Psoriasiform skin lesion and supprative acrodermatitis associated with Kawasaki disease followed by the treatment with infliximab: a case report.

UNLABELLED: A 4-month-old boy was diagnosed with Kawasaki disease. The ordinary treatments with intravenous gammaglobulin and metylpredonisolone were not effective. Infliximab (5 mg/kg) was administrated on 13th day of illness which led to defeverscence and improvement of clinical manifestations. On 23 days of illness, however, desquamative papules and plaques developed on both the extensor surfaces of the forearms and legs. In addition, typical subungual desquamations of fingers and toes followed crusted hyperkeratosis which resembled supprative acrodermatitis. Skin biopsy from the forearm showed inflammatory dyskeratosis with marked hyperkeratosis, epithelial parakeratotsis, loss of granular layer and dominant infiltration of CD8 + T-cells. Local treatment of steroid followed improvement of skin lesions within a few weeks. CONCLUSION: Although previous reports described the beneficial effects of infliximab in patients with Kawasaki disease, it is possible that the administration of infliximab modify psoriasiform skin lesion associated with Kawasaki disease.

Grouping of 20 reference strains of Legionella species by the growth ability within mouse and guinea pig macrophages.

20 Reference strains of Legionella species, isolated from human, were classified according to their ability to grow within thioglycolate-induced peritoneal macrophages of mice and guinea pigs. Inbred and congenic mice were used to study the effect of the natural resistance genes Lgn1 and Bcg that are expressed phenotypically in the mouse macrophages. The Lgn1 gene controlled the intracellular growth of Legionella pneumophila Philadelphia-1 and Legionella jordanis GIFU 12657, but the Bcg gene did not affect the intracellular growth of any organism examined. Based on these results and the growth ability in guinea pig macrophages, the 20 reference strains were divided into four groups. This grouping will help us to understand a variety of modes of interaction between Legionella species and macrophages.

Aeration conditions affecting growth of purple nonsulfur bacteria in an organic wastewater treatment process.

Effects of aeration on purple nonsulfur bacteria (PnSB) were studied in photobioreactors. Bacterial community changes were analyzed by denaturing gradient gel electrophoresis (DGGE) and fluorescence in situ hybridization (FISH). DGGE band pattern change was small and only few prominent bands were obtained at non-aeration condition. Sequencing results of the prominent DGGE bands obtained at this condition revealed that they represented mainly the PnSB, Rhodobacter sphaeroides and Rhodopseudomonas palustris. On the other hand, under aerated condition, some prominent bands originated from heterotrophs appeared but no proliferation of PnSB was observed. FISH was applied to detect PnSB and their population was quantified. Maximum PnSB ratio (up to 80%) was obtained both at non-aeration condition and at constant ORPs less than -200 mV. In the presence of DO, Rps. palustris was more competitive to chemoheterotrophs than Rb. sphaeroides.

Effectiveness of sodium hypochlorite in preventing inoculation of periapical tissues with contaminated patency files.

The aim of this study was to analyze the effectiveness of 5.25% sodium hypochlorite (NaOCI) in preventing inoculation of periapical tissues with contaminated patency files. Twenty-eight extracted human permanent teeth with single canals were used in the study. Group I teeth were filled with NaOCl, and #15 stainless steel files contaminated with Streptococcus sanguis (ATCC #10556) were allowed to pass through the NaOCI into the culture medium. The teeth in group II were also filled with NaOCl, but the contaminated files used in group II canals were immersed in NaOCl for 10 s prior to being placed into the canals and cultured. The negative control group used sterile files (0% growth), the first positive control group used contaminated patency files in teeth with empty canals (100% growth), and the second positive control group placed contaminated files into broth next to teeth filled with NaOCl (to evaluate potential chlorine leakage; 100% growth). The experimental results showed no positive growth of S. sanguis for groups I and II, indicating that the NaOCl present in the canal after irrigation was sufficient to kill the test organism.

D-penicillamine-induced pemphigus successfully treated with combination therapy of mizoribine and prednisolone.

A 63-year-old woman had D-penicillamine-induced pemphigus with a high index value of circulating autoantibodies against desmoglein 1. Because of the lack of response to prednisolone monotherapy, the patient was treated with a combination therapy of mizoribine and low-dose prednisolone. The skin eruption was improved by this combination with a declined value of circulating anti-desmoglein 1 antibody. Currently, a remission of 2 months has been achieved, and prednisolone could be tapered.

[Three cases of occupationally induced herpetic whitlow in health care workers].

