Noninvasive monitoring local variations of fever and edema on human: potential for point-of-care inflammation assessment

NASA Astrophysics Data System (ADS)

Li, Zebin; Li, Xianglin; Li, Ting

2018-02-01

Tissue inflammation is often accompanied by fever and edema, which are common and troublesome problems that probably trigger disability, lymphangitis, cosmetic deformity and cellulitis. Here we developed a device, which can measure concentration and temperature variations of water in local human body by extended near infrared spectroscopy in 900 1000 nm wavelength range. An experiment of four steps incremental cycling exercise was designed to change tissue water concentration and temperature of subjects. Body temperature was also estimated by tympanic thermometer and surface thermometer as comparisons during the experiment. In the stage of recovery after exercise, the signal detected by custom device is similar to tympanic thermometer at the beginning, but it is closer to the temperature of surface later. In particular, this signal shows a better linearity, and a significant change when the exercise was suspended. This study demonstrated the potential of optical touch-sensing for inflammation severity monitoring by measuring water concentration and temperature variations in local lesions.

[Acute skin infections and their imitators in children : A photo quiz].

PubMed

Theiler, M; Schwieger-Briel, A; Weibel, L

2017-10-01

Skin infections account for 40% of emergency visits in pediatric dermatology. It is important to promptly recognize skin infections with potential complications and initiate treatment. However some characteristic skin findings may imitate skin infections and are often misdiagnosed. To illustrate frequent pediatric skin infections and pitfalls in view of imitators and differential diagnoses. A photo quiz is presented with the discussion of a selection of acute pediatric skin infections in comparison to their infectious or noninfectious differential diagnoses. The following infectious skin conditions and imitators are described and clinical clues for differentiation highlighted: eczema herpeticum and bacterial superinfection of atopic dermatitis; exanthematous hand, foot and mouth disease and varicella infection; erythema chronicum multilocularis and anular urticaria; Gianotti-Crosti syndrome and Gianotti-Crosti-like reaction; bacterial folliculitis of the scalp and kerion celsi and eosinophilic pustular folliculitis of the scalp; cutaneous Leishmaniasis and idiopathic facial aseptic granuloma; allergic and bacterial lymphangitis; bullous impetigo contagiosa and nonaccidental scalding. Careful anamnesis and skin examination with attention to the here illustrated differential diagnoses are essential to avoid pitfalls in the evaluation of acute pediatric skin infections.

[Clinical and bacteriological evaluation of TMS-19-Q in superficial suppurative skin and soft tissue infection].

PubMed

Watanabe, S; Takizawa, K; Shimada, S; Yamada, K; Nakagawa, H; Kukita, A; Miura, Y; Tsukinaga, I; Tagami, H; Tanita, Y

1985-03-01

Clinical effectiveness of TMS-19-Q, a new macrolide antibiotic, was evaluated in superficial infectious diseases classified into 6 groups at 13 departments of dermatology. The results obtained were as follows: Final global improvement rating in 311 cases were excellent in 91, good in 158, fair in 45 and poor in 17 and the effective rate was 80.1%. Effective rates in each group were 71.1% in 1st group (folliculitis and acne pustulosa), 78.6% in 2nd group (furuncle, furunculosis and carbuncle), 100% in 3rd group (impetigo), 76.9% in 4th group (phlegmone, superficial lymphangitis, erysipelas and infectious paronychia), 88.7% in 5th group (inflammatory atheroma, subcutaneous abscess, hidradenitis suppurative and acne conglobata) and 77.3% in 6th group (secondary infection). Dominant strains isolated were S. aureus (40.7%), S. epidermidis (26.9%) and anaerobic bacteria (20.8%). S. aureus was frequently isolated from most of all disease. On the other hand, S. epidermidis and anaerobic bacteria were isolated mainly from 1st and 5th group. Optimum daily doses would be over 600 mg. Slight adverse reactions such as gastrointestinal disorders, eruption and malaise were observed in 12 cases.

Mondor's disease of penis: a forgotten disease.

PubMed

Kumar, B; Narang, T; Radotra, B D; Gupta, S

2005-12-01

Mondor's disease of penis is an uncommon genital condition involving the penile sulcus in a circumferential manner. Although this disorder is almost always self limited, it is associated with considerable psychological stress and sexual disharmony. All patients attending the sexually transmitted disease clinic during 1991-2003 were examined for evidence of Mondor's disease of penis. Detailed history and clinical findings were recorded in a specially designed proforma. Histopathological examination and staining with CD31 and CD34 monoclonal antibodies was also done in 11 patients. 18 out of 1296 patients attending the sexually transmitted diseases (STD) clinic during the study period were found to have penile Mondor's disease, giving an incidence of 1.39%. 17 patients had history of one or more episodes of STDs. Histopathological specimens showed prominent vessels with plump endothelial cells and thickened blood vessel walls. The occasional vessel showed complete occlusion of its lumen. In our study we did not find any evidence of lymphatic involvement. Non-lymphatic vessels, mainly veins, were predominantly involved. In our opinion Mondor's phlebitis of penis or Mondor's disease of penis are better terms to describe the condition rather than non-venereal sclerosing lymphangitis.

