Severe Rash Research Articles

Single Institutional Experience on Cutaneous Manifestation of Adult T-cell Leukemia/Lymphoma - Potential Diagnostic Pitfall

Abstract Introduction/Objective Adult T-cell Leukemia/Lymphoma (ATLL) is an aggressive peripheral T-cell neoplasm caused by the human T-cell lymphotropic virus-1 (HTLV1). Approximately half of the patients diagnosed with ATLL have heterogeneous cutaneous manifestations and 1/3 of those patients have skin changes e.g. rashes, papules, and nodules at initial presentation. There is clinical and morphologic overlap between ATLL and other cutaneous T-cell neoplasms such as Cutaneous T-Cell Lymphoma/mycosis fungoides (CTCL/MF) which could pose a potential diagnostic challenge. Methods A retrospective study was conducted using PathNet system to search for HTLV1 positive ATLL patients. Clinicopathologic features of the patients with cutaneous involvement were analyzed. Results Total 31 patients with ATLL were identified. Nine patients (29%, median 54.5 years, range 47-67 years, male: female ratio 2:7) showed skin manifestations, and the cutaneous involvement with ATLL was confirmed by skin biopsy. Five (55.5%, 5/9) cases were initially misdiagnosed as CTCL/MF. Among the 5 patients, 2 presented with skin rash or diffuse erythematous patch/plaque before developing generalized lymphadenopathy or overt circulating atypical lymphocytosis; 2 developed severe pruritic rash with erythematous skin changes resembling Sezary syndrome; and 1 patient had folliculotrophic MF diagnosed 12 years before. Notably, atypical lymphocytosis (0.46- 41.19/µL) occurred in 3 of the 4 remaining cases. In addition, eight of the 9 patients displayed a variable level of CD3+/CD4+/ CD25strong+ abnormal T-cells on flow cytometry. A low-level bone marrow involvement (2-10%) was found in 8 of 9 cases. Elevated calcium levels were identified in 3 of 9 cases (33%). There were 7 of 8 patients (87.5%) who developed generalized lymphadenopathy when diagnosis of ATLL was rendered. Conclusion In patients with cutaneous manifestations, features including hypercalcemia, atypical lymphocytosis, lymphadenopathy, CD3/CD4/strong CD25 coexpression, and bone marrow involvement should prompt a test for HTLV1. Early diagnosis of ATLL can initiate proper treatment and improve patient clinical outcomes.

Repository Corticotropin Injection for Persistently Active Systemic Lupus Erythematosus: Results from a Phase 4, Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial.

IntroductionWe assessed the efficacy and safety of repository corticotropin injection (RCI; Acthar® Gel) for persistently active systemic lupus erythematosus (SLE) despite use of moderate-dose glucocorticoids.MethodsThis multicenter, double-blind, randomized, placebo-controlled study enrolled patients ≥ 18 years with active SLE and moderate to severe rash and/or arthritis despite stable glucocorticoid doses (7.5–30 mg/day prednisone equivalent) and antimalarials for ≥ 4 weeks and/or immunosuppressants for ≥ 8 weeks before screening. Stable glucocorticoid doses were required through week 16 with optional taper from weeks 16 to 24. Patients were randomized (1:1) to 80 U RCI subcutaneously or placebo every other day to week 4, then twice weekly to week 24. Endpoints included the proportion of SLE Responder Index (SRI)-4 responders at week 16; changes from baseline to week 16 in 28 Swollen Joint Count/Tender Joint Count (28 SJC/TJC) and Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI)-Activity score; and changes from baseline to week 24 in inflammatory cytokines. Safety was assessed by adverse events.ResultsIn the modified intention-to-treat population (RCI, n = 84; placebo, n = 85), the proportion of SRI-4 responders at week 16 was not significantly different between groups (RCI, 47.6%; placebo, 43.5%; OR [95% CI] 1.2 [0.6 to 2.2]; p = 0.5762). RCI treatment resulted in a reduction from baseline to week 16 in 28 SJC/TJC and CLASI-Activity score and from baseline to week 8 in B-cell activating factor cytokine. Post hoc analyses demonstrated a greater proportion of BILAG-based Combined Lupus Assessment responders for RCI than placebo at weeks 4, 12, and 20 and greater SRI-4 response in RCI-treated patients with baseline SLE Disease Activity Index-2000 ≥ 10 and CLASI-Activity ≥ 11. No new safety signals were identified.ConclusionsDespite failure to achieve the primary endpoint, these results support the utility of RCI for treating persistently active SLE.Trial RegistrationClinicalTrials.gov identifier NCT02953821.Electronic Supplementary MaterialThe online version of this article (10.1007/s40744-020-00236-1) contains supplementary material, which is available to authorized users.

