Local neutrophil and eosinophil extracellular traps formation in pyodermatitis pyostomatitis vegetans.

Pyodermatitis pyostomatitis vegetans is a rare inflammatory condition, affecting the skin and/or mucous membrane. Some cases include both skin and mucous involvement, whereas others develop either skin or mucous lesions only. The typically affected areas are the scalp, face, trunk and extremities, including the flexural areas and umbilicus. Clinical features show erosive granulomatous plaques, keratotic plaques with overlying crusts and pustular lesions. Among mucous lesions, oral mucosa is most frequently involved, and gingival erythema, shallow erosions, cobblestone-like papules on the buccal mucosa or upper hard palate of the oral cavity are also observed. Some of the lesions assume a 'snail track' appearance. Although there are several similarities between pyodermatitis pyostomatitis vegetans and other diseases, that is pyoderma gangrenosum, pemphigus vegetans and pemphigoid vegetans, the histopathological features of pyodermatitis pyostomatitis vegetans are unique in that epidermal hyperplasia, focal acantholysis and dense inflammatory infiltrates with intraepidermal and subepidermal eosinophilic microabscesses are observed. Direct immunofluorescence findings are principally negative. Activated neutrophils are supposed to play an important role in the pathogenesis of pyodermatitis pyostomatitis vegetans. The expression of IL-36 and neutrophil extracellular traps (NETs) was observed in the lesional skin, and additionally, eosinophil extracellular traps (EETs) was detected in pyodermatitis pyostomatitis vegetans. A possible pathogenic role of NETs and EETs in the innate immunity and autoinflammatory aspects of pyodermatitis pyostomatitis vegetans was discussed.

Comparison of Aerobic Bacterial Culture Among Four Veterinary Microbiology Laboratories from Dogs with Superficial Pyoderma.

Bacterial culture and susceptibility are widely used in veterinary medicine to determine the specific bacteria causing infection as well as aid in appropriate antimicrobial selection. Previous studies have shown variable results with culture and susceptibility depending on the laboratory and methodology used. Samples from dogs with superficial pyoderma were obtained to make a homogeneous solution of bacteria. Sample acquisition from this solution was randomized and submitted to four veterinary laboratories for microbial identification and sensitivity. There was fair agreement among the laboratories in identification of a Staphylococcus spp. as well as fair agreement among the laboratories on the same Staphylococcus sp. Very good agreement was noted on identification of methicillin-resistant Staphylococcus spp. Additionally, good to very good agreement was noted on all antimicrobials that were tested across all four laboratories. A difference in turnaround time for sample processing was observed between the laboratories in the present study. Overall, there was mild variability among the laboratory results in this study.

Clinical and histopathological features of rostrolateral nasal alar arteriopathy of German shepherd dogs.

BACKGROUND: Dermal arteritis of the nasal philtrum (DANP) has been described in large-breed dogs. OBJECTIVES: To characterise clinically distinct, discrete fissures of the dorsolateral nasal alae associated with severe bleeding in German shepherd dogs (GSDs). ANIMALS: Fourteen privately owned GSDs with linear rostrolateral nasal alar fissures and a histopathological diagnosis of nasal vasculopathy. MATERIALS AND METHODS: Retrospective analysis of medical records and histological slides. RESULTS: Mean age of onset was 6 years. Before biopsy, episodic arteriolar bleeding was noted in 11 of the 14 (79%) dogs. Slide analysis revealed enlarged nasal arterioles with expanded vascular tunics and luminal stenosis beneath ulcers. Histopathological lesions consistent with mucocutaneous pyoderma and/or facial discoid lupus erythematosus were present in 5 of the 14 (36%) dogs. Enlarged arterioles stained blue with Alcian blue and Masson's trichrome stains, consistent with deposition of mucin and collagen, respectively. Immunohistochemical stains (neutrophil myeloperoxidase, IBA1, CD3) were performed. CD3 was negative for all dogs, whilst neutrophil myeloperoxidase and IBA1 occasionally demonstrated intramural neutrophils (3 of the 14 dogs, 21%) or histiocytes (1 of the 14 dogs, 7%) in altered vessels, respectively. All dogs underwent medical management and/or surgical excision. Treatments included tacrolimus, prednisone, ciclosporin-modified, pentoxifylline, antimicrobials and doxycycline/niacinamide. No dogs were treated with antimicrobials alone. For seven dogs with long-term follow-up, treatment response was complete in five (71%) and partial in two (29%), with six of the seven (86%) receiving immunomodulatory treatments to maintain remission. CONCLUSION AND CLINICAL RELEVANCE: Nasal alar arteriopathy of GSDs shares histopathological changes with DANP. It has characteristic clinical and histopathological features and appears amenable to immunomodulation.