Mondor's disease of penis: a forgotten disease

PubMed Central

Kumar, B; Narang, T; Radotra, B; Gupta, S

2005-01-01

Background: Mondor's disease of penis is an uncommon genital condition involving the penile sulcus in a circumferential manner. Although this disorder is almost always self limited, it is associated with considerable psychological stress and sexual disharmony. Methods: All patients attending the sexually transmitted disease clinic during 1991–2003 were examined for evidence of Mondor's disease of penis. Detailed history and clinical findings were recorded in a specially designed proforma. Histopathological examination and staining with CD31 and CD34 monoclonal antibodies was also done in 11 patients. Results: 18 out of 1296 patients attending the sexually transmitted diseases (STD) clinic during the study period were found to have penile Mondor's disease, giving an incidence of 1.39%. 17 patients had history of one or more episodes of STDs. Histopathological specimens showed prominent vessels with plump endothelial cells and thickened blood vessel walls. The occasional vessel showed complete occlusion of its lumen. Conclusions: In our study we did not find any evidence of lymphatic involvement. Non-lymphatic vessels, mainly veins, were predominantly involved. In our opinion Mondor's phlebitis of penis or Mondor's disease of penis are better terms to describe the condition rather than non-venereal sclerosing lymphangitis. PMID:16326851

Rickettsioses in Europe.

PubMed

Portillo, Aránzazu; Santibáñez, Sonia; García-Álvarez, Lara; Palomar, Ana M; Oteo, José A

2015-01-01

Bacteria of the genera Rickettsia and Orientia (family rickettsiaceae, order rickettsiales) cause rickettsioses worldwide, and are transmitted by lice, fleas, ticks and mites. In Europe, only Rickettsia spp. cause rickettsioses. With improvement of hygiene, the risk of louse-borne rickettsiosis (epidemic typhus) is low in Europe. Nevertheless, recrudescent form of Rickettsia prowazekii infection persists. There could be an epidemic typhus outbreak if a body lice epidemic occurs under unfavorable sanitary conditions. In Europe, endemic typhus or Rickettsia typhi infection, transmitted by rats and fleas, causes febrile illness. At the beginning of this century, flea-borne spotted fever cases caused by Rickettsia felis were diagnosed. Flea-borne rickettsiosis should be suspected after flea bites if fever, with or without rash, is developed. Tick-borne rickettsioses are the main source of rickettsia infections in Europe. Apart from Rickettsia conorii, the Mediterranean Spotted Fever (MSF) agent, other Rickettsia spp. cause MSF-like: Rickettsia helvetica, Rickettsia monacensis, Rickettsia massiliae or Rickettsia aeschlimannii. In the 1990s, two 'new' rickettsioses were diagnosed: Lymphangitis Associated Rickettsiosis (LAR) caused by Rickettsia sibirica mongolitimonae, and Tick-Borne Lymphadenopathy/Dermacentor-Borne-Necrosis-Erythema-Lymphadenopathy/Scalp Eschar Neck Lymphadenopathy (TIBOLA/DEBONEL/SENLAT), caused by Rickettsia slovaca, Candidatus Rickettsia rioja and Rickettsia raoultii. Lastly, European reports about mite-borne rickettsiosis are scarce. Copyright © 2015 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.

Use of US in the evaluation of patients with symptoms of deep venous thrombosis of the lower extremities.

PubMed

Useche, Juan N; de Castro, Alfredo M Fernández; Galvis, Germán E; Mantilla, Rodolfo A; Ariza, Alvaro

2008-10-01

Deep venous thrombosis (DVT) is a major health problem and is estimated to have an incidence of 600,000 cases per year. Clinical signs and symptoms of DVT are unreliable. If clinical signs alone were used to diagnose DVT, 42% of patients would receive unnecessary anticoagulation therapy. Most patients evaluated with ultrasonography (US) do not have DVT. The key to making a precise diagnosis is recognizing the characteristics of various diseases on US images. The anatomic approach is the most useful strategy for characterizing the spectrum of pathologic conditions seen in patients with symptoms that simulate DVT. The inferior extremity can be divided into four regions-inguinal, thigh, popliteal, and lower leg-with the rough limits defined for each as they are examined at US. The differential diagnoses affecting the lower extremities include infectious, neoplastic, traumatic, inflammatory, vascular, and miscellaneous entities. Some pathologic conditions seen in the inguinal region are adenopathies, lymphangitis, soft-tissue tumors, hematomas, adductor tendonitis, and hernias. In the thigh, cellulitis, myositis, abscess, benign and malignant tumors, and sports-related lesions are seen. In the popliteal region, cellulitis, arthritis, benign and malignant masses, muscle contusions, ruptured popliteal cysts, and thrombophlebitis are seen. And in the lower leg, cellulitis, lipomas, tennis leg, superficial thrombophlebitis, tendonitis, and soft-tissue hydrostatic edema secondary to cardiac and renal failure can simulate DVT. (c) RSNA, 2008.

Surgical treatment of varicocele by a subinguinal approach combined with antegrade intraoperative sclerotherapy of venous vessels.

PubMed

Colpi, Giovanni Maria; Carmignani, Luca; Nerva, Franco; Piediferro, Guido; Castiglioni, Fabrizio; Grugnetti, Cristina; Galasso, Giacomo

2006-01-01

To evaluate the efficacy, in terms of recurrences, complications and operative duration, of a new technique for treating varicocele. Between September 1999 and December 2002 we evaluated 307 men aged 17-51 years with varicocele. In all of the men the clinical diagnosis was confirmed by ultrasonography. The men were treated by a variant of the microsurgical technique described in 1994. A 2-3 cm distal subinguinal incision was made at the level of the superficial inguinal ring and the spermatic cord was exposed. The largest vein in the spermatic cord fat was cannulated. A 7-9 cm segment of the spermatic cord was clamped for 8-10 min; at the start of the ischaemia time, 1.5-3 mL of 3% atoxysclerol was injected into the cannulated vein. After sclerotherapy, the vein was ligated at the injection site, and the blood flow to the cord was restored. The mean operative duration was 25 min. Follow-up at 3 and 6 months after surgery, with objective examination and scrotal ultrasonography, revealed one case of clinical recurrence/persistence. The most common complication was penile lymphangitis (nine men) that regressed spontaneously; three men had temporary orchialgia. There were no cases of secondary hydrocele or testicular atrophy. The modified technique appears to be relatively easy and safe, and to of low cost. Given the promising results in terms of complications and persistence, the treatment appears to be a suitable first-line approach for the surgical treatment of varicocele.