Establishment and Application of a Predictive Model for Gefitinib-Induced Severe Rash Based on Pharmacometabolomic Profiling and Polymorphisms of Transporters in Non-Small Cell Lung Cancer

Background: Gefitinib-induced rash is a sign of favorable outcomes for patients with non-small cell lung cancer (NSCLC). However, whether patients with more severe rash, the more survival benefits obtained from gefitinib is still unknown, and as for the severe rash a risk factor prediction model is needed. Method: A total of 346 patients were enrolled in this study. Gefitinib/metabolites and 9 gene polymorphisms, were determined by pharmacometabolomic and pharmacogenomics methods in an exploratory cohort. External cohort patients were enrolled to validate this model. Findings: The survival for patients with rash were significantly higher than patients without rash (p=0.0002, p= 0.0089)，but no difference was found between grade 1/2 or grade 3/4. Only the concentration of gefitinib, but not its metabolites, was associated with severe rash, and the cutoff value of gefitinib was 204.6 ng/mL conducted by ROC curve (AUC=0.685). A predictive model for severe rash was established: gefitinib concentration (OR = 11.523, 95%CI=2.898-64.016, p = 0.0016), SLC22A8 rs4149179(CT vs CC, OR = 3.156, 95%CI = 0.958-11.164, p = 0.0629), SLC22A1 rs4709400(CG vs CC, OR = 10.267, 95%CI = 2.067-72.465, p = 0.0087; GG vs CC, OR=5.103, 95%CI=1.032-33.938, p=0.061). This model was confirmed in validation cohort with an excellent predictive ability (AUC = 0.749, 95%CI = 0.710-0.951). Interpretation: Our finding demonstrated that patients developed any grade rash predicted improved survival, the gefitinib concentration and polymorphisms of SLC22A8 and SLC22A1 were recommended to manage severe rash. However, our model would require further validation in a biomarker-led trial. Trial Registration: This study was registered at ClinicalTrials.gov (NCT01994057). Funding Statement: This study was funded by the National Natural Science Foundation of China (Grant Nos. 81730103, 81320108027, 81573507, 81473283, 81173131 and 81973398), The National Key Research and Development Program (Grant Nos. 2017YFC0909303 and 2016YFC0905001), Guangdong Provincial Key Laboratory of Construction Foundation (Grant No. 2017B030314030), Science and Technology Program of Guangzhou（201607020031）, National Engineering and Technology Research Center for New drug Druggability Evaluation (Seed Program of Guangdong Province (No. 2017B090903004) and the 111 project (Grant: B16047). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: The study was approved by Human Ethics of Sun Yat-sen University Cancer Center (B2013-038-1) and conducted in accordance with the principles of the Declaration of Helsinki and the Good Clinical Practice Guidelines of the International Conference on Harmonization.

Results of the non-small cell lung cancer part of a phase III, open-label, randomized trial evaluating topical corticosteroid therapy for facial acneiform dermatitis induced by EGFR inhibitors: stepwise rank down from potent corticosteroid (FAEISS study, NCCH-1512)

