Trypanosoma cruzi DTU II coinfection with bacteria producing prolonged cutaneous lesion in a healthy young male

ABSTRACT Chagas disease (CD) is a neglected tropical disease caused by Trypanosoma cruzi and is genetically classified in six discrete typing units (DTUs). The isolates reported in Mexico are generally associated with DTU I. We presented a case of a prolonged cutaneous lesion in a Mexican man, caused by DTU II in coinfection with Bacillus velezensis and Corynebacterium sp. The patient assessment included a complete clinical history, physical exam, laboratory tests, and a skin biopsy. In the facial tissues, intracellular parasites were revealed. The PCR tests were positive for T. cruzi in tissue and blood samples. DNA satellite sequencing was correlated with the DTU II. The initial serological tests reported negative results. However, four months later, two serological tests reported positive results. These exams were performed in different health centers. Mexico is considered an endemic area for CD; nevertheless, this is just the second cutaneous case associated with a DTU different from DTU-I noted in this country. From an ecological point of view, this fact suggests a geographical expansion of DTU II and an association with atypical skin manifestations. Further studies should be conducted to understand this exciting association between DTU-II and prolonged cutaneous expression in humans.

The Clinical Characteristics of Inpatients: An Audit in the Department of Dermatology Hospital Kuala Lumpur Between 2016 and 2020

Background@#Although Dermatology is primarily a non-acute, outpatient-centered clinical specialty, some of them require in-patient care for intensive skin management. We aim to describe the demographic data, clinical characteristics, and outcomes of Dermatology inpatients in Hospital Kuala Lumpur (HKL).@*Methods@#This is a retrospective study on all dermatology inpatients in HKL between 2016 and 2020. Data was obtained from admission records and further analyzed.@*Results@#A total of 1567 patients were admitted to the Dermatology ward between 2016 and 2020 accounted for 2292 admissions. The mean age was 45 years (range 8-93). The male to female ratio was 1.16:1. The majority were Malaysian (99.2%). Most Malaysian were Malays (60%) followed by Chinese (19.3%) and Indian (17.1%). About 91% of the admissions were arranged from the dermatology clinic. The mean length of stay was 5.06 days (range 0-63). About 20% of the patients required multiple admissions. The main dermatological diagnosis requiring inpatient care were non-infective dermatoses (60.4%) which included eczematous dermatoses, autoimmune dermatoses, psoriasis, cutaneous adverse drug reactions, inflammatory and non-inflammatory dermatoses. This was followed by cutaneous infections (24.5%) and drug allergy testing & drug provocation tests (7.9%). About 3% of patients were transferred to other departments for further intensive management, and the rest were discharged home well. No mortality occurred in the Dermatology ward.@*Conclusion@#The Dermatology ward HKL managed 2292 admissions between 2016 and 2020. The three main dermatological diagnoses requiring intensive skin management were eczematous conditions, cutaneous infections, and autoimmune dermatoses.

Bacillus pumilus severe wound infection in a healthy ten years old child: a rare case report

Bacillus pumilus is commonly isolated from a wide variety of soils, plants and environmental surfaces, but rarely from human specimens. In this report, we describe a case of infection caused by B. pumilus in a healthy 10-years-old child. The microorganism was recovered from a severe wound of the left knee after three days from trauma. Pathogen identification was carried out by mass spectrometry. The patient's outcome was positive following an ampicillin/sulbactam treatment without complications.

Infección por Serratia marcescens: una inusual causa de lesiones cutáneas / Serratia marcescens infection: an unusual cause of skin lesions

Serratia marcescens corresponde a un bacilo gram negativo, miembro de la familia Enterobacteriaceae. Este microorganismo tiene una alta capacidad de supervivencia en condiciones hostiles y ha sido implicado en infecciones del tracto respiratorio, vía urinaria, meningitis, endocarditis y sistema musculoesquelético. No obstante, es considerado una causa rara de infecciones cutáneas. Esta última tiene distintas presentaciones clínicas, la más frecuente es fascitis necrotizante seguida de celulitis. Los nódulos, las pápulas después de inyecciones de rellenos, las erupciones papulares diseminadas, las placas eritematosas, las pústulas y las úlceras son parte del amplio espectro de formas clínicas descritas en la literatura. Presentamos el caso de una paciente de 50 años, con historia de compromiso del estado general, lesiones cutáneas polimorfas y fiebre. Se confirmó una infección cutánea por Serratia marcescens mediante cultivos. Se destaca el polimorfismo y la coexistencia de distintas manifestaciones en una misma paciente, incluyendo celulitis, nódulo, ulceras y necrosis cutánea y la importancia del estudio microbiológico para el adecuado tratamiento antibiótico.

