Infectious Skin Diseases Research Articles

Pattern of Skin Disease of Patients Attending Skin &Vd Opd in a Private Medical College Hospital in Chittagong

Skin diseases cause morbidity in major numbers of people around the world. Their pattern of distribution varies on certain factors like age, sex, occupation, genetics, environment etc. The aim of the study was to analyze and found prevalence of different skin diseases in this particular area of the country to provide useful findings. This study was carried out in the outdoor Department of Dermatology and Venereology of Southern Medical College Hospital, a tertiary teaching and referral hospital in Chittagong, Bangladesh from July 2011 to June 2015. There were 1644 patient, of them 637(38.75%) was male and 1007(61.25%) was female. Highest (26.03%) numbers of patient were in the age group of 21-30 years followed by 11-20 years age group (23.73%). Both male and female suffered mostly from same condition: eczematous disease (20.72% & 18.87%) followed by fungal infection(14.9% and 18.57%). Non-infectious skin disease was in 59.18% and infectious skin disease in 40.82%. Among non-infectious and infectious skin disease, eczematous disease and fungal skin disease were commonest, comprising 19.59% and 17.15% of the total patient respectively. Among the eczematous diseases, highest 38.5 % had eczema. Psoriasis comprises highest 48.1% among papulosquamous diseases. Regarding fungal skin diseases, 75.89% had dermatophyte infection and 65.42% were female.
 JCMCTA 2016 ; 27 (1) : 23 - 27

The role of dermoscopy in non-pigmented skin disorders

The use of dermoscopy in non-pigmented skin disorders includes dermoscopy as a diagnostic tool for non-pigmented skin tumors, inflammatory diseases (inflammoscopy) and/or infectious disease (entomodermoscopy), lesions on nail fold and as a tool to monitor skin reaction as a response to treatment and/or side effect. The diagnosis becomes easier, faster and less expensive with dermoscopy without the need for invasive procedures. Knowledge on vascular pattern and its architectural arrangement; which is coupled with additional dermoscopic features, can aid clinicians to the diagnosis. Dermatoscopy can also predict, monitor and evaluate therapeutical response and/or side effect of skin disorders. Nonetheless, dermoscopy has its limitations. Many of various non-pigmented disorders have more specific clinical features than dermoscopic ones, for clinicians to rely on to establish a diagnosis. Keywords : dermoscopy, non-pigmented disorders, diagnosis

Antibiotic susceptibility and genomic variations in Staphylococcus aureus associated with Skin and Soft Tissue Infection (SSTI) disease groups.

BackgroundStaphylococcus aureus is associated with human skin and soft tissue infections (SSTIs); however, the involvement of virulence factors in different clinical presentations is unclear.MethodsWe analyzed methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) strains from Taiwan to determine correlations among the clinical characteristics of SSTIs, antimicrobial susceptibility and virulence factors of S. aureus with specific genetic backgrounds.ResultsWe identified 177 MRSA isolates and 130 MSSA isolates among the 307 SSTI-associated S. aureus isolates. Hospital-acquired (HA)- and community-acquired (CA)-MRSA isolates accounted for 61.6 % and 38.4 % of the isolates, respectively. Clinical presentations in SSTI patients differed significantly for the disease groups. Deep-seated MRSA infections presented with higher amputation rate than MSSA infections. MRSA isolates were all susceptible to linezolid, teicoplanin, and vancomycin, and >94 % of isolates were erythromycin- and clindamycin-resistant. Staphylococcal cassette chromosome (SCCmec) types IV, V, and VII were the most frequent in the CA-MRSA group (n = 68); types III, IV and V were the most frequent in the HA-MRSA group (n = 109). Panton-Valentine leukocidin (PVL) genes were significantly more frequent in CA-MRSA strains (75.0 %) than in HA-MRSA (33.0 %) and MSSA (24.6 %) and were found in 66.7 % (74/111) strains isolated from the abscess group. Exfoliatin A genes were more common in catheter-related exit-site MSSA infections (37.5 %) compared with other MSSA disease groups (P < 0.05). Exfoliatin B and superantigen exotoxin genes were uncommon in all SSTI disease types. Pulsotypes A (ST239), C, and D (ST59) were the predominant MRSA genotypes in deep-seated infections.ConclusionsIf not treated appropriately, deep-seated MRSA-associated infections present with higher amputation rates than deep-seated MSSA-associated infections. PVL-positive MRSA strains caused more frequently pus-forming lesions and less bacteremia and invasive diseases. Methods for discriminating CA-MRSA from HA-MRSA strains are now unreliable due to circulation of both ST 239 and ST 59 strains in the community and nosocomial settings. Initial antibiotic treatments should consider MRSA for patients with SSTIs in areas where MRSA is prevalent.