Epidemiologic and clinical aspects of animal bite injuries.

PubMed

Kizer, K W

1979-04-01

During 1975, 332 animal bite injuries accounted for 1.2% of all surgical problems treated at the UCLA Hospital Emergency Department. Data on 307 bite injuries were available and analyzed for environmental, animal, human, interaction, and clinical factors. More than half of the dog bites and almost three fourths of the cat bites-scratches happened at or near the victims' homes. Dog bites were almost twice as common among men, while cat bites-scratches were twice as common among women. Of the incidents in which ownership information was available, 85% of dog bites and 80% of cat bites-scratches were from an animal belonging to the victim, his family or friends, or another known person. Forty-three percent of dog bites, and 52% of cat bites-scratches were provoked, that is, happened while the victim was interacting with the animal. Of bites of the head and/or neck, 38% injured the upper lip; 17% of dog bites injured the eye or adjacent tissues; 48% were in children less than ten-years-old. On fifth of cat bites-scratches involved the head and/or neck, 60% of these injured orbital or periorbital tissues. Over 2% of patients were hospitalized. Five percent of dog bite victims and 29% of cat bite-scratch victims returned with complications, mostly cellulitis or lymphangitis. Pasteurella multocida was the most common pathogen cultured, as evidenced by the 50% and 80% culture-positive rates for dog and cat bite-scratches respectively in this series.

Elephantiasis nostras verrucosa: an institutional analysis of 21 cases.

PubMed

Dean, Steven M; Zirwas, Matthew J; Horst, Anthony Vander

2011-06-01

Previous reports regarding elephantiasis nostras verrucosa (ENV) have been typically limited to 3 or fewer patients. We sought to statistically ascertain what demographic features and clinical variables are associated with ENV. A retrospective chart review of 21 patients with ENV from 2006 to 2008 was performed and statistically analyzed. All 21 patients were obese (morbid obesity in 91%) with a mean body mass index of 55.8. The average maximal calf circumference was 63.7 cm. Concurrent chronic venous insufficiency was identified in 15 patients (71%). ENV was predominantly bilateral (86%) and typically involved the calves (81%). Proximal cutaneous involvement (thighs 19%/abdomen 9.5%) was less common. Eighteen (86%) related a history of lower extremity cellulitis/lymphangitis and/or manifested soft-tissue infection upon presentation. Multisegmental ENV was statistically more likely in setting of a higher body mass index (P = .02), larger calf circumference (P = .01), multiple lymphedema risk factors (P = .05), ulcerations (P < .001), and nodules (P < .001). Calf circumference was significantly and proportionally linked to developing lower extremity ulcerations (P = .02). Ulcerations and nodules were significantly prone to occur concomitantly (P = .05). Nodules appeared more likely to exist in the presence of a higher body mass index (P = .06) and multiple lymphedema risk factors (P = .06). The statistical conclusions were potentially inhibited by the relatively small cohort. The study was retrospective. Our data confirm the association among obesity, soft-tissue infection, and ENV. Chronic venous insufficiency may be an underappreciated risk factor in the genesis of ENV. Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

The IASLC Lung Cancer Staging Project: data elements for the prospective project.

PubMed

Giroux, Dorothy J; Rami-Porta, Ramón; Chansky, Kari; Crowley, John J; Groome, Patti A; Postmus, Pieter E; Rusch, Valerie; Sculier, Jean-Paul; Shepherd, Frances A; Sobin, Leslie; Goldstraw, Peter

2009-06-01

The International Association for the Study of Lung Cancer Retrospective Staging Project culminated in a series of recommendations to the International Union Against Cancer and to the American Joint Committee on Cancer regarding the seventh edition of the tumor, node, metastasis (TNM) classification for lung cancer. The International Staging Committee of the International Association for the Study of Lung Cancer now issues this call for participation in the Prospective Project designed to assess the validity of each component of T, N, and M, and other factors relevant to lung cancer staging and prognosis. In the Retrospective Project, the original data acquisition was typically motivated by interests other than staging. In contrast, the Prospective Project offers online data entry. Alternatively, participants may transfer existing data, provided core objectives are addressed. Cancer Research and Biostatistics will coordinate data management and analysis. The study population is newly diagnosed lung cancer patients. Data elements include patient characteristics, baseline laboratory values, first-line treatment, TNM plus supporting evidence, and survival. Pretreatment TNM will be collected for all cases; postsurgical TNM, if resection is attempted. T descriptors include size and degree of tumor extension, with further description of extent of visceral pleural invasion, venous invasion, carcinomatous lymphangitis, and pleural lavage cytology. M descriptors characterize the newly proposed M1a category and sites of distant metastases. Nodal station involvement is described by means of a newly proposed nodal map, facilitating international participation, and allowing further investigation of nodal zones. Successful collection and analysis of these data can be expected to yield unprecedented improvements in the utility and validity of lung cancer staging.

