Objective: To report the management of skin and soft tissue infections in the surgical area of Kara University Hospital in Togo. Material and Methods: This study was conducted retrospectively from January 1, 2021, to ...Objective: To report the management of skin and soft tissue infections in the surgical area of Kara University Hospital in Togo. Material and Methods: This study was conducted retrospectively from January 1, 2021, to December 31, 2022, in the general surgery and orthopedic trauma departments. The study focused on soft tissue infections of the pelvic and thoracic limbs and analyzed epidemiological, clinical, paraclinical, therapeutic, and evolutionary data. Results: We registered 165 patients, comprising 109 men and 56 women.The sex ratio (F/H) were 0.51. The mean age was 45 years with extremes ranging from 23 to 90 years. Farmers (64.8%) followed by housewives (34.0%) were the social strata most affected. The consultation period varied between 1 and 90 days. The pathologies found were necrotizing fasciitis (53.3%), erysipelas (18.2%), infected limb wounds (12.1%), pyomyositis (9.7%), and necrotizing dermo-hypodermitis (1.8%). The main procedures performed were necrosectomy and grafting (62.9%), sample necrosectomy (18.8%), drainage (9.7%), and pelvic limb amputation (1.2%). Follow-up was favorable in 86.7% of cases. The study noted a death rate of 13.3% due to septic shock secondary to a delay in consultation. Conclusion: Skin and soft tissue infections were a common reason for surgical hospitalization at Kara University Hospital, with a high mortality rate due to delayed consultations.展开更多
Background: Autoimmune diseases are a vast array of organ-specific as well as systemic diseases, whose pathogenesis results from the activation of B and T lymphocytes reacting against antigens of the body’s own tissu...Background: Autoimmune diseases are a vast array of organ-specific as well as systemic diseases, whose pathogenesis results from the activation of B and T lymphocytes reacting against antigens of the body’s own tissues (defined as self). Objective: To record skin tumors and infections in all autoimmune diseases gathered together in a one pathological state, compared with renal transplant recipients and normal control. Patients and Methods: Four hundred patients with different autoimmune diseases were examined. Fifty patients with pemphigus (15 males, 35 females) are aged from 20 - 70 (41.23 ± 3.89) years. Fifty patients with systemic lupus erythematosus (50 females) are aged from 17 - 45 (30.58 ± 10.08) years. One hundred patients with vitiligo (59 males, 41 females) are aged from 9 - 71 (42.89 ± 5.28) years. One hundred patients with alopecia areata (42 males, 58 females) are aged from 7 - 52 (38.67 ± 9.52) years. One hundred patients with psoriasis (56 males, 44 females) are aged from 7 - 71 (47.36 ± 8.62) years were evaluated. One hundred twenty kidney transplant recipients’ (101 males, 19 females) ages ranged from 14 - 70 (45.43 ± 4.63) years. All patients were examined thoroughly for any cutaneous manifestations and tumors and the findings were compared with the general population as a control group, which consisted of 500 healthy control individuals whose ages ranged from 20 - 71 (44.53 ± 11.48) years. This case series, descriptive, controlled study was performed in Baghdad Teaching Hospital from June 2014 to October 2015. Results: In renal transplant recipients, the findings were observed as follow herpetic infection in 30(25%), bacterial 12(10%) while fungal 24(20%) patients. These infections appeared early in the course of immunosuppression. While the tumors were noticed, the benign tumors were the commonest manifestations, which included viral warts in 45(37.5%) followed by actinic keratosis 15(12.5%), seborrheic keratosis 14(11.6%), sebaceous hyperplasia 13(10.8%) and keratoacanthoma 1(0.8%). While the malignant tumors were basal cell carcinoma 4(3.3%) followed by squamous cell carcinoma 3(2.5%), and kaposi’s sarcoma 4(3.3%), Bowen’s disease 1(0.8%). These malignancy usually appeared late in the course of immunosuppression. In pemphigus, viral warts were observed in 4(8%) cases;fungal infection was seen in 4(8%) cases and bacterial infections in 2(4%) of cases and herpetic infection in only 1(2%) of case;no tumors were found in all patients. In vitiligo, viral warts were observed in 2(2%) cases, while seborrhic keratosis and sebaceous hyperplasia were observed in 1(1%) case;herpetic and fungal infections were seen in 3(3%) of cases while bacterial infections were recorded in 2(2%) of cases but no tumors were found in all patients. In alopecia areata viral warts were observed in 9(9%) of cases, sebaceous hyperplasia in 1(1%) case, herpetic and bacterial in 3(3%) of cases and fungal in 4(4%) of cases;no tumors were found in all patients. In systemic lupus erythymatosus (SLE) viral warts were observed in 4(8%) of cases, herpetic infection in 12(12%) of cases, fungal infection in 10(20%) of