Metagenomic sequencing of the skin microbiota of the scalp predicting the risk of surgical site infections following surgery of traumatic brain injury in sub-Saharan Africa.

BACKGROUND: Surgical site infections (SSI) are a significant concern following traumatic brain injury (TBI) surgery and often stem from the skin's microbiota near the surgical site, allowing bacteria to penetrate deeper layers and potentially causing severe infections in the cranial cavity. This study investigated the relationship between scalp skin microbiota composition and the risk of SSI after TBI surgery in sub-Saharan Africa (SSA). METHODS: This was a prospective cohort study, enrolling patients scheduled for TBI surgery. Sterile skin swabs were taken from the surrounding normal skin of the head and stored for analysis at -80°Celcius. Patients were monitored postoperatively for up to three months to detect any occurrences of SSI. 16S rRNA sequencing was used to analyze the skin microbiota composition, identifying different taxonomic microorganisms at the genus level. The analysis compared two groups: those who developed SSI and those who did not. RESULTS: A total of 57 patients were included, mostly male (89.5%) with a mean age of 26.5 years, predominantly from urban areas in Uganda and victims of assault. Graphical visualization and metagenomic metrics analysis revealed differences in composition, richness, and evenness of skin microbiota within samples (α) or within the community (ß), and showed specific taxa (phylum and genera) associated with either the group of SSI or the No SSI. CONCLUSIONS: Metagenomic sequencing analysis uncovered several baseline findings and trends regarding the skin microbiome's relationship with SSI risk. There is an association between scalp microbiota composition (abundancy and diversity) and SSI occurrence following TBI surgery in SSA. We hypothesize under reserve that the scalp microbiota dysbiosis could potentially be an independent predictor of the occurrence of SSI; we advocate for further studies with larger cohorts.

Bacterial Skin Dysbiosis in Darier Disease.

INTRODUCTION: Darier disease is a rare inherited disease with dominant skin manifestations including keratotic papules and plaques on sebaceous and flexural areas. Secondary infection of skin lesions is common, and Staphylococcus aureus commonly colonizes these lesions. The aim of the study was to characterize the bacterial microbiome of cutaneous Darier lesions compared to normal-looking skin and disease severity. METHODS: All patients with a history of Darier followed up at Emek Medical Center were invited to participate in the study. Patients that did not use antibiotics in the past month and signed informed consent had four skin sites sampled with swabs: scalp, chest, axilla, and palm. All samples were analyzed for bacterial microbiome using 16S rDNA sequencing. RESULTS: Two hundred and eighty microbiome samples obtained from lesional and non-lesional skin of the scalp, chest, axilla, and palm of 42 Darier patients were included in the analysis. The most abundant bacterial genera across all skin sites were Propionibacterium, Corynebacterium, Paracoccus, Micrococcus, and Anaerococcus. Scalp and chest lesions featured a distinct microbiome configuration that was mainly driven by an overabundance of Staphylococci species. Patients with more severe disease exhibited microbiome alterations in the chest, axilla, and palm compared with patients with only mild disease, driven by Peptoniphilus and Moryella genera in scalp and palmar lesions, respectively. CONCLUSION: Staphylococci were significantly associated with Darier lesions and drove Darier-associated dysbiosis. Severity of the disease was associated with two other bacterial genera. Whether these associations also hold a causative role and may serve as a therapeutic target remains to be determined and requires further investigation.

Effect of two shampoo formulations on the prokaryotic and eukaryotic microbiota composition of the human scalp.

