Spectrum of skin diseases in Amerindian villages of the Upper Oyapock, French Guiana.

BACKGROUND: Due to their genetic characteristics, their isolation in rainforest areas, and their traditional way of life, Amerindian populations are likely to suffer from a specific spectrum of dermatoses. However, there are few available data on such skin disorders. Our aims were to describe all skin disorders in two Amerindian villages of French Guiana. METHODS: This retrospective study concerned all patients who consulted in the Health Centres of Camopi and Trois-Sauts between July 1, 2017, and December 31, 2018. We included all patients classified with an ICD code linked to a skin disorder. All medical records were cross-checked by two dermatologists to correct misclassifications. RESULTS: A total of 639 patients formed the study population, for 866 different skin disorders. Non-sexually transmitted infections represented 57.6% of all skin disorders, followed by eczema (11.5%) and bites/envenomations (9.1%). Bacteria were responsible for 238 skin infections, followed by fungi (141 cases) and parasites (69 cases, including 43 scabies, nine cutaneous leishmaniasis, and two tungiasis). We reported a low prevalence of sexually transmitted infections (10 cases) and an absence of skin cancers. CONCLUSIONS: This study revealed the absence of skin cancer in the Amerindian population of the Upper Oyapock and the important burden of infectious and animal-related diseases. Future studies should assess a possible underestimation of sexually transmitted diseases in this area. Public health policies should target neglected diseases such as cutaneous leishmaniasis, tungiasis, scabies, and envenomations. Atopic dermatitis was a significant and unexpected cause of consultations.

Double Infection in a Patient with Psoriatic Arthritis Under TNF-alpha Blockers Therapy: A Case Report.

BACKGROUND: Either direct or indirect tumor necrosis factor (TNF)-alpha blockers are usually used to treat psoriatic arthritis (PA), but their use can increase susceptibility to infectious diseases. CASE PRESENTATION: We report a rare case of double skin-knee wound and lung non-tubercular infection in a patient with PA under TNF-alpha blockers therapy. About 1 year after the beginning of adalimumab, a 48-year-old smoker suffering of PA was hospitalized for the skin-knee wound. RESULTS: Clinical evaluation and biochemical markers excluded the presence of a systemic disease, and a skin infection sustained by leishmaniasis probably related to adalimumab was diagnosed (Naranjo score: 6). Adalimumab was discontinued and oral treatment with apremilast and topical treatment with meglumine antimoniate was started with a complete remission of skin wound in 2 weeks. About 7 months later when the patient was under apremilast treatment, he presented to our observation for dyspnea, cough and fever. High-Resolution Computer Tomography (HRCT) chest highlighted alveolar involvement with centrilobular small nodules, branching linear and nodular opacities. Microbiological culture of both broncho-alveolar lavage fluid and sputum documented an infection sustained by nontuberculous mycobacteria. Even if apremilast treatment probably-induced lung infection, we can't exclude that it worsened a clinical condition induced by adalimumab. Apremilast was stopped and an empirical antitubercular treatment was started. Patient's breathlessness and cough improved as confirmed also by HRCT chest. CONCLUSION: This case highlights the importance to consider the possibility to develop leishmaniasis and/or non-tubercular mycobacterial infection in patients treated with TNF-alpha inhibitors.

Spatio-temporal dynamics and aetiology of proliferative leg skin lesions in wild British finches.

Proliferative leg skin lesions have been described in wild finches in Europe although there have been no large-scale studies of their aetiology or epizootiology to date. Firstly, disease surveillance, utilising public reporting of observations of live wild finches was conducted in Great Britain (GB) and showed proliferative leg skin lesions in chaffinches (Fringilla coelebs) to be widespread. Seasonal variation was observed, with a peak during the winter months. Secondly, pathological investigations were performed on a sample of 39 chaffinches, four bullfinches (Pyrrhula pyrrhula), one greenfinch (Chloris chloris) and one goldfinch (Carduelis carduelis) with proliferative leg skin lesions and detected Cnemidocoptes sp. mites in 91% (41/45) of affected finches and from all species examined. Fringilla coelebs papillomavirus (FcPV1) PCR was positive in 74% (23/31) of birds tested: a 394 base pair sequence was derived from 20 of these birds, from all examined species, with 100% identity to reference genomes. Both mites and FcPV1 DNA were detected in 71% (20/28) of birds tested for both pathogens. Histopathological examination of lesions did not discriminate the relative importance of mite or FcPV1 infection as their cause. Development of techniques to localise FcPV1 within lesions is required to elucidate the pathological significance of FcPV1 DNA detection.

Approach to skin and soft tissue infections in non-HIV immunocompromised hosts.

