Incidence Of Cutaneous Infections Research Articles

Cutaneous infections by dematiaceous opportunistic fungi: Diagnosis and management in 11 solid organ transplant recipients.

The incidence of cutaneous infections by dematiaceous fungi is rising in our environment due to the high number of solid organ transplant recipients (SOTR). To review our experience in the management of cutaneous phaeohyphomycoses in a Spanish reference centre for dermatological care of SOTR. Retrospective clinical, histopathological and microbiological review of all SOTR diagnosed of a phaeohyphomycosis in a 7-year period. Eleven SOTR were identified (8 lung and 3 kidney). The lesions were solitary in six patients and multiple in five, affecting mostly the lower extremities. Early lesions showed epidermal hyperplasia and a diffuse dermal suppurative granulomatous infiltrate that was progressively substituted by fibrosis when the lesions were treated. Septated fungal structures with refractile walls were identified. DNA sequencing confirmed the presence of Alternaria spp (8 cases), Cladosporium cladosporioides, Microsphaeropsis arundinis and Exophiala oligosperma. Three patients with single lesions were treated with surgery, while the other 8 required long-term antifungal therapy, including itraconazole, voriconazole and/or terbinafine, combined with surgery and reduction in tacrolimus doses. A clinical, histopathological and microbiological correlation is essential to corroborate this diagnosis. Solitary lesions are easily treated with surgery, but larger or multiple lesions may require long medical treatments combined with surgery and modification of immunosuppressive medication. The list of dematiaceous fungi implicated in cutaneous infections is expanding, in line with the availability of more sophisticated identification methods and the increasing number of immunosuppressed patients.

Complications in Pediatric Regional Anesthesia: An Analysis of More than 100,000 Blocks from the Pediatric Regional Anesthesia Network.

WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Complications in pediatric regional anesthesia are rare, so a large sample size is necessary to quantify risk. The Pediatric Regional Anesthesia Network contains data on more than 100,000 blocks administered at more than 20 children's hospitals. This study analyzed the risk of major complications associated with regional anesthesia in children. This is a prospective, observational study of routine clinical practice. Data were collected on every regional block placed by an anesthesiologist at participating institutions and were uploaded to a secure database. The data were audited at multiple points for accuracy. There were no permanent neurologic deficits reported (95% CI, 0 to 0.4:10,000). The risk of transient neurologic deficit was 2.4:10,000 (95% CI, 1.6 to 3.6:10,000) and was not different between peripheral and neuraxial blocks. The risk of severe local anesthetic systemic toxicity was 0.76:10,000 (95% CI, 0.3 to 1.6:10,000); the majority of cases occurred in infants. There was one epidural abscess reported (0.76:10,000, 95% CI, 0 to 4.8:10,000). The incidence of cutaneous infections was 0.5% (53:10,000, 95% CI, 43 to 64:10,000). There were no hematomas associated with neuraxial catheters (95% CI, 0 to 3.5:10,000), but one epidural hematoma occurred with a paravertebral catheter. No additional risk was observed with placing blocks under general anesthesia. The most common adverse events were benign catheter-related failures (4%). The data from this study demonstrate a level of safety in pediatric regional anesthesia that is comparable to adult practice and confirms the safety of placing blocks under general anesthesia in children.