PurposeThis FAEISS study was designed to confirm the superior efficacy of reactive topical corticosteroid strategies employing serially ranking-DOWN from very strong steroid levels for the treatment of facial acneiform rash induced by epidermal growth factor receptor (EGFR) inhibitors (EGFRIs), in comparison with strategies employing serially ranking-UP from weak steroid levels. This article reports the primary results of the non-small cell lung cancer (NSCLC) part of the trial.MethodsPatients with EGFR-mutated advanced NSCLC treated with erlotinib or afatinib were enrolled in the first registration. All patients received preemptive therapy with oral minocycline and heparinoid moisturizer from the initiation of an EGFR inhibitor. Enrolled patients who developed facial acneiform rash within 2 weeks were randomized at second registration to either a ranking-UP (WEAK) group or a ranking-DOWN group. The primary endpoint was incidence of grade ≥ 2 facial acneiform rash over 8 weeks.ResultsFifty-one patients were enrolled at the first registration and received EGFRIs (n = 30 for afatinib, n = 21 for erlotinib). However, 35 patients did not develop facial acneiform rash within 2 weeks; one patient discontinued preemptive treatment. Fifteen patients (29.4%) were enrolled in the second registration; nine were assigned to the WEAK group and six to the DOWN group. There was no significant difference in the incidence of grade ≥ 2 facial acneiform rash between the WEAK group (one patient, twice) and the DOWN group (one patient, twice; p = 0.8417). No patients developed severe facial acneiform rash within 10 weeks.ConclusionIn NSCLC patients who received EGFRIs, preemptive therapy of oral minocycline and heparinoid moisturizer reduced facial acneiform rash incidence.Trial registrationUMIN000024113

Usefulness of Rapid Desensitization Therapy for Severe Rash Caused by Molecularly Targeted Drugs Used in the Treatment of Non-small-cell Lung Cancer.

Molecular-targeted drugs (MTDs), such as epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) and anaplastic lymphoma kinase inhibitors, are used to treat non-small-cell lung cancer (NSCLC). The incidence of rash caused by EGFR-TKIs and discontinuation of MTDs because of rash are issues. Rapid desensitization therapy (RDT) was performed in five patients who developed severe rash after introduction of MTDs and was successful in four, all of whom showed no rash relapse. RDT may thus be useful for treating rash in patients receiving MTDs for NSCLC.

Sweet Syndrome in Eosinophilic Granulomatosis with Polyangiitis.

Sweet syndrome is a rare dermatologic disorder characterized by sterile neutrophilic infiltrate. Neutrophilic dermatoses have increasingly been recognized in antineutrophil cytoplasmic antibodies (ANCA)-associated vasculitis, with the notable exception of eosinophilic granulomatosis with polyangiitis (EGPA)1. A 46-year-old man with asthma presented with fever, dyspnea, difficulty ambulating, and a severe rash. Erythematous tender dermal plaques were present across his scalp (Figure 1). Labs were notable for leukocytosis with striking eosinophilia (absolute eosinophil count 7.75), high-titer myeloperoxidase …

Severe Mycoplasma-Induced Rash and Mucositis Treated With IVIG

Severe Mycoplasma-Induced Rash and Mucositis Treated With IVIG

Correlation of gefitinib and its metabolites with gefitinib induced rash in patients with non-small cell lung cancer (NSCLC).

e21712 Background: Gefitinib induced rash is the most common adverse reaction and severe rash of gefitinib often leads to discontinuation or termination of treatment. The concentrations of drug and its metabolites may affect drug induced toxicities, however, the association of gefitinib/metabolites with gefitinib-induced rash are poorly investigated. Therefore, we explored the association between concentrations of gefitinib and its four metabolites with gefitinib-induced rash in non-small cell lung cancer (NSCLC) patients. Methods: A total of 180 advanced NSCLC patients carrying EGFR sensitive mutations receiving gefitinib were enrolled. The concentrations of gefitinib, and its four metabolites including M537194, M387783, M523595 and M605211 were determined by liquid chromatography–tandem mass spectrometry (LC–MS/MS). The associations between concentration of gefitinib/its metabolites and gefitinib-induced rash were analyzed by Mann-Whiney U test. Operating characteristic curves(ROC) were used to determine gefitinib/metabolites cutoff values for gefitinib-induced rash. Results: M605211 was first detected in plasma in NSCLC patients. The concentrations of gefitinib and M605211, M537194 were found to be correlated with the incidence of gefitinib-induced rash ( P= 0.0002, 0.027 and 0.0097, respectively), moreover, the concentration of gefitinib was correlated with severe rash (Grade 0,1 vs. 2+, P= 0.017). Multivariate Logistic regression analysis showed that only gefitinib concentration was independent risk factor for gefitinib-induced rash (grade 0 vs grade1+, OR = 1.006, 95%CI (1.002-1.009), P = 0.00078; grade0,1 vs grade2+, OR = 1.003, 95%CI (1.001-1.005), P = 0.015, respectively). The cutoff values of gefitinib were 160.2 ng/ml (grade 0 vs grade1+, sensitivity = 78.7%, specificity = 47.7%, area under the curve (AUC) = 0.686, P = 0.0002, 95% CI (0.592-0.779)) and 201.7ng/ml (grade0,1 vs grade2+, sensitivity = 69.3%, specificity = 47.6%, AUC = 0.605, P = 0.0168, 95%CI (0.521-0.689)). Conclusions: This research demonstrated that the concentration of gefitinib and its metabolites were associated with gefitinib induced rash in NSCLC patients. Therapeutic drug monitoring of gefitinib concentration may have potential improvement for optimization of treatment with gefitinib. Clinical trial information: NCT01994057.