Epidemiology of elephantiasis with special emphasis on podoconiosis in Ethiopia: A literature review.

PubMed

Yimer, Mulat; Hailu, Tadesse; Mulu, Wondemagegn; Abera, Bayeh

2015-06-01

Elephantiasis is a symptom of a variety of diseases that is characterized by the thickening of the skin and underlying tissues, especially in the legs, male genitals and female breasts. Some conditions having this symptom include: Elephantiasis nostras, due to longstanding chronic lymphangitis; Elephantiasis tropica or lymphatic filariasis, caused by a number of parasitic worms, particularly Wuchereria bancrofti; non-filarial elephantiasis or podoconiosis, an immune disease caused by heavy metals affecting the lymph vessels; proteus syndrome, the genetic disorder of the so-called Elephant Man, etc. Podoconiosis is a type of lower limb tropical elephantiasis distinct from lymphatic filariasis. Lymphatic filariasis affects all population at risk, whereas podoconiosis predominantly affects barefoot subsistence farmers in areas with red volcanic soil. Ethiopia is one of the countries with the highest number of podoconiosis patients since many people are at risk to red-clay soil exposure in many parts of the country. The aim of this review was to know the current status and impact of podoconiosis and its relevance to elephantiasis in Ethiopia. To know the epidemiology and disease burden, the literatures published by different scholars were systematically reviewed. The distribution of the disease and knowledge about filarial elephantiasis and podoconiosis are not well known in Ethiopia. It is relatively well studied in southern Ethiopia but data from other parts of the country are limited. Moreover, programmes that focus on diagnosis, treatment, prevention and control of filarial elephantiasis and podoconiosis are also non-existent even in endemic areas. Furthermore, the disease mapping has not been carried out country-wide. Therefore, in order to address these gaps, Ethiopian Ministry of Health needs to take initiative for undertaking concrete research and mapping of the disease in collaboration with stakeholders.

Transnodal Lymphangiography in the Diagnosis and Treatment of Genital Lymphedema

DOE Office of Scientific and Technical Information (OSTI.GOV)

Gomez, F. M., E-mail: gomez_fermun@gva.es; Martinez-Rodrigo, J.; Marti-Bonmati, L.

2012-12-15

Purpose: To report the success of groin nodal lymphography in the diagnosis and treatment of genital lymphedema. Methods and Materials: We present one female (8 years old [patient no. 1]) and two male (69 and [patient no. 2] 31 years old [patient no. 3], respectively) patients with genital lymphedema in whom conservative treatment failed. The girl also had lymphorrhagia. Genital lymphedema was caused by radical cystectomy (patient no. 2), lymphatic hyperplasia (patient no. 1), and idiopathic lymphangitis (patient no. 3). All of them underwent ultrasound-guided bilateral groin lymph node puncture. Afterward, 4-8 ml Lipiodol Ultra-Fluide (Guerbet) were injected at amore » rate of 0.2 ml/s. Lipiodol progression was assessed by fluoroscopy. Computed tomography scan of the abdomen and pelvis was performed immediately after and again at 24 h after the procedure to confirm the leak. The follow-up period was 15, 13, and 9 months, respectively. Technical success was considered as bilateral pelvic and abdominal filling of lymphatic vessels. Therapeutic success was considered as improvement or disappearance of genital lymphedema and/or lymphorrhagia. Results: Lipiodol leak to the scrotum was observed in patients no. 2 and 3. Lymphaticopelvic fistula and genital lymphatic hyperplasia were seen in patient no. 1. Genital lymphedema diminished within 1 week and almost disappeared in two cases (patients no. 1 and 3) or significantly improved (patient no. 2). lymphorrhagia also resolved in patient no. 1. No recurrence or worsening was detected during follow-up. Conclusion: Therapeutic lymphangiography by lymph node injection seems to be effective to treat genital lymphedema. Lymph node puncture lymphangiography is feasible and less cumbersome than pedal lymphangiography.« less

Quality control in chronic wound management: the role of local povidone-iodine (Betadine) therapy.

PubMed

Daróczy, Judit

2006-01-01

The treatment of venous leg ulcers is often inadequate, because of incorrect diagnosis, overuse of systemic antibiotics and inadequate use of compression therapy. Stasis dermatitis related to chronic venous insufficiency accompanied by infected superficial ulcers must be differentiated from erysipelas, cellulitis and contact eczema. To assess the effectiveness of (1) topical povidone-iodine with and (2) without compression bandages, (3) to compare the efficacy of systemic antibiotics and topical antimicrobial agents to prevent the progression of superficial skin ulcers. 63 patients presenting ulcerated stasis dermatitis due to deep venous refluxes were included in the study. The clinical stage of all patients was homogeneous determined by clinical, aetiological, anatomical and pathological classification. They were examined by taking a bacteriological swab from their ulcer area. Compression bandages were used in a total of 42 patients. Twenty-one patients with superficial infected (Staphylococcus aureus) ulcers were treated locally with povidone-iodine (Betadine), and 21 patients were treated with systemic antibiotics (amoxicillin). Twenty-one patients were treated locally with Betadine but did not use compression. The end point was the time of ulcus healing. The healing process of the ulcers was related to the impact of bacterial colonization and clinical signs of infection. Compression increases the ulcer healing rate compared with no compression. Using the same local povidone-iodine (Betadine) treatment with compression bandages is more effective (82%) for ulcus healing than without compression therapy (62%). The healing rate of ulcers treated with systemic antibiotics was not significantly better (85%) than that of the Betadine group. Using systemic antibiotics, the relapse rate of superficial bacterial infections (impetigo, folliculitis) was significantly higher (32%) than in patients with local disinfection (11%). Compression is essential in the mobilization of the interstitial lymphatic fluid from the region of stasis dermatitis. Topical disinfection and appropriate wound dressings are important to prevent wound infection. Systemic antibiotics are necessary only in systemic infections (fever, lymphangitis, lymphadenopathy, erysipelas).