PURPOSE OF REVIEW: Skin and soft tissue infections are frequent contributors to morbidity and mortality in the immunocompromised host. This article reviews the changing epidemiology and clinical manifestations of the most common cutaneous pathogens in non-HIV immunocompromised hosts, including patients with solid organ transplants, stem cell transplants, solid tumors, hematologic malignancies, and receiving chronic immunosuppressive therapy for inflammatory disorders. RECENT FINDINGS: Defects in the innate or adaptive immune response can predispose the immunocompromised host to certain cutaneous infections in a predictive fashion. Cutaneous lesions in patients with neutrophil defects are commonly due to bacteria, Candida, or invasive molds. Skin lesions in patients with cellular or humoral immunodeficiencies can be due to encapsulated bacteria, Nocardia, mycobacteria, endemic fungal infections, herpesviruses, or parasites. Skin lesions may reflect primary inoculation or, more commonly, disseminated infection. Tissue samples for microscopy, culture, and histopathology are critical to making an accurate diagnosis given the nonspecific and heterogeneous appearance of these skin lesions due to a blunted immune response. SUMMARY: As the population of non-HIV immunosuppressed hosts expands with advances in medical therapies, the frequency and variety of cutaneous diseases in these hosts will increase.

A waterborn zoonotic helminthiase in an Italian diver: a case report of a cutaneous Sparganum infection and a review of European cases.

Many waterborne helminthes are opportunistic parasites that can travel directly from animals to man and may contain forms capable of penetrating the skin. Among these, Sparganum is the pseudophyllidean tapeworm that belongs to the genus Spirometra, which is responsible for parasitic zoonosis; it is rarely detected in Europe and is caused by the plerocercoid infective larva. Thus far, only six cases of cutaneous and ocular sparganosis have been reported in Europe; two and four cases have occurred in France and Italy, respectively. Herein, we describe a new case of sparganosis in Italy that affected a male diver who presented to the Bambino Gesù Children's Hospital of Rome. The patient's skin biopsy was submitted to the Parasitology department who, in consultation with Pathology, concluded that the morphologic and microscopic findings were those of Sparganum spp. larvae. The patient recovered following a single dose of 600 mg praziquantel.

Dirofilaria repens infection in a ten-year-old boy from the Istria Peninsula: case report.

Dirofilariasis is a zoonotic infection caused by worms belonging to the genus Dirofilaria. The disease is transmitted by mosquitoes and the hosts are usually dogs. Infections in humans are rare and they usually manifest as a subcutaneous nodule or a conjunctival form. We present a 10-year-old boy with a subcutaneous nodule on his left forearm, who was admitted to the hospital. On examination, the only significant findings were high levels of eosinophils. The pediatrician suspected dirofilariasis and the boy was referred to pediatric surgery. The whole lesion was surgically removed and histopathologic examination confirmed parasitic infection by Dirofilaria repens. Although human dirofilariasis is a rare disease, the number of reported cases has recently increased worldwide. The disease mainly occurs in southern European countries, but has also been described in eastern Europe, Central Asia and Sri Lanka. Croatia is one of the endemic areas for dirofilariasis, especially in the region of the Istria Peninsula. The case presented highlights the requirement for further monitoring of endemic areas in order to establish effective preventive measures.

Frequency of presentation of bovine cutaneous pythiosis (Pythium insidiosum) in three cattle farms in Cordoba, Colombia / Frecuencia de presentación de Pythiosis Cutánea Bovina (Pythiuminsidiosum) en tres explotaciones ganaderas de Córdoba, Colombia / Freqüência de apresentação da Pitiose Cutânea Bovina (Pythiuminsidiosum) em 3 fazendas em Córdoba, Colômbia

The skin pythiosis is a chronic granulomatous, often pruriginous, rapidly progressive illness, caused by Pythium insidiosum. The objective of this study was to determine the frequency of occurrence of bovine cutaneous pythiosis (Pythium insidiosum) in three farms in the department of Cordoba, Colombia. A prospective study in animals was performed, for convenience, between May and August 2011. 72 cattle with granulomatous skin lesions compatible with Pythiosis were evaluated clinical, epidemiological and histopathologically, from 187 cows belonging to three farms located in flood zones in the department of Cordoba, Colombia. The frequency of occurrence of bovine cutaneous Pythiosis in 3 cattle farms in Córdoba department, Colombia was 38,5%. It was concluded that clinical and epidemiological manifestations, macroscopic characteristics of the skin lesions and pathological findings, reported a median pythiosis presence of bovine dermal three farms located in flood zones of the department of Cordoba, Colombia.

La Pythiosis cutánea es una enfermedad crónica, granulomatosa, a menudo pruriginosa y rápidamente progresiva, causada por el Pythium insidiosum. El objetivo del presente estudio fue determinar la frecuencia de presentación de pythiosis cutánea bovina en tres explotaciones ganaderas del departamento de Córdoba, Colombia. Se realizó un estudio descriptivo prospectivo en animales a conveniencia, entre los meses de mayo y agosto de 2011. Fueron evaluados clínica, epidemiológica e histopatológicamente 72 bovinos con lesiones cutáneas granulomatosas compatibles con Pythiosis, a partir de 187 bovinos pertenecientes a tres explotaciones ganaderas ubicadas en zonas inundables del departamento de Córdoba, Colombia. La frecuencia de la enfermedad fue de 38.5%. Se concluye que por las manifestaciones clínico-epidemiológicas, las características macroscópicas de las lesiones cutáneas y los hallazgos histopatológicos, se informa una mediana presencia de pythiosis cutánea en bovinos de tres explotaciones ganaderas ubicadas en zonas inundables del departamento de Córdoba, Colombia.

