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Speciality
Spotlight

   




 

Dermatology & Venereology

 

     




Bacterial
and Fungal Infections

           

  • Gram
    – Negative Folliculitis

    Neubert U, Jansen T, Plewig G (Ludwig-Maximilians-Univ, Munich)

    Bacteriologic and Immunologic Aspects of Gram-Negative Folliculitis: A Study of 46 Patients

    Int J Dermatol 38: 270-274, 1999

         


    The authors regard gram-negative folliculitis as an entity sui-generis rather than an antibiotic treatment sequel only. Skin lesions and nasal mucosa were sites for culture material. 

         

    Klebsiella, Escherichia coli, and others were cultured. S. aureus was found in one patient. Skin tests with 11 microbial antigens revealed immediate, delayed, anergic or normal reactions. Raised IgE, lowered IgM and a-1-antitrypsin, were recorded. Granulocyte functions were normal.

           

    The authors concluded that altered immune reactions caused the infection. Retinoic acid had no effect on the bacterial content.

             
  • Mills CM, Llwelyn MB, Kelly DR, et al (Univ of Wales, Cardiff)

    A Man Who Pricked His Finger and Smelled Putrid for 5 Years

    Lancet 348: 1282, 1996

         

    This paper describes a man (29 years) presenting with a malodorous erythematous finger developing after a chicken bone injury. 

         

    Clostridium novyi was cultured from the initial skin biopsy. Three others were isolated from the arm and chest.

        

    He was immunologically normal. After treatment with antibiotics and hyperbaric oxygen the finger improved but the putrid odor persisted. 

        

    The authors suggest a “blind spot” in the immune system allowing skin colonization by Clostridia. 

        

    They want to know if anyone has seen this and how to treat this condition.

       
  • Epidemiology 

    Pomeranz AJ, Sabnis SS, McGrath GJ, et al (Children’s Hosp of Wisconsin, Milwaukee)

    Asymptomatic Dermatophyte Carriers in the Households of Children With Tinea Capitis 


    Arch Pediatr Adolesc Med 153: 483-486, 1999

         



    The most common infecting organism for African American city children with Tinea capitis is Trichophyton tonsurans.

         


    Children with active infections were regarded as the primary case and adults of the family were included in the study. The primary or index case showed 98% positive cultures and the contacts 100% positivity.



    Use of combs as community objects and sleeping together were the main etiology leading to spread of infection. The authors suggest further research. 

       
  • Therapy

    Hart R, Bell-Syer SEM, Crawford F, et al (Univ of Wales, Cardiff; Univ of York, England)

    Systematic Review of Topical Treatments for Fungal Infections of the Skin and Nails of the Feet


    BMJ 319: 79-82, 1999

          



    This article is a study of 72 laboratory confirmed trials. 

          


    The authors suggest for skin infections undecenoic acid or azoles to start the treatment and allylamines in cases of failures with these. For the nails amorolfine lacquer (effective in 90% of patients) or clotrimazole with tea tree oil (effective in 10% of the subjects), were used.

           
  • Mehregan DR, Gee SL (Wayne State Univ, Detroit; Pinkus Dermatopathology Lab, Monroe, Mich)

    The Cost Effectiveness of Testing for Onychomycosis Versus Empiric Treatment of Onychodystrophies With Oral Antifungal Agents


    Cutis 64: 407-410, 1999

         



    Laboratory study of nails upon a diagnosis of nail dystrophy is essential as 65 per cent of such patients reveal fungal disease. 35 per cent constitute nail dystrophy.

         


    The authors suggest this procedure rather than empiric treatment as it saves the patient avoidable expenditure.

         
  • Therapy


    de Wet PM, Rode H, van Dyk A, et al (Red Cross War Mem Children’s Hosp, Rondebosch, South Africa)

    Perianal Candidosis: A Comparative Study With Mupirocin and Nystatin 

    Int J Dermatol 38: 618-622, 1999

         



    Recurrent perianal candidosis of children involving the perianal skin is studied in this article.

          


    Patients on local application of 2 per cent mupirocin in polyethylene glycol showed clearance of Candida in 2-6 days. Restoration of normal bacterial colonization is reported and healing took an average of 4.7 days.

          


    With nystatin cream (100,000 units/g), the authors found candidal eradication in 5 days with healing of 2 wounds, but the dermatitis and excoriations persisted for a longer period.

         


    Comment: Mupirocin is conventionally used as an antibacterial agent in treatment of impetigo contagiosa. This paper reveals a wider spectrum of action. 

