A "seasonal bromoderma" in a farmer.

Bromoderma is a rare skin disease caused by the ingestion, inhalation, or contact with products containing bromides. We report a case of bromoderma in a 36-year-old farmer, characterized by remission during the spring and exacerbation during the winter. The recognition of the use of products containing bromides during the winter helped us to understand the cause of the clinical condition.

[Cutaneous larva migrans: report of three cases from the Western Black Sea Region, Turkey]. / Kütanöz larva migrans: Bati Karadeniz Bölgesi'nden üç olgu sunumu.

Cutaneous larva migrans (CLM) is a parasitosis frequently seen in persons who have travelled to tropical or subtropical regions and in those who have worked in contact with soil. The disease frequently develops due to Ancylostoma braziliensis and Ancylostoma caninum species. After penetrating the skin and entering the body, the hookworm larva proceeds to bore tunnels through the epidermis, creating pruritic, erythematous, serpiginous lesions. Secondary bacterial infections of the lesions can often be seen, especially on the legs and buttocks. In this article we presented three atypical local cases which have not been declared previously in our country. The first case, a 54-year-old male who was admitted to hospital in August with complaints of an obverse body rash and itching lasting for a week. Eruptions were observed over a small area on the right side of the abdomen, consisting of itchy, raised, erythematous, curvilinear string-like lesions. Moreover, no eosinophilia was detected in the patient, whose culture showed a growth of Streptococcus pyogenes. The patient was clinically diagnosed with CLM accompanied by secondary bacterial infection and treated for three days with 1 g of amoxicillin-clavulanic acid, mupirocin cream and albendazole 400 mg/d. Under this regime, the lesions were seen to decline. The second case, a 38-year-old male was also admitted in August, complaining of itching and redness on his body. The patient, whose blood count values were normal, exhibited itchy, raised, serpiginous string-like lesions located on the left side of his body. The patient, whose bacterial culture was negative, was clinically diagnosed as CLM and treated for three days with albendazole 400 mg/d and the lesions were seen to improve. The third case, a 23-year old male was admitted in September complaining of itching and redness on his neck. An itchy, crescent-shaped erythematous lesion was detected on his neck; bacteriological cultures and blood count were normal. The common feature for all three cases was the story of working in a hazelnut orchard and mowing weeds using a motorized string trimmer (weed whacker). None of them had a history of travel outside the country. Therefore CLM assumed to be occurred due to the aeration of surface earth layer with the force of motorized string trimmer and entrance of the larvae were from the open parts of the body. In conclusion, it should be keep in mind that hookworm larva-related CLM can be encountered in our country, and reporting of the patients with similar findings are necessary to determine the prevalence of this parasitosis in our country.

[Brucellosis as a cause of hemophagocytic syndrome]. / Hemofagositik sendrom sebebi olarak bruselloz.

Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome of excessive inflammation and tissue destruction due to abnormal immune activation and inflammation. HLH can occur primarily due to genetic etiology, or secondarily associated with malignancies, autoimmmune diseases or infections. There are a number of reports that revealed the relationship of hemophagocytosis with brucellosis. In this report, we described a brucellosis-related HLH case. A 73-year-old male who work as farmer was admitted to our hospital with the complaints of fever continuing for 10 days, loss of appetite and back pain. Physical examination revealed right upper quadrant tenderness and hepatomegaly. Since the patient exhibited five of the diagnostic criteria for HLH (fever, hepatosplenomegaly, bicytopenia, hypertriglyceridemia and high ferritin level), he was diagnosed as secondary HLH. PCR, microscopic agglutination and indirect fluorescent antibody tests gave negative results for the diagnosis of Crimean-Congo hemorrhagic fever, leptospirosis and Q fever, respectively. On the other hand, Rose Bengal test for brucellosis was positive, while standard tube agglutination test (STA) was negative. The patient's serum yielded a very high positive (1/1280) result when Coombs' test was performed in terms of the possibility of blocking antibodies or prozone phenomenon. Additionally, B.melitensis was isolated from his blood culture on the sixth day. The patient was treated with doxycycline and rifampicin, and on the 10th day of antibiotic therapy the patient was discharged and recommended to complete his treatment up to 6 weeks. In conclusion, in patients with secondary HLH symptoms especially in the endemic areas, brucellosis should be considered as a predisposing infection.