Application of PD-1/PD-L1 immune checkpoint inhibitors treating lung cancer in Yerevan Armenia: Two-center experience.

e15058 Background: Over the past few years PD-1/PD-L1 pathway blockade through immune checkpoint inhibitors appeared to be an effective treatment approach in advanced lung cancer. The current study aims to investigate the utilization of immunotherapy for lung cancer management purposes in Armenia. Methods: For this retrospective, hospital-based cohort study census sampling method was approached. Data was collected on all the patients who were diagnosed with stage III and IV lung cancer and passed treatment in the departments of Adult Solid Tumors in Hematology Center after prof. Yeolyan and Institute of Surgery after Mikaelyan from 01.05.2019 till 12.01.2020. The time period was selected based on the initiation of PD-L1 testing in Armenia. The prevalence of non-small cell (NSCLC) and small cell (SCLC) lung cancer was calculated. The patients’ PD-L1 testing performance, subsequent immunotherapy utilization, and developed adverse effects were evaluated. Results: According to the hospital-based data, during the mentioned time period 60 patients diagnosed with stage III and IV lung cancer received treatment in the two units. In the cohort, the patients’ median age was 65,5 years (range 46 – 88). The male-to-female ratio was 5.6. The prevalence of NSCLC and SCLC was 61.7% and 28.3% respectively. At the time of follow-up on 10.02.2020, 74.4% of NSCLC patients and 64.7% of SCLC patients were alive. Of the 43 NSCLC subjects, only 11 were checked for the PD-L1 status. Among them, 7 were determined to be PD-L1 positive and 5 of them received immunotherapy. For SCLC patients PD-L1 status wasn’t checked. Of 17 SCLC patients, only one has received immunotherapy. Overall only one case of immunotherapy related adverse effect was observed (severe rash and pruritus). At the time of follow-up, one of the six patients who underwent immunotherapy was dead. Conclusions: The presented data demonstrate a lack of PD-L1 test performance and underutilization of immunotherapy treatment. In the future, it is recommended to perform a nationwide study on the current topic to assess the immune checkpoint inhibitors impact on the survival rates of advanced lung cancer patients.

Protecting medical staff from skin injury/disease caused by personal protective equipment during epidemic period of COVID-19: experience from China.

Linked articles: COVID‐19 SPECIAL FORUM. J Eur Acad Dermatol Venereol 2020; 34: e210–e216.

Metallic allergy requiring removal of iliac stent: report of a case

BackgroundThe use of metallic stents, which are predominantly composed of nickel, in the treatment of patients with nickel allergy has not been well studied.Case presentationA patient who suffered from contact dermatitis due to implantation of an iliac stent was successfully treated by removing the stent that caused nickel allergy. The patient has exhibited no symptoms of claudication or severe pruritic rash in the 2-year follow-up period after iliac stent removal.ConclusionsWe herein report a case of nickel allergy in which a metallic iliac stent that was predominantly composed of nickel was removed. The patient showed a marked recovery from her contact dermatitis. In cases of suspected metallic allergy, it is necessary to consider revascularization without using a metal device.

