Streptococcus pyogenes carriage and infection within households in The Gambia: a longitudinal cohort study.

BACKGROUND: Streptococcus pyogenes causes more than 500 000 deaths per year globally, which occur disproportionately in low-income and middle-income countries. The roles of S pyogenes skin and pharyngeal carriage in transmission are unclear. We aimed to investigate the clinical epidemiology and household transmission dynamics of both S pyogenes asymptomatic carriage and infection in a high-burden setting. METHODS: We did a 1-year prospective, longitudinal, household cohort study, recruiting healthy participants from households in Sukuta, The Gambia. Households were eligible if they comprised at least three members, including one child younger than 18 years, and were excluded if more than half of household members declined to participate. Households were identified by random GPS coordinates derived from census data. At monthly visits, pharyngeal and normal skin swabs were collected for S pyogenes culture, and sociodemographic data were recorded by interview. Incident pharyngitis and pyoderma infections were captured. Cultured isolates underwent emm genotyping. The primary outcome measures were incidence of S pyogenes carriage and disease. Additional outcomes were prevalence of S pyogenes skin and pharyngeal carriage, S pyogenes skin and pharyngeal clearance time, S pyogenes emm type, risk factors for carriage and disease events, household secondary attack rate, and emm-linked household transmission events. The study is registered on ClinicalTrials.gov, NCT05117528. FINDINGS: Between July 27, 2021, and Sept 28, 2022, 442 participants were enrolled from 44 households. The median age was 15 years (IQR 6-28) and 233 (53%) were female. We identified 17 pharyngitis and 99 pyoderma events and 49 pharyngeal and 39 skin S pyogenes carriage acquisition events. Mean monthly prevalence was 1·4% (95% CI 1·1-1·9) for S pyogenes pharyngeal carriage and 1·2% (0·9-1·6) for S pyogenes skin carriage. Incidence was 120 per 1000 person-years (95% CI 87-166) for S pyogenes pharyngeal carriage, 124 per 1000 person-years (90-170) for S pyogenes skin carriage, 51 per 1000 person-years (31-84) for S pyogenes pharyngitis, and 263 per 1000 person-years (212-327) for S pyogenes pyoderma. Pharyngeal carriage risk was higher during the rainy season (HR 5·67, 95% CI 2·19-14·69) and in larger households (per additional person: 1·03, 1·00-1·05), as was pharyngitis risk (rainy season: 3·00, 1·10-8·22; household size: 1·04, 1·02-1·07). Skin carriage risk was not affected by season or household size, but was lower in female than in male participants (0·45, 0·22-0·92) and highest in children younger than 5 years compared with adults (22·69, 3·08-167·21), with similar findings for pyoderma (female sex: 0·34, 0·19-0·61; age <5 years: 7·00, 2·78-17·64). Median clearance time after carriage acquisition was 4·0 days for both skin (IQR 3·5-7·0) and pharynx (3·5-7·3). The mean household secondary attack rate was 4·9 (95% CI 3·5-6·3) for epidemiologically linked S pyogenes events and 0·74 (0·3-1·2) for emm-linked S pyogenes events. Of the 204 carriage and disease events, emm types were available for 179 (88%). Only 18 emm-linked between-visit household transmission events were identified. Pyoderma was the most common source of S pyogenes household transmissions in 11 (61%) of 18 emm-linked transmissions. Both pharynx to skin and skin to pharynx transmission events were observed. INTERPRETATION: S pyogenes carriage and infection are common in The Gambia, particularly in children. Most events are non-household acquisitions, but skin carriage and pyoderma have an important role in S pyogenes household transmission and bidirectional transmission between skin and pharynx occurs. FUNDING: Wellcome Trust, Chadwick Trust, Fonds National de la Recherche Scientifique (Belgium), European Society for Paediatric Infectious Diseases, and Medical Research Council (UK).

Staphylococci isolated from cats in Italy with superficial pyoderma and allergic dermatitis: Characterisation of isolates and their resistance to antimicrobials.