Genomic resources and draft assemblies of the human and porcine varieties of scabies mites, Sarcoptes scabiei var. hominis and var. suis.

BackgroundThe scabies mite, Sarcoptes scabiei, is a parasitic arachnid and cause of the infectious skin disease scabies in humans and mange in other animal species. Scabies infections are a major health problem, particularly in remote Indigenous communities in Australia, where secondary group A streptococcal and Staphylococcus aureus infections of scabies sores are thought to drive the high rate of rheumatic heart disease and chronic kidney disease.ResultsWe sequenced the genome of two samples of Sarcoptes scabiei var. hominis obtained from unrelated patients with crusted scabies located in different parts of northern Australia using the Illumina HiSeq. We also sequenced samples of Sarcoptes scabiei var. suis from a pig model. Because of the small size of the scabies mite, these data are derived from pools of thousands of mites and are metagenomic, including host and microbiome DNA. We performed cleaning and de novo assembly and present Sarcoptes scabiei var. hominis and var. suis draft reference genomes. We have constructed a preliminary annotation of this reference comprising 13,226 putative coding sequences based on sequence similarity to known proteins.ConclusionsWe have developed extensive genomic resources for the scabies mite, including reference genomes and a preliminary annotation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13742-016-0129-2) contains supplementary material, which is available to authorized users.

Epidemiology of infectious skin disorders among out patient in a tertiary care hospital, Srinagar, Uttarakhand

Epidemiology of infectious skin disorders among out patient in a tertiary care hospital, Srinagar, Uttarakhand

The Application of Modern Dressings to Buruli Ulcers: Results from a Pilot Implementation Project in Ghana.

Buruli ulcer (BU) is a tropical, infectious skin disease. The resulting ulcer can take a long time to heal, and a high standard of wound care is essential. Currently, the only dressing used for BU wound care is gauze, and its removal causes pain and bleeding. We performed a pilot implementation project using HydroTac(®) (HARTMANN, Heidenheim, Germany), a modern dressing combining foam with a hydrogel component. For future BU treatment, we recommend to use a more absorbent dressing than the HydroTac dressing used in the current project. However, we show that modern dressings can be applied to BUs and that HydroTac dressings yield clean, healing wounds, and prevent the pain and bleeding associated with gauze dressings. Wound care is a vital but to date neglected aspect of BU management.

Cytotoxicity of 15 Cameroonian medicinal plants against drug sensitive and multi-drug resistant cancer cells