cases, bacterial infection in 3(3%) of cases and sebaceous hyperplasia in only 1(2%) of case, but no tumors were seen. In psoriasis, viral warts were observed in 14(14%) of cases, herpetic infection in 10(10%) of cases, bacterial infection in 3(3%) of cases, fungal infection in 2(2%) of cases, sebaceous hyperplasia in 2(2%) of cases and seborrhiec hyperkeratosis in 1(1%) case, while no tumors were demonstrated. In healthy control individuals, herpetic infection was present in 36(7.2%) and viral warts in 52(10.4%) individuals, fungal infection in 29(5.8%) of individuals and regarding tumors solar keratosis was present in 24(4.8%);basal cell carcinoma and squamous cell carcinoma were present in 2(0.4%) individuals of each. Conclusions: Patients with autoimmune diseases were protected against infections and tumors while kidney transplant recipients had no such protection although all these groups were on prolonged immunosuppression.展开更多
BACKGROUND In recent years,the cosmetic intervention related infections caused by nontuberculous mycobacteria(NTM)are increasing as the informal cosmetic treatments are performed.However,many dermatologists are inexpe...BACKGROUND In recent years,the cosmetic intervention related infections caused by nontuberculous mycobacteria(NTM)are increasing as the informal cosmetic treatments are performed.However,many dermatologists are inexperienced in the diagnosis and management of similar cases.Here we report a case of subcutaneous infection caused by Mycobacterium abscessus(M.abscessus)following cosmetic injections of botulinum toxin.CASE SUMMARY A 53-year-old woman presented with multiple abscesses and nodules on her forehead and both temporal sites for half a month after cosmetic injections of botulinum toxin.Her lesions did not show any alleviation after 2-wk prescription of antibiotics.Laboratory examinations indicated that she had no sign of immunodeficiency and the whole body of computed tomography did not find any systemic infection or diseases.The pathology of skin tissue showed inflammatory cell infiltration with the negative results of Periodic acid Schiff(PAS)and Acidfast staining and the culture yielded no microbiome.Afterwards,the puncture on abscess was performed and M.abscessus was successfully isolated.The pathogen was identified by acid-fast staining and DNA sequencing.The patient was treated with the strategy of clarithromycin,ofloxacin,and amikacin according to the result of drug sensitivity test and got complete remission of the lesions.CONCLUSION The case presents the whole process of diagnosis and management of NTM infection after cosmetic intervention and highlights the diagnostic thoughts.In a word,the mycobacterium infection should be aware in patients after cosmetic performance.展开更多
Staphylococcal pleuropulmonary disease (SPP) is the localization of pathogenic staphylococcal disease in the lung and pleura and its general haematogenic consequences. This location is not primary, but follows a prima...Staphylococcal pleuropulmonary disease (SPP) is the localization of pathogenic staphylococcal disease in the lung and pleura and its general haematogenic consequences. This location is not primary, but follows a primary skin or mucous infection that may go unnoticed. This is a very rare phenomenon in neonatology and in the various literature reviews. Through our observation we report the clinical diagnosis of a newborn 13-day age with pleuro-pulmonary staphyloccocia point of departure cutaneous, thus the paraclinical explorations performed in our patient therapeutic management and evolutionary profile after a 3-month decline. Note that the problem of resistance of staphylococci to different antibiotics is currently a real public health problem making the choice of treatment very difficult for the clinician.展开更多
Cryptococcus is a yeast typically found in bird feces such as pigeon droppings. Infection may occur through inhalation of spores or via direct inoculation into the skin. Typically there is a history of immunosuppressi...Cryptococcus is a yeast typically found in bird feces such as pigeon droppings. Infection may occur through inhalation of spores or via direct inoculation into the skin. Typically there is a history of immunosuppression, but cases are also reported in immunocompetent hosts. Cryptococcus may manifest as pulmonary disease or primary cutaneous infection, but dissemination to a systemic illness is the most life-threatening concern. We present the case of a 71-year-old man with a four-year history of idiopathic lung disease, treated with oral prednisone and mycophenolate, presents with a new onset skin rash on the right wrist. He has a history of cleaning and clearing barns and sheds after a recent storm devastated the area. Birds and bats were present in these structures while he was working. Initial therapy failed, and subsequent biopsy showed the presence of Cryptococcus yeast. Further investigation yielded a positive, low titer Cryptococcus antigen screen but negative blood cultures. This case illustrates three valuable facets of patient care. Ideally, one diagnosis will explain all of the clinical presentation, but when that is not the case then multiple etiologies must be explored. Sometimes first-line therapy is ineffective, and the clinician should not be afraid to recognize that and change course. Importantly with skin lesions, failure to respond to treatment or worsening of the lesion in the face of topical and/or oral steroids should lead one to consider the possibility of infection, particularly in an immunosuppressed patient, and prompt biopsy is prudent.展开更多
