Pustule Formation Research Articles

Kerion – rare, but important form of tinea capitis – a case report

Tinea capitis is one of the most frequent dermatophytic infections of the scalp in children. The most common pathogen is Trichophyton torsurans and Microsporum canis. One of the most severe forms is described as kerion, which usually occurs due to advanced infection and exaggerated host response resulting in widespread inflammation, frequently with pustule and abscess formation. Prolonged infection may lead to permanent alopecia. Differential diagnosis and adequate treatment play critical role especially when it affects the children.

Characterization of a Hypovirus-Regulated Septin Cdc11 Ortholog, CpSep1, from the Chestnut Blight Fungus Cryphonectria parasitica.

We identified a protein spot showing downregulation in the presence of Cryphonectria hypovirus 1 and tannic acid supplementation as a septin subunit with the highest homology to the Aspergillus nidulans aspA gene, an ortholog of the Saccharomyces cerevisiae Cdc11 gene. To analyze the functional role of this septin component (CpSep1), we constructed its null mutant and obtained a total of eight CpSep1-null mutants from 137 transformants. All CpSep1-null mutants showed retarded growth, with fewer aerial mycelia and intense pigmentation on plates of potato dextrose agar supplemented with L-methionine and biotin. When the marginal hyphae were examined, hyperbranching was observed in contrast to the wild type. The inhibition of colonial growth was partially recovered when the CpSep1-null mutants were cultured in the presence of the osmostabilizing sorbitol. Conidia production of the CpSep1-null mutants was significantly increased by at least 10-fold more. Interestingly, the conidial morphology of the CpSep1-null mutants changed to circular in contrast to the typical rod-shaped spores of the wild type, indicating a role of septin in the spore morphology of Cryphonectria parasitica. However, no differences in the germination process were observed. Virulence assays using excised chestnut bark, stromal pustule formation on chestnut stems, and apple inoculation indicated that the CpSep1 gene is important in pathogenicity.

Very Severe (4th Grade) Closed Comedonal Acne Vulgaris That was Complicated by Staphylococcus Epidermidis and Pityrosporum Ovale Folliculities in 16th Years Old Atopic Hystory Girl that was Treated with 4x Tca 10% Chemical Peeling at 2 Weeks Intervals

Acne vulgaris was very common self limitting disease, affected approximately 85% of adolesence, that was defined as a chronic inflammation of pilosebaceous units. It was characterized (diagnosed) by the formation of comedones (as primarily acne lession), erythemathous papules and pustules, less frequently nodules and pseudocyst, and was accompanied by scarring in some cases that caused psychosocial problems. Cunliffe classified the severity of acne vulgaris into 4 types based on the kind and number of acne lessions : mild, moderate, severe, very severe. Four major factors were involved in the etiopathogenesis: follicular hyperkeratinization, increased sebum production, abnormality of microbial flora and inflammation process. The goal of therapy were : removed plugging of the pilar drainage, reduced sebum production, treated bacterial colonization, prevented from scaring. The complications were acne scar, persistent hyperpigmentation, pyogenic granuloma formation, persistent swelling, gram negative bacteria folliculitis, bacterial and fungal folliculitis as secondary infection, resistances to antibiotics. The purpose of this case report was to share experience in treating very severe comedonal acne vulgaris because of the chronicity course of acne vulgaris was difficult to be eradicated and there were many resistances problems to antibiotics in some literatures and journals. Case Presentation: It was a very severe (4th grade) closed comedonal acne vulgaris that was complicated by Staphylococcus epidermidis and Pityrosporum ovale folliculitis in 16th years old atopic hystory girl based on anamnesis, clinical finding and laboratory examination. And this case was treated by 4x TCA 10% chemical peeling at 2 weeks intervals, 2 weeks antibiotic and 10 days ketokonazole after the result of culture and laboratory examination were positive. And the result was good. There was significant improvement in clinical stage (4th grade to 1st grade acne vulgaris), decreased the count of comedones, diminished papules-pustules and inflammation, no scar and post inflamatory hyperpigmentation were occured Discussion: TCA 10% was superficial chemical peeling, considered as adjunctive therapy to the first line acne therapy retinoids and antibiotic, and TCA was the first line therapy for acne scar and skin rejuvenation. TCA was cheap and save because no systemic absorbtion, had keratolytic effect (comedolytic action) and anti inflammatory effect (bactericidal action). It could be combined to antibiotics and antifungal therapy and solved resistance problems to antibiotic and antifungal in acne therapy