BACKGROUND: In cats, superficial pyoderma traditionally is considered rare and few reports are available. There is a particular lack of studies concerning Staphylococcus species associated with pyoderma in subjects affected by allergic skin diseases. HYPOTHESIS/OBJECTIVES: (i) To evaluate the association between Staphylococcus spp. and superficial pyoderma in allergic cats and (ii) to characterise isolated staphylococci and analyse their antimicrobial resistance patterns. ANIMALS: Forty-one cats with allergic dermatitis and superficial pyoderma in Italy. MATERIALS AND METHODS: Skin swabs were cultured for the isolation of Staphylococcus spp. Species identification was performed by matrix-assisted laser desorption/ionisation time of flight mass spectrometry and 16S-rRNA sequencing. Staphylococcus aureus isolates were further characterised by staphylococcal protein A gene-typing. Antimicrobial susceptibility was performed by the disk diffusion method. RESULTS: Staphylococci were isolated from 36/41 cats sampled and 39 different isolates were identified. Uneven distribution of staphylococcal species was observed among different body locations. The 39 isolates were S. aureus (n = 15), S. felis (n = 10), S. pseudintermedius (n = 8) and other staphylococci (n = 6). Eight different S. aureus spa-types associated with human clonal complexes were identified. Antimicrobial resistance was observed to penicillin (56.4%), tetracycline (46.2%), enrofloxacin (33.3%), erythromycin (28.2%), amikacin (25.6%), clindamycin (23.1%), marbofloxacin (15.4%), gentamicin (12.8%), trimethoprim-sulfamethoxazole (10.3%), chloramphenicol (7.7%) and cefoxitin/oxacillin (5.1%). Fifteen isolates (38.4%) were multidrug-resistant while meticillin resistance was associated only with S. pseudintermedius. CONCLUSIONS AND CLINICAL RELEVANCE: These results confirm that S. aureus, S. pseudintermedius, and S. felis are frequently associated with superficial pyoderma in allergic cats. Semi-synthetic penicillins remain a suitable first-line treatment in this study, yet the high prevalence of antimicrobial resistant isolates suggests that antimicrobial susceptibility testing should be performed routinely.

Prevalence of methicillin resistance in Staphylococcus pseudintermedius isolates from dogs with skin and ear infections in South Africa.

ABSTRACT: Staphylococcus pseudintermedius (SP) is an important opportunistic pathogen, frequently associated with pyoderma and otitis in dogs. The emergence and rapid expansion of methicillin-resistant Staphylococcus pseudintermedius (MRSP) is problematic due to multidrug resistance and reduced treatment options. The aim of this study was to determine i) the prevalence of MRSP in dogs with pyoderma or otitis externa, ii) the antimicrobial resistance patterns of MRSP from South African isolates, and iii) the risk factors for MRSP-associated pyoderma or otitis externa in dogs in South Africa (RSA). Sixty-eight presumptive clinical SP isolates (collected from 65 dogs) from five geographically dispersed laboratories in RSA were collected over 2 years. Possible MRSP isolates were flagged when resistance to oxacillin was observed. Thereafter, all isolates were confirmed as SP by polymerase chain reaction (PCR) and further genotyped for the mecA gene. Fifty-seven of 68 isolates were confirmed to be SP (83.8%), while 49/57 (85.9%) carried mecA. Our findings showed that preliminary phenotypic methods supplemented by genotypic methods increased the accuracy of correctly identifying SP. All isolates were resistant to at least one antimicrobial drug. There was a high incidence of amoxicillin (70.1%) and enrofloxacin (65%) resistance. Important risk factors for mecA positive carriage were previous hospital admission, pruritus, and previous antibacterial failure. This study demonstrates a high prevalence of mecA positive carriage (85.9% of samples) in MRSP pyoderma and otitis in dogs in RSA. There is an urgent need for better laboratory diagnosis of MRSP and surveillance of dogs presenting with pyoderma and otitis in South Africa.

Prevalence of antimicrobial-resistant staphylococci in nares and affected sites of pet dogs with superficial pyoderma.