A pitiose cutânea é uma doença granulomatosa crônica, muitas vezes pruriginosa e rapidamente progressiva, causada por Pythium insidiosum. O objetivo deste estudo foi determinar a freqüência de ocorrência de pitiose cutânea bovina (Pythium insidiosum) em três fazendas no departamento de Córdoba, Colômbia. Foi realizado um estudo prospectivo em animais a conveniência, entre Maio e Agosto de 2011. Foram avaliados clínica, epidemiológica e histopatologicamente 72 bovinos com lesões cutâneas granulomatosas compatíveis com pitiose, a partir de 187 bovinos pertencentes a 3 fazendas localizadas em zonas inundáveis, no departamento de Córdoba, Colômbia. A freqüência de ocorrência de pitiose cutânea bovina em 3 fazendas no departamento de Córdoba, Colômbia foi de 38,5%. Concluímos que as manifestações clínicas e epidemiológicas, características macroscópicas das lesões de pele e achados patológicos, relatou uma presença mediana de pitiose bovina cutânea em 3 fazendas localizadas em zonas inundáveis no departamento de Córdoba, na Colômbia.

Subcutaneous dirofilariasis caused by Dirofilaria repens in Greece: a case report.

Dirofilaria repens (formerly Dirofilaria conjunctiva) is a natural parasite of the subcutaneous tissues of dogs, cats and wild carnivores in Europe, Africa and Asia. Microfilariae are transmitted to humans by various species of mosquito. An autochthonous case of subcutaneous dirofilariasis is reported in a Greek patient from the island of Corfu. The clinical manifestation of the infection was a palpable, painless, subcutaneous nodule in the region of the groin, which 2 days before the patient consulted the doctor developed symptoms and signs of inflammation (pain, edema and redness). The entire lesion was surgically removed, and the nematode worm D. repens was identified on histological sections of biopsy material. The aim of this report was (a) to describe the microscopic morphological features of D. repens that enable identification of the parasite on histological examination and (b) to emphasize the importance of consideration of subcutaneous dirofilariasis in the differential diagnosis of subcutaneous nodules with inflammatory eosinophilic infiltration in countries where the infection is endemic.

Long-term benzimidazole treatment of alveolar echinococcosis with hematogenic subcutaneous and bone dissemination.

We report a case of advanced alveolar echinococcosis (AE) that presented like a malignant tumor. It was diagnosed histologically from a subcutaneous nodule with skin inflammation on the right leg. Additionally, the patient showed bone metastases in the lower thoracic spine and the left third toe. This is the first case with proven hematogenic spread of AE to a subcutaneous site. The patient was treated with albendazole and remained stable for 6 years. When progression of AE occurred the therapy was changed to mebendazole, resulting in a stable condition for further 4 years.

The immune compromised host in the twenty-first century: management of mucocutaneous infections.

Infectious diseases encountered in dermatology have changed tremendously during the past few decades with the emergence of the immunocompromised host. This change is a result of the human immunodeficiency virus epidemic, use of immunomodulating drugs, bone marrow transplantation, increasing prevalence of diabetes mellitus, and an aging population. New pathogens have been discovered and new disorders have occurred. In the compromised host, infection can be more aggressive and widespread locally, be caused by opportunistic pathogens, and be disseminated hematogenously from or to the skin. The prevalence of nonmelanoma skin cancer has increased, and squamous cell carcinomas can be more aggressive with more rapid local growth as well as frequency of metastasis.

Disseminated Strongyloides stercoralis infection.

A case of disseminated S stercoralis is an immunosuppressed patient manifested with diarrhea, a rash, and progressive respiratory insufficiency. The parasites were eradicated with thiabendazole despite continued steroid therapy, and the patient survived the hospitalization. The characteristics of S stercoralis allow it to be harbored within a host for prolonged periods of time, only to disseminate once cell-mediated immunity is suppressed. A diagnosis of strongyloidiasis should be considered in an immunocompromised patient with a petechial rash. Prompt diagnosis and initiation of thiabendazole therapy provides the greatest opportunity for patient survival. Secondary bacterial infections should be aggressively sought. Mortality from disseminated strongyloidiasis approaches 80%.

Dermatologic manifestations of human immunodeficiency virus infection.

Human immunodeficiency virus (HIV) infection and the acquired immunodeficiency syndrome (AIDS) have become major health problems in the United States, and patients with manifestations of these diseases are seen by physicians in all areas of medicine. Cutaneous manifestations develop in as many as 92% of HIV-positive persons. Familiarity with these manifestations facilitates early diagnosis and enhances the care of HIV-infected patients. The spectrum of mucocutaneous disorders in these patients includes an acute exanthem, multiple infections, neoplastic processes, and miscellaneous disorders. Herein we review the most common and the most specific dermatologic manifestations associated with HIV infection, which often are atypical, more severe, or less responsive to treatment than the corresponding diseases encountered in non-HIV-infected persons.