Feasibility of Pathology-Correlated Lung Imaging for Accurate Target Definition of Lung Tumors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stroom, Joep; Blaauwgeers, Hans; Baardwijk, Angela van

2007-09-01

Purpose: To accurately define the gross tumor volume (GTV) and clinical target volume (GTV plus microscopic disease spread) for radiotherapy, the pretreatment imaging findings should be correlated with the histopathologic findings. In this pilot study, we investigated the feasibility of pathology-correlated imaging for lung tumors, taking into account lung deformations after surgery. Methods and Materials: High-resolution multislice computed tomography (CT) and positron emission tomography (PET) scans were obtained for 5 patients who had non-small-cell lung cancer (NSCLC) before lobectomy. At the pathologic examination, the involved lung lobes were inflated with formalin, sectioned in parallel slices, and photographed, and microscopic sectionsmore » were obtained. The GTVs were delineated for CT and autocontoured at the 42% PET level, and both were compared with the histopathologic volumes. The CT data were subsequently reformatted in the direction of the macroscopic sections, and the corresponding fiducial points in both images were compared. Hence, the lung deformations were determined to correct the distances of microscopic spread. Results: In 4 of 5 patients, the GTV{sub CT} was, on average, 4 cm{sup 3} ({approx}53%) too large. In contrast, for 1 patient (with lymphangitis carcinomatosa), the GTV{sub CT} was 16 cm{sup 3} ({approx}40%) too small. The GTV{sub PET} was too small for the same patient. Regarding deformations, the volume of the well-inflated lung lobes on pathologic examination was still, on average, only 50% of the lobe volume on CT. Consequently, the observed average maximal distance of microscopic spread (5 mm) might, in vivo, be as large as 9 mm. Conclusions: Our results have shown that pathology-correlated lung imaging is feasible and can be used to improve target definition. Ignoring deformations of the lung might result in underestimation of the microscopic spread.« less

Bacterial and protozoal pathogens found in ticks collected from humans in Corum province of Turkey

PubMed Central

Karasartova, Djursun; Gureser, Ayse Semra; Gokce, Tuncay; Celebi, Bekir; Yapar, Derya; Keskin, Adem; Celik, Selim; Ece, Yasemin; Erenler, Ali Kemal; Usluca, Selma; Mumcuoglu, Kosta Y.

2018-01-01

Background Tick-borne diseases are increasing all over the word, including Turkey. The aim of this study was to determine the bacterial and protozoan vector-borne pathogens in ticks infesting humans in the Corum province of Turkey. Methodology/Principal findings From March to November 2014 a total of 322 ticks were collected from patients who attended the local hospitals with tick bites. Ticks were screened by real time-PCR and PCR, and obtained amplicons were sequenced. The dedected tick was belonging to the genus Hyalomma, Haemaphysalis, Rhipicephalus, Dermacentor and Ixodes. A total of 17 microorganism species were identified in ticks. The most prevalent Rickettsia spp. were: R. aeschlimannii (19.5%), R. slovaca (4.5%), R. raoultii (2.2%), R. hoogstraalii (1.9%), R. sibirica subsp. mongolitimonae (1.2%), R. monacensis (0.31%), and Rickettsia spp. (1.2%). In addition, the following pathogens were identified: Borrelia afzelii (0.31%), Anaplasma spp. (0.31%), Ehrlichia spp. (0.93%), Babesia microti (0.93%), Babesia ovis (0.31%), Babesia occultans (3.4%), Theileria spp. (1.6%), Hepatozoon felis (0.31%), Hepatozoon canis (0.31%), and Hemolivia mauritanica (2.1%). All samples were negative for Francisella tularensis, Coxiella burnetii, Bartonella spp., Toxoplasma gondii and Leishmania spp. Conclusions/Significance Ticks in Corum carry a large variety of human and zoonotic pathogens that were detected not only in known vectors, but showed a wider vector diversity. There is an increase in the prevalence of ticks infected with the spotted fever group and lymphangitis-associated rickettsiosis, while Ehrlichia spp. and Anaplasma spp. were reported for the first time from this region. B. microti was detected for the first time in Hyalomma marginatum infesting humans. The detection of B. occultans, B. ovis, Hepatozoon spp., Theileria spp. and Hemolivia mauritanica indicate the importance of these ticks as vectors of pathogens of veterinary importance, therefore patients with a tick infestation should be followed for a variety of pathogens with medical importance. PMID:29649265

Bacterial and protozoal pathogens found in ticks collected from humans in Corum province of Turkey.

