Familial Monkeypox Virus Infection Involving 2 Young Children.

We report intrafamilial transmission of monkeypox virus to all members of a family (father, mother, and 2 children). Case reports in young children have been extremely rare during the 2022 mpox outbreak. Their clinical signs were mild, and clinical diagnosis would be difficult without knowledge of the father's monkeypox virus infection.

Erythema Migrans Caused by Borrelia spielmanii, France.

We describe a rare case of early Lyme borreliosis in France caused by Borrelia spielmanii, which manifested as a large erythema chronicum migrans rash. The patient completely recovered after a 15-day course of amoxicillin. Absence of pathognomonic signs prevented distinguishing B. spielmanii from other etiologies as cause in this case-patient.

Anti-BP180 IgG antibody ELISA values correlate with adverse pregnancy outcomes in pemphigoid gestationis.

BACKGROUND: Adverse pregnancy outcomes (APO) occur in 35% of patients with pemphigoid gestationis (PG). No biological predictor of APO has been established yet. OBJECTIVES: To assess a potential relationship between the occurrence of APO and the serum value of anti-BP180 antibodies at the time of PG diagnosis. METHODS: Multicentre retrospective study conducted from January 2009 to December 2019 in 35 secondary and tertiary care centres. INCLUSION CRITERIA: (i) diagnosis of PG according to clinical, histological and immunological criteria, (ii) ELISA measurement of anti-BP180 IgG antibodies determined at the time of PG diagnosis with the same commercial kit and (iii) obstetrical data available. RESULTS: Of the 95 patients with PG included, 42 had one or more APO, which mainly corresponded to preterm birth (n = 26), intrauterine growth restriction (IUGR) (n = 18) and small weight for gestational age at birth (n = 16). From a ROC curve, we identified a threshold of 150 IU ELISA value as the most discriminating to differentiate between patients with or without IUGR, with 78% sensitivity, 55% specificity, 30% positive and 91% negative predictive value. The threshold >150 IU was confirmed using a cross-validation based on bootstrap resampling, which showed that the median threshold was 159 IU. Upon adjusting for oral corticosteroid intake and main clinical predictors of APO, an ELISA value of >150 IU was associated with the occurrence of IUGR (OR = 5.11; 95% CI: 1.48-22.30; p = 0.016) but not with any other APO. The combination of blisters and ELISA values higher than 150 IU led to a 2.4-fold higher risk of all-cause APO (OR: 10.90; 95% CI: 2.33-82.3) relative to patients with blisters but lower values of anti-BP180 antibodies (OR of 4.54; 95% CI 0.92-34.2). CONCLUSION: These findings suggest that anti-BP180 antibody ELISA value in combination with clinical markers is helpful in managing the risk of APO, in particular IUGR, in patients with PG.

Nocardia takedensis: a newly recognized pathogen responsible for skin and soft tissue infections.

Nocardia takedensis was first isolated in 2005, from soil in Japan. We report here two cases of lymphangitis in France (2012-2017) caused by N. takedensis both occurring after skin injury while gardening, which enabled its inoculation. The two patients were immunocompromised and successfully treated by an antimicrobial agent active on the isolated strain, trimethoprim-sulfamethoxazole and amoxicillin-clavulanic acid for patient one and patient two, respectively. Our study along with previous ones supports the idea of a newly recognized cutaneous opportunistic pathogen and reinforces the recommendation of using gloves during soil exposure for immunocompromised patients. Lastly, according to data found in the literature, we would recommend trimethoprim-sulfamethoxazole as an efficient empirical antibiotic therapy in case of cutaneous infection caused by N. takedensis.

Skin Infections Caused by Staphylococcus aureus.

Staphylococcus aureus is the most common pathogen involved in skin infections worldwide, regardless of the patient's age, the climate or geographical area. The main skin clinical manifestations can be linked to a few toxins produced by the bacteria, which give rise to a rich and varied clinical spectrum. Panton Valentine leucocidin, exfoliatins, enterotoxins and toxin shock syndrome toxin 1 are the main toxins involved in most dermatological manifestations associated with S. aureus. Other less frequent cutaneous manifestations can occur in endocarditis, bacteraemia. Currently, the most important event is worldwide emergence of community-acquired S. aureus resistant to methicillin (CA-MRSA), mainly causing skin infections.

Prevalence and Clinical Characteristics of Cutaneous Manifestations Associated with Bacteraemia: A Cross-sectional Prospective Study.

Bacteraemias are life-threatening conditions that require rapid care and antibiotherapy. Dermatological signs might help in deciding the most relevant treatment. The aim of this study was to determine the prevalence and clinical characteristics of cutaneous manifestations in hospitalized patients with bacteraemia. A cross-sectional study was conducted over a period of 1 year. All consecutive patients with a bacteraemia (except contaminations) were included and examined by a dermatologist within 48 h after positive blood cultures. Clinical (skin manifestations, diagnosis, origin of the bacteraemia) and laboratory (bacteria) data were recorded. In total, 401 bacteraemias in 375 patients were included for the final analysis. Thirty-nine cutaneous manifestations in 34 patients were noted, corresponding to a prevalence of 9%; 69% (n = 27) were considered primary cutaneous manifestations, 18% (n = 7) as secondary ones, 10% (n = 4) as contiguous, and 3% (n = 1) as undetermined. Gram-positive cocci, specifically Staphylococcus aureus and Streptococcus species, were the most frequent bacteria (n = 27, 69%).