Currently, antimicrobial-resistant staphylococci, particularly methicillin-resistant Staphylococcus pseudintermedius (MRSP), are frequently isolated from canine superficial pyoderma in Japan. However, little is known regarding the nasal prevalence of MRSP in pet dogs. Here, we determined the prevalence of antimicrobial-resistant staphylococci in nares and affected sites of pet dogs with superficial pyoderma. Of the 125 nares and 108 affected sites of pet dogs with superficial pyoderma, 107 (13 species) and 110 (eight species) staphylococci strains, respectively, were isolated. The isolation rate of S. pseudintermedius from pyoderma sites (82/110 strains, 74.5%) was significantly higher than that from nares (57/107 strains, 53.3%) (P<0.01). Notably, the prevalence of MRSP (18/57 strains, 31.6%) in nares was equivalent to that in pyoderma sites (28/82 strains, 34.1%). Furthermore, the phenotypes and genotypes of antimicrobial resistance in MRSP strains from nares were similar to those from pyoderma sites. Our findings revealed that the prevalence of antimicrobial-resistant staphylococci in the nares of pet dogs with superficial pyoderma is the same level as that in affected sites. Therefore, considerable attention should be paid to the antimicrobial resistance of commensal staphylococci in companion animals.

Association between Fur Animal Necrotizing Pyoderma in breeding farm mink (Neovison vison) and reduced fertility.

BACKGROUND: The disease Fur Animal Necrotizing Pyoderma (FNP) has since 2000 been reported in many fur producing countries including Canada, Finland and Denmark. Development of FNP is characterised by rapidly forming treatment-resistant wounds on paws and in the head region. Economic losses related to FNP have been associated with mortality and decreased fur quality as well as increased veterinary costs. Also it has been suggested that FNP may be associated with reduced production results for breeding mink. The aim of this study was to evaluate if there is an association between FNP lesions in breeding animals and reduced production results based on a retrospective cohort study. RESULTS: 1465 breeding animals (244 males and 1221 females) were followed during the breeding season 2019 on five Danish mink farms. Two farms were removed from the analysis since no occurrence of FNP appeared in the observation group. After exclusion, 846 breeding animals (148 males and 698 females) remained in the analysis and were divided into two groups: exposed (EXP) or non-exposed (N-EXP) depending on the disease history of the males during mating. Females exposed to FNP positive males during breeding in average produce 14% fewer kits (P = 0.032) and these females were also more than double as likely to produce small litters (N ≥ 3) than N-EXP females. Female's from the EXP group were introduced more times to males than females in the N-EXP group (P = 0.0001, 2.5 more times in average). Females in the EXP group did not have a statistically higher risk of becoming barren (P = 0.138) though the relative risk of becoming barren was 77% higher after encountering a FNP male. CONCLUSIONS: This study shows that FNP has more economic losses for the farms than direct loss of animals. Females in contact with males with FNP lesion during breeding have a higher risk of becoming barren, and produce significantly fewer kits compared to females whom haven't been in contact with a FNP positive male.

Evidence of new sequence types of methicillin-resistant Staphylococcus pseudintermedius in Italy.

Staphylococcus pseudintermedius (SP) and methicillin-resistant SP (MRSP) is one of the most important veterinary pathogens in the dog. Herein, from a total of 126 S. pseudintermediusstrains, 23 MRSP (18%) were identified. Multi-Locus Sequence Typing (MLST) revealed that most of MRSP strains belonged to ST71 (26%), which have been already reported in Italy and other countries. Interestingly, nine new sequence types (39%), from 1053 up to 1061, were described for the first time. Moreover, the isolated MRSP strains showed relevant antibiotic resistance profiles. This report highlights the circulation of new sequence types of MRSP in Italy and underlines the need of a global epidemiological surveillance to limit the increasing spread of multidrug-resistant MRSPstrains worldwide, since they may represent a considerable concern for dog's health.

The prevalence of scabies, pyoderma and other communicable dermatoses in the Bijagos Archipelago, Guinea-Bissau.