Serratia marcescens corresponds to gram negative bacillus, a member of the Enterobacteriaceae family. This microorganism has a high survival capacity in hostile conditions and has been implicated in respiratory tract, urinary tract, meningitis, endocarditis and musculoskeletal system infections. However, it is considered a infrequent cause of cutaneous infections. Has different clinical presentations, the most frequent is necrotizing fasciitis followed by cellulite. Nodules, papules after filler injections, disseminated papular eruption, erythematous plaques, pustules and ulcers are part of the broad spectrum of clinical forms described in the literature. We present the case of a 50 year old patient with a history of compromised general condition, polymorphic cutaneous lesions and fever. Serratia marcescens cutaneous infection was confirmed by cultures. The polymorphism and the coexistence of different manifestations in the same patient, including cellulitis, nodule, ulcers and skin necrosis, and the importance of the microbiological study for the adequate antibiotic treatment are highlighted.

Cutaneous Mycobacterium massiliense Infection Associated with Acupuncture / 대한피부과학회지

No abstract available.

A Suspected Case of Cutaneous Mycobacterium immunogenum Infection / 나학회지

M. immunogenum was identified as the etiologic agent of a variety of hospital-acquired infections, including an outbreak of keratitis, and as the potential cause of hypersensitivity pneumonitis in industrial metal-grinding machinists. This microorganism appears to differ from other members of the M. chelonae?abscessus group. Clinically significant isolates have been recovered from skin lesions, corneal ulcers, joint fluid, central venous catheter sites, and blood. There have been some cases of M. immunogenum skin infection reported. We report a suspected case of cutaneous Mycobacterium immunogenum infection in a 23-year-old male, migrant Workers from Sri Lanka, who presented with an erythematous plaque on his right ear. M. immunogenum was suspected by PCR-restriction fragment length polymorphism & sequencing of PCR product. The patient was treated with clarithromycin & ofloxacin. The lesion started to improve 4 weeks after initiation of the therapy. We have the patient in therapy for 3 months, and the lesion is slowing disappeared.

Cutaneous Infection Due to Mycobacterium abscessus / 대한피부과학회지

No abstract available.

Localized Cutaneous Infection due to Stenotrophomonas maltophilia in Immunocompetent Patient / 대한피부과학회지

No abstract available.

utaneous Paecilomyces lilacinus infections in immunocompromised and immunocompetent patients.

Paecilomyces is a genus of saprophytic fungus that has been associated, in rare instances, with human disease. We report two cases in which Paecilomyces lilacinus was isolated from cutaneous and subcutaneous lesions in an immunocompromised and an immunocompetent host. The first case was a subcutaneous infection due to P. lilacinus in a patient with a renal transplant and diabetes mellitus. The second case was an immunocompetent young woman who developed a cutaneous infection, with no identified predisposing factors. A biopsy from each patient provided an initial diagnosis of fungal elements in the tissues under examination and multiple positive fungal cultures were obtained from the tissue biopsy samples. Both microscopic and macroscopic examinations of the biopsy revealed the presence of P. lilacinus. Each of the two cases was successfully treated with oral ketoconazole (200 mg/day) and itraconazole. We also review previously reported cases in which the clinical history and response to therapy were noted.

Cutaneous Infection Caused by Klebsiella pneumonia in a Patient with Aplastic Anemia / 대한피부과학회지

Klebsiella pneumonia is an opportunistic pathogen that can lead to severe diseases such as septicemia, pneumonia, urinary and hepatobiliary track infection, in mainly hospitalized, immunocompromised patients. It has been reported to produce cellulitis, ecthyma gangrenosum in cutaneous manifestions, which are more commonly induced by bacteremia and spreading from other internal organs than primary inoculation. Herein, we present a case of a 75-year-old man with aplastic anemia, which progressed to septic shock and secondary cutaneous infection caused by Klebsiella pneumonia, but showed similar skin lesions to systemic fungal infection with dispersed erythematous macules and vesicular change on the center of his erythema.

Localized Cutaneous Infection due to Scedosporium apiospermum / 대한의진균학회지

Scedosporium(S) apiospermum is the asexual stage of Pseudallescheria boydii. The organism has been isolated from polluted water, soil, sewage and potted plants in a hospital with low virulence. This ubiquitous fungus causes not only mycetoma, but also infections of variety of body sites including the skin. Localized skin infection without grain production due to this organism is much rarer than mycetoma. Infection may occur via direct inoculation and usually affects the extremities. We report a case of localized cutaneous infection due to S. apiospermum which occurred in a 79-year old female. She presented multiple erythematous papulopustules on the right wrist. Culture isolation for definitive diagnosis showed S. apiospermum. The patient was treated successfully with oral itraconazole 200 mg daily for 4 weeks.