Ethnopharmacological relevanceCameroonian medicinal plants are traditionally used to treat many ailments, including cancer and related diseases. Cancer is characterized as a condition with complex signs and symptoms. It has been recommended that ethnopharmacological usages such as immune and skin disorders, inflammatory, infectious, parasitic and viral diseases should be taken into account when selecting plants for anticancer screenings, since these reflect disease states bearing relevance to cancer or cancer-like symptoms. Aim of the studyThe present study aims at investigating 20 methanol extracts from 15 Cameroonian medicinal plants on a panel of human cancer cell lines, including various drug-resistant phenotypes. Possible modes of action of the of the most active plant were analyzed. Materials and methodsMethanol extracts from different plant parts (leaves, bark, roots, fruits or whole plant) were evaluated for their cytotoxicity using resazurin reduction assay on a panel of nine sensitive and multi-drug resistant (MDR) cancer cell lines. Cell cycle, apoptosis, mitochondrial membrane potential (MMP), and reactive oxygen species (ROS) were measured by flow cytometry. ResultsPrescreening of extracts at 80µg/mL showed that 6 extracts out of 20 inhibited more than 50% proliferation of leukemia CCRF-CEM cells; these include extracts from Anthocleista schweinfurthii fruits (ASF; 48.28%), Morus mesozygia bark (MMB; 42.76%), Nauclea latifolia bark (NLB; 38.75%), Tridesmostemon omphalocarpoides bark (TOB; 38.53%), Nauclea latifolia leaves (NLL; 35.17%) and Erythrina sigmoidea bark (ESB; 33.77%). Subsequent investigations revealed IC50 values below or around 20µg/mL for extracts from MMB, NLB, NLL and ESB towards sensitive CCRF-CEM cells and its resistant P-glycoprotein over-expressing subline CEM/ADR5000. The best extract, ESB also displayed IC50 values below 20µg/mL colon carcinoma HCT116 (p53+/+) cells with an IC50 value of 19.63µg/mL and it resistant p53 knockout subline HCT116 (p53−/−) with an IC50 value of 16.22µg/mL. ConclusionErythrina sigmoidea, Anthocleista schweinfurthii, Morus mesozygia, Nauclea latifolia, Tridesmostemon omphalocarpoides used in African traditional medicine are good cytotoxic plants that can be exploited to develop phytomedicine to fight cancers including MDR phenotypes.

Development of an isothermoal amplification-based assay for rapid visual detection of an Orf virus.

BackgroundOrf virus (ORFV) is the causative agent of a severe infectious skin disease (also known as contagious ecthyma) in goats, sheep and other small ruminants. Importantly, ORFV also infect humans which causes a public health concern in the context of changing environment and increase in human populations. The rapid detection is critical in effective control of the disease and urgently needed.ResultsA novel “point of care” molecular amplification assay for rapid visual detection of ORFV was developed based on isothermoal recombinase polymerase amplification (RPA) technology in combination with a simpler lateral flow immunoassay strip (ORFV RPA- LFD assay). The developed ORFV RPA- LFD assay was able to detect ORFV in less than 25 min. This assay was highly sensitive, with detection limit of as low as 80 copies/reaction, and highly specific, with no cross-reactions with capripox virus, foot-and-mouth disease virus and peste des petits ruminants virus. Furthermore, the ORFV RPA- LFD assay has good correlation with qPCR assay for detection of ORFV present in clinical samples.ConclusionsThe developed ORFV RPA-LFD assay was a sensitive and specific method for rapid detection of ORFV, and has great potential as an onsite molecular diagnostic tool in control of Orf.Electronic supplementary materialThe online version of this article (doi:10.1186/s12985-016-0502-x) contains supplementary material, which is available to authorized users.

The quality of dermatology consultation documentation in discharge summaries: a retrospective analysis.

IntroductionGood quality documentation of dermatology consults in discharge summaries allows diagnostic and therapeutic plans to be communicated to other health professionals and ensures that appropriate governmental funds are provided to dermatology departments.MethodsA retrospective analysis was performed of all dermatology consults seen in 2013 at a public tertiary hospital in Sydney, Australia.ResultsTwo hundred nineteen discharge summaries related to inpatient dermatology consultations were analysed; 80.6% of dermatology consults, 72.2% of skin biopsies, and 57.6% of diagnoses were duly included in the discharge summaries; 82.5% of the discharge summaries were completed before the discharge. The accuracy rate of diagnosis documentation was 54.5% and was correlated with clear dermatology team documentation, the use of a problems list, infectious skin diseases and junior medical staff authorship.ConclusionThis study highlights the need for improvement in dermatology consult documentation in discharge summaries. It suggests the use of a problems list in discharge summaries, clarity in dermatology teams’ documentations, and postdischarge follow-up.

