Vesicular Skin Research Articles

Alterations of hemogram, serum biochemistry, oxidative/nitrosative balance, and copper/zinc homeostasis in dromedary camels naturally infected with poxvirus.

Camel pox (CMLP), a contagious viral disease of camels, causes considerable economic loss in terms of milk, meat, wool, and leather production besides reduction of draught power. The effect of spontaneous CMLP infection on hemogram, oxidative/nitrosative imbalance, and trace mineral homeostasis has not been studied earlier in dromedary camels. In the current study, hemogram, serum biochemistry, oxidant/antioxidant imbalance, and zinc (Zn)-copper (Cu) homeostasis were evaluated in healthy and pox-infected camels. The CMLP was confirmed from pooled samples of vesicular fluid, oral mucosa, and skin samples by polymerase chain reaction (PCR) targeting the C18L gene of CMLP virus. Hemogram was performed manually in whole blood. The serum was analyzed for biochemistry. The oxidative/nitrosative imbalance was measured by determining the concentrations of malondialdehyde (MDA), nitrite and nitrate (NOx), and glutathione S-transferase (GST) activity in serum. Simultaneously, copper (Cu) and zinc (Zn) concentrations were measured in serum. A pronounced leucopenia (p = 0.019), lymphopenia (p = 0.005), and hypoproteinemia (p = 0.014) were noted in CMLP-infected camels compared to healthy animals. The significant elevation of the MDA (p = 0.005) and NOx (p = 0.044) concentrations in serum of CMLP-infected indicated marked oxidative stress during the disease. The zinc concentration (p = 0.014) in CMLP-infected camels was significantly lower than healthy camels. The study supports that oxidative/nitrosative imbalance and Cu-Zn homeostasis are compromised and related to the pathophysiology of CMLP infection. The finding will be helpful to veterinary clinicians to adopt effective therapeutic strategies using antioxidants and trace minerals during CMLP outbreak. The timely vaccination and bio-security will be the mainstay for prevention of the diseases.

A novel poxvirus isolated from an Egyptian fruit bat in Israel.

An Egyptian fruit bat (Rousettus aegyptiacus) from the Zoological Gardens, at Tel Aviv, Israel, showed pox‐like clinical signs including vesicular and nodular skin lesions on the wings. Cell culture isolation, histopathology, electron microscopy and molecular analysis, revealed the presence of a novel bat poxvirus. Future research is needed to determine whether this virus can affect human health.

English

English

A rare case of COL71A1 heterozygous mutations resulting in neonatal dystrophic epidermolysis bullosa

Epidermolysis bullosa is a group of rare hereditary vesicular skin diseases associated with mutations of COL7A1. At present, there is no effective treatment. Approximately forty percent of patients die within the first year of life, and the quality of life of survivors is seriously compromised. Pre-pregnancy genetic counseling and prenatal diagnosis is of great clinical significance for these patients and families. We describe a rare case of dystrophic epidermolysis bullosa secondary to heterozygous mutations in COL7A1.

Maternal Death due to Viral Sepsis

Sepsis accounts for approximately 10% of all maternal deaths and in pregnancy, as a result of cell-mediated immunity is altered and prone for infection. Varicella zoster virus (VZV) commonly causes chickenpox in children and herpes zoster in adults. In this case, viral sepsis probably due to VZV has caused a death of an apparently immune-competent young mother. A 19-year-old unmarried sex worker with Grave’s disease presented in her second trimester with ankle oedema and shortness of breath. She was hypertensive and anaemic and was treated for secondary hypertension due to thyrotoxicosis. Later, she developed fever, oliguria and heart failure. She was treated in intensive care unit with hyperthyroid crisis induced by sepsis due to pneumonia. She developed high fever, intra-uterine death, hepato-renal failure, disseminated intravascular coagulation (DIC) and died on day fourteen. At autopsy, dermotomal vesicular skin lesions and vulval viral warts were seen. The internal organs showed sepsis. Blood for HIV was negative. Histopathology revealed viral pneumonia, myocarditis and DIC. Cause of death was given as sepsis due to viral pneumonia probably following VZV. The clinical diagnosis was septicaemia, due to pneumonia, but herpes zoster infection was not diagnosed. VZV infection can be life threatening even in immune-competent adults. The diagnosis of multi-organ failure from VZV should always be clinically suspected in the presence of atypical skin lesions and a temporarily immune-compromised state such as pregnancy.