English

INTRODUCTION: The kidney and the skin are the two large networks of the body with their abundant blood supply, far in excess of their nutritional demands, the former for the constancy of the milieu interior and the latter maintaining mainly homeostasis. No wonder therefore, that they share many diseases and reflect mutually one another’s pathology which should be made use of by the clinician. Scientific and technologic improvements during the second-half of the 20th century have provided renal replacement therapy as a life sustaining option for many individuals who otherwise might have died. In each and every year of the last decade, the number of individuals with ESRD (end stage renal disease) has grown approximately from 20 to 30,000 per year. Cutaneous examination of patients with ESRD has shown that 50 – 100% of patients have at least one dermatologic condition. In addition to ESRD, uraemia and conditions associated with renal replacement therapy are fraught with numerous and often, relatively unique cutaneous manifestations. AIMS OF THE STUDY: 1. To study the various cutaneous manifestations and their incidence in patients with chronic renal failure. 2. To study the agewise and sexwise incidence of the individual cutaneous manifestation. 3. To study the incidence of cutaneous manifestations in renal transplant recipients. 4. To study the incidence of cutaneous manifestations of associated systemic disorder that may contribute to chronic renal failure. MATERIALS AND METHODS: This study was done for 2 years from October 2009 to October 2011 at Nephrology OPD, ward and medicine ward, Tirunelveli Medical College Hospital, Tirunelveli. Approval was obtained from the institutional ethical committee prior to the conduct of this study. During this period, 100 patients who had the presence of skin manifestations were selected and studied. 80 patients were known cases of chronic renal failure, diagnosed at Nephrology department or medical department and 20 patients were renal transplant recipients who were referral cases. Patient selection: Inclusion criteria: 1. Age : All ages, 2. Sex : Both males and females, 3. Patients with chronic renal failure, 4. Renal transplant patients. Exclusion criteria : 1. Patients with HIV infection, 2. Patients with previous malignancies, 3. Drug related cutaneous manifestations, 4. Patients on dialysis. SUMMARY: This clinical study of cutaneous manifestations of chronic renal failure and renal transplant recipients done during the period from October 2009 to October 2011, revealed the following: 1. Most of the specific cutaneous manifestations of chronic renal failure and renal transplantation were noted in this study. Pruritus (58.8%) and xerosis (57.5%) were the most common among the specific cutaneous manifestations of chronic renal failure, which is similar to another study[104]. Pigmentary changes (55%) and nail abnormalities (56.2%) were the next. Mucosal and hair abnormalities were noted in good percentage of cases. Nearly 4 % had perforating dermatosis. Interesting findings noted in this study were digital gangrene, poor wound healing and restless leg syndrome. The onset of cutaneous manifestations after CRF ranges between 6 months to 3 years in this study. 2. Skin changes due to renal transplantation were mostly due to infections (excluding medication related disorders), with fungal infections (40%) being the most commonly noted. The next to follow was viral infections (35%) with verruca vulgaris being the commonest manifestation. The high incidence of cutaneous infections in these patients could be due to impaired immunity resulting in increased susceptibility to infections. Premalignant and malignant lesions were not noted in this study. After renal transplantation, there is improvement in pruritus in 9 (45%) patients and xerosis in 6 (30%) patients. 3. Skin changes specific to associated systemic diseases helped in finding various etiologies of chronic renal failure such as diabetes mellitus, systemic lupus erythematosus, scleroderma, vasculitis and ITP. 4. Other associated skin conditions were not related to etiology and were found to be just coincidental. CONCLUSION: Pruritus and xerosis were the most common among the specific cutaneous manifestations of chronic renal failure, followed by nail abnormalities and pigmentary changes. Calciphylaxis and uremic frost were not noted in any patient. The incidence of hair and nail abnormalities were more among females than males in this study. Cutaneous manifestations of renal transplantation were mostly due to infections, of which fungal infections were commonly observed followed by viral infections.

Cutaneous infection due to Mycobacterium immunogenum: an European case report and review of the literature

(no more than 200 words): In the last few years, the incidence of cutaneous infections caused by nontuberculous mycobacteria is increasing. Since Mycobacterium immunogenum was first described in 2001, few case reports have been described, all of them in the American continent. We report a case with cutaneous infection caused by this newly discovered NTB in Europe.A 65-year-old woman presented with a 3-months history of pruritic lesions on abdomen. Examination revealed erythematous inflammatory papules, pustules, and crusts. Three weeks later, mycobacteria were cultured from the biopsy specimen. Mycobacterium immunogenum was identified based on susceptibility test results and polymerase chain reaction (PCR) restriction enzyme analysis. Treatment with clarithromycin was started. M. immunogenum is a nontuberculous mycobacterium that was first described by Wilson et al. in 2001 as a rapidly growing variety and new species in the Mycobacterium chelonae-Mycobacterium abscessus group. PCR-restriction analysis of a 439-bp segment of the hsp65 gene and/or sequencing the species-specific region of the 16S rDNA can confirm this new species. Since the description of M. immunogenum, 8 clinical case reports have been published, most involving cutaneous infections and all of them in the American continent. We present a case of cutaneous infection caused by M. immunogenum in a Spanish woman.