Resistance of Group A β-hemolytic streptococcus

Group A β-hemolytic streptococcus (GAS), namely Streptococcus pyogenes, is one of the most important human pathogen.GAS can cause skin and mucous membrane superficial infectious diseases, life-threatening invasive disease, toxin-mediated diseases and immune-related diseases.Antibiotic is an effective mean to control GAS infection.The β-lactam antibiotics remain the first-choice treatment for GAS infection and the macrolides are often recommended as a replacement therapy for β-lactam antibiotics allergic patients or a means to blocking GAS exotoxin product.But with the widespread use of macrolides autibiotics, macrolide-resistant GAS spread in the world.This paper will elaborate the situation of macrolide-resistant clones. Key words: Group A β-hemolytic streptococcus; Macrolide antibiotics; Resistance

Outcome of Streptomycin-Rifampicin treatment of Buruli Ulcer in two Ghanaian districts

IntroductionBuruli ulcer (BU) is an infectious skin disease, caused by Mycobacterium ulcerans, endemic in more than 30 countries worldwide especially Africa. Brong-Ahafo Region implemented WHO recommended daily treatment with streptomycin and rifampicin for eight weeks (SR8). Yet limited assessment of therapy exists. This study seeks to determine the outcome of SR8 therapy on BU in two endemic districts in Brong-Ahafo.MethodsLongitudinal study was done with laboratory confirmed Buruli ulcer patients selected consecutively and put on SR8. Patient follow-up involved daily administration of SR8 and Bi-Weekly monitoring of treatment in the form of measurement of wound size and taking photographs.ResultsThe mean age of participants was 34.6 ± 16.6 years with minimum and maximum ages of 10 to 65 respectively. Those in the 10-19year age group 13 (26%) were most affected. Majority, 26 (52%) had no formal education and 27 (54.0%) were peasant farmers. Thirty-eight (76.0%) had previously used traditional treatment. Forty completed treatment and of these, 28 (70.0%) healed completely and 12 (30. 0%) improved by 80%-90%. Duration of lesion before seeking healthcare (P =0.04), use of traditional treatment P < 0.001, clinical form of lesion P = 0.04, lesion category (p = 0.01), significantly affected healing. Mean time to healing, was 7.7 weeks (95% CI, 7.3 - 7.9).ConclusionThough SR8 is effective in curing BU, late reporting, use of herbs and access to health care impeded wound healing. This calls for provision of accessible health care and education to improve early reporting.

Abberant Sudomotor Functions in Sjögren's Syndrome: Comparable Study with Atopic Dermatitis on Dry Skin Manifestation.

This chapter summarizes recent advances in the pathogenesis and management of Sjögren's syndrome (SS). Major topics are newly described pathomechanisms and cutaneous manifestations of SS, with special references to hypohidrosis and related mucocutaneous manifestations. Although the significance of cutaneous manifestations in SS has been gradually recognized in rheumatologists, sudomotor function has not been fully evaluated and recognized in the diagnosis of SS except by dermatologists. SS is a relatively underestimated collagen disease in contrast to systemic lupus erythematosus, systemic sclerosis, or dermatomyositis, and special care is needed not to misdiagnose SS when we see patients with common skin diseases such as drug eruption, infectious skin disease, or xerosis in daily practice. In contrast to SS, the reduced sweating function seen in atopic dermatitis (AD) is restricted only to axon reflex-induced indirect sweating, which is usually restored to normal levels after improvement of the dermatitis. Therefore, the xerotic skin lesions seen in SS and AD might be attributable to different pathomechanisms with similar dry skin manifestations. It is well known that dry skin is occasionally seen in SS, and clinical use of muscarinic M3-receptor agonists occasionally improves this condition through recovery of sweating function. Therefore, this M3-receptor agonist might be a promising drug and should be evaluated for the treatment of impaired sweating in AD complicated with or without SS.

Identification Of Health Disorders A Prison Population

Objectives: to identify the main health problems of the prison population, describe the sociodemographic and health of convicts profile; point the main complaints and more frequent pathologies. Method: exploratory, descriptive, quantitative and qualitative, held in a maximum security prison. The study sample was composed of 63 convicts, which answer a semi-structured form. For the analysis, there was the simple descriptive statistics and discourse analysis of the collective subject. Results: the prison population is young, with low educational level and family income, present as the main pathologies skin disorders, respiratory disorders, gastrointestinal, cardiovascular, and infectious diseases. Final considerations are numerous health problems presented by the detainees, as well as their complaints ranging from lack of medical care and other health professionals, to the unsanitary conditions in which live, and picture of state failure and the competent bodies.