Autochthonous Cutaneous Larva Migrans in France and Europe.

Cutaneous larva migrans is a dermatitis, typically acquired in warm tropical or sub-tropical countries, caused by migration of the larvae of nematodes (hookworm; mainly Ancylostoma braziliense and, occasionally, Ancylostoma caninum or Uncinaria stenocephala), which are parasitic on animals such as cats and dogs, into the patient's skin. The larvae penetrate the skin after contact with infected soil and cause a typical creeping eruption. Patients with cutaneous larva migrans seen in Europe have usually acquired the disease following a stay in a tropical or sub-tropical area. How-ever, some cases of cutaneous larval migrans are acquired in Europe. We report here 5 autochthonous cases in France and give an overview of European autochthonous cases.

Clinical Aspects of Syphilis Reinfection in HIV-Infected Patients.

BACKGROUND: The incidence of HIV-syphilis co-infection has risen since 2000, especially among men having sex with men (MSM). Syphilis reinfection can occur, but the clinical features of such events remain poorly characterized. OBJECTIVE: To compare the cutaneous lesions seen with syphilis reinfections with those of first episodes in HIV-infected patients. METHODS: In a cohort of HIV-infected patients, syphilis reinfection was established both clinically and biologically by evaluating changes in Venereal Disease Research Laboratory titers. Photographs and medical records were studied in order to determine the type of skin lesions and their quantification. RESULTS: Among 533 HIV-infected patients, 42 (8%) experienced a first syphilis infection. Thirteen episodes of reinfection occurred in 12/42 (28%) patients, all MSM. In 78% of cases, reinfections were less symptomatic than first episodes. All patients presented classical syphilis lesions. CONCLUSIONS: We observed a high rate of reinfection, but with less severe skin manifestations during reinfection episodes.

Different patterns of skin manifestations associated with parvovirus B19 primary infection in adults.

BACKGROUND: Skin involvement is reported during primary parvovirus B19 infection in adults. OBJECTIVES: We sought to describe the cutaneous presentations associated with parvovirus B19 primary infection in adults. METHODS: We conducted a descriptive, retrospective, multicenter study. The patients included (>18 years old) had well-established primary infections with parvovirus B19. RESULTS: Twenty-nine patients were identified between 1992 and 2013 (17 women, 12 men). The elementary dermatologic lesions were mostly erythematous (86%) and often purpuric (69%). Pruritus was reported in 48% of cases. The rash predominated on the legs (93%), trunk (55%), and arms (45%), with a lower frequency of facial involvement (20%). Four different but sometimes overlapping patterns were identified (45%): exanthema, which was reticulated and annular in some cases (80%); the gloves-and-socks pattern (24%); the periflexural pattern (28%); and palpable purpura (24%). LIMITATIONS: The limitations of this study were its retrospective design and possible recruitment bias in tertiary care centers. CONCLUSION: Our findings suggest that primary parvovirus B19 infection is associated with polymorphous skin manifestations with 4 predominant, sometimes overlapping, patterns. The acral or periflexural distribution of the rash and the presence of purpuric or annular/reticulate lesions are highly suggestive of parvovirus B19 infection.

Secondary Bacterial Infections in Patients with Atopic Dermatitis or Other Common Dermatoses.

Secondary bacterial infections of common dermatoses such as atopic dermatitis, ectoparasitosis, and varicella zoster virus infections are frequent, with Staphylococcus aureus and Streptococcus pyogenes being the bacteria most involved. There are also Gram-negative infections secondary to common dermatoses such as foot dyshidrotic eczema and tinea pedis. Factors favoring secondary bacterial infections in atopic dermatitis, ectoparasitosis, and varicella zoster virus infections mainly include an epidermal barrier alteration as well as itch. Mite-bacteria interaction is also involved in scabies and some environmental factors can promote Gram-negative bacterial infections of the feet. Furthermore, the bacterial ecology of these superinfections may depend on the geographical origin of the patients, especially in ectoparasitosis. Bacterial superinfections can also have different clinical aspects depending on the underlying dermatoses. Subsequently, the choice of class, course, and duration of antibiotic treatment depends on the severity of the infection and the suspected bacteria, primarily targeting S. aureus. Prevention of these secondary bacterial infections depends first and foremost on the management of the underlying skin disorder. At the same time, educating the patient on maintaining good skin hygiene and reporting changes in the primary lesions is crucial. In the case of recurrent secondary infections, decolonization of S. aureus is deemed necessary, particularly in atopic dermatitis.

Absence of community-acquired methicillin-resistant Staphylococcus aureus carriage or infection in a cohort of 300 men who have sex with men attending an inner-city sexually transmitted disease clinic in Paris, France.