One-Month Outcomes of Cases Receiving Ticagrelor after Percutaneous Coronary Intervention; a Case Series.

Ticagrelor is the first reversibly binding oral P2Y12 receptor antagonist that can block ADP-induced platelet aggregation. This study aimed to describe one-month follow-up findings of cases undergoing ticagrelor therapy after percutaneous coronary intervention (PCI). This case series was performed on acute coronary syndrome (ACS) patients who were candidates for PCI and received aspirin plus ticagrelor after PCI. Patients were followed for one month and their outcomes were described. 156 cases with the mean age of 59.74 ± 9.24 years were studied (63% male). 45 (28.8%) cases complained of dyspnea (39 cases with mild and 6 cases with severe dyspnea). Bleeding occurred in 4 (2.5%) cases (intra-cranial hemorrhage (ICH) in one, hematuria in two, and skin hemorrhage in one case). There were no cases with bradycardia or thrombosis. One (0.6%) patient developed drug hypersensitivity reaction, which manifested as skin rash. The use of drug was stopped in 10 (6.4%) cases due to severe dyspnea (n= 6), ICH (n=1), skin rash (n=1), and concomitant left ventricular (LV) clot (n=2). The most important finding of one-month ticagrelor consumption were dyspnea, bleeding, and hypersensitivity reaction. No case of bradycardia and stent thrombosis was detected. In our study , iranian population has more susceptibility to dyspnea than PLATO result. The rate of drug discontinuation in this series of cases was 6.4 %.

Effect of phenytoin on retinal ganglion cells in acute isolated optic neuritis.

Phenytoin has been shown to reduce the peripapillary retinal nerve fiber layer (pRNFL) loss in optic neuritis (ON). We evaluated the effects of phenytoin on retinal ganglion layers and visual outcomes of newly diagnosed acute ON. A randomized, placebo-controlled trial was conducted in a tertiary referral eye hospital and patients with the first episode of typical demyelinating ON, without any history of multiple sclerosis were randomly assigned to phenytoin or placebo. The thickness of ganglion cell-inner plexiform layer (GCIPL) measured by optical coherence tomography (OCT) was considered as the primary outcome. One patient in the phenytoin group developed severe cutaneous rashes that progressed to Stevens-Johnson syndrome (SJS)/toxic epidermal necrosis (TEN), and further allocation of patients to the phenytoin group was stopped, and finally fifteen participants were included in the phenytoin group. Fifty-one patients were enrolled to the placebo group, from which four were excluded. Both visual acuity and field were not significantly different between the control and phenytoin groups after 1 and 6months. Mean 3- and 6-mm macular GCIPL thicknesses decreased after 6months to 73.6 ± 14.1 and 57.9 ± 7.5μm, respectively, in the phenytoin group and to 71.6 ± 15.7 and 55.6 ± 6.6μm, respectively, in the placebo group with no significant differences between the two groups (P = 0.77 and P = 0.26, respectively, linear multilevel model). Phenytoin is not probably safe and effective as neuroprotection after acute ON. Further investigation with other sodium channel inhibitors could be considered.

Dolutegravir (DTG) Based Fixed Dose Combination (FDC) of Tenofovir/Lamivudine/Dolutegravir (TLD) and Viral Load Suppression in Children in Port Harcourt, Nigeria