BACKGROUND Leishmaniasis includes a range of chronic infections in humans and animals and can be caused by more than 20 species of Leishmania protozoa.The manifestations of leishmaniasis are diverse and dependent on t...BACKGROUND Leishmaniasis includes a range of chronic infections in humans and animals and can be caused by more than 20 species of Leishmania protozoa.The manifestations of leishmaniasis are diverse and dependent on the immune response capacity of the host and the type of Leishmania.In East Asia,leishmaniasis is relatively rare and prone to misdiagnosis and underdiagnosis.CASE SUMMARY We report a case of a 36-year-old male with cutaneous leishmaniasis.The patient had been misdiagnosed with a bacterial skin infection and was given a dressing change and oral levofloxacin,which proved ineffective.Histopathological examination revealed amastigote(Leishman-Donovan body)in the histocytes,and nucleic acid sequencing proved that the pathogen was Leishmania major.The patient was treated successfully by regional injection of sodium gluconate(600 mg)three times.The ulcer healed and did not recur at 1.5-year follow-up.CONCLUSION Skin ulcers caused by leishmaniasis are easily misdiagnosed in non-epidemic countries,yet it should not be overlooked.展开更多
Skin and soft tissue infections(SSTIs)refer to infections involving the skin,subcutaneous tissue,fascia,and muscle.In transplant populations with hematological malignancies,an immunocompromised status and the routine ...Skin and soft tissue infections(SSTIs)refer to infections involving the skin,subcutaneous tissue,fascia,and muscle.In transplant populations with hematological malignancies,an immunocompromised status and the routine use of immunosuppressants increase the risk of SSTIs greatly.However,to date,the profiles and clinical outcomes of SSTIs in hematopoietic stem cell transplantation(HSCT)patients remain unclear.This study included 228 patients(3.67%)who developed SSTIs within 180 days after allogeneic HSCT from January 2004 to December 2019 in Peking University People’s Hospital.The overall annual survival rate was 71.5%.We compared the differences between survivors and non-survivors a year after transplant and found that primary platelet graft failure(PPGF),comorbidities of acute kidney injury(AKI),and hospital-acquired pneumonia(HAP)were independent risk factors for death in the study population.A PPGF-AKI-HAP risk stratification system was established with a mortality risk score of 1×PPGF+1×AKI+1×HAP.The areas under the curves of internal and external validation were 0.833(95%CI 0.760–0.906)and 0.826(95%CI 0.715–0.937),respectively.The calibration plot revealed the high consistency of the estimated risks,and decision curve analysis showed considerable net benefits for patients.展开更多
With the increasing prevalence of drug-resistant bacterial infections and the slow healing of chronically infected wounds,the development of new antibacterial and accelerated wound healing dressings has become a serio...With the increasing prevalence of drug-resistant bacterial infections and the slow healing of chronically infected wounds,the development of new antibacterial and accelerated wound healing dressings has become a serious challenge.In order to solve this problem,we developed photo-crosslinked multifunctional antibacterial adhesive anti-oxidant hemostatic hydrogel dressings based on polyethylene glycol monomethyl ether modified glycidyl methacrylate functionalized chitosan(CSG-PEG),methacrylamide dopamine(DMA)and zinc ion for disinfection of drug-resistant bacteria and promoting wound healing.The mechanical properties,rheological properties and morphology of hydrogels were characterized,and the biocompatibility of these hydrogels was studied through cell compatibility and blood compatibility tests.These hydrogels were tested for the in vitro blood-clotting ability of whole blood and showed good hemostatic ability in the mouse liver hemorrhage model and the mouse-tail amputation model.In addition,it has been confirmed that the multifunctional hydrogels have good inherent antibacterial properties against Methicillin-resistant Staphylococcus aureus(MRSA).In the full-thickness skin defect model infected with MRSA,the wound closure ratio,thickness of granulation tissue,number of collagen deposition,regeneration of blood vessels and hair follicles were measured.The inflammation-related cytokines(CD68)and angiogenesis-related cytokines(CD31)expressed during skin regeneration were studied.All results indicate that these multifunctional antibacterial adhesive hemostatic hydrogels have better healing effects than commercially available Tegaderm™Film,revealing that they have become promising alternative in the healing of infected wounds.展开更多