Staphylococci isolated from cats in Italy with superficial pyoderma and allergic dermatitis: Characterisation of isolates and their resistance to antimicrobials.

BACKGROUND: In cats, superficial pyoderma traditionally is considered rare and few reports are available. There is a particular lack of studies concerning Staphylococcus species associated with pyoderma in subjects affected by allergic skin diseases. HYPOTHESIS/OBJECTIVES: (i) To evaluate the association between Staphylococcus spp. and superficial pyoderma in allergic cats and (ii) to characterise isolated staphylococci and analyse their antimicrobial resistance patterns. ANIMALS: Forty-one cats with allergic dermatitis and superficial pyoderma in Italy. MATERIALS AND METHODS: Skin swabs were cultured for the isolation of Staphylococcus spp. Species identification was performed by matrix-assisted laser desorption/ionisation time of flight mass spectrometry and 16S-rRNA sequencing. Staphylococcus aureus isolates were further characterised by staphylococcal protein A gene-typing. Antimicrobial susceptibility was performed by the disk diffusion method. RESULTS: Staphylococci were isolated from 36/41 cats sampled and 39 different isolates were identified. Uneven distribution of staphylococcal species was observed among different body locations. The 39 isolates were S. aureus (n = 15), S. felis (n = 10), S. pseudintermedius (n = 8) and other staphylococci (n = 6). Eight different S. aureus spa-types associated with human clonal complexes were identified. Antimicrobial resistance was observed to penicillin (56.4%), tetracycline (46.2%), enrofloxacin (33.3%), erythromycin (28.2%), amikacin (25.6%), clindamycin (23.1%), marbofloxacin (15.4%), gentamicin (12.8%), trimethoprim-sulfamethoxazole (10.3%), chloramphenicol (7.7%) and cefoxitin/oxacillin (5.1%). Fifteen isolates (38.4%) were multidrug-resistant while meticillin resistance was associated only with S. pseudintermedius. CONCLUSIONS AND CLINICAL RELEVANCE: These results confirm that S. aureus, S. pseudintermedius, and S. felis are frequently associated with superficial pyoderma in allergic cats. Semi-synthetic penicillins remain a suitable first-line treatment in this study, yet the high prevalence of antimicrobial resistant isolates suggests that antimicrobial susceptibility testing should be performed routinely.

Genomic Features of Antimicrobial Resistance in Staphylococcus pseudintermedius Isolated from Dogs with Pyoderma in Argentina and the United States: A Comparative Study.

Staphylococcus pseudintermedius is the most common opportunistic pathogen in dogs and methicillin resistance (MRSP) has been identified as an emerging problem in canine pyoderma. Here, we evaluated the antimicrobial resistance (AMR) features and phylogeny of S. pseudintermedius isolated from canine pyoderma cases in Argentina (n = 29) and the United States (n = 29). 62% of isolates showed multi-drug resistance. The AMR genes found: mecA, blaZ, ermB, dfrG, catA, tetM, aac(6')-aph(2″), in addition to tetK and lnuA (only found in U.S. isolates). Two point mutations were detected: grlA(S80I)-gyrA(S84L), and grlA(D84N)-gyrA(S84L) in one U.S. isolate. A mutation in rpoB (H481N) was found in two isolates from Argentina. SCCmec type III, SCCmec type V, ΨSCCmec57395 were identified in the Argentinian isolates; and SCCmec type III, SCCmec type IVg, SCCmec type V, and SCCmec type VII variant in the U.S. cohort. Sequence type (ST) ST71 belonging to a dominant clone was found in isolates from both countries, and ST45 only in Argentinian isolates. This is the first study to comparatively analyze the population structure of canine pyoderma-associated S. pseudintermedius isolates in Argentina and in the U.S. It is important to maintain surveillance on S. pseudintermedius populations to monitor AMR and gain further understanding of its evolution and dissemination.