[Oxidative stress and antioxidant therapy with alpha-lipoic acid inclusion in acute poisoning by herbicide based on 2,4-dichlorphenoxyacetic acid].

In patients with acute poisoning amine salt herbicide 2,4-D develops oxidative stress with simultaneous inhibition of intracellular and extracellular antioxidant factors. These changes are more pronounced with neurological disorders that occur in conjunction with a toxic damage of liver or heart. The inclusion of a comprehensive detoxification therapy alpha-lipoic acid not only promotes a more pronounced therapeutic effect but also an earlier recourse cytolytic syndrome, a marked recovery of levels of malondialdehyde and indices of antioxidant system (superoxide dismutase and ceruloplasmin) than for patients in the comparison group.

First report of probable neurobrucellosis in Australia.

We report the first known Australian case of probable neurobrucellosis, in a young feral-pig shooter who presented with episodic left-sided visual loss and left-sided numbness and headache. Treatment with intravenous ceftriaxone and oral rifampicin, doxycycline and trimethoprim­sulfamethoxazole resulted in a good clinical response.

Cutaneous infection caused by Bacillus anthracis in Larissa, Thessaly, Central Greece, July 2012.

In July 2012, a confirmed case of cutaneous anthraxinfection in a stockbreeder in the prefecture of Larissa, Thessaly, Central Greece was reported. The investigation revealed five related deaths in animals (two dogs and three sheep). Control measures have been taken immediately in order to prevent further spread in humans and animals.

[Sporotrichosis: prevalence, clinical and epidemiological features in a reference center in Colombia]. / Esporotricosis: prevalencia, perfil clínico y epidemiológico en un centro de referencia en Colombia.

BACKGROUND: Sporotrichosis is a subacute and chronic infection caused by Sporothrix schenckii, which affects humans and other mammals. Clinical and epidemiological information in Colombia is scarce. OBJECTIVE: To describe clinical and socio-demographic findings and diagnostic tests in patients with sporotrichosis from 1996 to 2005 in a national reference center in Colombia, and to determine the institutional prevalence from 2002 to 2005. MATERIAL AND METHODS: This was a prevalence study, including patients with clinical diagnosis of sporotrichosis and at least one of the following criteria: positive culture with S. schenckii, pathologic diagnosis suggestive of sporotrichosis, or response to treatment with potassium iodide. RESULTS: Sixty cases were included, 67% were male, and 25% of them were farmers. The most affected anatomical areas were the forearms and hands (32.5% and 22.8% respectively). Most cases came from the Cundinamarca and Boyacá areas. The cases presented as fixed cutaneous sporotrichosis and lymphangitic sporotrichosis. Differential diagnoses with: leishmaniasis and chromoblastomycosis were performed in most of the cases. All patients were treated with potassium iodide. The prevalence for our center from 2002 to 2005 was 8 cases per 100,000 patients. CONCLUSIONS: The characteristics of our patients are similar to those described in other populations, with some differences. The culture continues to be the gold standard for diagnosis purposes. Potassium iodide is the treatment of choice in our center.

[Pustules from the cow barn]. / Pusteln aus dem Kuhstall.

A 54-year-old cattle farmer presented with crusty purulent plaques in the neck area. The clinical picture and microscopical proof of hyphae in the skin smear combined with Wood's lamp testing led to the diagnosis of Tinea barbae, a mycological infection of the skin transmitted by cattle (typically Trichophyton verrucosum). Therapy with itraconazole 200 mg q.d. p.o. and miconazole ointment 1×/day over 2 weeks was successful. This case report and its image are designed to bring attention to this rarely diagnosed pathology.

