Topical clotrimazole cream for the treatment of tinea cruris: A retrospective study.

This retrospective study assessed the efficacy and safety of 1% topical clotrimazole cream for the treatment of patients with tinea cruris (TC).We included 86 patients with confirmed TC for the presence of fungal hyphae. Of those, 43 patients received 1% topical clotrimazole cream for a total of 4 consecutive weeks, and were assigned to an experimental group. The other 43 patients underwent 1% topical butenafine cream for a total of 2 consecutive weeks, and were allocated to a control group. The efficacy and safety were measured and analyzed after 4 weeks treatment.After treatment, patients in both groups achieved better improvements in erythema (P < .01), scaling (P < .01), itching (P < .01), and KOH-negative results (P < .01), compared with those in patients before the treatment. However, there were not significant differences in erythema (P = .61), scaling (P = .57), itching (P = .47), and KOH-negative results (P = .67) between 2 groups. In addition, no treatment-related adverse events were recorded in both groups.Both 1% topical clotrimazole and butenafine cream are found to be effective and safe for patients with TC. However, there is not significant difference in efficacy and safety between two groups.

[Multiple erythema annulare centrifugum associated with knee monoarthritis revealing Capnocytophagacanimorsus infection]. / Erythème annulaire centrifuge multiple et monoarthrite révélateurs d'une infection à Capnocytophaga canimorsus.

INTRODUCTION: Capnocytophagacanimorsus (C. canimorsus), a commensal Gram-negative bacillus found in the oral cavity of dogs and cats, is pathogenic for humans, with the most common clinical manifestations being septicemia, meningitis and endocarditis. Herein we report a case of CC bacteremia manifesting as multiple plaques of erythema annulare centrifugum associated with monoarthritis of the knee. PATIENTS AND METHODS: A 66-year-old man consulted for a skin rash and monoarthritis of the right knee with fever following an insect bite on his right hallux. Cutaneous examination revealed numerous erythematous annular plaques on the trunk and limbs with centrifugal extension. Analysis of synovial fluid from the right knee showed an inflammatory liquid with a sterile bacteriological culture and PCR was negative for Borrelia. C. canimorsus bacteria were isolated from blood cultures. 16S RNA PCR performed on the synovial fluid was positive for the same organism. The patient's history revealed that his hallux wound had been licked by his dog. DISCUSSION: C. canimorsus most frequently affects immunosuppressed subjects. Cutaneous signs are seen in half of all cases, most frequently presenting as cellulitis, pathological livedo or thrombotic purpura. We report herein a case of CC bacteremia in an immunocompetent patient manifesting as multiple plaques of erythema annulare centrifugum, an unusual sign, and monoarthritis of one knee.

Carditis in Acute Rheumatic Fever in a High-Income and Moderate-Risk Country.

OBJECTIVE: To describe clinical presentation, electrocardiographic, and echocardiographic characteristics of carditis at the time of diagnosis of acute rheumatic fever (ARF) over a 13-year period. STUDY DESIGN: A single-center retrospective chart analysis was conducted involving all consecutive patients diagnosed with ARF between 2003 and 2015. Patient age, sex, clinical characteristics, recent medical history for group A streptococcal pharyngotonsillitis and antibiotic treatment, and laboratory, echocardiographic, and electrocardiographic findings were recorded. RESULTS: Of 98 patients (62 boys, mean age 8.81 ± 3.04 years), 59 (60.2%) reported a positive history of pharyngotonsillitis; 48 (49%) had received antibiotic (mean duration of treatment of 5.9 ± 3.1 days), and, among these, 28 (58.3%) had carditis. Carditis was the second most frequent finding, subclinical in 27% of patients. Mitral regurgitation was present in 49 of 56 patients (87.5%) and aortic regurgitation in 36/56 (64.3%) no stenosis was documented. CONCLUSIONS: ARF is still present in high-income countries and can develop despite primary prophylaxis, especially when given for a short course. Our findings highlight the need for 10 days of antistreptococcal treatment to prevent ARF. Echocardiography is important because 27% of cases with carditis were subclinical.

Acute rheumatic fever and streptococci: the quintessential pathogenic trigger of autoimmunity.

Acute rheumatic fever (ARF) is a non-suppurative complication of pharyngeal infection with group A streptococcus. Signs and symptoms of ARF develop 2 to 3 weeks following pharyngitis and include arthritis, carditis, chorea, subcutaneous nodules, and erythema marginatum. In developing areas of the world, ARF and rheumatic heart disease are estimated to affect nearly 20 million people and remain leading causes of cardiovascular death during the first five decades of life. ARF still represents one of the quintessential examples of a pathogenic trigger culminating in autoimmune manifestations. In this review, we will focus on the pathogenesis and etiology of ARF and its complications, along with diagnostic and treatment approaches to both ameliorate and prevent long-term sequelae of this potentially debilitating disease.

Adult-onset acute rheumatic fever: possible resurgence in southern Taiwan.