INTRODUCTION: Skin diseases represent a significant public health problem in most low and middle income settings. Nevertheless, there is a relative paucity of high-quality epidemiological data on the prevalence of these conditions. MATERIALS/METHODS: We conducted two cross-sectional population-based skin-surveys of children (6 months to 9 years old) in the Bijagós Archipelago of Guinea-Bissau during the dry season (February-March 2018) and the wet season (June-July 2018). Following a period of training, a nurse performed a standardised examination for communicable dermatoses for each participant. We calculated the prevalence of each skin condition and investigated demographic associations. RESULTS: 1062 children were enrolled in the dry season survey of whom 318 (29.9%) had at least one skin diseases. The most common diagnosis was tinea capitis (154/1062, 14.5% - 95% CI 12.5-16.8%) followed by tinea corporis (84/1062, 7.9% - 95% CI 6.4-9.7%), pyoderma (82/1062, 7.7% - 95% CI 6.2-9.5%) and scabies (56/1062. 5.2% - 95%CI 4.0-6.8%). 320 children were enrolled in the wet season survey of whom 121 (37.8%) had at least one skin problem. Tinea capitis remained the most common diagnosis (79/320, 24.7% - 95% CI 20.1-29.9%), followed by pyoderma (38/320, 11.9% - 95% CI 8.6-16.1%), tinea corporis (23/320, 7.2% - 95% 4.7-10.7%) and scabies (6/320, 1.9% - 95% CI 0.8-4.2%). CONCLUSIONS: Our study, which utilised robust population-based cluster random sampling methodology, demonstrates the substantial disease burden caused by common communicable dermatoses in this setting. Given these findings, there is a need to consider common dermatoses as part of Universal Health Coverage to deliver 'skin-health for all'.

High burden and seasonal variation of paediatric scabies and pyoderma prevalence in The Gambia: A cross-sectional study.

BACKGROUND: Scabies is a WHO neglected tropical disease common in children in low- and middle-income countries. Excoriation of scabies lesions can lead to secondary pyoderma infection, most commonly by Staphyloccocus aureus and Streptococcus pyogenes (group A streptococcus, GAS), with the latter linked to acute post-streptococcal glomerulonephritis (APSGN) and potentially rheumatic heart disease (RHD). There is a paucity of data on the prevalence of these skin infections and their bacterial aetiology from Africa. METHODOLOGY/PRINCIPAL FINDINGS: A cross-sectional study, conducted over a four-month period that included the dry and rainy season, was conducted to determine the prevalence of common skin infections in Sukuta, a peri-urban settlement in western Gambia, in children <5 years. Swabs from pyoderma lesions were cultured for S. aureus and GAS. Of 1441 children examined, 15.9% had scabies (95% CI 12.2-20.4), 17.4% had pyoderma (95% CI 10.4-27.7) and 9.7% had fungal infections (95% CI 6.6-14.0). Scabies was significantly associated with pyoderma (aOR 2.74, 95% CI 1.61-4.67). Of 250 pyoderma swabs, 80.8% were culture-positive for S. aureus, and 50.8% for GAS. Participants examined after the first rains were significantly more likely to have pyoderma than those examined before (aRR 2.42, 95% CI 1.38-4.23), whereas no difference in scabies prevalence was seen (aRR 1.08, 95% CI 0.70-1.67). Swab positivity was not affected by the season. CONCLUSIONS/SIGNIFICANCE: High prevalence of scabies and pyoderma were observed. Pyoderma increased significantly during the rainy season. Given the high prevalence of GAS pyoderma among children, further research on the association with RHD in West Africa is warranted.

Prevalence of Community-Acquired Pyoderma in Dermatological Outpatient Department of a Tertiary Care Hospital.

INTRODUCTION: Pyoderma is defined as any purulent skin disease and represents infections in epidermis and dermis or hair follicles. This study aims to find out the prevalence of community-acquired pyoderma in dermatological outpatient department of a tertiary care hospital. METHODS: A descriptive cross-sectional study was carried out among patients who presented at dermatology outpatient department of Kathmandu Medical College Teaching Hospital between December 2018 and March 2019 after ethical clearance from institutional review committee. Convenience sampling method was done. Data was collected and analysis was done using SPSS software, point estimate at 95% CI was calculated along with frequency and proportion for binary data. RESULTS: Out of 385 cases, 72 (18%) cases were of community-acquired pyoderma. Prevalence of community-acquired pyoderma is 72 (18%). Primary pyoderma was seen in 49 (12.72%) mainly folliculitis 17 (4.41%), furunculosis 16 (4.15%), impetigo 6 (1.55%), abscess 6 (1.55%) and bacterial paronychia 4 (1.03%). Staphylococcus aureus was the most common organism isolated in 42 (58.3%) cases and Staphylococcus epidermidis was isolated in 3 (4.17%) cases. Staphylococcus aureus was most sensitive to Vancomycin 42 (100%) followed by Gentamycin 40 (95.2%), Ciprofloxacin 40 (95.2%) and Ceftriaxone 40 (95.2%). Highest resistance was seen to Azithromycin in 13 (30.95%), followed by Cloxacilllin in 11 (26.19%). Males were affected predominantly in 49 (68.06%) as compared to females in 23 (31.94%). CONCLUSIONS: Prevalence of community-acquired pyoderma is high among patients visiting dermatological outpatient departments of a tertiary care hospital compared to other studies. Antibiotic resistance of commonly used antibiotics are increasing and thus proper culture and sensitivity reports may be required to guide our treatment.