Survey Results of the Occurrence of a Seasonal Teat Lesion Syndrome in Dairy Cows in Wisconsin

Seventy-two dairy practitioners in the state of Wisconsin participated in a telephone survey to determine the prevalence of a seasonal vesicular skin disease of dairy cows. Results of the survey indicated that there was widespread recognition of a skin disease that appears clinically similar to bovine herpes mammillitis but with the following differences: sporadic occurrence, non-infectious pattern of occurrence, almost exclusive predilection for first-calfheifers with severe udder edema, and dry gangrene and sloughing of teats.

The Diagnostic Value of Tzanck Test in Vesiculobullous, Pustular, and Oral Lesions in The Dermatology Clinic

Background: Vesiculobullous disorders represent a heterogeneous group of dermatoses with protean manifestations. The accurate diagnosis of bullous disorders of the skin and mucous membrane requires evaluation of clinical, histological, and immunofluorescence findings. Objective: The aim of this study was to investigate Tzanck smear findings and to determine the diagnostic value of this test in moist (erosive, vesicular, bullous, and pustular) skin and oral lesions. Patients and Methods: This cross sectional study was conducted on one hundred patients presented with vesicular, bullous, and pustular skin lesions and/or oral lesions. All patients were included from Dermatology Outpatient Clinic at Al-Zahraa University Hospital over the period from March 2018 to March 2019. Results: Positivity of multinucleated giant cells in herpetic infection, acantholytic cells in pemphigus, dyskeratotic acantholytic cells and cocci in bullous impetigo were useful landmarks in Tzanck smear. A decrease in viral shedding from herpetic lesions of longer duration may correlate with the lower sensitivity of the Tzanck smear. Therefore, in this study we excluded the lesions older than 3 days. The percentage of positivity in vesicles was much higher than that of pustules. Conclusion: According to this study, Tzanck smear was an inexpensive, simple, and rapid test and did not require any specialized laboratory equipment for evaluation of various vesiculobullous and pustular lesions either skin or mucosal one.

Acute hepatitis as a manifestation of primary HSV infection in a healthy child

Several herpesviruses can cause hepatic injury, but herpes simplex virus (HSV) is rarely involved in immune-competent patients, beyond the neonatal age. We report a rare case of acute hepatitis associated with primary HSV infection in a previously healthy child. Therefore, HSV infection should be actively investigated in healthy children developing acute hepatitis without acute liver failure, if the most common infectious agents have been excluded, despite the absence of the typical vesicular herpetic skin and/or mucosal manifestations.

Caso atípico de herpes zoster recorrente em paciente imunocompetente: abordagem, diagnóstico e tratamento.

Herpes zoster (HZ) é uma doença infecciosa causada pela reativação do vírus varicela zoster nos gânglios sensoriais dorsais ou cranianos, caracterizada por erupções cutâneas vesiculares agrupadas que acometem um ou mais dermátomos. É mais comum em idosos, em associação ao declínio da imunidade celular que se manifesta com a idade. Em adultos jovens, a infecção por HZ correlaciona-se com condições clínicas de baixa imunidade. Esse artigo trata de caso clínico de HZ com apresentação atípica, tanto no que diz respeito à localização quanto à alta frequência de recorrência, em adulta jovem imunocompetente. O objetivo é discutir o caso, com base na evidência científica atual, enfatizando-se a sintomatologia, apresentação clínica, diagnóstico diferencial, impacto na qualidade de vida, conduta e tratamento.

Acquired vulvar lymphangioma: Report of two cases

Vulvar lymphangioma is a rare case and often being misdiagnosed as genital wart. This acquired disorder manifests as dilatation of superficial lymph vessel due to obstruction. It is caused by urogenital infection and most often occurs following surgery and radiotherapy of cervical cancer. The diagnosis is established based on clinical and histopathological features. Treatment aimed to eliminate the cause of obstruction. This article reports two cases of vulvar lymphangioma found in our Hospital. First case was a 43-year-old female with a history of surgery and radiation for cervical cancer 10 years ago presented with vesicular skin lesion in genital area, oozing copious clear fluid since 4 years ago. There are multiple lenticular vesicles containing clear fluid in vulvar area accompanied with bilateral lymphedema of lower extremities. Histopathological features demonstrated dilated superficial lymph vessels. Second case was a 44-year-old female with enlargement of lower abdomen with vesicular lesion containing clear fluid in genital area since 3 years ago. Abdominal USG showed enlarged inguinal lymph node. Histopathological features demonstrated dilated superficial lymph vessels. The treatment for both cases were gradual electrosurgery. In both cases, vulvar dermis’ superficial lymph node dilatation caused the skin lesions. Obstruction of lymph vessel due to radiation and surgery for cervical cancer in the first case and of inguinal lymph node in the second case lead to increased lymphatic pressure in the dermis and later on the dilatations. The treatment in both cases using electrical excision produced good responses; however, we should be attentive on recurrent case. Keywords: acquired vulvar lymphangioma, dilatation of dermal lymph vessels, electrosurgery

A Case of Drug-induced Cutaneous Toxicity Observed in Cynomolgus Monkeys.