Blastomycosis-like pyoderma: A pitfall for the misdiagnosis of squamous cell carcinoma.

Blastomycosis-like pyoderma is a rare cutaneous disease presenting as solitary or multiple verrucous or ulcerated plaques and nodules in a susceptible patient. The diagnostic criteria include characteristic verrucous plaques with pustules and elevated borders, histopathologic findings of pseudoepitheliomatous hyperplasia with abscesses, growth of at least one bacterium in tissue culture, and exclusion of other infectious sources. This report describes a case of a 62-year-old man with poorly controlled type 2 diabetes mellitus who presented with plaques, nodules, and ulcers in both groins and the right ankle. The patient was initially misdiagnosed with multiple squamous cell carcinomas and underwent several operations. A review of the pathology slides revealed pseudoepitheliomatous hyperplasia with multiple dermal abscesses, while repeated wound and tissue cultures were positive for coagulase-negative Staphylococcus. Blastomycosis-like pyoderma was diagnosed. The patient was subsequently treated with culture-guided prolonged antibiotic therapy followed by intralesional steroid injection, which led to gradual resolution of the lesions.

Antibiotic-resistant status and pathogenic clonal complex of canine Streptococcus canis-associated deep pyoderma.

BACKGROUND: Streptococcus canis causes deep pyoderma in canines, which raises concerns about the risk of isolates from lesions acquiring an antibiotic-resistant phenotype. It is necessary to identify effective antibiotics and the characteristics of the pathogenic cluster for S. canis-associated deep pyoderma. RESULTS: The signalment, molecular typing, and antibiotic-resistant status of S. canis isolated from deep pyoderma lesions (27 strains) and oral cavities (26 strains) were analyzed. Older dogs tended to have S. canis-associated deep pyoderma (15 of 27 dogs over 10 years old). Veterinarians chose quinolones for 10/16 cases (63%), even though the rate of quinolone-resistant strains of S. canis is 38-59%. Although 70% of the strains showed resistance to three or more antibiotic classes (37/53), 94% (50/53) strains showed sensitivity for penicillins. We also identified ß-lactamase activity among penicillin-resistant strains of S. canis. Clonal complex 13 (CC13) was detected only in lesions and formed independent clusters in the phylogenetic tree. One strain of CC13 was resistant to the anti-methicillin-resistant Staphylococcus aureus drugs, vancomycin and linezolid. CONCLUSION: Although antibiotic-resistant strains of S. canis are isolated at a high rate, they can currently be treated with ß-lactamase-inhibiting penicillins. CC13 may be a pathogenic cluster with high levels of antibiotics resistance.

Vegetative lesions associated with inhaled cocaine use.

We present two cases of vegetating exudative lesions involving the oral mucosa, in patients that are cocaine users, with findings in biopsy and in direct immunofluorescence consistent with the diagnosis of pyostomatitis vegetans-pyodermatitis vegetans.

Efficacy of a quaternary ammonium compound in reducing coagulase-positive staphylococcal colony counts in veterinary dermatology exam rooms following two cleaning instruction protocols.