PubMed

Karasartova, Djursun; Gureser, Ayse Semra; Gokce, Tuncay; Celebi, Bekir; Yapar, Derya; Keskin, Adem; Celik, Selim; Ece, Yasemin; Erenler, Ali Kemal; Usluca, Selma; Mumcuoglu, Kosta Y; Taylan-Ozkan, Aysegul

2018-04-01

Tick-borne diseases are increasing all over the word, including Turkey. The aim of this study was to determine the bacterial and protozoan vector-borne pathogens in ticks infesting humans in the Corum province of Turkey. From March to November 2014 a total of 322 ticks were collected from patients who attended the local hospitals with tick bites. Ticks were screened by real time-PCR and PCR, and obtained amplicons were sequenced. The dedected tick was belonging to the genus Hyalomma, Haemaphysalis, Rhipicephalus, Dermacentor and Ixodes. A total of 17 microorganism species were identified in ticks. The most prevalent Rickettsia spp. were: R. aeschlimannii (19.5%), R. slovaca (4.5%), R. raoultii (2.2%), R. hoogstraalii (1.9%), R. sibirica subsp. mongolitimonae (1.2%), R. monacensis (0.31%), and Rickettsia spp. (1.2%). In addition, the following pathogens were identified: Borrelia afzelii (0.31%), Anaplasma spp. (0.31%), Ehrlichia spp. (0.93%), Babesia microti (0.93%), Babesia ovis (0.31%), Babesia occultans (3.4%), Theileria spp. (1.6%), Hepatozoon felis (0.31%), Hepatozoon canis (0.31%), and Hemolivia mauritanica (2.1%). All samples were negative for Francisella tularensis, Coxiella burnetii, Bartonella spp., Toxoplasma gondii and Leishmania spp. Ticks in Corum carry a large variety of human and zoonotic pathogens that were detected not only in known vectors, but showed a wider vector diversity. There is an increase in the prevalence of ticks infected with the spotted fever group and lymphangitis-associated rickettsiosis, while Ehrlichia spp. and Anaplasma spp. were reported for the first time from this region. B. microti was detected for the first time in Hyalomma marginatum infesting humans. The detection of B. occultans, B. ovis, Hepatozoon spp., Theileria spp. and Hemolivia mauritanica indicate the importance of these ticks as vectors of pathogens of veterinary importance, therefore patients with a tick infestation should be followed for a variety of pathogens with medical importance.

Tomographic findings of acute pulmonary toxoplasmosis in immunocompetent patients.

PubMed

de Souza Giassi, Karina; Costa, Andre Nathan; Apanavicius, Andre; Teixeira, Fernando Bin; Fernandes, Caio Julio Cesar; Helito, Alfredo Salim; Kairalla, Ronaldo Adib

2014-11-25

Toxoplasmosis is one of the most common human zoonosis, and is generally benign in most of the individuals. Pulmonary involvement is common in immunocompromised subjects, but very rare in immunocompetents and there are scarce reports of tomographic findings in the literature. The aim of the study is to describe three immunocompetent patients diagnosed with acute pulmonary toxoplasmosis and their respective thoracic tomographic findings. Acute toxoplasmosis was diagnosed according to the results of serological tests suggestive of recent primary infection and the absence of an alternative etiology. From 2009 to 2013, three patients were diagnosed with acute respiratory failure secondary to acute toxoplasmosis. The patients were two female and one male, and were 38, 56 and 36 years old. Similarly they presented a two-week febrile illness and progressive dyspnea before admission. Laboratory tests demonstrated lymphocytosis, slight changes in liver enzymes and high inflammatory markers. Tomographic findings were bilateral smooth septal and peribronchovascular thickening (100%), ground-glass opacities (100%), atelectasis (33%), random nodules (33%), lymph node enlargement (33%) and pleural effusion (66%). All the patients improved their symptoms after treatment, and complete resolution of tomographic findings were found in the followup. These cases provide a unique description of the presentation and evolution of pulmonary tomographic manifestations of toxoplasmosis in immunocompetent patients. Toxoplasma pneumonia manifests with fever, dyspnea and a non-productive cough that may result in respiratory failure. In animal models, changes were described as interstitial pneumonitis with focal infiltrates of neutrophils that can finally evolve into a pattern of diffuse alveolar damage with focal necrosis. The tomographic findings are characterized as ground glass opacities, smooth septal and marked peribronchovascular thickening; and may mimic pulmonary congestion, lymphangitis, atypical pneumonia and pneumocystosis. This is the largest series of CT findings of acute toxoplasmosis in immunocompetent hosts, and the diagnosis should be considered as patients that present with acute respiratory failure in the context of a subacute febrile illness with bilateral and diffuse interstitial infiltrates with marked peribronchovascular thickening. If promptly treated, pulmonary toxoplasmosis can result in complete clinical and radiological recovery in immunocompetent hosts.

[Diagnosis and therapy of cutaneous and mucocutaneous Leishmaniasis in Germany].

PubMed

Boecken, Gerhard; Sunderkötter, Cord; Bogdan, Christian; Weitzel, Thomas; Fischer, Marcellus; Müller, Andreas; Löbermann, Micha; Anders, Gerlind; von Stebut, Esther; Schunk, Mirjam; Burchard, Gerd; Grobusch, Martin; Bialek, Ralf; Harms-Zwingenberger, Gundel; Fleischer, Bernhard; Pietras, Mathias; Faulde, Michael; Erkens, Kay