Cytotoxicity of 91 Kenyan indigenous medicinal plants towards human CCRF-CEM leukemia cells

Ethnopharmacological relevancePlants from Kenyan flora are traditionally used against many ailments, including cancer and related diseases. Cancer is characterized as a condition with complex signs and symptoms. Recently there are recommendations that ethnopharmacological usages such as immune and skin disorders, inflammatory, infectious, parasitic and viral diseases should be taken into account when selecting plants that treat cancer. AimThe present study was aimed at investigating the cytotoxicity of a plethora of 145 plant parts from 91 medicinal plants, most of which are used in the management of cancer and related diseases by different communities in Kenya, against CCRF-CEM leukemia cell line. Materials and methodsExtracts from different plant parts (leaves, stems, stem bark, roots, root barks, aerial parts and whole herb) were obtained by cold percolation using different solvent systems, such as (1:1v/v) dichloromethane (CH2Cl2) and n-hexane (1), methanol (MeOH) and CH2Cl2 (2); neat MeOH (3), 5% H2O in MeOH (4) and with ethanol (EtOH, 5); their cytotoxicities were determined using the resazurin reduction assay against CCRF-CEM cells. ResultsAt a single concentration of 10μg/mL, 12 out of 145 extracts exhibited more than 50% cell inhibition. These include samples from the root bark of Erythrina sacleuxii (extracted with 50% n-hexane-CH2Cl2), the leaves of Albizia gummifera, and Strychnos usambarensis, the stem bark of Zanthoxylum gilletii, Bridelia micrantha, Croton sylvaticus, and Albizia schimperiana; the root bark of Erythrina burttii and E. sacleuxii (extracted with 50% CH2Cl2–MeOH), the stem bark of B. micrantha and Z. gilletii (extracted using 5% MeOH–H2O) and from the berries of Solanum aculeastrum (extracted with neat EtOH). The EtOH extract of the berries of S. aculeastrum and A. schimperiana stem bark extract displayed the highest cytotoxicity towards leukemia CCRF-CEM cells, with IC50 values of 1.36 and 2.97µg/mL, respectively. Other extracts having good activities included the extracts of the stem barks of Z. gilletii and B. micrantha and leaves of S. usambarensis with IC50 values of 9.04, 9.43 and 11.09µg/mL, respectively. ConclusionsThe results of this study provided information related to the possible use of some Kenyam medicinal plants, and mostly S. aculeastrum, A. schimperiana, C. sylvaticus, Z. gilletii, B. micrantha and S. usambarensis in the treatment of leukemia. The reported data helped to authenticate the claimed traditional use of these plants. However, most plants are used in combination as traditional herbal concoctions. Hence, the cytotoxicity of corresponding plant combinations should be tested in vitro to authenticate the traditional medical practitioners actual practices.

Ocular manifestations of infectious skin diseases

Ocular complications of infectious skin diseases are a common occurrence. Managing the inflamed or infected eye in the emergency setting presents a diagnostic and therapeutic challenge to the emergency physician. Infectious agents may affect any part of the eye. Ocular findings may be the first sign of many infectious diseases, such as, for example, gonorrhea or chlamydia infection. Understanding the various forms of ocular involvement in these conditions is important, because untreated ophthalmic involvement can lead to severe vision loss. This review focuses on the significant ocular manifestations of the most common infectious diseases, including bacterial, viral, fungal, and parasitic infections, that both ophthalmologists and dermatologists may encounter.

Medicinal Plants for the Treatment of Acne Vulgaris: A Review of Recent Evidences.

Context:Acne vulgaris affects about 85% of teenagers and may continue to adulthood. There are about two million visits to physicians per year for teenagers and the direct cost of acne treatment in the US exceeds $1 billion per year.Evidence Acquisition:A wide variety of treatment regimens exist for acne vulgaris including benzoil peroxide, retinoids, isotretinoids, keratolytic soaps, alpha hydroxy acids, azelaic acid, salicilic acid as well as hormonal, anti-androgen or antiseborrheic treatments. However, none of these methods is free of side effects and their exact role in therapy is not clear. In this paper apart from presenting the possible causes of acne vulgaris and its available drugs, recently published papers about medicinal plants used in the treatment of acne vulgaris were reviewed.Results:Consumption of alternative and complementary medicine, including medicinal plants, is increasing and is common amongst patients affected by acne and infectious skin diseases. Medicinal plants have a long history of use and have been shown to possess low side effects. These plants are a reliable source for preparation of new drugs.Conclusions:Many plants seem to have inhibitory effects on the growth of bacteria, fungi and viruses in vitro. However, there are a few clinical evidences about the effectiveness and safety of these plants in the treatment of acne and other skin infections.