BACKGROUND: Nosocomial meticillin-resistant (MR) staphylococcal infections are of global concern. Veterinary dermatology exam room surfaces may be a reservoir given the commonness of staphylococcal pyoderma. HYPOTHESIS/OBJECTIVES: First, efficacy of exam room surface decontamination using a quaternary ammonium compound was assessed after use of two different cleaning instruction protocols. Second, coagulase-positive staphylococcal (CoPS) colony counts were assessed after use of rooms by dogs with pyoderma, and then after cleaning and disinfection. METHODS AND MATERIALS: In Part I, 10 room surfaces were tagged with a discreet fluorescent dye, Glo Germ, to assess the efficacy of surface cleaning between two Virex II 256-based cleaning protocols. In Part II, CoPS colonies were quantified via 3M Staph Express System. Ten standardised room surfaces were sampled after use by a dog with staphylococcal pyoderma, and immediately after a detailed cleaning and disinfection protocol. RESULTS: A total of 24 of 100 and 81 of 100 surfaces were completely cleaned by the general and detailed protocols, respectively. The mean number of surfaces adequately cleaned was higher with the detailed protocol (P = 0.003). The detailed protocol reduced CoPS colony counts of eight surfaces (P < 0.01), and not chairs (P = 0.055). No CoPS were isolated from the exam table under a table mat. CONCLUSIONS AND CLINICAL RELEVANCE: Detailed exam room cleaning and disinfection protocols are recommended to minimise contamination of veterinary exam room surfaces with staphylococci. The appropriate disinfection of chairs necessitates further study.

Effects of the clinical severity of disease and concomitant pyoderma on serum acute-phase proteins concentrations in dogs with sarcoptic mange.

BACKGROUND: Information on acute-phase protein (APP) concentrations in dogs with sarcoptic mange (SM) is scarce. OBJECTIVE: To determine the effects of the clinical severity of disease and concomitant pyoderma on serum C-reactive protein (CRP), serum amyloid-A (SAA), haptoglobin (Hp) and ceruloplasmin (Cp) concentrations in dogs with SM. ANIMALS: Forty client-owned dogs with SM (INF group) and 10 healthy control dogs (CON group). MATERIALS AND METHODS: The INF group was divided into three subgroups; Group 1 (mild/moderate), Group 2 (severe) and Group 3 (severe+pyoderma) according to the extent of skin lesions and the presence of concomitant pyoderma. Serum CRP, SAA, Hp and Cp concentrations of all study groups were measured. RESULTS: Serum CRP (P < 0.001), SAA (P < 0.001) and Hp (P = 0.016) concentrations of the INF group were higher than the CON group, with no difference in terms of Cp. A statistical difference was measured between groups 2 and 1 in SAA only. C-reactive protein was found to be significantly higher in dogs with severe SM accompanied by pyoderma (Group 3) when compared with dogs with severe SM (Group 2). The area under the receiver-operating characteristic curves differentiating pyoderma among dogs with severe SM was 0.850 for CRP (P = 0.0001, cut-off value >61.3 mg/L with sensitivity 69.29% and specificity 90.91%). CONCLUSIONS: The unique findings in this were that the SAA serum concentrations are related to the severity of SM and that serum CRP concentrations are effective in detecting the presence of pyoderma in dogs with severe SM.

Conclusions - The unique findings in this were that the SAA serum concentrations are related to the severity of SM and that serum CRP concentrations are correlated with the presence of pyoderma in dogs with severe SM. Contexte - Les informations sur les concentrations de protéines de phase aiguë (APP) chez les chiens atteints de gale sarcoptique (SM) sont rares. Objectif - Déterminer les effets de la gravité clinique de la maladie et de la pyodermite concomitante sur les concentrations sériques de protéine C-réactive (CRP), d'amyloïde-A (SAA), d'haptoglobine (Hp) et de céruloplasmine (Cp) chez les chiens atteints de SM. Animaux - Quarante chiens de propriétaires atteints de SM (groupe INF) et 10 chiens témoins sains (groupe CON). Matériels et méthodes - Le groupe INF a été divisé en trois sous-groupes ; Groupe 1 (léger/modéré), Groupe 2 (sévère) et Groupe 3 (sévère + pyodermite) selon l'étendue des lésions cutanées et la présence de pyodermite concomitante. Les concentrations sériques de CRP, SAA, Hp et Cp de tous les groupes d'étude ont été mesurées. Résultats - Les concentrations sériques de CRP (P < 0,001), SAA (P < 0,001) et Hp (P = 0,016) du groupe INF étaient supérieures à celles du groupe CON, sans différence en termes de Cp. Une différence statistique a été mesurée entre les groupes 2 et 1 en SAA uniquement. La protéine C-réactive s'est avérée significativement plus élevée chez les chiens atteints de SM sévère accompagnée de pyodermite (groupe 3) par rapport aux chiens atteints de SM sévère (groupe 2). L'aire sous les courbes caractéristiques de fonctionnement du récepteur différenciant la pyodermite chez les chiens atteints de SM sévère était de 0,850 pour la CRP (P = 0,0001, valeur seuil > 61,3 mg/L avec une sensibilité de 69,29 % et une spécificité de 90,91 %). Conclusions - Les résultats uniques dans ce cas étaient que les concentrations sériques de SAA sont liées à la gravité de la SM et que les concentrations sériques de CRP sont corrélées à la présence de pyodermite chez les chiens atteints de SM sévère.