FLUTTER, FEVER, AND A FIERY RED RASH: A CASE OF AGEP SECONDARY TO DILTIAZEM

Introduction Acute Generalized Exanthematous Pustulosis (AGEP) is a severe cutaneous reaction that is characterized by acute formation of sterile pustules, accompanied with systemic features such as fever and leukocytosis. Case Description A 39-year old man with a past medical history of diastolic congestive heart failure presented to the hospital in an exacerbation. On day two of admission, he was diagnosed with new onset Atrial Flutter, and subsequently started on Diltiazem. On day ten of admission; patient noticed a rash in the intertriginous regions and the abdomen which spread to involve the face, chest and extremities. On examination, temperature was 102.7 degrees fahrenheit, heart rate 30 beats/min, blood pressure- 80’s systolic. Examination revealed an erythematous confluent rash with the presence of wide spread pustular lesions. His laboratory investigations were relevant for leukocytosis of 39.5 k/uL with 93% neutrophilia, and mild renal impairment. Skin biopsy demonstrated band like mild to moderate inflammatory infiltrate with scattered pigment laden macrophages. His AGEP validation score was 8 consistent with a definitive AGEP diagnosis. Diltiazem was stopped. He was started on topical triamcinolone cream twice daily. He had complete resolution of his rash within fifteen days of onset. Discussion Diltiazem is a medication widely used in the treatment of cardiac pathologies ie angina, atrial flutter/fibrillation and supraventricular tachycardia. AGEP has been documented as a rare side effect of this medication. This case highlights the need to increase awareness amongst clinicians of an uncommon adverse effect, as timely diagnosis can lead to complete resolution and favorable outcomes.

Interleukin (IL)-8 and IL-36γ but not IL-36Ra are related to acrosyringia in pustule formation associated with palmoplantar pustulosis.

Palmoplantar pustulosis (PPP) is a refractory, nonbacterial impetigo confined to the palms and soles. Its pathogenesis is still obscure, but it may be associated with the large eccrine sweat glands and pores of palmoplantar skin. PPP is considered to be a localized pustular psoriasis. Interleukin (IL)-8, IL-36γ and IL-36Ra play important roles in the pathogenesis of pustular psoriasis, but their role in PPP is unclear. To evaluate IL-8, IL-36γ and IL-36Ra expression in PPP, and their relationship with acrosyringia and pustule formation. mRNA expression was quantified in skin samples from patients with PPP (n = 7), patients with psoriasis vulgaris (PSV; n = 8) and healthy controls (HCs) (n = 6) by reverse-transcription-real-time PCR. Protein expression was characterized by immunohistochemistry (PPP, n = 17; PSV, n = 14; HCs, n = 12). Sweat ducts, including acrosyringia, were stained for epithelial membrane antigen (EMA). IL-8 mRNA and protein were markedly increased in PPP lesions compared with PSV lesions or HC skin. IL-36γ mRNA and protein were significantly more abundant in PPP lesions than in HC skin. IL-36Ra mRNA was significantly overexpressed in PPP lesions compared with HC skin, but there was no difference in IL-36Ra protein between PPP, PSV and HCs. IL-8 was abundantly expressed by neutrophils in PPP pustules, while IL36Ra was localized in the keratinocytes of PPP, PSV and HC skin. IL-36γ and EMA were colocalized in cells surrounding PPP pustules, and IL-36γ was also expressed in sweat duct cells in the dermis. IL-8, IL-36γ and IL-36Ra are overexpressed in PPP lesions. IL-8, IL-36γ and acrosyringia, rather than IL-36Ra, are associated with pustule formation in PPP.

In vitro comparison of acyclovir, ganciclovir and cidofovir against equid alphaherpesvirus 3 and evaluation of their efficacy against six field isolates

Equid alphaherpesvirus 3 (EHV3) is the etiological agent of equine coital exanthema (ECE), which is a venereal, highly contagious disease, characterized by the formation of papules, vesicles, pustules and ulcers on the external genitalia of mares and stallions. EHV3 remains in a latent state after a successful infection and there are latently infected animals in which the virus is reactivated and generally re-excreted subclinically. There are no available vaccines for this condition and prevention is based on the clinical examination of mares prior to mating, which allows to segregate those showing clinical signs. As this approach does not eliminate the risk of contagion in stallions from subclinically infected mares, there is a need for a specific EHV3 treatment. Nowadays, there exist various antiviral compounds of proven effectiveness for other alphaherpesviruses affecting humans and animals. The aim of the present study was to compare the efficacy of three antiviral compounds, acyclovir, ganciclovir and cidofovir against EHV3 in vitro, and to assess their efficacy against six EHV3 Argentinian field isolates. To determine the efficacy of these compounds in vitro, three parameters were analyzed: reduction of plaque number, reduction of plaque size and reduction of viral production. Additionally, the effectiveness of the three compounds at an optimum concentration previously determined in this study was investigated for the EHV3 field isolates. Based on our results, ganciclovir was the most potent antiviral compound to reduce EHV3 replication in vitro and may thus be a valuable candidate for treatment and prevention of ECE in mares and stallions.