Burden of Skin Diseases in Western Nepal: A Hospital Based Study

There is a substantial lack of data regarding the actual burden of skin diseases in Nepal. Skin diseases often account for a significant number of hospital visits specially in the rural areas of Nepal. 20-30% of the general population is affected by skin disorders at any given time. A hospital based retrospective study reviewed the medical data over a period of one year (June 2014 to May 2015). A total number of 6009 patients presented to the Department of Dermatology which accounted for 6% of the total hospital patients. There was almost equal number of males (51%) & females (49%). Cutaneous infections and dermatitis alone was responsible for more than 50% of the cases (cutaneous infection-34% & dermatitis-20%) whereas pigmentary disorders, including melasma contributed to only 6% of the cases. The occurrence of skin disease did not have significant correlation with socioeconomic class & personal hygiene (p-value>0.05). Conclusively, we need to focus more towards controlling infectious skin diseases.

Antidermatophytic activity of hydroalcoholic extracts from Rosmarinus officinalis and Tetradenia riparia

Rosmarinus officinalis and Tetradenia riparia are used in folk medicine for the treatment of disease, including infectious diseases and skin disorders. The purpose of this study was to investigate the antifungal activity of hydroalcoholic extracts from R.officinalis and T.riparia against strains of Trichophyton rubrum, T.mentagrophytes and Microsporum gypseum. Hydroalcoholic extracts prepared with dried leaves from R.officinalis, Psidium guajava and T.riparia were assayed against dermatophyte species by the microdilution technique and by microscopy. R.officinalis and T.riparia were the most active against dermatophytes, as determined from the minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC), and were investigated further. Fluorescence microscopy and scanning electron microscopy were used to investigate inhibition of hyphal growth by the two extracts, and showed a strong inhibition and an irregular growth pattern. Both extracts showed good action against dermatophytes, inhibiting fungal growth and causing alterations in their hyphae. Therefore, R.officinalis and T.riparia are potential sources of new compounds for the development of antifungal drugs.

Relation of Sociodemographics and Personal Hygiene on Different Childhood Dermatoses.

Skin diseases in children contribute to significant morbidity and psychological distress. Infective dermatoses are one of the major dermatoses in children. Low socioeconomic status, overcrowding and poor personal hygiene has been linked to skin diseases. To find out the prevalence of infectious skin disease in children, rate of transmissible skin disease and association of sociodemographic factors and personal hygiene on infective childhood dermatoses. This was a cross-sectional study conducted in the Pediatric and Dermatology Department, Manipal Teaching Hospital, Pokhara, Nepal. A total of 226 patients were examined over a period of one year. Relation of sociodemographics, crowding and personal hygiene on skin disease were assessed. The most common category was Infections and Infestations (51.3%) followed by Dermatitis (27.9%). Transmissible skin disease was seen in 49.6%. Low socioeconomic status and overcrowding were associated with increased risk for infective dermatoses. Skin disease in children constitutes a public health problem. Improving the socioeconomic status and personal hygiene can help to reduce the incidence of skin disease in children.

Syringometaplasia: variants and underlying mechanisms.

Syringometaplasia is an adaptive, benign, metaplastic cellular process that affects the eccrine ducts and glands in response to a variety of physiological or pathological stimuli. Different subtypes of syringometaplasia have been described, including the squamous, mucinous, and adenomatous types. These metaplastic changes have been reported in association with chemotherapeutic agents, as well as with a variety of skin disorders including multiple infectious, neoplastic, and inflammatory skin diseases. In this review, we attempt to shed light on the different patterns of syringometaplasia, its pathogenesis, the plethora of skin conditions in which it may be observed, and the differential diagnoses that should be considered.