2011-11-01

The incidence of cutaneous and mucocutaneous Leishmaniasis (CL/MCL) is increasing globally, also in Germany, although the cases are imported and still low in number. The current evidence for the different therapies has many limitations due to lack of sufficient studies on the different Leishmania species with differing virulence. So far there is no international gold standard for the optimal management. The aim of the German joint working group on Leishmaniasis, formed by the societies of Tropical Medicine (DTG), Chemotherapy (PEG) and Dermatology (DDG), was to establish a guideline for the diagnosis and treatment of CL and MCL in Germany, based on evidence (Medline search yielded 400 articles) and, where lacking, on consensus of the experts. As the clinical features do not necessarily reflect the involved Leishmania species and, as different parasite species and even geographically distinct strains of the same species may require different treatments or varying dosages or durations of therapy, the guidelines suggest for Germany to identify the underlying parasite prior to treatment. Because of relevant differences in prognosis and ensuing therapy species should be identified in i) New World CL/MCL (NWCL/ MCL) to distinguish between L. mexicana-complex and subgenus Viannia, ii) in suspected infections with L. mexicana-complex to distinguish from L. amazonensis, and iii) in Old World CL (OWCL) to distinguish between L. infantum and L. major, L. tropica, or L. aethiopica. A state-of-the-art diagnostic algorithm is presented. For recommendations on localized and systemic drug treatment and physical procedures, data from the accessible literature were adjusted according to the involved parasite species and a clinical differentiation into uncomplicated or complex lesions. Systemic therapy was strictly recommended for i) complex lesions (e. g. > 3 infected lesions, infections in functionally or cosmetically critical areas such as face or hands, presence of lymphangitis), ii) lesions refractory to therapy, iii) NWCL by the subgenus Viannia or by L. amazonensis, iv) in MCL and v) in recalcitrant, or disseminating or diffuse cutaneous courses. In e. g. infection with L. major it encompasses miltefosine, fluconazole and ketoconazole, while antimony or allopurinol were here considered second choice. Local therapy was considered appropriate for i) uncomplicated lesions of OWCL, ii) L. mexicana-complex and iii) pregnant women. In e. g. infection with L. major it encompasses perilesional antimony, combined with cryotherapy, paromomycin 15 %/in methylbenzethoniumchlorid 12 % and thermotherapy. The group also stated that there is an urgent need for improving the design and the way of publishing of clinical trials in leishmaniasis.

Folliculotropic Cutaneous Metastases and Lymphangitis Carcinomatosa: When Cutaneous Metastases of Breast Carcinoma Are Mistaken for Cutaneous Infections.

PubMed

Paolino, Giovanni; Panetta, Chiara; Didona, Dario; Donati, Michele; Donati, Pietro

2016-06-01

Dear Editor, Cutaneous metastases (CM) are detected in about 0.6-10.4% of patients with an internal malignancy (1-3). Excluding melanoma, breast and lung carcinomas are the main source of CM in women and men, respectively (1,4,5). CM can have different clinical features, and a diagnosis of CM is usually suspected before performing a biopsy. However, this can be a pitfall for clinicians when the clinical presentation is not the typical inflammatory nodule or mass. Herein we report 2 cases of cutaneous metastases of breast carcinoma, initially treated as a common skin infection. Case 1 A 51-year-old Caucasian woman presented to our Institute with a four-month history of diffuse and erythematous pustular, lesions on the right arm that were painless and non pruritic (Figure 1). The patient had undergone excision for a breast adenocarcinoma (stage IIIA) 5 years earlier. An initial diagnosis of folliculitis was established, and the patient started systemic and topical antibiotics without any improvement. Based on the clinical features and the patient medical history, we performed a skin biopsy. Pathologically dermal nests of tumor cells, arranged in a glandular-like pattern and involving the perifollicular and follicular areas (Figure 2, Figure 3), were highlighted. The tumor cells were positive to cytokeratin (CK) 7, CK19, and carcinoembryonic antigen (CEA) and negative for CK20, CK5/6, CD10, and thyroid transcription factor-1 (TTF-1) (Figure 4). According to the clinical history and pathology, a final diagnosis of folliculotropic metastatic breast carcinoma was established. Unfortunately, the patient died after 10 months. Case 2 A 61-year old Caucasian woman presented to our Department with a two-month history of pink/violet macular lesions with diffuse telangiectasia on the left breast and arm (Figure 5, Figure 6). Five years earlier she had undergone excision for a breast adenocarcinoma (stage II A). A previous diagnosis of cellulitis had been made, and systemic antibiotic therapy had been started without any improvement. Based on the clinical features and the patient medical history, a punch biopsy was performed. Examination of skin biopsy showed a diffuse, sclerotic, and mixoid stroma with several dense ectatic lymphatic vessels (Figure 7, Figure 8). The dermal and hypodermal lymphatic lumens were filled with neoplastic cells. Thus, a diagnosis of cutaneous lymphangitis carcinomatosa (CLC) was established. Unfortunately, the patient died after 8 months. Discussion CM are present after breast carcinoma in about 23.9% of patients, often involving the chest and abdomen and manifesting on average 5 years after surgical removal of the first malignancy (1,6). CM of breast cancer are usually solitary or multiple nodular pinkish lesions (ranging between 1 and 3 cm) (1). However, several clinical features have been reported in the literature, including telangiectatic carcinoma, erythema-like, erythema annulare centrifugum-like, morphea-like, erysipelas-like, dermatofibroma-like, herpes-zoster-like, and alopecia-like lesions (1,7-10). Clinical and pathological images of folliculitis-like metastases are rarely reported in the literature, especially after breast cancer (11,13) Clinically, folliculitis-like metastases could resemble a zosteriform-like metastatic lesion (7,14,15) although they do not follow a dermatome and are pustular lesions rather than violaceous indurate papules and/or nodules (13,14) Pathologically, our cases showed an infiltration of the dermis and pilosebaceous units growing through the pilosebaceous unit in a "pseudo-eruptive way". In this regard, folliculitis-like CM could be similar to alopecia neoplastica, where the metastatic process involves and destroys the pilosebaceous units completely, leading to scarring alopecia (9,10). However, in our case, the pilosebaceous unit was still slightly recognizable, and clinically there were no scar-like features. The mechanism of folliculitis-like metastasis formation is currently unknown. As reported in zosteriform-like metastases, the lymphatic and hematogenous spread of malignant cells or the koebnerization at the site of a previous viral and/or bacterial infection could lead to metastasis (7,14-16). However, unlike zosteriform-like metastases, the spread of neoplastic cells from the dorsal root ganglia was not a plausible mechanism of metastasization in our cases because of the absence of dermatome involvement. Furthermore, there were no signs of possible koebnerization in a previous bacterial and/or viral infection site (7,13) In our opinion, folliculitis-like metastasis may be a result of the skin extruding malignant cells through the pilosebaceous unit to limit the neopalstic proliferation. This could explain the clinical and pathological features of folliculitis-like metastasis. Alternatively, the adnexotropic behavior of malignant cells may be explained by homing mechanisms, involving the up-regulation of the intercellular adhesion molecule 1 (ICAM-1) on the follicular epithelium, such as folliculotropic mycosis fungoides (17). In our patient, the folliculitis-like eruption was the first sign of recurrence after 5 years of disease-free survival. It is evident that the unusual folliculitis-like eruption of CM led to a delay in the diagnosis. CLC is a rare presentation of skin metastasis, characterized by an occlusion of dermic lymphatic vessels by neoplastic cells (18). CLC has been reported in the literature in association with several malignancies, including lung, breast, and ovarian cancer (19). CLC shows pink/violet macular lesions with diffuse telangiectasias, often associated with itching and burning sensation. The main differential diagnoses are erysipelas and cellulitis. However, CLC is not associated with fever, chills, and leukocytosis. Furthermore, CLC shows no response to antibiotic therapies. Several clinicopathological types of cutaneous metastasis have been reported in the literature, including telangiectatic metastatic breast carcinoma (TMBC) and carcinoma erysipelatous (CE). TMBC is characterized by yellowish/reddish or violaceous papulo-vesicular lesions. CE usually shows blistering erythematous eruptions resembling erysipelas. However, CLC, TMBC, and CE are different clinical expressions of the same metastatic process, pathologically characterized by edema of the dermis and ectatic lymphatic vessels. Positivity to CD31 and podoplanin in the endothelial cells shows that the tumor metastatises predominantly via lymphatic vessels (20). In conclusion, we stress that every cutaneous lesion should be studied and examined carefully in patients with a personal history of cancer. Indeed, a correct diagnosis remains the pivotal point for a better management of these patients.