The therapeutic effect of artesunate on rosacea through the inhibition of the JAK/STAT signaling pathway.

Acne rosacea is a type of chronic dermatosis with the characteristics of erubescence, angiotelectasis and pustule formation. However, current treatment methods are limited due to the side effects. Artesunate demonstrated a promising therapeutic efficacy with a high safety margin. HaCaT cells were treated with antibacterial peptide LL‑37 to simulate rosacea caused by Demodex folliculorum (D. folliculorum) infection. Cell Counting kit 8 and flow cytometry assays were performed to measure cellular proliferation, apoptosis, the stage of the cell cycle and reactive oxygen species generation in order to determine the level of cell damage. Then the damaged cells were treated with different concentrations of artesunate and doxycycline to determine the therapeutic effect of artesunate. Pro‑inflammatory cytokines tumor necrosis factor‑α (TNF‑α), interleukin (IL)‑6, IL‑8 and C‑C motif chemokine 2 (MCP‑1) were measured using an ELISA, while western blotting was used to detect the expression of Janus kinase 2 (JAK2) and signal transducer and transcription activator (STAT3). As a result, LL‑37 treated HaCaT cells decreased in cell viability, had an increased apoptotic rate and cell cycle arrest, indicating that cell damage caused by rosacea was simulated. In addition, upregulated concentrations of the pro‑inflammatory cytokines TNF‑α, IL‑6, IL‑8 and MCP‑1 were attenuated in the artesunate group in a dose‑dependent fashion, indicating the therapeutic effect of artesunate. Furthermore, higher concentrations of artesunate exhibited an improved effect compared with the doxycycline group. In addition, increased expression levels of JAK2 and STAT3 following treatment with LL‑37 suggested that rosacea caused by D. folliculorum infection may lead to inflammation through the JAK/STAT signaling pathway. In conclusion, the potential mechanism by which damage occurs in rosacea was revealed and a promising therapeutic method against rosacea was demonstrated.

Functional characterization of the citrus canker susceptibility gene CsLOB1.

Xanthomonas citri ssp. citri (Xcc) is an important plant-pathogenic bacterium that causes citrus canker disease worldwide. PthA, a transcriptional activator-like (TAL) effector, directs the expression of the canker susceptibility gene CsLOB1. Here, we report our recent progress in the functional characterization of CsLOB1. Subcellular localization analysis of CsLOB1 protein in citrus protoplast revealed that CsLOB1 is primarily localized in the nucleus. We showed that CsLOB1 expression driven by dexamethasone (DEX) in CsLOB1-GR transgenic plants is associated with pustule formation following treatment with DEX. Pustule formation was not observed in DEX-treated wild-type plants and in non-treated CsLOB1-GR transgenic plants. Water soaking is typically associated with symptoms of citrus canker. Weaker water soaking was observed with pustule formation in CsLOB1-GR transgenic plants following DEX treatment. When CsLOB1-GR-transgenic Duncan grapefruit leaves were inoculated with Xcc306ΔpthA4 and treated with DEX, typical canker symptoms, including hypertrophy, hyperplasia and water soaking symptoms, were observed on DEX-treated transgenic plant leaves, but not on mock-treated plants. Twelve citrus genes that are induced by PthA4 are also stimulated by the DEX-induced expression of CsLOB1. As CsLOB1 acts as a transcriptional factor, we identified putative targets of CsLOB1 via bioinformatic and electrophoretic mobility shift assays. Cs2g20600, which encodes a zinc finger C3HC4-type RING finger protein, has been identified to be a direct target of CsLOB1. This study advances our understanding of the function of CsLOB1 and the molecular mechanism of how Xcc causes canker symptoms via CsLOB1.