OBJECTIVE: The human scalp is characterized by a moderately diverse microbial community, comprising prokaryotic (bacteria) and eukaryotic (fungi) members. Although the details are far from being fully understood, the human scalp microbiota is implicated in several scalp disorders, in particular dandruff formation. Hence, the protection of an intact and diverse scalp microbiota can be regarded as a quality criterion for hair and scalp care formulations. In this study, we investigated the influence of two commercially available, non-antimicrobial shampoo formulations on the structure of the scalp microbiota. METHODS: Scalp microbiota samples, obtained by swab sampling from two cohorts of probands (n = 25, each), were analysed before and after daily use of two different shampoo formulations for 2 weeks, respectively. A polyphasic approach was used, comprising quantitative cultivation of bacteria and fungi on selective media as well as sequencing of PCR-amplified 16S rRNA and 18S rRNA genes, respectively. RESULTS: All analyses revealed a microbiota composition typical for the human scalp. While in particular fungal germ numbers increased significantly during the treatments, overall bacterial and fungal community composition was not affected, based on alpha- and beta-diversity measures. However, we observed an increase in structural bacterial diversity with the age of the probands. CONCLUSIONS: Over an application period of 2 weeks, the investigated shampoo induced quantitative but no qualitative changes in the scalp microbial community structure of the investigated probands, suggesting no adverse but rather preserving or even stimulating effects of the underlying formulations on the scalp microbiota. Further investigation will have to clarify if this is also true for longer application periods and if the formulations might affect community functionality, for example microbial gene expression, rather than community composition.

OBJECTIF: Le cuir chevelu humain se caractérise par une communauté microbienne modérément diversifiée, comprenant des membres procaryotes (bactéries) et eucaryotes (champignons). Bien que l'on soit loin de comprendre totalement les détails, le microbiote du cuir chevelu humain est impliqué dans différents troubles du cuir chevelu, en particulier la formation de pellicules. La protection du microbiote du cuir chevelu intact et diversifié peut être considérée comme un critère de qualité pour les formulations de soins pour les cheveux et le cuir chevelu. Dans cette étude, nous avons examiné l'influence de deux formulations de shampooing non antimicrobien disponibles dans le commerce sur la structure du microbiote du cuir chevelu. MÉTHODES: Des échantillons de microbiote du cuir chevelu, obtenus par écouvillonnage dans deux cohortes de proposants (n = 25 dans chaque cohorte), ont été analysés respectivement avant et après l'utilisation quotidienne de deux formulations de shampooing pendant deux semaines. Une approche en plusieurs phases a été utilisée, dont une culture quantitative de bactéries et de champignons sur des milieux sélectifs et un séquençage respectivement des gènes de l'ARN ribosomique 16S et de l'ARN ribosomique 18S amplifiés par PCR. RÉSULTATS: Toutes les analyses ont révélé une composition du microbiote typique pour le cuir chevelu humain. Bien que le nombre de germes fongiques en particulier ait augmenté significativement pendant les traitements, la composition globale des communautés bactériennes et fongiques n'a pas été affectée, d'après les mesures de diversité alpha et bêta. Cependant, nous avons observé une augmentation de la diversité bactérienne structurelle avec l'âge des proposants. CONCLUSIONS: Sur une période d'utilisation de deux semaines, le shampooing étudié a induit des modifications quantitatives, mais pas qualitatives, de la structure des communautés microbiennes du cuir chevelu des proposants étudiés, ce qui suggère qu'il n'y a pas d'effets indésirables, mais qu'il y a des effets de préservation, voire de stimulation, des formulations sous-jacentes sur le microbiote du cuir chevelu. Des recherches supplémentaires devront clarifier si cela s'avère également pour des périodes d'utilisation plus longues et si les formulations peuvent affecter la fonctionnalité des communautés, par exemple, l'expression des gènes microbiens, plutôt que la composition des communautés.

Biomolecules of Fermented Tropical Fruits and Fermenting Microbes as Regulators of Human Hair Loss, Hair Quality, and Scalp Microbiota.