A Case of Mycobacterium kansasii Cutaneous Infection in a Heart Transplant Recipient / 대한내과학회지

Mycobacterium kansasii is a slow-growing, nontuberculous mycobacterium (NTM) that primarily affects lung tissue. Cutaneous infection with M. kansasii has not been reported previously in heart transplant recipients in Korea. We report a case of cutaneous infection caused by M. kansasii in a heart transplant recipient. The patient was treated successfully for 18 months with ciprofloxacin, clarithromycin, ethambutol, and rifampin.

A Case of Mycobacterium kansasii Cutaneous Infection in a Heart Transplant Recipient / 대한내과학회지

Mycobacterium kansasii is a slow-growing, nontuberculous mycobacterium (NTM) that primarily affects lung tissue. Cutaneous infection with M. kansasii has not been reported previously in heart transplant recipients in Korea. We report a case of cutaneous infection caused by M. kansasii in a heart transplant recipient. The patient was treated successfully for 18 months with ciprofloxacin, clarithromycin, ethambutol, and rifampin.

Cutaneous Infection due to Mycobacterium fortuitum Originated from Soil / 대한피부과학회지

Mycobacterium (M.) fortuitum is a rapidly growing mycobacterium. It is classified as Runyon's group IV with M. abcessus and M. chelonae that are mostly found in water and soil. M. fortuitum infection usually occurs after trauma, surgery or procedures such as acupuncture that cause cutaneous or soft tissue manifestations. We report a case of cutaneous infection due to M. fortuitum in a 72-year-old woman with erythematous deep-seated nodules on her left hand. She inflicted a minor injury to her left hand in a farm. Culture from skin biopsy specimens on 3% Ogawa medium yielded bacterial colonies after 5 days. The microorganism was subsequently identified as M. fortuitum by PCR-restriction fragment length polymorphism analysis. The skin lesions were improved by antibiotic therapy with clarithromycin for 6 months.

Infección labial por citomegalovirus en un paciente infectado con VIH-1 / Labial cytomegalovirus infection in a patient infected with HIV-1

En pacientes infectados con el virus de la inmunodeficiencia humana tipo 1 (VIH-1), la infección por citomegalovirus (CMV) ocurre principalmente en estadios avanzados de la enfermedad, especialmente cuando el recuento de células T CD4+ en sangre periférica se encuentra por debajo de 100 células/mm3, lo cual favorece la progresión al sida y aumenta la probabilidad de muerte. El compromiso de la retina es la manifestación más común de esta coinfección, pero existen otras manifestaciones, como la radiculopatía periférica, la encefalopatía y el compromiso gastrointestinal; en raras ocasiones se observa neumonitis. Esta coinfección también puede presentarse como un cuadro fatal, asociado con una viremia alta y persistente, y con un compromiso grave de varios órganos. La infección cutánea por CMV es una manifestación muy rara en los pacientes positivos para VIH-1, la cual se observa cuando el recuento de células T CD4+ es menor de 50/mm3 y cursa con úlceras crónicas en la piel o las mucosas.Se presentan las características clínicas e inmunológicas de un caso de infección cutánea por CMV en un paciente positivo para VIH-1, y se revisa la literatura.

In patients infected with the type 1-human immunodeficiency virus (HIV-1), the cytomegalovirus (CMV) infection occurs mainly in advanced stages of the disease, especially when the CD4+ T-cell count in under 100 cells/millilitre, which accelerates the progression to AIDS and increases the risk of death. The retina compromise is the most frequent manifestation of the CMV infection associated to HIV-1. Other manifestations include peripheralpolyradiculopathy, encephalopathy, andgastrointestinal compromise. Pneumonitis is rarely observed. In addition, this coinfection can be presented as a fatal disease associated with high and persistent viremia and severe compromise of several organs. The cutaneous CMV infection is a very rare manifestation in HIV-1-infected patients, which is observed when the CD4+ T-cell count is under 50 cells/millilitre, and course with chronicskin and mucosal ulcers. We present the clinic and immunological characteristicsof an HIV-1-infected individual with aCMV cutaneous infection, making a comprehensive review of literature published.