BACKGROUND: By the late 1980s, acute rheumatic fever (ARF) had become a rare disease in Taiwan. The low prevalence rate in this area is attributed to a better economic status, which has led to improved public health and adequate medical services. OBJECTIVES: The increasing number of patients with adult-onset ARF in the United States described in the literature prompted us to evaluate the cases diagnosed in our medical center. METHODS: A retrospective chart review was performed for patients with arthritis from July 1988 to October 2004. To be included, patients had to meet revised Jones criteria. RESULTS: Three adult patients with ARF have been diagnosed since June 2001, with no childhood ARF being diagnosed. All cases presented with migratory polyarthritis, whereas 1 had erythema marginatum and transient carditis. These patients responded well to treatment with antibiotics and nonsteroidal antiinflammatory drugs. CONCLUSIONS: Clinicians must provide careful assessment and treatment to patients presenting with acute pharyngitis. A possible resurgence of ARF can be eradicated by primary prevention of streptococcal pharyngitis.

Therapy of difficult cases of canine pyoderma with marbofloxacin: a report of 39 dogs.

Thirty-nine dogs with severe and/or recurrent lesions of pyoderma were treated with marbofloxacin at an average dosage of 2.12 mg/kg bodyweight, once daily, for time periods varing from 10 to 213 days. Forty-seven strains of bacteria, isolated from 34 cultures, were tested for sensitivity to various antibiotics. At day 0, no resistance to marbofloxacin was found, but one refractory case, a strain of Staphylococcus intermedius resistant to marbofloxacin, was cultured at day 28. Thirty-three dogs (84.6 per cent) showed an excellent response (cure), one (2.6 per cent) a clear improvement and one (2.6 per cent) a smaller improvement, while the remaining four dogs showed no response after 11 to 60 days. Fifteen dogs (45.5 per cent) relapsed over the follow-up period of three to 191 days, but none of the dogs in the study exhibited any adverse effects.

Analysis of antibody response to the outer surface protein family in lyme borreliosis patients.

Studies on frequencies of serum antibodies to outer surface proteins (Osps) in Lyme disease have produced conflicting results. Osp antigens (A, B, and C) enriched by butanol extraction, which aids band identification in immunoblotting, were used to test sera for IgG antibody to Osp antigens from Borrelia burgdorferi isolates from each subspecies (sensu stricto, afzelii, and garinii). Individual isolates were selected to include all five known European OspA genotypes. Of arthritis sera, 83% (n=29), and of acrodermatitis chronica atrophicans sera, 81% (n=26), recognized OspA, B, and/or C. Of erythema migrans sera, 23% recognized OspA and/or B and a further 15% OspC alone. Only 5 (6%) of 86 sera (4 arthritis, 1 acrodermatitis chronica atrophicans, 0 erythema migrans) recognized all five OspA phenotypes tested. Marked differences in the reactions of individual sera to the various Osp antigens were seen, which helps reveal the causes of discrepancies between previous reports.

Tick-borne Borrelia infection in Sweden.

Spirochetes were cultivated from 17% of 114 Ixodes ricinus ticks in the Stockholm area. Three strains of these spirochetes were selected for studies by electron microscopy. These three strains had definite morphological similarities to spirochetes of the genus Borrelia, as judged by the number of flagella, absence of cytoplasmic tubules, and dimensions. The three strains were not identical, but seemed to consist of two different kinds of cells, one with eight and one with eleven flagella. The three strains were also shown to react with a monoclonal antibody that reacts with Lyme disease spirochetes (Borrelia burgdorferi), but not with strains of other Borreliae, Treponemes, or Leptospiras. These results indicate the possibility of transmission of Borrelia spirochetes from ticks to humans in Sweden. The antibody response to one of the spirochetal strains isolated from Swedish I. ricinus was studied in 37 patients with the typical clinical picture of erythema chronicum migrans (ECM), in 45 patients with chronic meningitis (CMe) cured by high-dose intravenous penicillin, in 298 patients with post-infectious arthritis, and in controls. The antibody response was estimated by indirect immunofluorescence assay (IFA) enzyme-linked immunosorbent assay (ELISA). The antibody levels differed significantly between patients with CMe and healthy individuals (p less than 0.001), both with respect to serum antibody levels and CSF-antibody levels. The antibody levels also differed significantly between patients with ECM and healthy controls as measured by ELISA (p less than 0.05), whereas the difference was not significant as measured by IFA. Five of 298 patients with post-infectious arthritis had higher titers than any of the controls, and two of these five patients had titers higher than any patient with CMe or ECM. These results indicate spirochetal aetiology of ECM, and in some patents with CMe or postinfectious arthritis. As a diagnostic test for ECM, both IFA and ELISA were of limited value, since only 5/37 (14%) ECM patients were positive by IFA, and 14/37 (38%) by ELISA. Regarding patients with CMe, 23/45 (51%) were seropositive by IFA and 30/45 (67%) by ELISA. However, measurement of CSF-antibodies were found to be a more sensitive method than measurement of serum antibodies both by IFA and ELISA, since 38/45 (84%) CMe patients were positive by IFA, and 41/45 (91%) by ELISA. In addition, estimation of CSF antibodies was also found to be a more specific method than estimation of serum antibodies.(ABSTRACT TRUNCATED AT 400 WORDS)