P.2.033 - Self-esteem and mental health in adolescents with acne vulgaris

Introduction Acne Vulgaris is a dermatological genetic-hormonal illness, self-limited, in pilosebaceous locations, with formation of comedones, papules and cysts in which evolution to a greater inflammatory process is added, leading to formation of pustules and abscesses, with frequent cicatricial success, causing great psychological impact in patients affected by this disease [1]. Acne Vulgaris lesions predominate in exposed areas such as face and thorax, which leads to feelings of guilt, shame and social isolation. Facial appearance has an important role in self- perception, as well as in the interaction with others, face lesions cause a significant impact in children quality of life.According to Thomas: In the long run acne may cause cutaneous as well as psychological scars [2]. \nIts prevalence is highest in adolescence. It affects 85% of young adults aged 12–25 years. Different researches indicate that rates of anxiety and depression among individuals with significant acne symptoms are about double those of non-acne sufferers [3]. The impact of acne vulgaris on mental health and self-esteem has been identified in different studies [4], but there are no data in Albanian patients. Aim The aim of this study is to assess the impact of Acne Vulgaris on self - esteem, and their relationship with mental health problems in an Albanian sample of adolescents. Methods 65 adolescents with acne vulgaris, aged 13–19 years without any psychiatric or medical co morbidity were recruited, from the Dermatology Outpatient unit of University Hospital, Tirana. The control group consisted of 60 adolescents, recruited in a high school, in the same age range, who had neither psychiatric disease nor acne. Severity of acne was evaluated by Global Acne Grading System. Self-esteem of the patients was evaluated with Rosenberg Scale, Hospital Anxiety and Depresion Score were applied to both groups. Results Acne is associated with increased anxiety, poor self-esteem. Significant correlation between poor self-esteem, anxiety and severity of acne p=0.01 Non singificant correlation between depression and severity of acne vulgaris, p=0.05 Conclusions Acne Vulgaris must be considered as an illness with the potential to affect the quality of life and mental health. Effective treatment of the acne itself, in combination with the appropriate mental health support, offers the highest chance of improving the quality of life of acne sufferers. Acne is not a trivial disease in comparison with other chronic conditions.Even if acne is not associated with severe morbidity, mortality or physical disability, it can nevertheless have considerable psychological and social consequences [5]. Reducing the psycho social impact of acne is considered one of the guiding principles for its clinical management, and it is important to measure and evaluate this impact .The severe burden of acne is strong justification for effective acne treatment and psychiatric screening for patients with the condition. Most important, improvements in acne after appropriate treatment have been shown to result in enhanced self-esteem, body image and social functioning.

Comparative analysis of reflectance confocal microscopy features between Paget′s disease and eczema on the scrotum

Objective To analyze and compare reflectance confocal microscopy (RCM) features between Paget′s disease and eczema on the scrotum. Methods RCM was performed to image scrotal lesions of 5 male patients with suspected Paget′s disease and 5 male patients with eczema. Then, the scrotal lesions were resected and subjected to histopathological examination, and a comparison was conducted between the confocal microscopic and pathological findings. Results RCM imaging for the 5 cases of Paget′s disease showed disorganized epidermal structure, absence of normal honeycomb structures, single or clustered pagetoid cells in the prickle cell layer. RCM imaging for the 5 cases of eczema showed intercellular edema in the prickle cell layer, reticular degeneration of blisters in all the cases, and pustule formation in some cases. Conclusion RCM features are obviously different between Paget′s disease of the scrotum and scrotal eczema, so RCM imaging can facilitate the early diagnosis of Paget′s disease. Key words: Paget disease, extramammary; Eczema; Scrotum; Microscopy, confocal

Immunosuppressed cutaneous District: The finale of the fascinating farrago of confounding responses?

Immunosuppressed cutaneous District: The finale of the fascinating farrago of confounding responses?