Herpetic whitlow is one of the herpes simplex virus (HSV) infections, and is known as an occupational disease. In Japan, however, there have been only a few reports of this disease. Recently, we experienced three cases of herpetic whitlow in health care workers. They presented painful vesicles on the right ring finger, the left thumb and the left index finger, respectively. All of them were considered to have been infected by HSV when they were engaged in mouth care of inpatients. We reviewed these three cases from the aspect of occupational medicine, and propose the following three points for preventing this serious nosocominal infection to health care workers: 1) re-education and enlightenment for the workers regarding hazardous behavior of HSV, 2) keeping the hands and fingers free from skin impairments, and 3) early diagnosis and treatment for herpetic whitlow of health care professionals to prevent further nosocominal infection.

[A case of occupational contact dermatitis due to hydroxylamine].

A 36-year-old man, working in a chemical industry, had a generalized pruritic eruption. A forty-eight hour patch test revealed positivity for 1% hydroxylamine. Prevention of exposure to this chemical resulted in a dramatic improvement of the symptoms. Based on these findings, we diagnosed this case as occupational contact dermatitis due to hydroxylamine. There has been few case reports of contact dermatitis due to hydroxylamine. Histopathological examination revealed a marked spongiosis and a spongiotic bulla formation in the epidermis and follicular infundibulum, suggesting an allergic reaction.

[A case of autoimmune progesterone dermatitis].

A 41-year-old Japanese woman came to our clinic complaining of multiple edematous erythemas on the trunk and legs. The eruptions recurred periodically in association with the menstrual cycle. She had received oral progesterone therapy between 24 and 34 years of age. There were no abnormal values found in the routine and hormonal examinations, including progesterone and estrogen levels in serum and urine. After an intradermal skin test with progesterone, she had no reaction after 20 minutes but a positive reaction after 48 hours.

[Occupationally induced hydrofluoric acid burns: an analysis of 9 patients from the aspect of occupational health].

We report here 9 patients suffering from hydrofluoric acid burn who visited our clinic from July, 1979 to February, 2000. These 9 cases occupied 25% of all chemical burn cases experienced in our clinic. All the patients were men ranging in age from 20 to 53 (mean age 35 years; average 36.8 years). At the time of accidental exposures, 6 patients had been engaged in washing or cleaning work, and 2 had been changing the parts of instruments containing hydrofluoric acid. Eight patients received burns on the hands and/or fingers. During the work, 2 patients had used vinyl chloride or rubber gloves, but three patients employed no protection for the hands. After the symptoms began to develop, it was found that the glove of one patient had a pin hole. Coupled with the occasions described in previous reports, the causal factors of hydrofluoric acid burn could be divided as follows: 1) negligence or carelessness of workers, in particular skilled persons, in handling hydrofluoric acid, 2) ignorance of the dangerousness of hydrofluoric acid, 3) the presence of pin hole (s) in protection gloves, and 4) unexpected accident. Hydrofluoric acid is one of the most corrosive inorganic acids, and can produce progressive and serious tissue necrosis with severe pain. To prevent burns due to this chemical, enlightenment and reeducation of the workers regarding the hazard of hydrofluoric acid are necessary.

[A case of pemphigus foliaceus associated with bullous impetigo successfully treated with tetracycline and nicotinamide].

A 50-year-old Japanese woman visited our clinic, complaining of generalized erythema with painful erosions and bullae. The histopathological findings of the skin lesion suggested development of impetigo. Gentamycin-resistant Staphylococcus aureus was detected by the bacterial culture examination from the impetiginous bullae. A direct immunofluorescence study of the lesion showed an intercellular deposition of IgG and C3 in the upper epidermis. We diagnosed this case as pemphigus foliaceus associated with bullous impetigo. A combined oral administration of tetracycline (200 mg/day) and nicotinamide (1200 mg/day) for 3 weeks was successful. In Japan, patients with moderate to severe symptoms of pemphigus foliaceus are usually treated with oral steroid therapy. To our knowledge, however, there is no reported pemphigus case which has been successfully treated only with tetracycline and nicotinamide.

Vitiligo with inflammatory raised borders, associated with atopic dermatitis.

A 31-year-old man had had atopic dermatitis since childhood and developed vitiligo with inflammatory raised borders 5 years prior to presentation. Immunohistochemically, CD4+ T cells infiltrated predominantly in the raised border of vitiligo, while CD8+ T cells were present just outside of the borders, suggesting that CD8+ cells were an antecedent to the CD4+ cells. Despite the presence of atopic dermatitis, the percentage of CXCR3+ CD4+ Th1 cells increased in the patient's peripheral blood, compared with a representative atopic patient showing a high percentage of CCR4+CD4+ Th2 cells. This case suggests that vitiligo with inflammatory raised borders can occur even in patients with atopic dermatitis when Th1 cells are activated and overcome the Th2-dominant state.

Occupational skin injury by hydrogen peroxide.