[Primary cutaneous aspergillosis in an immunocompetent farmworker]. / Aspergillose cutanée primitive chez un agriculteur immunocompétent.

INTRODUCTION: Aspergillosis is an uncommon fungal infection in which primary cutaneous sites are very rare. Most cases occur in immunodepressed patients and are disseminated in the blood. We report a case of primary cutaneous aspergillosis in a 37-year-old immunocompetent farmworker presenting as a kerion-like lesion. CASE REPORT: A 37-year-old farmworker presented erythematous and nodular lesions of the face. These lesions were not associated with any general symptoms and failed to respond to antibiotic treatment. Histological examination of a skin biopsy sample showed a granulomatous reaction in the dermis associated with an extensive neutrophilic infiltrate. PAS staining revealed the presence of right-angled branched hyphae with conidia. Aspergillus fumigatus was isolated and identified in cultures. Clinical and biological examinations did not reveal any systemic localisation of aspergillosis, ruling out the hypothesis of blood dissemination. This primary cutaneous infection occurred in an immunocompetent patient, in whom laboratory tests ruled out any underlying immunosuppression. Systemic antifungal treatment with voriconazole led to complete resolution. DISCUSSION: Reports in the literature of primary cutaneous aspergillosis in immunocompetent patients are extremely rare. Clinical lesions may comprise often painful weeping or necrotic macules or papules or subcutaneous nodules that can progress towards abscess or necrosis. The semiological similarity between these lesions and kerions can lead to misdiagnosed cases and delayed treatment.

A Radical Approach to Acute Lymphoblastic Leukemia Treatment: A Case Study of a Veterinarian Specializing in Livestock who Developed Disseminated Mucormycosis during Induction Therapy.

Mucormycosis has emerged as the third-most common fungal mycosis and is one of the most fatal molds. We herein report a case study of a 30-year-old woman who was a veterinarian, specializing in livestock, who developed disseminated mucormycosis during induction therapy for acute lymphoblastic leukemia. We successfully used a radical approach for treatment, including a surgical procedure and allogeneic transplantation, with continuous administration of antifungal agents. Reports of successful treatments are extremely rare, and our case has had the longest documented remission from disseminated disease. We speculate that our case's occupational environment may represent a risk factor for development of mucormycosis.

A Case of Rheumatoid Arthritis with Strongyloides stercoralis Hyperinfection.

The patient was a 83-year- old male who worked as a farmer. He had complaints of weight loss, abdominal pain and joint pains for almost 5 months. Twenty days ago, the patient was checked at another hospital for complaints of occasional coughing and bloody sputum. He was treated with a diagnosis of pneumonia. His respiratory complaints were reduced, but there was no relief of his ongoing abdominal pain. Gastroduodenoscopy and colonoscopy were performed to examine for possible etiologies of continuous abdominal pain. Biopsies were taken from duodenal bulbus and second duodenal segment. Intense eosinophilic leukocyte infiltration and Strongyloides stercoralis larvae were observed in pathologic examination. The patient was successfully treated with albendazole 2x400 mg/day for 7+7 day.

Faecal carriage of extended spectrum beta-lactamase (ESBL) and New Delhi metallo beta-lactamase(NDM) producing Escherichia coli between piglets and pig farmworkers.