IL-1 and IL-36 are dominant cytokines in generalized pustular psoriasis

Generalized pustular psoriasis (GPP) is a rare, debilitating, and often life-threatening inflammatory disease characterized by episodic infiltration of neutrophils into the skin, pustule development, and systemic inflammation, which can manifest in the presence or absence of chronic plaque psoriasis (PV). Current treatments are unsatisfactory and warrant a better understanding of GPP pathogenesis. We sought to understand better the disease mechanism of GPP to allow improved targeted therapies. We performed a gene expression study on formalin-fixed paraffin-embedded GPP (n=28) and PV (n=12) lesional biopsies and healthy control (n=20) skin. Differential gene expression was analyzed using gene ontology and enrichment analysis. Gene expression was validated with quantitative RT-PCR and immunohistochemistry, and a potential disease mechanism was investigated using primary human cell culture. Compared with healthy skin, GPP lesions yielded 479 and PV 854 differentially expressed genes, respectively, with 184 upregulated in both diseases. We detected significant contributions of IL-17A, TNF, IL-1, IL-36, and interferons in both diseases; although GPP lesions furnished higher IL-1 and IL-36 and lower IL-17A and IFN-γ mRNA expression than PV lesions did. We detected prominent IL-36 expression by keratinocytes proximal to neutrophilic pustules, and we show that both neutrophils and neutrophil proteases activate IL-36. Suggesting another mechanism regulating IL-36 activity, the protease inhibitors serpin A1 and A3, which inhibit elastase and cathepsin G, respectively, were upregulated in both diseases and inhibited activation of IL-36. Our data indicate sustained activation of IL-1 and IL-36 in GPP, inducing neutrophil chemokine expression, infiltration, and pustule formation, suggesting that the IL-1/IL-36 inflammatory axis is a potent driver of disease pathology in GPP.

A Japanese Case of Nonpustular Annular Psoriasis

Introduction Nonpustular annular psoriasis is a rare form of psoriasis with clinically annular ring-shaped configuration [1]. In contrast to recurrent circinate erythematous psoriasis (Psoriasis a type d’erytheme circine recidivant de Bloch) [2], which is the mildest form of pustular psoriasis, no evidence of histopathological Kogoi’s spongiform pustule formation is detected.

Host Polymorphisms in TLR9 and IL10 Are Associated With the Outcomes of Experimental Haemophilus ducreyi Infection in Human Volunteers.

In humans inoculated with Haemophilus ducreyi, there are host effects on the possible clinical outcomes-pustule formation versus spontaneous resolution of infection. However, the immunogenetic factors that influence these outcomes are unknown. Here we examined the role of 14 single-nucleotide polymorphisms (SNPs) in 7 selected pathogen-recognition pathways and cytokine genes on the gradated outcomes of experimental infection. DNAs from 105 volunteers infected with H. ducreyi at 3 sites were genotyped for SNPs, using real-time polymerase chain reaction. The participants were classified into 2 cohorts, by race, and into 4 groups, based on whether they formed 0, 1, 2, or 3 pustules. χ(2) tests for trend and logistic regression analyses were performed on the data. In European Americans, the most significant findings were a protective association of the TLR9 +2848 GG genotype and a risk-enhancing association of the TLR9 TA haplotype with pustule formation; logistic regression showed a trend toward protection for the TLR9 +2848 GG genotype. In African Americans, logistic regression showed a protective effect for the IL10 -2849 AA genotype and a risk-enhancing effect for the IL10 AAC haplotype. Variations in TLR9 and IL10 are associated with the outcome of H. ducreyi infection.

Identification of an Extracellular Endoglucanase That Is Required for Full Virulence in Xanthomonas citri subsp. citri

Xanthomonas citri subsp. citri causes citrus canker disease, which is characterized by the formation of water-soaked lesions, white or yellow spongy pustules and brown corky canker. In this work, we report the contribution of extracellular endoglucanase to canker development during infection. The ectopic expression of nine putative cellulases in Escherichia coli indicated that two endoglucanases, BglC3 and EngXCA, show carboxymethyl cellulase activity. Both bglC3 and engXCA genes were transcribed in X. citri subsp. citri, however, only BglC3 protein was detected outside the cell in western blot analysis. The deletion of bglC3 gene resulted in complete loss of extracellular carboxymethyl cellulase activity and delayed the onset of canker symptoms in both infiltration- and wound-inoculation assays. When growing in plant tissue, the cell density of bglC3 mutant was lower than that of the wild type. Our data demonstrated that BglC3 is an extracellular endoglucanase required for the full virulence of X. citri subsp. citri.

Immunoglobulins in autoimmune bullous diseases

As one of active immune effector molecules, immunoglobulins play an important role in the pathogenesis, diagnosis and treatment of autoimmune bullous diseases. Human immunoglobulins can be divided into 5 categories, including IgG, IgA, IgM, IgD and IgE, and all of them participate in and play different roles in the pathogenesis of autoimmune bullous diseases except IgD. IgG can induce the formation of blisters by activating complements and leukocytes as well as by releasing proteolytic enzymes, and different subtypes of IgG differ in biological activities. IgA can cause granulocyte migration and lead to the formation of blisters and pustules. IgE is associated with urticaria-like erythema and eosinophil infiltration. IgM is usually seen in Brazilian pemphigus foliaceus. These findings may provide new ideas for the diagnosis and treatment of autoimmune bullous diseases. Key words: Skin diseases, vesiculobullous; Immunoglobulins; Antibodies; Autoimmunity; Diagnosis

Nonpustular annular psoriasis: a variant of annular pustular psoriasis but without clinical or histopathological evidence of pustule formation

Nonpustular annular psoriasis: a variant of annular pustular psoriasis but without clinical or histopathological evidence of pustule formation

The development of quick, robust, quantitative phenotypic assays for describing the host-nonhost landscape to stripe rust.