Plant-derived secondary metabolites (polyphenols/terpenes/alkaloids) and microbial exometabolites/membrane components of fermented tropical fruits are known as highly bioavailable biomolecules causing skin and hair improvement effects (wound healing, anti-inflammatory, antioxidant, antidiabetic, antiacne, skin/hair microbiota balancing, hair growth-promoting, and hair loss-inhibiting). Caffein is considered as a hair growth promoter. A randomized placebo- and caffein-controlled clinical trial on the efficacy of fermented papaya (FP) plus fermented mangosteen (FM) towards human hair quality and loss was conducted. Shampoo and lotion hair care products containing FP, FM, and caffein as active agents were developed and applied to 154 subjects of both sexes with clinically confirmed androgenic or diffuse alopecia for 3 months. Their clinical efficacy was assessed subjectively by questionnaires filled in by dermatologists/trichologists, and by the objective trichomicroscopical calculations. Hair and scalp skin quality was determined by microbiota pattern and ATP, SH-groups, protein, and malonyl dialdehyde quantification. Comparative clinical data showed that the experimental hair care cosmetics significantly inhibited hair loss, increased hair density/thickness, and improved hair follicle structure versus placebo and caffein controls. The cosmetics with FP and FM substantially normalized the microbiota pattern and increased ATP content in hair follicle, while inhibiting lipid peroxidation in the scalp skin, and SH-group formation in the hair shaft.

Heat-killed Lacticaseibacillus paracasei GMNL-653 ameliorates human scalp health by regulating scalp microbiome.

BACKGROUND: The equilibrium of the scalp microbiome is important for maintaining healthy scalp conditions, including sebum secretion, dandruff, and hair growth. Many different strategies to improve scalp health have been reported; however, the effect of postbiotics, such as heat-killed probiotics, on scalp health remains unclear. We examined the beneficial effects of heat-killed probiotics consisting of Lacticaseibacillus paracasei, GMNL-653, on scalp health. RESULTS: Heat-killed GMNL-653 could co-aggregate with scalp commensal fungi, Malassezia furfur, in vitro, and the GMNL-653-derived lipoteichoic acid inhibited the biofilm formation of M. furfur on Hs68 fibroblast cells. The mRNA of hair follicle growth factors, including insulin-like growth factor-1 receptor (IGF-1R), vascular endothelial growth factor, IGF-1, and keratinocyte growth factor was up-regulated in skin-related human cell lines Hs68 and HaCaT after treatment with heat-killed GMNL-653. For clinical observations, we recruited 22 volunteer participants to use the shampoo containing the heat-killed GMNL-653 for 5 months and subsequently measured their scalp conditions, including sebum secretion, dandruff formation, and hair growth. We applied polymerase chain reaction (PCR) to detect the scalp microbiota of M. restricta, M. globosa, Cutibacterium acnes, and Staphylococcus epidermidis. A decrease in dandruff and oil secretion and an increase in hair growth in the human scalp were observed after the use of heat-killed GMNL-653-containing shampoo. The increased abundance of M. globosa and the decreased abundance of M. restricta and C. acnes were also observed. We further found that accumulated L. paracasei abundance was positively correlated with M. globosa abundance and negatively correlated with C. acnes abundance. S. epidermidis and C. acnes abundance was negatively correlated with M. globosa abundance and positively correlated with M. restricta. Meanwhile, M. globosa and M. restricta abundances were negatively associated with each other. C. acnes and S. epidermidis abundances were statistically positively correlated with sebum secretion and dandruff, respectively, in our shampoo clinical trial. CONCLUSION: Our study provides a new strategy for human scalp health care using the heat-killed probiotics GMNL-653-containing shampoo. The mechanism may be correlated with the microbiota shift.

Longitudinal study of the scalp microbiome suggests coconut oil to enrich healthy scalp commensals.