Disorders of Bulldogs under primary veterinary care in the UK in 2013.

The Bulldog is a popular companion breed in the UK despite widely reported disease predispositions. This study aimed to characterise the demography, mortality and common disorders of Bulldogs under veterinary care in the UK during 2013. VetCompass collates anonymised clinical data from UK primary-care veterinary practices for epidemiological research. The clinical records of all Bulldogs available in the VetCompass study dataset were reviewed manually in detail to extract the most definitive diagnoses recorded for all disorders that existed during 2013 and for all deaths. Bulldogs comprised 1621 (0.36%) of 445,557 study dogs. Bulldogs increased from 0.35% of the 2009 birth cohort to 0.60% in 2013. Median longevity was 7.2 years, which was lower in males (6.7 years) than females (7.9 years) (P = 0.021). The most prevalent fine-level precision disorders recorded were otitis externa (n = 206, prevalence 12.7%, 95% CI: 11.1-14.4), pyoderma (142, 8.8%, 95% CI: 7.4-10.2) and overweight/obesity (141, 8.7%, 95% CI: 7.4-10.2). The most prevalent disorder groups were cutaneous (n = 463, prevalence: 28.6%, 95% CI: 26.4-30.8), ophthalmological (292, 18.0%, 95% CI: 16.2-20.0), aural (211, 13.0%, 95% CI: 11.4-14.8), enteropathy (188, 11.6%, 95% CI: 10.1-13.3) and upper respiratory tract (171, 10.5%, 95% CI: 9.1-12.1). Provision of an evidence base on the most common disorders and causes of mortality within breeds can support owners, breeders and the veterinary profession to improve health and welfare within these breed.

Low prevalence of mupirocin resistance in Staphylococcus pseudintermedius isolates from canine pyoderma in Korea.

BACKGROUND: Mupirocin is a topical antibacterial drug used for the treatment of staphylococcal infections, including meticillin-resistant Staphylococcus pseudintermedius (MRSP). The recent emergence of resistance to mupirocin is a major concern in many countries. OBJECTIVES: This study investigated the prevalence and genotype of mupirocin-resistant S. pseudintermedius isolated from pet dogs with pyoderma. SAMPLES: A total of 110 clinical isolates of S. pseudintermedius were collected from dogs with pyoderma (n = 110) between July 2010 and September 2016. All animals were client-owned dogs. METHODS: Low- and high-level mupirocin resistance were evaluated with both the broth microdilution and disk diffusion tests. Mupirocin resistance in S. pseudintermedius isolates was confirmed by genetic analysis of the ileS-2 and naïve ileS genes. RESULTS: MRSP and meticillin-susceptible S. pseudintermedius were detected in 69 and 41 dogs, respectively. One MRSP strain was highly resistant to mupirocin and contained the high-level mupirocin resistance gene ileS-2. There were no low-level mupirocin-resistant isolates. CONCLUSION AND CLINICAL IMPORTANCE: Mupirocin is a useful topical antibacterial for MRSP, but a clinical MRSP isolate that had not previously been exposed to mupirocin exhibited the high-level mupirocin resistance in phenotype and genotype. Therefore, continuous monitoring for mupirocin resistance is important in small animal practice.

Clonal Complexes and Antimicrobial Susceptibility Profiles of Staphylococcus pseudintermedius Isolates from Dogs in the United States.