Hydrogen peroxide is widely used in products such as rocket fuel, bleaching preparations and topical disinfectants. Contact of hydrogen peroxide with the skin can cause severe skin damage. In this report, we describe a case of skin injury induced by hydrogen peroxide. The patient was a 34-year-old man working in a dry cleaning shop. While he was pouring 35% hydrogen peroxide, some of it accidentally splashed over his left shoulder and back, and then an erythema, purpura and vacuolar eruption, similar to bubble wrap, appeared on his left shoulder and down the left side of his back. Histologically, numerous vacuolar structures were observed in the epidermis, dermis and subcutaneous tissue. Coupled with the clinical features, these vacuolar structures were considered as 'oxygen bubbles'. Subcutaneous emphysema was detected by chest X-ray examination. All skin eruptions rapidly healed without scarring by using a steroid ointment. As far as we know, this is the first time such clinical and histological features have been described

Entry and intracellular localization of Legionella dumoffii in Vero cells.

Organisms of some Legionella species are known to internalize and multiply within epithelial cell lines. During the study on interaction between Legionella spp. and Vero cells, we found that L. dumoffii Tex-KL (ATCC 33343) can enter into Vero cells approximately four to 20 times more often than five other strains of four species of legionella. The mode of entry between L. dumoffii Tex-KL and L. pneumophila Philadelphia-1 was compared and studied by treating Vero cells with reagents which inhibit phagocytosis and endocytosis. Monodansylcadaverine, cytochalasin D and nocodazol were used as inhibitors of receptor-mediated endocytosis, microfilament-dependent phagocytosis and polymerization of microtubules, respectively. The uptake of L. dumoffii Tex-KL required receptor-mediated endocytosis by Vero cells, while the uptake of L. pneumophila Philadelphia-1 used mainly microfilament-dependent phagocytosis. Polymerization of microtubules was necessary for Vero cells for the uptake of both strains of legionella. An electron microscopic examination revealed that some organisms of the L. dumoffii strain Tex-KL escaped from endosomal vacuoles into cytoplasm in the early stage of infection, and proliferated in the cytoplasm. At that period, most of the bacteria were surrounded by rough endoplasmic reticula. In contrast, L. pneumophila Philadelphia-1 proliferated only within ribosome-lined endosome. We suggest that L. dumoffii Tex-KL internalize and proliferate in Vero cells in a different way to L. pneumophila Philadelphia-1, and that there is a variety of the mode of interaction between Legionella spp. and epithelial cells.

Development of a new seminested PCR method for detection of Legionella species and its application to surveillance of legionellae in hospital cooling tower water.

The presence of PCR inhibitors in water samples is well known and contributes to the fact that a practical PCR assay has not been developed for legionella surveillance. In this study, we devised a new seminested PCR assay for detection of Legionella spp. in water samples as a means of overriding the PCR inhibitors without loss of sensitivity. The seminested PCR assay utilized primers to amplify the 16S rRNA gene (LEG primers) of 39 Legionella spp. The assay was specific to legionellae, and the sensitivity was 1 fg of extracted Legionella DNA in laboratory examination. To evaluate the feasibility and sensitivity of the PCR assay in identifying the presence of legionellae, it was used to survey Legionella contamination in the water of 49 cooling towers of 32 hospitals. A commercially available EnviroAmp Legionella kit and a culture method were also used in the survey for comparison with the seminested PCR assay. The detection rates of legionellae in the samples were 91.8% (45 of 49) by the PCR assay and 79.5% (39 of 49) by the culture method. The EnviroAmp kit revealed that 30.6% of the water samples (15 of 49) contained inhibitors of the PCR amplification. However, the seminested PCR assay could produce the Legionella-specific DNA bands in 14 of the 15 samples. Although 8 of the 14 samples were positive in the first-step PCR, 6 of the 14 samples became positive in the second-step PCR. These results suggest that the effect of PCR inhibitors in samples, if any, can be reduced because of the dilution of the sample in the second-step PCR and that sensitivity of detection can be increased by the second-step PCR. Thus, the seminested PCR assay with LEG primers to amplify the 16S rRNA gene of 39 Legionella spp. was a practical and sensitive method to detect Legionella spp. in water samples.

Observation of Multi-TeV Gamma Rays from the Crab Nebula using the Tibet Air Shower Array.

The Tibet experiment, operating at Yangbajing (4300 m above sea level), is the lowest energy air shower array, and the new high-density array constructed in 1996 is sensitive to gamma-ray air showers at energies as low as 3 TeV. With this new array, the Crab Nebula was observed in multi-TeV gamma-rays and a signal was detected at the 5.5 sigma level. We also obtained the energy spectrum of gamma-rays in the energy region above 3 TeV which partially overlaps those observed with imaging atmospheric Cerenkov telescopes. The Crab spectrum observed in this energy region can be represented by the power-law fit dJ&parl0;E&parr0;&solm0;dE=&parl0;4.61+/-0.90&parr0;x10-12&parl0;E&solm0;3 TeV&parr0;-2.62+/-0.17 cm-2 s-1 TeV-1. This is the first observation of gamma-ray signals from point sources with a conventional air shower array using scintillation detectors.