Dandruff is a recurrent chronic scalp disorder, affecting majority of the population worldwide. Recently a metagenomic study of the Indian scalp microbiome described an imperative role of bacterial commensals in providing essential vitamins and amino acids to the scalp. Coconut oil and its formulations are commonly applied on the scalp in several parts of the world to maintain scalp health. Thus, in this study we examined the effect of topical application of coconut oil on the scalp microbiome (bacterial and fungal) at the taxonomic and functional levels and their correlation with scalp physiological parameters. A 16-weeks-long time-course study was performed including 12-weeks of treatment and 4-weeks of relapse phase on a cohort of 140 (70 healthy and 70 dandruff) Indian women, resulting in ~ 900 metagenomic samples. After the treatment phase, an increase in the abundance of Cutibacterium acnes and Malassezia globosa in dandruff scalp was observed, which were negatively correlated to dandruff parameters. At the functional level, an enrichment of healthy scalp-related bacterial pathways, such as biotin metabolism and decrease in the fungal pathogenesis pathways was observed. The study provides novel insights on the effect of coconut oil in maintaining a healthy scalp and in modulating the scalp microbiome.

Gram-negative infections in patients with folliculitis decalvans: a subset of patients requiring alternative treatment.

Background Folliculitis decalvans is a neutrophilic cicatricial alopecia whose etiology remains unknown. It is frequently associated with staphylococcal infections. We aimed to determine the rate of gram-negative infections in patients with folliculitis decalvans. Methods A retrospective chart review was performed of patients with biopsy-proven folliculitis decalvans seen at a tertiary hair referral center. The results of bacterial cultures were evaluated. Subjects were determined to have no infection, gram-positive infections, gram-negative infections, or mixed infections. Results Thirty-nine subjects were included in the study. Ninety-three cultures were performed. The majority of cultures were positive for staphylococci. Eleven patients (28%) had gram-negative infections of the scalp. Gram-negative infections comprised one-third of all cultures (33%). Conclusion We present the largest cohort of folliculitis decalvans patients with gram-negative infections, suggesting the need for routine bacterial cultures in patients who are not responsive to standard anti-staphylococcal antibiotics. Awareness of the incidence of these infections may lead to better therapeutic outcomes.

A 9-day-old neonate with giant scalp abscess: A case report.

RATIONALE: Neonatal scalp mass is common in clinical practice. After birth canal compression and traction force, a cephalohematoma is usually found. However, cephalohematoma with abscess is extremely rare and dangerous. So far, there have been no reported cases of multidrug-resistant Escherichia coli infections in giant neonatal scalp hematoma. PATIENT CONCERNS: We present a 9-day-old with a scalp abscess and a large scalp defect that remained after surgical drainage. DIAGNOSIS: Physical examination showed a giant mass suggestive in the parietal region. B-mode ultrasound indicated the scalp mass was liquid. The early diagnosis was massive scalp hematoma. During conservative treatment, purulent fluid flowed from the mass region through a rupture in the scalp. MR examination showed the scalp had burst and no abnormalities were found in the medial side of the skull and skull. INTERVENTIONS: The surgeon opened up the mass and removed necrotic tissue. The scalp was severely damaged; the aseptic auxiliary materials that we made in-house were used to gradually reduce the defect. OUTCOMES: The scalp was healed by anti-infection treatment and frequent changing of the dressings. The patient was successfully treated without two-stage surgery. There were no complications. LESSONS: A scalp hematoma is a potential site of infection. Anti-infection treatment and surgery are necessary to correct infected scalp hematoma. This work offers a new way of treating other large scalp defects.

Dermatophytic mycetoma of the scalp due to an atypical strain of Microsporum audouinii identified by MALDI-TOF MS and ITS sequencing.

Dermatophytic mycetoma of the scalp is a rarity, especially when not associated with tinea capitis. Here, we report a case of dermatophytic mycetoma of the scalp, that was not associated with tinea capitis, caused by an atypical Microsporum audouinii strain. To our knowledge, this is the second reported case, thirty-eight years after the first that was published in 1980.

Case Report: Scalp Eschar and Neck Lymphadenopathy Associated with Bacteremia due to Coxiella-Like Bacteria.