Background: Currently, dolutegravir (DTG) based fixed dose combinations (FDC) of tenofovir/ lamivudine/dolutegravir (TLD) and Abacavir/lamivudine/dolutegravir (ABC/3TC/DTG) is now recommended by the World Health Organisation (WHO) as the preferred first-and second line antiretroviral drug necessitating transition of eligible children to TLD.
 Objective: The objective of this study is to compare the HIV viral suppression rate at baseline and after 6 months of transition to TLD and to determine adverse drug reaction associated with the use of TLD if any.
 Methods: This was a prospective cross-sectional study carried out among stable children who were on treatment and follow up for HIV disease at the Paediatric HIV clinic of the University of Port Harcourt Teaching Hospital (UPTH). All Children who were eligible for transition to TLD, whose care givers/parents gave a verbal consent and who gave consent or accent were recruited for the study. Information obtained included the sociodemographic characteristics, weight and height, ART regimen at initiation of treatment and when it was commenced, the baseline viral load and viral load 6 months after transition and any adverse drug reaction. Obtained data were analysed. Comparison of categorical variables was done using chi square and Fischer’s exact test while A p-value of < 0.05 was set as statistically significant.
 Results: A total 106 children aged 9 to 18 years with a mean age of 13.4±2.3 years were recruited for the study. Sixty (56.6%) were males, while 59 (55.5%) were from the lower socioeconomic class. The mean weight was 44.4±11.1 kg while the mean height was 151.3 ± 15.2 cm. At baseline, 48 (45.3%) were virally suppressed (viral load < 1000 copies/ml), however after 6 months, 97 (91.5%) became virally suppressed, the difference in viral suppression rate was statistically significant (X2 =53.77, p= 0.0001). Twenty-five (23.6%) had undetectable viral load (<20 copies/ml) at baseline while 61(57.5%) had undetectable viral load after transition. All those who were virally suppressed at baseline remained so 6 months after transition. Also, 80.6% (29/36) of those with treatment failure became virally suppressed. Only one child developed severe erythematous skin rashes. There was no statistically significant relationship between viral suppression and age, sex and social class (P >0.05).
 Conclusion: This study has shown that DTG-based FDC is efficacious in the treatment of eligible children and adolescents with HIV/AIDS with significant viral load suppression in all age groups, gender and social class. Adverse drug reaction with the use of DTG-based ART is low. Transition to TLD is therefore advocated in eligible patients.

Characteristics of breakthrough varicella cases with different doses of varicella vaccine immunization history in Tongzhou District of Beijing during 2013 to 2017

Objective To analyze the epidemiological characteristics of breakthrough varicella cases with different doses of varicella vaccine immunization history in Beijing Tongzhou from 2013 to 2017. Methods Data about varicella incidence and immunization history were obtained through spot investigation and consulting the information systems of Chinese Disease Control and Prevention and Beijing′s Immunization Programme. Descriptive epidemiological method was used for statistical analysis. Results From 2013 to 2017, Tongzhou District reported 2 102 cases of varicella in primary and middle schools and kindergartens, which included 989 cases of primary varicella, 966 breakthrough varicella cases with one-dose vaccine immunization history, and 147 breakthrough varicella cases with two-dose vaccine immunization history. There were significant differences in gender, age, and occupation among the three groups. Among the primary cases, the incidence of fever and moderate and severe rash was 46.71% and 34.68%; among the breakthrough cases with one-dose immunization history, the incidence of fever and moderate and severe rash was 41.20% and 17.39%; among the breakthrough cases with two-dose immunization history, the incidence of fever and moderate and severe rash was 26.53% and 7.48%. There were significant differences in the incidence of fever and rash among the three groups. The median number of varicella morbidity interval was 5.11 years in one-dose immunization history group and 2.44 years in two-dose immunization history group, and the difference between them was statistically significant. Conclusions The symptoms of fever and rash in breakthrough varicella cases become less atypical as the dose of vaccination increases. Because the clinical symptoms are relatively mild, breakthrough cases as a source of infection in collective units are more likely to be neglected. Key words: Varicella; Breakthrough case; Characteristics

Risk factors for severe rash with use of vemurafenib alone or in combination with cobimetinib for advanced melanoma: pooled analysis of clinical trials