Staphylococcus pseudintermedius is the primary cause of canine pyoderma and has been associated with diseases in other animals, including human beings. A high prevalence of methicillin and multidrug resistance has been reported in this bacterium in some geographic regions of the United States. Multilocus sequence type (MLST) 68 was implicated, initially, as the major clonal genotype based on a limited number of samples. The objectives of this study were to determine the population genetics of S. pseudintermedius isolated from a cross-section of the United States using a seven-locus multilocus sequence typing method, to identify clonal complexes (CCs), and to correlate sequence types with antimicrobial susceptibility profiles. A total of 190 S. pseudintermedius with 86 different MLSTs were detected and the constituents of three major CCs of methicillin-resistant S. pseudintermedius (MRSP), CC68, CC71, and CC84, were identified. Different patterns of resistance were associated with each CC. CC71 from the United States had notable differences with CC71 studied on other continents with chloramphenicol, tetracycline, and trimethoprim/sulfamethoxazole resistance. Some isolates with resistance to the broadest range of drugs tested, including that to chloramphenicol, had STs unrelated to the major CCs, suggesting the potential for the emergence of new clonal populations of MRSP that are resistant to most therapeutically useful antimicrobials.

Pyoderma outbreak among kindergarten families: Association with a Panton-Valentine leukocidin (PVL)-producing S. aureus strain.

OBJECTIVES: We report on an outbreak of skin and soft tissue infections (SSTI) among kindergarten families. We analyzed the transmission route and aimed to control the outbreak. METHODS: The transmission route was investigated by nasal screening for Panton-Valentine leukocidin (PVL)-producing Staphylococcus aureus (PVL-SA), subsequent microbiological investigation including whole genome sequencing and a questionnaire-based analysis of epidemiological information. The control measures included distribution of outbreak information to all individuals at risk and implementation of a Staphylococcus aureus decontamination protocol. RESULTS: Individuals from 7 of 19 families were either colonized or showed signs of SSTI such as massive abscesses or eye lid infections. We found 10 PVL-SA isolates in 9 individuals. In the WGS-analysis all isolates were found identical with a maximum of 17 allele difference. The clones were methicillin-susceptible but cotrimoxazole resistant. In comparison to PVL-SAs from an international strain collection, the outbreak clone showed close genetical relatedness to PVL-SAs from a non-European country. The questionnaire results showed frequent travels of one family to this area. The results also demonstrated likely transmission via direct contact between families. After initiation of Staphylococcus aureus decontamination no further case was detected. CONCLUSIONS: Our outbreak investigation showed the introduction of a PVL-SA strain into a kindergarten likely as a result of international travel and further transmission by direct contact. The implementation of a Staphylococcus aureus decontamination protocol was able to control the outbreak.

Clonal distribution of methicillin-resistant Staphylococcus pseudintermedius isolates from skin infection of dogs in Korea.

Bacterial infection by methicillin-resistant Staphylococcus pseudintermedius (MRSP) is challenging in a small animal practice. Zoonotic transmission may occur. The aim of this study was to investigate the genotypic profiles of MRSP isolated from bacterial infections of canine skin in Korea and to compare their molecular lineages with dominant strains from other countries. Sixty MRSP isolates were obtained from the lesions of canine pyoderma and otitis externa. Their genetic diversity was assessed by multilocus sequence typing (MLST), staphylococcal protein A (spa) typing and direct-repeat unit (dru) typing. Staphylococcal cassette chromosome mec (SCCmec) elements were characterized by multiplex PCR. Thirty-nine different sequence types (STs) were detected. Among them, 21 STs were identified as internationally new sequence types. Fourteen dru types (dts) were detected, and the major types were dt11a and dt11y. spa typing characterised 21 isolates (35%, 21/60), including spa types t02 (n=8), t05 (n=5), t06 (n=6), and t15 (n=2). Two clonal complexes, CC568 and CC677, were revealed by MLST; this result differed from the dominant STs detected in MRSP isolates from Europe, North America, and other Asian countries. SCCmec type V was the major type (27/60. 45%), and 30 (50%) isolates were non-typeable by conventional classifying method. This is the first report about the clonal lineage of MRSP isolated from Korea. MRSP isolated from dogs in Korea displays independent lineage from other countries. Surveillance is needed to confirm cross-national disseminating patterns.