Species of the Trichophyton benhamiae complex are predominantly zoophilic pathogens with a worldwide distribution.These pathogens have recently become important due to their epidemic spread in pets and pet owners.Cons...Species of the Trichophyton benhamiae complex are predominantly zoophilic pathogens with a worldwide distribution.These pathogens have recently become important due to their epidemic spread in pets and pet owners.Considerable genetic and phenotypic variability has been revealed in these emerging pathogens,but the species limits and host spectra have not been clearly elucidated.In this study,we used an approach combining phylogenetic analysis based on four loci,population-genetic data,phenotypic and physiological analysis,mating type gene characterization and ecological data to resolve the taxonomy of these pathogens.This approach supported the inclusion of nine taxa in the complex,including three new species and one new variety.Trichophyton benhamiae var.luteum var.nov.(“yellow phenotype”strains)is currently a major cause of zoonotic tinea corporis and capitis in Europe(mostly transmitted from guinea pigs).The isolates of the“white phenotype”do not form a monophyletic group and are segregated into three taxa,T.benhamiae var.benhamiae(mostly North America;dogs),T.europaeum sp.nov.(mostly Europe;guinea pigs),and T.japonicum sp.nov.(predominant in East Asia but also found in Europe;rabbits and guinea pigs).The new species T.africanum sp.nov.is proposed for the“African”race of T.benhamiae.The introduction to new geographic areas and host jump followed by extinction of one mating type gene have played important roles in the evolution of these pathogens.Due to considerable phenotypic similarity of many dermatophytes and phenomena such as incomplete lineage sorting or occasional hybridization and introgression,we demonstrate the need to follow polyphasic approach in species delimitation.Neutrally evolving and noncoding DNA regions showed significantly higher discriminatory power compared to conventional protein-coding loci.Diagnostic options for species identification in practice based on molecular markers,phenotype and MALDI-TOF spectra are presented.A microsatellite typing scheme developed in this study is a powerful tool for the epidemiological surveillance of these emerging pathogens.展开更多
Background:Skin and soft tissue infections are frequent.Candidiasis and Aspergillosis are the most common cutaneous fungal infections.Yemeni alum(Aluminium Potassium Sulphate)is a natural mineral with antifungal and a...Background:Skin and soft tissue infections are frequent.Candidiasis and Aspergillosis are the most common cutaneous fungal infections.Yemeni alum(Aluminium Potassium Sulphate)is a natural mineral with antifungal and antibacterial properties.Objective:This study aimed to confirm Yemeni alum’s antifungal effectiveness against selected fungal strains and develop useful topical formulations.Methods:Using different alum concentrations,we prepared twenty-three formulations,including four non-adjusted aqueous solutions,eight adjusted pH aqueous solutions,eight glycerite solutions,and three Oil/Water cream formulations.Then,we examined the antifungal activity against the suggested fungus.The animal skin irritation test evaluated the local skin sensitivity reactions that might happen upon using the formulations we pre-pared on the intact animal’s skin.Additionally,this study also included six weeks of stability testing to estimate the expected shelf life(t90)of the selected formulations.Results:Alum exerted antifungal effect against Candida albicans,Aspergillus niger,and Aspergillus flavus.The animal’s skin was not irritated by any of the formulations examined.The 5%alum aqueous solution and the 10%alum Oil/Water cream exhibited promising results among all tested formulations.The approximate formulation’s shelf-lives(t90)were 2 and 1.52 years with alum content(%)ranging between 105.75%to 106.02%,respectively.Conclusion:Based on the results we found,10%alum Oil/Water cream is a promising formulation for large-scale manufacture.展开更多