Coxiella-like bacteria have been recently proposed as human pathogens. Using molecular techniques, we detected Coxiella-like bacteria in the blood and serum samples of a patient with a scalp eschar, neck lymphadenopathy, severe urticaria, edema, fever, and arthralgia indicating that this organism can provide systemic complications.

Neonatal Cutaneous Invasive Aspergillosis Accompanied by Hemophagocytic Lymphohistocytosis.

We describe a 6-week-old female infant with cutaneous invasive aspergillosis accompanied with hemophagocytic lymphohistocytosis. Aspergillus flavus was isolated from biopsies of necrotic skin lesions on the forehead and scalp; morphologic identification was confirmed by molecular analysis. In vitro antifungal susceptibility testing showed that amphotericin B and triazoles had potent activity. The patient responded well to treatment with intravenous amphotericin B combined with oral posaconazole and local wound care. The hemophagocytic lymphohistocytosis abated after treatment of cutaneous aspergillosis. Both cutaneous invasive aspergillosis and hemophagocytic lymphohistocytosis are severe disorders with high morbidity and mortality requiring prompt diagnosis and treatment.

Synergistic antimicrobial activity of Boswellia serrata Roxb. ex Colebr. (Burseraceae) essential oil with various azoles against pathogens associated with skin, scalp and nail infections.

Antimicrobials from natural sources have gained immense importance in recent times to combat the global challenge of antibiotic resistance. Essential oils are implicated in antimicrobial action against several species. Here, we have screened nine commercially available essential oils for their antimicrobial activity against organisms associated with skin, scalp and nail infections mainly Propionibacterium acnes, Malassezia spp., Candida albicans and Trichophyton spp. Among nine essential oils, Boswellia serrata essential oil demonstrated superior antimicrobial activity against all the micro-organisms and surprisingly it showed maximum activity against Trichophyton spp. The gas chromatography-mass spectrometry analysis of B. serrata oil indicates a major composition of α thujene, ρ cymene and sabinene. Additionally, B. serrata oil was found to inhibit Staphylococcus epidermidis biofilm, and its combination with azoles has shown synergistic activity against azole-resistant strain of C. albicans. These broad-spectrum antimicrobial activities of B. serrata oil will make it an ideal candidate for topical use. SIGNIFICANCE AND IMPACT OF THE STUDY: Eradication of skin and nail infections still remain a challenge and there are serious concerns regarding the recurrence of the diseases associated with these infections. Antimicrobials from plant sources are gaining importance in therapeutics because they encounter minimal challenges of emergence of resistance. We have demonstrated the antimicrobial activity of Boswellia serrata essential oil against micro-organisms involved in skin, scalp and nail infections, especially if it has shown favourable synergistic antifungal activity in combination with azoles against the azole-resistant Candida albicans strain. Thus, B. serrata oil can be one of the plausible therapeutic agents for management of skin, scalp and nail infections.

Aspergillus niger – a possible new etiopathogenic agent in Tinea capitis? Presentation of two cases

Abstract Tinea capitis is generally considered as the most frequent fungal infection in childhood, as it accounts for approximately 92% of all mycosis in children. The epidemiology of this disease varies widely ranging from antropophillic, zoophilic, and geophillic dermatophytes, as the main causative agent in different geographic areas, depending on several additional factors. Nowadays, the etiology is considered to vary with age, as well with gender, and general health condition. The former reported extraordinary Tinea capitis case reports have been replaced by original articles and researches dealing with progressively changing patterns in etiology and clinical manifestation of the disease. This fact is indicative that under the umbrella of the well-known disease there are facts still hidden for future revelations. Herein, we present two rare cases of Tinea capitis in children, which totally differ from the recently established pattern, in their clinical presentation, as well as in the etiological aspect, as we discuss this potential new etiological pattern of the disease, focusing on our retrospective and clinical observation. Collected data suggest that pathogenic molds should be considered as a potential source of infection in some geographic regions, which require total rationalization of the former therapeutic conception, regarding the molds’ higher antimitotic resistance compared to dermatophytes. Molds-induced Tinea capitis should be also considered in clinically resistant and atypical cases, with further investigations of the antifungal susceptibility of the newest pathogens in the frame of the old disease. Further investigations are still needed to confirm or reject this proposal.