Questionnaire survey of detrimental fur animal epidemic necrotic pyoderma in Finland.

BACKGROUND: In 2007, a previously unrecorded disease, fur animal epidemic necrotic pyoderma (FENP), was detected in farmed mink (Neovision vision), foxes (Vulpes lagopus) and Finnraccoons (Nyctereutes procyonoides) in Finland. Symptoms included severe pyoderma with increased mortality, causing both animal welfare problems and economic losses. In 2011, an epidemiologic questionnaire was mailed to all members of the Finnish Fur Breeders' Association to assess the occurrence of FENP from 2009 through the first 6 months of 2011. The aim was to describe the geographical distribution and detailed clinical signs of FENP, as well as sources of infection and potential risk factors for the disease. RESULTS: A total of 239 farmers (25%) returned the questionnaire. Clinical signs of FENP were observed in 40% (95% CI 34-46%) of the study farms. In addition, the survey clarified the specific clinical signs for different animal species. The presence of disease was associated with the importation of mink, especially from Denmark (OR 9.3, 95% CI 2.6-33.0). The transmission route between Finnish farms was associated with fur animal purchases. Some risk factors such as the farm type were also indicated. As such, FENP was detected more commonly on farms with more than one species of fur animal in comparison to farms with, for example, only foxes (OR 4.6, 95% CI 2.4-8.6), and the incidence was higher on farms with over 750 breeder mink compared to smaller farms (OR 3.8, 95% CI 1.6-9.0). Contact between fur animals and birds and other wildlife increased the risk of FENP on farms. Responses also indicated that blocking the entry of wildlife to the animal premises protected against FENP. CONCLUSIONS: FENP was most likely introduced to Finland by imported mink and spread further within the country via domestically purchased fur animals. Some potential risk factors, such as the type and size of the farm and contact with wildlife, contributed to the spread of FENP. Escape-proof shelter buildings block the entry of wildlife, thus protecting fur animals against FENP.

Pyostomatitis vegetans (PSV)-pyodermatitis vegetans (PDV): A clinicopathologic study of 7 cases at a tertiary referral center.

BACKGROUND: Pyostomatitis vegetans (PSV)-pyodermatitis vegetans (PDV) is a rare inflammatory mucocutaneous disease associated with inflammatory bowel disease. OBJECTIVE: We sought to evaluate the clinicopathologic findings of PSV-PDV in a series of 7 patients. METHODS: We conducted a retrospective review of all cases of PSV-PDV at the Mayo Clinic from 1995 to 2014. RESULTS: Seven patients with PSV-PDV were included, and all had inflammatory bowel disease. Three had Crohn's disease and 4 had ulcerative colitis. Three patients had peripheral blood eosinophilia. Two had concomitant pyoderma gangrenosum in which pyoderma gangrenosum lesions were recalcitrant to therapy. Primary sclerosing cholangitis was seen in 3 patients. Two patients had direct and 3 had indirect immunofluorescence findings. Tissue eosinophilia was seen in the majority of mucosal and cutaneous lesions. LIMITATIONS: Limited sample size and retrospective study design are limitations. CONCLUSIONS: PSV-PDV is associated with inflammatory bowel disease and primary sclerosing cholangitis and may precede gastrointestinal symptoms. Immunofluorescence findings in select PSV-PDV cases may indicate possible overlap with autoimmune bullous disease. Tissue eosinophilia may be helpful in distinguishing PSV-PDV from pyoderma gangrenosum. Strict control of bowel disease and close monitoring of patients with subclinical disease is warranted.

Clinico-bacteriological profile of primary pyodermas in Kashmir: a hospital-based study.