文摘Objective: To report the management of skin and soft tissue infections in the surgical area of Kara University Hospital in Togo. Material and Methods: This study was conducted retrospectively from January 1, 2021, to December 31, 2022, in the general surgery and orthopedic trauma departments. The study focused on soft tissue infections of the pelvic and thoracic limbs and analyzed epidemiological, clinical, paraclinical, therapeutic, and evolutionary data. Results: We registered 165 patients, comprising 109 men and 56 women.The sex ratio (F/H) were 0.51. The mean age was 45 years with extremes ranging from 23 to 90 years. Farmers (64.8%) followed by housewives (34.0%) were the social strata most affected. The consultation period varied between 1 and 90 days. The pathologies found were necrotizing fasciitis (53.3%), erysipelas (18.2%), infected limb wounds (12.1%), pyomyositis (9.7%), and necrotizing dermo-hypodermitis (1.8%). The main procedures performed were necrosectomy and grafting (62.9%), sample necrosectomy (18.8%), drainage (9.7%), and pelvic limb amputation (1.2%). Follow-up was favorable in 86.7% of cases. The study noted a death rate of 13.3% due to septic shock secondary to a delay in consultation. Conclusion: Skin and soft tissue infections were a common reason for surgical hospitalization at Kara University Hospital, with a high mortality rate due to delayed consultations.
文摘Background: Autoimmune diseases are a vast array of organ-specific as well as systemic diseases, whose pathogenesis results from the activation of B and T lymphocytes reacting against antigens of the body’s own tissues (defined as self). Objective: To record skin tumors and infections in all autoimmune diseases gathered together in a one pathological state, compared with renal transplant recipients and normal control. Patients and Methods: Four hundred patients with different autoimmune diseases were examined. Fifty patients with pemphigus (15 males, 35 females) are aged from 20 - 70 (41.23 ± 3.89) years. Fifty patients with systemic lupus erythematosus (50 females) are aged from 17 - 45 (30.58 ± 10.08) years. One hundred patients with vitiligo (59 males, 41 females) are aged from 9 - 71 (42.89 ± 5.28) years. One hundred patients with alopecia areata (42 males, 58 females) are aged from 7 - 52 (38.67 ± 9.52) years. One hundred patients with psoriasis (56 males, 44 females) are aged from 7 - 71 (47.36 ± 8.62) years were evaluated. One hundred twenty kidney transplant recipients’ (101 males, 19 females) ages ranged from 14 - 70 (45.43 ± 4.63) years. All patients were examined thoroughly for any cutaneous manifestations and tumors and the findings were compared with the general population as a control group, which consisted of 500 healthy control individuals whose ages ranged from 20 - 71 (44.53 ± 11.48) years. This case series, descriptive, controlled study was performed in Baghdad Teaching Hospital from June 2014 to October 2015. Results: In renal transplant recipients, the findings were observed as follow herpetic infection in 30(25%), bacterial 12(10%) while fungal 24(20%) patients. These infections appeared early in the course of immunosuppression. While the tumors were noticed, the benign tumors were the commonest manifestations, which included viral warts in 45(37.5%) followed by actinic keratosis 15(12.5%), seborrheic keratosis 14(11.6%), sebaceous hyperplasia 13(10.8%) and keratoacanthoma 1(0.8%). While the malignant tumors were basal cell carcinoma 4(3.3%) followed by squamous cell carcinoma 3(2.5%), and kaposi’s sarcoma 4(3.3%), Bowen’s disease 1(0.8%). These malignancy usually appeared late in the course of immunosuppression. In pemphigus, viral warts were observed in 4(8%) cases;fungal infection was seen in 4(8%) cases and bacterial infections in 2(4%) of cases and herpetic infection in only 1(2%) of case;no tumors were found in all patients. In vitiligo, viral warts were observed in 2(2%) cases, while seborrhic keratosis and sebaceous hyperplasia were observed in 1(1%) case;herpetic and fungal infections were seen in 3(3%) of cases while bacterial infections were recorded in 2(2%) of cases but no tumors were found in all patients. In alopecia areata viral warts were observed in 9(9%) of cases, sebaceous hyperplasia in 1(1%) case, herpetic and bacterial in 3(3%) of cases and fungal in 4(4%) of cases;no tumors were found in all patients. In systemic lupus erythymatosus (SLE) viral warts were observed in 4(8%) of cases, herpetic infection in 12(12%) of cases, fungal infection in 10(20%) of cases, bacterial infection in 3(3%) of cases and sebaceous hyperplasia in only 1(2%) of case, but no tumors were seen. In psoriasis, viral warts were observed in 14(14%) of cases, herpetic infection in 10(10%) of cases, bacterial infection in 3(3%) of cases, fungal infection in 2(2%) of cases, sebaceous hyperplasia in 2(2%) of cases and seborrhiec hyperkeratosis in 1(1%) case, while no tumors were demonstrated. In healthy control individuals, herpetic infection was present in 36(7.2%) and viral warts in 52(10.4%) individuals, fungal infection in 29(5.8%) of individuals and regarding tumors solar keratosis was present in 24(4.8%);basal cell carcinoma and squamous cell carcinoma were present in 2(0.4%) individuals of each. Conclusions: Patients with autoimmune diseases were protected against infections and tumors while kidney transplant recipients had no such protection although all these groups were on prolonged immunosuppression.