Suppurative and granulomatous dermatitis with pseudocysts: a useful tissue reaction pattern

Non-tuberculous mycobacteria represent a heterogenous group of opportunistic pathogens which differ from Mycobacterium tuberculosis in their culture characteristics and sensitivities to various antimycobacterial agents. The incidence of cutaneous infection by these organisms has increased dramatically in the past several years due to widespread use of immunosuppressive therapies. Clinically, the features can be diverse with many patients having unusual presentations. The histological changes vary from a predominantly suppurative process to pure granulomatous inflammation, depending on the duration of the lesion sampled and the immunological status. Although the microscopic features are not species specific, a predominantly suppurative dermatitis with small pseudocystic spaces is often seen in cutaneous infections by a rapid growing non-tuberculous mycobacterial species. The granulomatous inflammation accompanying such cases is often, either poorly formed or absent. An awareness of this phenomenon should prompt the histopathologist to request pertinent histochemical stains and also guide the clinician towards appropriate ancillary microbiological investigations.

Levamisole Therapy in Atopic Dermatitis

A randomized double-blind study of levamisole hydrochloride therapy in atopic dermatitis is reported. No improvement was noted in any of several assessments, which included patients' subjective impressions; physicians' clinical impressions; comparison of clinical extent and severity scores; and incidence of cutaneous infections or lessening of serum IgE levels. A trend toward improvement was seen in a majority of cases, whether treatment was with a placebo or an active drug. This study emphasizes the need for double-blind techniques for therapeutic trial in the management of patients with atopic dermatitis.

Microbiological studies in Western Samoa: I. Effects of a yaws control programme on the incidence of superficial skin lesions and their aerobic bacterial flora, with an appendix on the normal flora of the nose

1. 1) The incidence of cutaneous infections and of the micro-organisms which could be isolated from them, after the completion of a yaws control programme in W. Samoa, has been investigated and compared with similar studies made prior to the mass treatment. 2. 2) Active yaws lesions showed a dramatic reduction, the incidence having dropped from 26.2 per cent. of subjects in 1953 to 1.6 per cent. in 1958. The incidence of scabies, “impetigo” boils and other infections remains unchanged. 3. 3) Pathogenic staphylococci were isolated from more than 50 per cent. of all lesions sampled and were as numerous in 1958 as in 1953. Penicillin resistance was found in more than 20 per cent. of the cutaneous strains isolated. The majority of these resistant strains belonged to phage-type 71 or had related patterns. 4. 4) Streptococci showing beta-haemolysis were isolated from more than 47 per cent. of the lesions, a much higher figure than was obtained in 1953 when 32 per cent. of the lesions yielded them. Of the 46 strains grouped, 44 (96 per cent.) belonged to Group A. 5. 5) Corynebacterium diphtheriae was isolated from 21.5 per cent. of lesions sampled in 1958, and from 28.7 per cent. in 1953. Positive virulence tests were obtained from 65 per cent. of the isolates in 1958, while only 18 per cent. of those obtained in 1953 were virulent when tested. This difference is discussed and is thought to be due to the better storage method, and briefer storage time of the 1958 sample. 6. 6) The effect of the yaws control programme is discussed. The lesions other than yaws and their bacterial flora appeared to be unaltered by mass treatment with penicillin. The continued presence of cutaneous strains of virulent C. diphtheriae suggests that spontaneous active immunization against diphtheria is still taking place in Western Samoa.