Pyodermas are a common group of infectious dermatological conditions on which few studies have been conducted. This study aimed to characterise the clinical and bacteriological profile of pyodermas, and to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) infection in primary pyodermas in a dermatology outpatient department in Kashmir. Methods We conducted a hospital based cross-sectional study in the outpatient Department of Dermatology, Sexually Transmitted Diseases and Leprosy of Shri Maharaja Hari Singh Hospital, Srinagar, Jammu and Kashmir, India. Patients presenting with primary pyodermas were included in the study. A detailed history and complete physical and cutaneous examination was carried out along with microbiological testing to find aetiological microorganisms and their respectiveantimicrobial susceptibility patterns. Antimicrobial susceptibility testing, including that for methicillin resistance, was carried out by standard methods as outlined in the current Clinical and Laboratory Standards Institute guidelines. Results In total, 110 patients were included; the age of the study population ranged from 3 to 65 years (mean age 28 years); 62% were male. Poor personal hygiene was noted in 76 (69%). Furunculosis (56; 51%) was the most common clinical presentation. Staphylococcus aureus was isolated in 89 (81%) of cases, and MRSA formed 54/89 (61%) of Staphylococcus aureus isolates. All MRSA strains were sensitive to vancomycin. Conclusion The prevalence of MRSA was high in this sample of communityacquired primary pyodermas. It is therefore important to monitor the changing trends in bacterial infection and their antimicrobial susceptibility patterns and to formulate a definite antibiotic policy which may be helpful in decreasing the incidence of MRSA infection.

Antimicrobial resistance, integron carriage, and gyrA and gyrB mutations in Pseudomonas aeruginosa isolated from dogs with otitis externa and pyoderma in Brazil.

BACKGROUND: Pseudomonas aeruginosa is associated with otitis and pyoderma in dogs and is frequently resistant to several antimicrobial drugs. Resistance genes can be carried by integrons with quinolone resistance mainly due to mutations in DNA topoisomerases II and IV. OBJECTIVE: To evaluate the antimicrobial susceptibility, integron carriage, and gyrA and gyrB mutations in P. aeruginosa isolates from canine otitis and pyoderma. ANIMALS: One hundred and four P. aeruginosa strains isolated from dogs with otitis externa (n = 93) and pyoderma (n = 11). METHODS: Antimicrobial susceptibility against 16 antibacterial agents was evaluated through agar diffusion tests. Integron carriage, class and gyrA and gyrB mutations were analysed by PCR, restriction fragment length polymorphism (RFLP)-PCR and genetic sequencing assays. RESULTS: Isolates were mostly resistant to enrofloxacin (72.2%) and ticarcillin (59.7%). Lower resistance to ciprofloxacin (7.7%), tobramycin (3.8%) and polymixin B (0.0%) was detected. Ten (9.6%) multidrug-resistant (MDR) strains were detected. Eight (7.7%) strains carried class 1 integrons and this was associated with MDR (three isolates, P ≤ 0.05). Five of the integron-carrying strains exhibited aminoglycoside resistance genes. Mutations of gyrA and gyrB were observed in 10 isolates, seven of them resistant to all fluoroquinolones tested. CONCLUSIONS AND CLINICAL IMPORTANCE: Enrofloxacin and ticarcilin resistance was widespread in P. aeruginosa isolated from dogs in Brazil. Pseudomonas aeruginosa carrying integrons may present a significant challenge for treatment.

The Global Epidemiology of Impetigo: A Systematic Review of the Population Prevalence of Impetigo and Pyoderma.

OBJECTIVE: We conducted a comprehensive, systematic review of the global childhood population prevalence of impetigo and the broader condition pyoderma. METHODS: PubMed was systematically searched for impetigo or pyoderma studies published between January 1 1970 and September 30 2014. Two independent reviewers extracted data from each relevant article on the prevalence of impetigo. FINDINGS: Sixty-six articles relating to 89 studies met our inclusion criteria. Based on population surveillance, 82 studies included data on 145,028 children assessed for pyoderma or impetigo. Median childhood prevalence was 12·3% (IQR 4·2-19·4%). Fifty-eight (65%) studies were from low or low-middle income countries, where median childhood prevalences were 8·4% (IQR 4·2-16·1%) and 14·5% (IQR 8·3-20·9%), respectively. However, the highest burden was seen in underprivileged children from marginalised communities of high-income countries; median prevalence 19·4%, (IQR 3·9-43·3%). CONCLUSION: Based on data from studies published since 2000 from low and low-middle income countries, we estimate the global population of children suffering from impetigo at any one time to be in excess of 162 million, predominantly in tropical, resource-poor contexts. Impetigo is an under-recognised disease and in conjunction with scabies, comprises a major childhood dermatological condition with potential lifelong consequences if untreated.