文摘BACKGROUND In recent years,the cosmetic intervention related infections caused by nontuberculous mycobacteria(NTM)are increasing as the informal cosmetic treatments are performed.However,many dermatologists are inexperienced in the diagnosis and management of similar cases.Here we report a case of subcutaneous infection caused by Mycobacterium abscessus(M.abscessus)following cosmetic injections of botulinum toxin.CASE SUMMARY A 53-year-old woman presented with multiple abscesses and nodules on her forehead and both temporal sites for half a month after cosmetic injections of botulinum toxin.Her lesions did not show any alleviation after 2-wk prescription of antibiotics.Laboratory examinations indicated that she had no sign of immunodeficiency and the whole body of computed tomography did not find any systemic infection or diseases.The pathology of skin tissue showed inflammatory cell infiltration with the negative results of Periodic acid Schiff(PAS)and Acidfast staining and the culture yielded no microbiome.Afterwards,the puncture on abscess was performed and M.abscessus was successfully isolated.The pathogen was identified by acid-fast staining and DNA sequencing.The patient was treated with the strategy of clarithromycin,ofloxacin,and amikacin according to the result of drug sensitivity test and got complete remission of the lesions.CONCLUSION The case presents the whole process of diagnosis and management of NTM infection after cosmetic intervention and highlights the diagnostic thoughts.In a word,the mycobacterium infection should be aware in patients after cosmetic performance.
文摘Staphylococcal pleuropulmonary disease (SPP) is the localization of pathogenic staphylococcal disease in the lung and pleura and its general haematogenic consequences. This location is not primary, but follows a primary skin or mucous infection that may go unnoticed. This is a very rare phenomenon in neonatology and in the various literature reviews. Through our observation we report the clinical diagnosis of a newborn 13-day age with pleuro-pulmonary staphyloccocia point of departure cutaneous, thus the paraclinical explorations performed in our patient therapeutic management and evolutionary profile after a 3-month decline. Note that the problem of resistance of staphylococci to different antibiotics is currently a real public health problem making the choice of treatment very difficult for the clinician.
文摘Cryptococcus is a yeast typically found in bird feces such as pigeon droppings. Infection may occur through inhalation of spores or via direct inoculation into the skin. Typically there is a history of immunosuppression, but cases are also reported in immunocompetent hosts. Cryptococcus may manifest as pulmonary disease or primary cutaneous infection, but dissemination to a systemic illness is the most life-threatening concern. We present the case of a 71-year-old man with a four-year history of idiopathic lung disease, treated with oral prednisone and mycophenolate, presents with a new onset skin rash on the right wrist. He has a history of cleaning and clearing barns and sheds after a recent storm devastated the area. Birds and bats were present in these structures while he was working. Initial therapy failed, and subsequent biopsy showed the presence of Cryptococcus yeast. Further investigation yielded a positive, low titer Cryptococcus antigen screen but negative blood cultures. This case illustrates three valuable facets of patient care. Ideally, one diagnosis will explain all of the clinical presentation, but when that is not the case then multiple etiologies must be explored. Sometimes first-line therapy is ineffective, and the clinician should not be afraid to recognize that and change course. Importantly with skin lesions, failure to respond to treatment or worsening of the lesion in the face of topical and/or oral steroids should lead one to consider the possibility of infection, particularly in an immunosuppressed patient, and prompt biopsy is prudent.