The purpose of this article is to describe a case of drug-induced cutaneous toxicity observed in cynomolgus monkeys and to introduce approaches attempted in order to elucidate mechanisms. The test article was a small molecule with a ubiquitously distributed target, especially in rapidly dividing cells, and which modulated cell cycle regulation. After 7 consecutive days of oral dosing, animals developed multifocal skin lesions. The lesions were characterized clinically by vesicles and scabs formation and were distributed mainly in thin-skinned areas of the body including the cheek, chest, abdomen, and inner limbs. Microscopically, the lesions were confirmed as epidermal vesicle formation and ulceration. Immunohistochemical staining revealed that the levels within the epidermis where separation (vesicle formation) occurred were not consistent. The differential diagnoses for vesicular skin lesions and our efforts to elucidate the mechanism of toxicity using in-house database searches and immunohistochemistry are discussed. To the best of our knowledge, similar cutaneous toxicity has not been reported previously, although there are reports of other types of cutaneous toxicities. Understanding the mechanisms of the toxicity is very important when assessing human relevancy during drug development. Our investigative approach can be utilized when unusual skin toxicities are observed in the future.

Herpes zoster como primeira manifestação de infeção por vírus varicela-zoster numa criança saudável

Herpes zoster (HZ) results from reactivation of varicellazoster virus. HZ’s incidence increases with age and although rarely, it can affect healthy children. We describe a previously healthy 29-months-old girl with herpes zoster ophtalmicus. She presented with fever and a painful vesicular skin rash covering the right forehead. She had no past history of clinical varicella or varicella vaccination, although she had household contact with varicella at two months-old. Serologic varicella zoster virus tests were initially negative, but seroconversion occurred 8 weeks later. Polymerase chain reaction assay of the vesicles fluid was positive for the virus. Intravenous acyclovir was started and the patient recovered without sequelae. HZ may occur in an otherwise healthy young child without previous noticed varicella and with negative acute phase serology. This can be explained by the immaturity of the immune system associated with transplacental transfer of maternal antibodies affecting immunologic response to early primary infection.

Vibrio tapetis isolated from Vesicular Skin Lesions in Dover Sole (Solea solea)

Vibrio tapetis is primarily known as the causative agent for brown ring disease in bivalves, although it has been isolated from cultivated fish during mortalities on farms. Here we describe the first isolation of V. tapetis from wild-caught and subsequently captive-held Dover sole Solea solea. Pathological features consisted of multifocal circular greyish-white skin discolourations evolving into vesicular lesions and subsequent ulcerations on the pigmented side. On the non-pigmented side, multiple circular lesions-white at the center and red at the edges-were evident. Histological examination of the vesicular lesions revealed dermal fluid-filled spaces, collagen tissue necrosis and a mixed inflammatory infiltrate, with large numbers of small rod-shaped bacteria. In the deep skin lesions, loss of scales and dermal connective tissue, with degeneration and fragmentation of the myofibres bordering the ulceration, were noted. Serotyping, DNA-DNA hybridization and REP- and ERIC-PCR techniques showed that the retrieved isolates displayed a profile similar to the representative strain of genotype/serotype O2 which originally was isolated from carpet-shell clam Venerupis decussata and to which isolates obtained from wedge sole Dicologoglossa cuneata were also closely related.

Unusual Manifestation of Herpes Zoster Infection Involving the Greater, Lesser Occipital and Transverse Cervical Nerve: A Case Report

We here present a case of Varicella Zoster Virus (VZV) infection with involvement of C2 and C3 right cranial nerve. The initial symptoms (right occipital neuralgia, pharyngodynia, and otalgia) were complicated by vesicular skin lesions spread along the course of the right transverse cervical and of greater occipital nerve. The diagnosis was confirmed by serological tests. Therapeutical approach is then commented.

Laboratory diagnosis and epidemiology of herpes simplex 1 and 2 genital infections.