Nonhost resistance is often conceptualized as a qualitative separation from host resistance. Classification into these two states is generally facile, as they fail to fully describe the range of states that exist in the transition from host to nonhost. This poses a problem when studying pathosystems that cannot be classified as either host or nonhost due to their intermediate status relative to these two extremes. In this study, we investigate the efficacy of the Poaceae-stripe rust (Puccinia striiformis Westend.) interaction for describing the host–nonhost landscape. First, using barley (Hordeum vulgare L.) and Brachypodium distachyon (L.) P. Beauv. We observed that macroscopic symptoms of chlorosis and leaf browning were associated with hyphal colonization by P. striiformis f. sp. tritici, respectively. This prompted us to adapt a protocol for visualizing fungal structures into a phenotypic assay that estimates the percent of leaf colonized. Use of this assay in intermediate host and intermediate nonhost systems found the frequency of infection decreases with evolutionary divergence from the host species. Similarly, we observed that the pathogen’s ability to complete its life cycle decreased faster than its ability to colonize leaf tissue, with no incidence of pustules observed in the intermediate nonhost system and significantly reduced pustule formation in the intermediate host system as compared to the host system, barley-P. striiformis f. sp. hordei. By leveraging the stripe rust pathosystem in conjunction with macroscopic and microscopic phenotypic assays, we now hope to dissect the genetic architecture of intermediate host and intermediate nonhost resistance using structured populations in barley and B. distachyon.

DksA and (p)ppGpp have unique and overlapping contributions to Haemophilus ducreyi pathogenesis in humans.

The (p)ppGpp-mediated stringent response is important for bacterial survival in nutrient limiting conditions. For maximal effect, (p)ppGpp interacts with the cofactor DksA, which stabilizes (p)ppGpp's interaction with RNA polymerase. We previously demonstrated that (p)ppGpp was required for the virulence of Haemophilus ducreyi in humans. Here, we constructed an H. ducreyi dksA mutant and showed it was also partially attenuated for pustule formation in human volunteers. To understand the roles of (p)ppGpp and DksA in gene regulation in H. ducreyi, we defined genes potentially altered by (p)ppGpp and DksA deficiency using transcriptome sequencing (RNA-seq). In bacteria collected at stationary phase, lack of (p)ppGpp and DksA altered expression of 28% and 17% of H. ducreyi open reading frames, respectively, including genes involved in transcription, translation, and metabolism. There was significant overlap in genes differentially expressed in the (p)ppGpp mutant relative to the dksA mutant. Loss of (p)ppGpp or DksA resulted in the dysregulation of several known virulence determinants. Deletion of dksA downregulated lspB and rendered the organism less resistant to phagocytosis and increased its sensitivity to oxidative stress. Both mutants had reduced ability to attach to human foreskin fibroblasts; the defect correlated with reduced expression of the Flp adhesin proteins in the (p)ppGpp mutant but not in the dksA mutant, suggesting that DksA regulates the expression of an unknown cofactor(s) required for Flp-mediated adherence. We conclude that both (p)ppGpp and DksA serve as major regulators of H. ducreyi gene expression in stationary phase and have both overlapping and unique contributions to pathogenesis.

Intramammary coinfection by vaccinia virus and staphylococcus aureus in a bovine vaccinia outbreak

Introduction: Bovine vaccinia virus (VACV) is a well‐known zoonotic agent related to exanthemous lesions in skin and mucous membranes of dairy cattle and humans, characterized by the formation of vesicles, pustules and ulcers. Mastitis is one of the most common infectious diseases of dairy herds. Bovine mammary infections are caused mainly by bacterial micro‐organisms, especially staphylococci. To the best of our knowledge, intramammary coinfection with VACV and Staphylococcus aureus in cows has not been reported previously. Case presentation: During an outbreak of exanthematic bovine VACV infection with animals showing vesicles, pustules and haemorrhagic ulcers on the teats, milk samples were collected for mastitis detection. Conclusion: The present report describes a case of intramammary coinfection by VACV and S. aureus in a bovine VACV outbreak.