BackgroundRash is one of the most common severe adverse events associated with use of vemurafenib for the treatment of melanoma, either as monotherapy or in combination with cobimetinib. The study aimed to identify pre-treatment patient characteristics predictive of developing severe rash with vemurafenib therapy.MethodsThis was a secondary pooled analysis of individual patient data from the BRIM-2, BRIM-3 and coBRIM clinical trials, including all patients treated with vemurafenib alone and vemurafenib plus cobimetinib. Patient age, sex, performance status, body weight, body mass index, liver function markers and estimated glomerular filtration rate were assessed for association with development of severe (grade 3 or 4) rash using logistic regression.ResultsOf 962 patients treated with vemurafenib, 150 (16%) patients experienced severe rash. Female sex was identified as a significant risk factor for severe rash development (P < 0.001), having a two-fold increased risk compared to males (22% vs 11%, odds ratio [OR] 2.17; 95% CI 1.52 to 3.09). Low body weight was also associated with increased risk of severe rash (P = 0.002), but this association was not significant after adjustment for sex. The association between sex and risk of severe rash was consistent across clinical trials and treatments (vemurafenib monotherapy, vemurafenib plus cobimetinib).ConclusionFemales had approximately two-fold increased risk of developing severe rash compared to males in clinical trials of vemurafenib alone or in combination with cobimetinib.

Experiencia con el uso de daptomicina en un hospital pediátrico de alta complejidad

Vancomycin has been considered the treatment of choice especially for methicillin-resistant Staphylococcus aureus (MRSA) infections; but its poor tissue penetration, renal toxicity, and requiring of dosages monitoring, raises the need for new treatment alternatives such as daptomycin. To analyze the safety and effectiveness of daptomycin in children. Children with microbiologically documented infections treated with daptomycin were retrospectively included. The most frequent infections were endocarditis in 9 (32%), sepsis in 4 (14%), bacteremia in 7 (associated with catheter in 3) (25%), osteomyelitis in 3 (10%), peritonitis associated with dialysis in 3 (10%) and suppurative thrombophlebitis in 2 patients (p) (7%). Methicillin-resistant Staphylococcus aureus was the most common pathogen in 18 patients (64%). The indications for daptomycin were due to the failure of conventional treatment in 17 (61%), and the toxicity or intolerance to vancomycin in 11 patients (39%). The average duration of treatment was 19 days (95% ICR 7-42 days). Four patients (14%) completed outpatient treatment, 22 patients had a favorable response (79%). Adverse events were reported in 3 patients (2 creatinine-phosfo-kinase increase) and in one severe skin rash. Daptomycin demonstrated a favorable efficacy and safety in this pediatric population.

A study looking at different types of severe rashes called acute exanthemas

A study looking at different types of severe rashes called acute exanthemas

Monkeypox Rash Severity and Animal Exposures in the Democratic Republic of the Congo.

Experimental studies have suggested a larger inoculum of monkeypox virus may be associated with increased rash severity; however, little data are available on the relationship between specific animal exposures and rash severity in endemic regions. Using cross-sectional data from an active surveillance program conducted between 2005 and 2007 in the Sankuru Province of the Democratic Republic of the Congo, we explored the possible relationship between rash severity and exposures to rodents and non-human primates among confirmed MPX cases. Among the 223 PCR-confirmed MPX cases identified during active surveillance, the majority of cases (n = 149) presented with mild rash (5-100 lesions) and 33% had a more serious presentation (> 100 lesions). No association between exposure to rodents and rash severity was found in the multivariable analysis. Those that self-reported hunting NHP 3weeks prior to onset of MPX symptoms had 2.78 times the odds of severe rash than those that did not report such exposure (95% CI: 1.18, 6.58). This study provides a preliminary step in understanding the association between animal exposure and rash severity and demonstrates correlation with exposure to NHPs and human MPX presentation. Additional research exploring the relationship between rash severity and NHPs is warranted.

Recent Progress in Vaccine Development Against Chikungunya Virus.

Chikungunya fever (CHIKF) is an acute infectious disease that is mediated by the mosquito-transmitted chikungunya virus (CHIKV). People infected with CHIKV may experience high fever, severe joint pain, skin rash, and headache. In recent years, this disease has become a global public health problem. However, there is no licensed vaccine available for CHIKV. Accumulating research data have provided novel approaches and new directions for the development of CHIKV vaccines. Our review focuses on recent progress in CHIKV vaccine studies. The potential vaccine candidates are classified into seven types: inactivated vaccine, subunit vaccine, live-attenuated vaccine, recombinant virus-vectored vaccine, virus-like particle vaccine, chimeric vaccine, and nucleic acid vaccine. These studies will provide important insights into the future development of CHIKV vaccines.