and tissue reconstruction. This represents the first reported case of erythromycin extravasation and graphically illustrates the potentially devastating effects of this uncommon injury. Little is known about the mechanism of injury in erythromycin extravasation, though it is likely to be multifactorial. Immediate management is with local irrigation of the injury site, elevation and symptomatic relief. In large-volume extravasations and late diagnosis, the clinical signs are much more pronounced, with rapid necrosis and tissue loss which can mimic necrotising fasciitis.

Clearance of experimental cutaneous Staphylococcus aureus infections in mice

Staphylococcal skin infections are quite common in human patients. These infections often clear spontaneously, but may also progress locally and/or disseminate to cause serious and sometimes fatal deep infections. The present studies were undertaken to examine the clearance phase of experimental cutaneous Staphylococcus aureus infections in a mouse model system. Previous work in this system has shown that staphylococci applied to the skin rapidly disseminate to the spleen and kidney. In the present experiments the bacteria were found to persist at the skin infection site at a time (8 days after inoculation) when they had disappeared from the spleen and kidney. Examination of the infected skin at earlier times revealed rapid (within 6 h) invasion into the stratum corneum, stratum Malpighii, and dermis, but subsequent redistribution of bacteria (at 1-2 days) to more superficial sites, particularly crusts located just above the skin surface. The crusts seen in these infections were of two distinct types, which were termed type 1 and type 2. Type 1 crusts appeared first, consisted of bacteria, inflammatory cells, and debris, and developed over an intact epidermis. Type 2 crusts arose from the process of dermal necrosis previously reported to take place at 2 days in this model system. In the latter situation the bacteria were not really cleared from the epidermis and dermis; rather those layers were transformed into a superficial crust that contained the bacteria. Deep hair follicle infections in the dermis were found in these infections, but they did not persist and did not seem to be a reservoir for organisms in the dermis. Resolution of these experimental infections appeared to involve redistribution of invading bacteria to more superficial locations in crusts above the skin surface, marked proliferation of the epidermis, loss of the bacteria-laden crusts from the skin, and eventual healing of the cutaneous damage.

Lipid peroxidation and antioxidant defense system in spawn of brown trout (Salmo trutta m. trutta L.) affected by ulcerative dermal necrosis

The objective of the present study was to investigate the importance of the antioxidant enzymes: superoxide dismutase (SOD), catalase (CAT), glutathione reductase (GR), and glutathione peroxidase (GPX) in the defense against lipid and protein oxidation in spawn from female brown trout, Salmo trutta m. trutta L. affected by ulcerative dermal necrosis (UDN). UDN induced increased lipid and protein oxidation levels. The current results show that UDN infection led to oxidative stress with the inhibition of antioxidant defense mechanisms. The inhibition of glutathione defense system activity might be responsible for this failure in cellular antioxidant defenses. UDN induces irreversible changes in proand antioxidative function which effected decreased spawn survival as well as reductions in spawning efficiency.