A cross-sectional study on five organized pig farms was conducted to assess the faecal carriage of ESBL and blaNDM carbapenemase-producing E. coli in piglets and pig farmworkers. Faecal samples from piglets (n = 155) and pig farmworkers (n = 21) were processed for isolation and characterization of E. coli. A total of 124 E. coli isolates from piglets and 21 E. coli isolates pig farmworkers were recovered and screening for ESBL production showed that 44.4 % (55/124) of the isolates from piglets and 42.9 % (9/21) of the isolates from farmworkers were ESBL positive. The ESBL positive isolates from piglets and farmworkers harbored blaCTX-M and also co-harbored other beta-lactams, sulphonamide, quinolone and tetracycline resistance genes. Diarrhoeic (50%, 49/98) and crossbred piglets (52.7%, 39/74) harbored a significantly higher number of ESBL producing isolates than non-diarrhoeic (23.1 %, 6/26) and purebred piglets (32%, 16/50) (p < 0.05). Piglets and pig farmworkers harbored nine and two carbapenem-resistant isolates, respectively. Interestingly, two isolates from piglets and one isolate from farmworkers harbored the blaNDM gene. The blaNDM positive E. coli isolated from piglets and farmworkers of the same farm revealed similar antibacterial resistance patterns, resistant genes, sequence (ST-167) and plasmid type (IncX3). In India, carbapenems are not used in food animal treatment, hence carbapenem resistant E. coli in piglets possibly originated from the human contact or common environment and is of public health importance.

Spectrum of fungal keratitis in central China.

PURPOSE: To investigate the epidemiology, risk factors, fungal spectrum and to test antifungal drug susceptibility of these isolates at a tertiary eye care referral centre in central China. METHODS: The medical and microbiology records of 2064 culture-proven cases (2064 eyes) of fungal keratitis diagnosed at Henan Eye Institute between January 2000 to March 2009 was retrospectively reviewed. The fungal isolates were identified and a subgroup of 103 isolates were subjected to drug susceptibility tests for amphotericin B, fluconazole and ketoconazole by broth microdilution method. RESULTS: A total of 2064 cases of confirmed fungal keratitis were identified. The predominant fungal species isolated was Fusarium spp. followed by Aspergillus spp. Alternaria spp. were another most common fungi in central China. Fungal keratitis was more common among men. A large proportion of the patients were middle-aged adults, and most were farmers. Ocular trauma was a highly significant risk factor and vegetative injuries were identified as a significant cause for fungal keratitis. Greatest number of cases of fungal keratitis was higher between September and December. Fusarium was mostly sensitive to amphotericin B, next to ketoconazole. Aspergillus was sensitive to amphotericin B and ketoconazole. Relatively, both Fusarium and Aspergillus were insensitive to fluconazole. CONCLUSION: Fusarium and Aspergillus are always the most isolated pathogens of fungal keratitis in central China, followed by Alternaria. Document available on the epidemiological features of a large series would greatly help ophthalmologists at primary and second health care centres in the management of this disease.

Caterpillar stings: a case study.

Lepidoptera can cause serious injury from toxic envenomation to humans. This case study involves a report of a caterpillar stinging a greens keeper foreman while working.

Green tobacco sickness: mecamylamine, varenicline, and nicotine vaccine as clinical research tools and potential therapeutics.

INTRODUCTION: Green tobacco sickness occurs from transdermal absorption of chemicals from freshly harvested, green tobacco leaves. Signs and symptoms include nausea, vomiting, headache, and abdominal cramps. Prevalence has shifted from the United States and Europe to China, India, and Brazil. Worldwide 8 million individuals are afflicted, including women and children. Areas covered: Mecamylamine (Inversine®, Vecamyl®), a nicotinic acetylcholine receptor (nAChR) antagonist, should be tested as a remedy for green tobacco sickness. Mecamylamine is approved as an oral tablet for the treatment of hypertension, is safe, and is off-patent. Mecamylamine attenuates many of the effects of nicotine and tobacco including seizures, thereby supporting its use as an effective pharmacotherapy for tobacco dependence. Varenicline (Chantix®) and cytisine (Tabex®) are low efficacy (i.e. intrinsic activity) nAChR agonists, are used as smoking cessation aids, and are viable options to test as remedies against green tobacco sickness. Nicotine immunization strategies may provide further options for future testing. Expert commentary: Efforts to demonstrate reversal and/or prevention of green tobacco sickness by mecamylamine will underscore the importance of nicotine in this illness and highlight a new medication for effective treatment of tobacco poisoning.