[THE TRUTH ABOUT THE RINGWORM AFFAIR].

INTRODUCTION: Ringworm of the scalp (Tinea Capitis), a fungal skin ailment that appears on the scalp, was treated until the early sixties by radiation therapy. It was discovered during the seventies that radiation treatment for ringworm may be associated with a higher risk of cancerous and benign tumors in the head and neck area for patients undergoing treatment. In 1995, Israel enacted a law to compensate ringworm irradiation patients which provided monetary compensation for those who were treated between 1946 and 1960. "The Ringworm Affair" focuses on the issue of radiation treatment for ringworm and the social perceptions surrounding the ethnic identity of the patients. Common opinion in Israel holds that the target population for these treatments was limited to the children of North African immigrants, and that the treatment was intentionally administered despite knowledge of its health hazards. Furthermore, according to these beliefs, over 100,000 children of immigrants were treated. This paper examines these common arguments in light of historical and research-based data regarding the ethnic background and total number of patients treated. Moreover, this paper will examine the argument that a mass operation took place to cure those children only in Israel between 1946 and 1960. As evidence will show, these arguments are unfounded. Notably, radiation therapy was used worldwide; other populations in Israel as well as other Jewish communities in Europe and North Africa were exposed to the same treatment since the 20's. The total number of patients in Israel is less than 100,000.

[A recurrent case of adult favus successfully treated with terbinafine]. / Terbinafi n ile basarili olarak tedavi edilen bir eriskin nüks favus olgusu.

Favus or tinea capitis favosa, is a chronic inflammatory dermatophytosis of the scalp. The disease is particularly common in children aged 6 to 10 years, more often in boys, and it also occurs in adults. Human-to-human transmission is therefore possible. Anthropophilic Trichophyton schöenleinii is responsible for over 95% of favus cases. In addition, there are rare cases of anthropophilic T.violaceum, zoophilic (T.verrucosum, T.quinckeanum, and Microsporum canis) and geophilic M.gypseum species recorded as agents of favus. It is also reported in mice (T.quinckeanum), poultry (M.gallinae), and cats (M.incurvatum). Favus is common in Iran, Nigeria, and China, however it has been reported rarely in the last two decades in Turkey. Although Turkish records are not sufficient to indicate an accurate incidence rate, favus is still present in Turkey. In this report, a 20-year-old female with favus was presented. She had squames and areas of alopecia on the right frontoparietal area of her scalp. Scalp biopsy and hair follicle samples were taken for histopathological examination and fungal culture. According to the conventional identification by mycological methods and internal transcribed spacer (ITS) sequencing analysis, the pathogen was identified as T.schöenleinii. The patient was treated with oral terbinafine (250 mg/day) for 4 weeks and topical isoconazole and ketoconazole for 6 weeks. Clinical recovery was observed after 6 weeks, however, fungal culture could not be repeated. Six months after the initial presentation, the patient's symptoms recurred due to the poor adherence and T.schöenleinii was repeatedly grown in culture. Antifungal treatment was administered with the same drugs for the same period. There was a clinical and mycological recovery 8 months after initial presentation. Favus, which is not frequently observed in adults, is an uncommon disease. Confusion arises in its diagnosis because other diseases have similar clinical appearances, and asymptomatic carriage have also been reported. For these reasons, and because of improvements in health conditions, treatment might be delayed. With accurate assessment of the patient's medical history, the clinical characteristics of the disease, and results of laboratory analyses, coupled with effective mycologist-clinician collaboration, it is possible for the patient to continue a healthy social life. Consequently, favus is still an important health problem encountered in Turkey.