           


 



 

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Speciality Spotlight

   

     

Bacterial and Fungal Infections
           

  • Gram – Negative Folliculitis
    Neubert U, Jansen T, Plewig G (Ludwig-Maximilians-Univ, Munich)
    Bacteriologic and Immunologic Aspects of Gram-Negative Folliculitis: A Study of 46 Patients
    Int J Dermatol 38: 270-274, 1999
         

    The authors regard gram-negative folliculitis as an entity sui-generis rather than an antibiotic treatment sequel only. Skin lesions and nasal mucosa were sites for culture material. 
         
    Klebsiella, Escherichia coli, and others were cultured. S. aureus was found in one patient. Skin tests with 11 microbial antigens revealed immediate, delayed, anergic or normal reactions. Raised IgE, lowered IgM and a-1-antitrypsin, were recorded. Granulocyte functions were normal.
           
    The authors concluded that altered immune reactions caused the infection. Retinoic acid had no effect on the bacterial content.
             
  • Mills CM, Llwelyn MB, Kelly DR, et al (Univ of Wales, Cardiff)
    A Man Who Pricked His Finger and Smelled Putrid for 5 Years
    Lancet 348: 1282, 1996
         
    This paper describes a man (29 years) presenting with a malodorous erythematous finger developing after a chicken bone injury. 
         
    Clostridium novyi was cultured from the initial skin biopsy. Three others were isolated from the arm and chest.
        
    He was immunologically normal. After treatment with antibiotics and hyperbaric oxygen the finger improved but the putrid odor persisted. 
        
    The authors suggest a “blind spot” in the immune system allowing skin colonization by Clostridia. 
        
    They want to know if anyone has seen this and how to treat this condition.
       
  • Epidemiology 
    Pomeranz AJ, Sabnis SS, McGrath GJ, et al (Children’s Hosp of Wisconsin, Milwaukee)
    Asymptomatic Dermatophyte Carriers in the Households of Children With Tinea Capitis 
    Arch Pediatr Adolesc Med 153: 483-486, 1999
         

    The most common infecting organism for African American city children with Tinea capitis is Trichophyton tonsurans.
         
    Children with active infections were regarded as the primary case and adults of the family were included in the study. The primary or index case showed 98% positive cultures and the contacts 100% positivity.

    Use of combs as community objects and sleeping together were the main etiology leading to spread of infection. The authors suggest further research. 
       
  • Therapy
    Hart R, Bell-Syer SEM, Crawford F, et al (Univ of Wales, Cardiff; Univ of York, England)
    Systematic Review of Topical Treatments for Fungal Infections of the Skin and Nails of the Feet
    BMJ 319: 79-82, 1999
          

    This article is a study of 72 laboratory confirmed trials. 
          
    The authors suggest for skin infections undecenoic acid or azoles to start the treatment and allylamines in cases of failures with these. For the nails amorolfine lacquer (effective in 90% of patients) or clotrimazole with tea tree oil (effective in 10% of the subjects), were used.
           
  • Mehregan DR, Gee SL (Wayne State Univ, Detroit; Pinkus Dermatopathology Lab, Monroe, Mich)
    The Cost Effectiveness of Testing for Onychomycosis Versus Empiric Treatment of Onychodystrophies With Oral Antifungal Agents
    Cutis 64: 407-410, 1999
         

    Laboratory study of nails upon a diagnosis of nail dystrophy is essential as 65 per cent of such patients reveal fungal disease. 35 per cent constitute nail dystrophy.
         
    The authors suggest this procedure rather than empiric treatment as it saves the patient avoidable expenditure.
         
  • Therapy
    de Wet PM, Rode H, van Dyk A, et al (Red Cross War Mem Children’s Hosp, Rondebosch, South Africa)
    Perianal Candidosis: A Comparative Study With Mupirocin and Nystatin 
    Int J Dermatol 38: 618-622, 1999
         

    Recurrent perianal candidosis of children involving the perianal skin is studied in this article.
          
    Patients on local application of 2 per cent mupirocin in polyethylene glycol showed clearance of Candida in 2-6 days. Restoration of normal bacterial colonization is reported and healing took an average of 4.7 days.
          
    With nystatin cream (100,000 units/g), the authors found candidal eradication in 5 days with healing of 2 wounds, but the dermatitis and excoriations persisted for a longer period.
         
    Comment: Mupirocin is conventionally used as an antibacterial agent in treatment of impetigo contagiosa. This paper reveals a wider spectrum of action.