BACKGROUND: Community-acquired methicillin-resistant Staphylococcus aureus (caMRSA) skin and soft-tissue infections are a major cause for concern. Communities of men who have sex with men (MSM) in the USA being prone to caMRSA epidemics, we investigated whether MSM attending our sexually transmitted disease clinic were carriers of or infected by caMRSA. METHODS: 300 MSM were prospectively recruited, interrogated and examined. Swabs of their nares and of their pubic and perineal skin were taken and cultured. RESULTS: No evidence of carriage or infection by caMRSA was found. Nasal carriage of methicillin-sensitive S. aureus was within French estimates. Perineal carriage significantly correlated with the number of sexual partners. CONCLUSION: Although caMRSA carriage or infection does not seem to affect Paris MSM, prospective sampling may not be the best method to monitor them. The correlation between number of partners and perineal carriage suggests that thorough hygiene after intercourse could limit the spread of S. aureus in MSM with multiple partners.

Bedbugs and infectious diseases.

Bedbugs are brown and flat hematophagous insects. The 2 cosmopolite species, Cimex lectularius and Cimex hemipterus, feed on humans and/or domestic animals, and recent outbreaks have been reported in occidental countries. Site assessment for bedbug eradication is complex but can be assured, despite emerging insecticide resistance, by hiring a pest-control manager. The common dermatological presentation of bites is an itchy maculopapular wheal. Urticarial reactions and anaphylaxis can also occur. Bedbugs are suspected of transmitting infectious agents, but no report has yet demonstrated that they are infectious disease vectors. We describe 45 candidate pathogens potentially transmitted by bedbugs, according to their vectorial capacity, in the wild, and vectorial competence, in the laboratory. Because of increasing demands for information about effective control tactics and public health risks of bedbugs, continued research is needed to identify new pathogens in wild Cimex species (spp) and insecticide resistance.

Panton-Valentine leukocidin-positive Staphylococcus aureus strains are associated with follicular skin infections.

BACKGROUND/AIMS: Panton-Valentine leukocidin (PVL)-positive Staphylococcus aureus have been associated with suppurative infections; however, their precise role in skin infections has not been elucidated. We studied the rate of PVL-positive S. aureus in the different types of skin infections and compared follicular to nonfollicular skin infections. METHODS: In our institution, patients with a skin infection caused by S. aureus were enrolled in a prospective, observational cohort study (from July 1, 2003 to June 30, 2010). We studied the rate of PVL-positive S. aureus in the different clinical types of skin infections and compared the rate of PVL-positive S. aureus in follicular infections to that in nonfollicular infections. RESULTS: A total 229 skin infections were included: 97 (42.5%) were caused by PVL-positive strains. Thirty-nine of the 53 (74%) follicular infections [8 of the 17 (47%) with folliculitis, 30 of the 35 (85.5%) with furuncles and 1 with a carbuncle (100%)] were caused by PVL-positive S. aureus, compared to 16 of the 131 (12%) nonfollicular infections (p < 0.001). CONCLUSION: PVL-positive S. aureus strains are mainly associated with follicular skin infections.

A systematic review and an individual patient data meta-analysis of ivermectin use in children weighing less than fifteen kilograms: Is it time to reconsider the current contraindication?

BACKGROUND: Oral ivermectin is a safe broad spectrum anthelminthic used for treating several neglected tropical diseases (NTDs). Currently, ivermectin use is contraindicated in children weighing less than 15 kg, restricting access to this drug for the treatment of NTDs. Here we provide an updated systematic review of the literature and we conducted an individual-level patient data (IPD) meta-analysis describing the safety of ivermectin in children weighing less than 15 kg. METHODOLOGY/PRINCIPAL FINDINGS: A systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for IPD guidelines by searching MEDLINE via PubMed, Web of Science, Ovid Embase, LILACS, Cochrane Database of Systematic Reviews, TOXLINE for all clinical trials, case series, case reports, and database entries for reports on the use of ivermectin in children weighing less than 15 kg that were published between 1 January 1980 to 25 October 2019. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO): CRD42017056515. A total of 3,730 publications were identified, 97 were selected for potential inclusion, but only 17 sources describing 15 studies met the minimum criteria which consisted of known weights of children less than 15 kg linked to possible adverse events, and provided comprehensive IPD. A total of 1,088 children weighing less than 15 kg were administered oral ivermectin for one of the following indications: scabies, mass drug administration for scabies control, crusted scabies, cutaneous larva migrans, myiasis, pthiriasis, strongyloidiasis, trichuriasis, and parasitic disease of unknown origin. Overall a total of 1.4% (15/1,088) of children experienced 18 adverse events all of which were mild and self-limiting. No serious adverse events were reported. CONCLUSIONS/SIGNIFICANCE: Existing limited data suggest that oral ivermectin in children weighing less than 15 kilograms is safe. Data from well-designed clinical trials are needed to provide further assurance.

Two Episodes of Cutaneous Larva Migrans, Two Months Apart, Despite a Single Exposure Period.

We present a case of a 22-month-old girl who had 2 episodes of cutaneous larva migrans 2 months apart after returning from a tropical area, despite a single exposure period.