Herpes simplex virus types 1 and 2 are the main cause of genital ulcers worldwide. Although herpes simplex virus type 2 is the major cause of genital lesions, herpes simplex virus type 1 accounts for half of new cases in developed countries. Herpes simplex virus type 2 seroprevalence rises with sexual activity from adolescence through adulthood. Slovenian data in a high-risk population shows 16% seroprevalence of HSV-2. HSV-1 and HSV-2 DNA in genital swabs was detected in 19% and 20.7%, respectively. In most cases, genital herpes is asymptomatic. Primary genital infection with herpes simplex virus types 1 and 2 can be manifested by a severe clinical picture, involving the vesicular skin and mucosal changes and ulcerative lesions of the vulva, vagina, and cervix in women and in the genital region in men. Direct methods of viral genome detection are recommended in the acute stage of primary and recurrent infections when manifest ulcers or lesions are evident. Serological testing is recommended as an aid in diagnosing genital herpes in patients with reinfection in atypical or already healed lesions. When herpes lesions are present, all sexual activities should be avoided to prevent transmission of infection. Antiviral drugs can reduce viral shedding and thus reduce the risk of sexual transmission of the virus.

Diagnostic value of Tzanck smear in various erosive, vesicular, and bullous skin lesions.

Background:Cutaneous cytology has long been shown to be useful in the diagnosis of several erosive, vesicular, and bullous skin lesions. The Tzanck smear although an old tool, still remains a simple, rapid, easily applied, and inexpensive test for these skin lesions.Aims and Objectives:The aim of this study was to evaluate the diagnostic value of Tzanck smear by determining its sensitivity and specificity in various erosive, vesicular, and bullous skin lesions.Materials and Methods:One hundred and forty-two patients with erosive, vesicular, and/or bullous skin lesions were included in the study. Four groups of disorders were identified: infections, immunologic disorders, genodermatosis, and spongiotic dermatitis. All the study cases were evaluated by Tzanck smear. Definitive diagnosis was established by standard diagnostic techniques (including when appropriate, viral serology, bacterial culture, histopathology, direct immunoflourescence).Results:The sensitivity and specificity of cytologic findings was respectively 86.36% and 91.30% for viral infections; for bacterial infections, it was 85.7% and 66.6%. The sensitivity and specificity of Tzanck smear was respectively 85.0% and 83.33% for pemphigus; for bullous pemhigoid it was 11.11% and 100.0%. Tzanck smear sensitivity in genodermatoses was 100%. The sensitivity and specificity of the test in spongiotic dermatitis could not be calculated due to an insufficient number of patients.Conclusion:The Tzanck smear is a quick and reliable tool for the evaluation of various erosive and vesiculobullous skin lesions.

Epidemic Varicella Zoster Virus Reactivation in Renal Transplant Recipients: A Case Report

Immunosuppression after transplantation renders the transplant recipient susceptible to a broad array of viral pathogens. Of 31 patients transplanted during 2012 in our center, 6 (19.3%) experienced varicella zoster virus (VZV) reactivation. The median time from transplantation to reactivation was 6.2 months. Immunosuppression consisted of antithymocyte globulin in 5 patients and basiliximab in 1, followed by tacrolimus, mycophenolic acid, and prednisolone. Two patients had T-cell–mediated rejection and were treated with pulse doses of corticosteroids. All patients received valganciclovir as prophylaxis of CMV infection. In 3 patients a disseminated vesicular skin rash was the sole manifestation of VZV reactivation. Two were successfully treated with acyclovir and 1 with ganciclovir. Ramsay Hunt syndrome complicated herpes zoster in the fourth patient, whereas the remaining 2 patients had visceral involvement, pneumonitis, and encephalitis, and died in spite of full doses of antiviral therapy. This was the first case of “epidemic” VZV reactivation in the 35-year history of our transplant center. VZV-specific cellular immunity pretransplantation is not sufficient to protect kidney transplant recipients from herpes zoster episodes. Considering the potentially devastating consequences of VZV reactivation, additional treatment options and universal prophylaxis should be contemplated.

Herpes Zoster-Induced Ogilvie's Syndrome.

Ogilvie's syndrome due to herpes zoster infection is a rare manifestation of VZV reactivation. The onset of rash of herpes zoster and the symptoms of intestinal obstruction can occur at different time intervals posing a significant diagnostic challenge resulting in avoidable surgical interventions. Herein, we describe a case of 35-year-old male who presented with 6-day history of constipation and colicky abdominal pain along with an exquisitely tender and vesicular skin eruption involving the T8–T11 dermatome. Abdominal X-ray and ultrasound revealed generalized gaseous distention of the large intestine with air up to the rectum consistent with paralytic ileus. Colonoscopy did not show any obstructing lesion. A diagnosis of Ogilvie's syndrome associated with herpes zoster was made. He was conservatively managed with nasogastric decompression, IV fluids, and acyclovir. The patient had an uneventful recovery and was later discharged.

Surgical Resection of Acquired Vulvar Lymphangioma Circumscriptum

Surgical Resection of Acquired Vulvar Lymphangioma Circumscriptum

Hemophagocytic lymphohistiocytosis in adults.

Hemophagocytic lymphohistiocytosis in adults.