Cutaneous infection caused by Corynebacterium pseudodiphtheriticum: a microbiological report / Infecção cutânea causada por Corynebacterium pseudodiphtheriticum: relato microbiológico

We report here a rare case of cutaneous infection due to Corynebacterium pseudodiphtheriticum. The patient presented to the clinical laboratory with a skin ulcer on his left leg. Gram-stained preparation of the purulent secretion revealed the presence of numerous rod-shaped Gram-positive organisms in the absence of any other species. The organism was grown in pure culture on sheep blood agar and was further identified as C. pseudodiphtheriticum using a commercial identification system (API-Coryne, BioMérieux, France). The infection was successfully treated with ciprofloxacin. This case emphasizes the importance of the clinical microbiology laboratory in correctly identifying Gram-positive organisms obtained in pure culture from skin ulcers.

Reportamos o isolamento de Corynebacterium pseudodiphtheriticum de um caso de infecção cutânea. O paciente apresentou-se ao laboratório clínico com uma úlcera na perna esquerda. A coloração de Gram do material revelou a presença de bacilos Gram-positivos e ausência de outras espécies bacterianas. O organismo foi isolado em cultura pura no ágar sangue de carneiro e foi identificado como C. pseudodiphtheriticum através de um sistema de identificação comercial (API-Coryne, BioMérieux, França). A infecção foi tratada com sucesso através do uso de ciprofloxacina. Este caso reforça a importância do laboratório de microbiologia clínica na identificação de organismos Gram-positivos isolados de cultura pura de amostras de úlceras cutâneas.

A Case of Sporotrichoid Cutaneous Infection Caused by Mycobacterium marinum / 감염과화학요법

Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infection. Risk factors include a history of trauma and water/fish-related hobbies or occupations. This infection is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 51-year-old man with ulcer and erythematous nodules on his right hand. The patient owned a tropical fish tank and remembered having previous hand trauma. The lesions extended to his forearm and formed sporotrichoid appearance. M. marinum was isolated from tissue specimens. The patient was treated with rifampin, etambutol and clarithromycin for 5 months, then the skin lesions were cured. The key to the diagnosis of this case are clinical awareness and a detailed history. M. marinum infection should be considered in chronic sporotrichoid skin lesions, particularly when there is a clinical suspicion on an infectious cause, and it could lead to successful treatment.

A Case of Sporotrichoid Cutaneous Infection Caused by Mycobacterium marinum / 감염과화학요법

Mycobacterium marinum is a nontuberculous mycobacterium responsible for skin infection. Risk factors include a history of trauma and water/fish-related hobbies or occupations. This infection is characteristically limited to the skin but deep soft tissue may be involved. We report a case of M. marinum infection in a 51-year-old man with ulcer and erythematous nodules on his right hand. The patient owned a tropical fish tank and remembered having previous hand trauma. The lesions extended to his forearm and formed sporotrichoid appearance. M. marinum was isolated from tissue specimens. The patient was treated with rifampin, etambutol and clarithromycin for 5 months, then the skin lesions were cured. The key to the diagnosis of this case are clinical awareness and a detailed history. M. marinum infection should be considered in chronic sporotrichoid skin lesions, particularly when there is a clinical suspicion on an infectious cause, and it could lead to successful treatment.

A Case of Mycobacteria chelonae Infection after Injection of Filler / 대한피부과학회지

Mycobacterium chelonae is a rapidly-growing, atypical mycobacterium that can cause both systemic and cutaneous infections as a human pathogen. This saprophyte is ubiquitous in the environment and has been found in water, soil, and dust particles. Clustered outbreaks usually occur after inoculation with contaminated fluids or injectable medications. We report a case of M. chelonae infection in a 53-year-old female, who presented with multiple, tender, firm, erythematous nodules and plaques on the face which occurred 2 months after a filler injection. Culture demonstrated coagulase negative staphylococcus and atypical mycobacterium, which was identified as M. chelonae by polymerase chain reaction.

M. chelonae Soft Tissue Infection Spreading to Osteomyelitis

A previously healthy, 54-year-old woman presented with Mycobacterium chelonae soft tissue infection and osteomyelitis of her left lower leg. The infection had started from soft tissue emerging at the medial aspect of the distal femur and had spread through the bone because of delayed diagnosis. The largely indolent, 8-month course to diagnosis was attributable to unremarkable clinical manifestations combined with a low index of suspicion such as immunocompetent patient and/or inadequate finding of acid-fast bacilli in a lesion smear, characteristic histopathological features, and culture techniques. Soft tissue infection and osteomyelitis were successfully treated without surgical intervention and with a 6-month course of chemotherapy.