基金Supported by Shandong Provincial Natural Science Foundation,No.ZR2020QH138
文摘BACKGROUND Leishmaniasis includes a range of chronic infections in humans and animals and can be caused by more than 20 species of Leishmania protozoa.The manifestations of leishmaniasis are diverse and dependent on the immune response capacity of the host and the type of Leishmania.In East Asia,leishmaniasis is relatively rare and prone to misdiagnosis and underdiagnosis.CASE SUMMARY We report a case of a 36-year-old male with cutaneous leishmaniasis.The patient had been misdiagnosed with a bacterial skin infection and was given a dressing change and oral levofloxacin,which proved ineffective.Histopathological examination revealed amastigote(Leishman-Donovan body)in the histocytes,and nucleic acid sequencing proved that the pathogen was Leishmania major.The patient was treated successfully by regional injection of sodium gluconate(600 mg)three times.The ulcer healed and did not recur at 1.5-year follow-up.CONCLUSION Skin ulcers caused by leishmaniasis are easily misdiagnosed in non-epidemic countries,yet it should not be overlooked.
基金supported by National Key Research and Development Program of China(No.2017YFA0105503)National Natural Science Foundation of China(Nos.81970113 and 81800116)+1 种基金Key Program of National Natural Science Foundation of China(No.81730004)Beijing Natural Science Foundation(No.H2018206423).
文摘Skin and soft tissue infections(SSTIs)refer to infections involving the skin,subcutaneous tissue,fascia,and muscle.In transplant populations with hematological malignancies,an immunocompromised status and the routine use of immunosuppressants increase the risk of SSTIs greatly.However,to date,the profiles and clinical outcomes of SSTIs in hematopoietic stem cell transplantation(HSCT)patients remain unclear.This study included 228 patients(3.67%)who developed SSTIs within 180 days after allogeneic HSCT from January 2004 to December 2019 in Peking University People’s Hospital.The overall annual survival rate was 71.5%.We compared the differences between survivors and non-survivors a year after transplant and found that primary platelet graft failure(PPGF),comorbidities of acute kidney injury(AKI),and hospital-acquired pneumonia(HAP)were independent risk factors for death in the study population.A PPGF-AKI-HAP risk stratification system was established with a mortality risk score of 1×PPGF+1×AKI+1×HAP.The areas under the curves of internal and external validation were 0.833(95%CI 0.760–0.906)and 0.826(95%CI 0.715–0.937),respectively.The calibration plot revealed the high consistency of the estimated risks,and decision curve analysis showed considerable net benefits for patients.
基金jointly supported by the National Natural Science Foundation of China(grant numbers:51973172,and 51673155)the Natural Science Foundation of Shaanxi Province(No.2020JC-03 and 2019TD-020)+5 种基金State Key Laboratory for Mechanical Behavior of Materials,and the Fundamental Research Funds for the Central Universitiesthe World-Class Universities(Disciplines)and the Characteristic Development Guidance Funds for the Central UniversitiesOpening Project of Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research,College of Stomatology,Xi’an Jiaotong University(No.2019LHM-KFKT008)the Key R&D Program of Shaanxi Province(No.2019ZDLSF02-09-01,2020GXLH-Y-019)Innovation Capability Support Program of Shaanxi Province(Program No.2019GHJD-14,2021TD-40)Scientific Research Program Funded by Shaanxi Provincial Education Department(Program No.18JC027).
文摘With the increasing prevalence of drug-resistant bacterial infections and the slow healing of chronically infected wounds,the development of new antibacterial and accelerated wound healing dressings has become a serious challenge.In order to solve this problem,we developed photo-crosslinked multifunctional antibacterial adhesive anti-oxidant hemostatic hydrogel dressings based on polyethylene glycol monomethyl ether modified glycidyl methacrylate functionalized chitosan(CSG-PEG),methacrylamide dopamine(DMA)and zinc ion for disinfection of drug-resistant bacteria and promoting wound healing.The mechanical properties,rheological properties and morphology of hydrogels were characterized,and the biocompatibility of these hydrogels was studied through cell compatibility and blood compatibility tests.These hydrogels were tested for the in vitro blood-clotting ability of whole blood and showed good hemostatic ability in the mouse liver hemorrhage model and the mouse-tail amputation model.In addition,it has been confirmed that the multifunctional hydrogels have good inherent antibacterial properties against Methicillin-resistant Staphylococcus aureus(MRSA).In the full-thickness skin defect model infected with MRSA,the wound closure ratio,thickness of granulation tissue,number of collagen deposition,regeneration of blood vessels and hair follicles were measured.The inflammation-related cytokines(CD68)and angiogenesis-related cytokines(CD31)expressed during skin regeneration were studied.All results indicate that these multifunctional antibacterial adhesive hemostatic hydrogels have better healing effects than commercially available Tegaderm™Film,revealing that they have become promising alternative in the healing of infected wounds.