Bacterial diseases of the skin.

PubMed

Edlich, Richard F; Winters, Kathryne L; Britt, L D; Long, William B

2005-01-01

When considering common bacterial diseases of the skin, rather distinct clinical responses to a variety of bacterial infections have been identified. In these cases, it is the specific site of infection and the attendant inflammatory responses that provide the characteristic clinical picture. When the pyoderma extends just below the stratum corneum, it is called impetigo. Nonbullous impetigo is the most common pediatric skin infection. It usually starts in a traumatized area. The typical lesion begins as an erythematous papule, after which it becomes a unilocular vesicle. When the subcorneal vesicle becomes pustular, it ruptures and eventually becomes a yellow, golden crust that is a hallmark of the disease process. Bullous impetigo is a less common form of impetigo, accounting for fewer than 30% of all impetigo cases. It occurs in infants and is characterized by rapid progression of vesicles to the formation of bullae measuring larger than 5 mm in diameter in previously untraumatized skin. Treatment of nonbullous impetigo must include intervention against the pathogen as well as improvements in the hygiene and living conditions of the patient. A fundamental tenet is to debride the crust (scab) from the wound surface using poloxamer 188. If the lesions are not widespread, topical mupirocin is the treatment of choice. Treatment of bullous impetigo is similar, except that the local cleansing and topical antibiotic must be complemented by systemic antibiotics if there is evidence of disseminating infections. Ecthyma is usually a consequence of failure to treat effectively impetigo. The untreated infection extends deep into the tissue in shallow ulcerations that often heal without scar. Treatment for ecthyma usually requires systemic antibiotics against either staphylococcus or streptococcus. Folliculitis is a pyoderma located within a hair follicle, secondary to follicular occlusion by keratin, overhydration, or either bacterial or fungal infection. Folliculitis may be divided into either a deep or a superficial type. In the superficial type, the pustule is located at the opening of the hair follicle. In the deep form, the infection may extend beyond the confines of the hair follicle, becoming a furuncle or boil. Carbuncles are aggregates of interconnected furuncles that drain through multiple openings of the skin. Treatment of folliculitis must include searching for and avoiding any factors predisposing to infection. If topical antibiotic therapy is ineffective in controlling the infection, surgical drainage of the infected skin abscess will be necessary. Paronychia is the most common bacterial infection of the hand, which often requires surgical incisional drainage. Similarly, a felon that is an infection of the distal pulp of a finger usually requires surgical drainage. Finally, cellulitis is an acute inflammatory reaction involving the skin and underlying subcutaneous tissue. It usually starts as erysipelas and may advance to lymphangitis, lymphadenitis, or gangrene,which will respond to life-saving interventions in the hospital that usually include systemic antibiotic treatment as well as surgical intervention.