基金Charles University Grant Agency(GAUK 600217):A.ČmokováCzech Ministry of Health(AZV 17-31269A):M.Kolařík,R.Dobiáš,H.Janouškovcová,I.Kuklová,N.Mallátová,K.Mencl,T.Větrovský,V.Hubka+3 种基金BIOCEV(CZ.1.05/1.1.00/02.0109)providedthe Ministry of Education,Youth and Sports of the Czech Republic and ERDF:V.HubkaCharles University Research Centre program no.204069:V.HubkaCzech Academy of Sciences(Project RVO 67985939):M.Man.
文摘Species of the Trichophyton benhamiae complex are predominantly zoophilic pathogens with a worldwide distribution.These pathogens have recently become important due to their epidemic spread in pets and pet owners.Considerable genetic and phenotypic variability has been revealed in these emerging pathogens,but the species limits and host spectra have not been clearly elucidated.In this study,we used an approach combining phylogenetic analysis based on four loci,population-genetic data,phenotypic and physiological analysis,mating type gene characterization and ecological data to resolve the taxonomy of these pathogens.This approach supported the inclusion of nine taxa in the complex,including three new species and one new variety.Trichophyton benhamiae var.luteum var.nov.(“yellow phenotype”strains)is currently a major cause of zoonotic tinea corporis and capitis in Europe(mostly transmitted from guinea pigs).The isolates of the“white phenotype”do not form a monophyletic group and are segregated into three taxa,T.benhamiae var.benhamiae(mostly North America;dogs),T.europaeum sp.nov.(mostly Europe;guinea pigs),and T.japonicum sp.nov.(predominant in East Asia but also found in Europe;rabbits and guinea pigs).The new species T.africanum sp.nov.is proposed for the“African”race of T.benhamiae.The introduction to new geographic areas and host jump followed by extinction of one mating type gene have played important roles in the evolution of these pathogens.Due to considerable phenotypic similarity of many dermatophytes and phenomena such as incomplete lineage sorting or occasional hybridization and introgression,we demonstrate the need to follow polyphasic approach in species delimitation.Neutrally evolving and noncoding DNA regions showed significantly higher discriminatory power compared to conventional protein-coding loci.Diagnostic options for species identification in practice based on molecular markers,phenotype and MALDI-TOF spectra are presented.A microsatellite typing scheme developed in this study is a powerful tool for the epidemiological surveillance of these emerging pathogens.
文摘Background:Skin and soft tissue infections are frequent.Candidiasis and Aspergillosis are the most common cutaneous fungal infections.Yemeni alum(Aluminium Potassium Sulphate)is a natural mineral with antifungal and antibacterial properties.Objective:This study aimed to confirm Yemeni alum’s antifungal effectiveness against selected fungal strains and develop useful topical formulations.Methods:Using different alum concentrations,we prepared twenty-three formulations,including four non-adjusted aqueous solutions,eight adjusted pH aqueous solutions,eight glycerite solutions,and three Oil/Water cream formulations.Then,we examined the antifungal activity against the suggested fungus.The animal skin irritation test evaluated the local skin sensitivity reactions that might happen upon using the formulations we pre-pared on the intact animal’s skin.Additionally,this study also included six weeks of stability testing to estimate the expected shelf life(t90)of the selected formulations.Results:Alum exerted antifungal effect against Candida albicans,Aspergillus niger,and Aspergillus flavus.The animal’s skin was not irritated by any of the formulations examined.The 5%alum aqueous solution and the 10%alum Oil/Water cream exhibited promising results among all tested formulations.The approximate formulation’s shelf-lives(t90)were 2 and 1.52 years with alum content(%)ranging between 105.75%to 106.02%,respectively.Conclusion:Based on the results we found,10%alum Oil/Water cream is a promising formulation for large-scale manufacture.