Introducción- la información sobre las concentraciones de proteína de fase aguda (APP) en perros con sarna sarcóptica (SM) es escasa. Objetivo- determinar los efectos de la gravedad clínica de enfermedad y pioderma concomitante en las concentraciones de proteína C reactiva (CRP) sérica, amiloide-A sérica (SAA), haptoglobina (Hp) y ceruloplasmina (Cp) en perros con SM. Animales - Cuarenta perros de propietarios particulares con SM (grupo INF) y 10 perros de control sanos (grupo CON). Materiales y métodos - El grupo INF se dividió en tres subgrupos; Grupo 1 (leve/moderada), Grupo 2 (grave) y Grupo 3 (grave+pioderma) según la extensión de las lesiones cutáneas y la presencia de pioderma concomitante. Se midieron las concentraciones séricas de CRP, SAA, Hp y Cp de todos los grupos de estudio. Resultados- las concentraciones séricas de CRP (P < 0,001), SAA (P < 0,001) y Hp (P = 0,016) del grupo INF fueron más altas que las del grupo CON, sin diferencias en términos de Cp. Se observó una diferencia estadística entre los grupos 2 y 1 en SAA solamente. Se encontró que la proteína C reactiva era significativamente más alta en perros con SM severa acompañada de pioderma (Grupo 3) en comparación con perros con SM severa (Grupo 2). El área bajo las curvas de características operativas del receptor que diferencian la pioderma entre perros con SM grave fue de 0,850 para CRP (P = 0,0001, valor de corte >61,3 mg/l con sensibilidad del 69,29 % y especificidad del 90,91 %). Conclusiones- los hallazgos únicos en esto estudio fueron que las concentraciones séricas de SAA están relacionadas con la gravedad de la SM y que las concentraciones séricas de CRP están correlacionadas con la presencia de pioderma en perros con SM grave.

Contexto - São escassas as informações sobre as concentrações de proteínas de fase aguda (PFA) em cães com sarna sarcóptica (SS) são escassas. Objetivo - Determinar os efeitos da gravidade da doença e a piodermite concomitante nas concentrações de proteína C-reativa (PCR), amiloide sérico A (ASA), haptoglobina (Hp) e ceruloplasmina (Cp) em cães com SS. Animais - Quarenta cães de clientes com SS (grupo INF) e 10 cães controle saudáveis (grupo CON). Materiais e métodos - O grupo INF foi dividido em três subgrupos; Grupo 1 (leve/moderado), Grupo 2 (grave), Grupo 3 (grave + piodermite) de acordo com a extensão das lesões cutâneas e a presença de piodermite concomitante. As concentrações séricas de PCR, ASA, Hp e Cp, foram mensuradas. Resultados - As concentrações séricas de PCR (P < 0,001), ASA (P < 0,001) e Hp (P = 0,016) no grupo INF foram maiores que no grupo COM, sem diferenças em termos de Cp. Mensurou-se a diferença estatística entre os grupos 2 e 1 no ASA apenas. A proteína C-reativa foi significativamente maior em cães com SS grave com piodermite (Grupo 3) quando comparado com cães com SS grave (Grupo 2). A área sob as curvas características de operação do receptor que diferenciam piodermite entre cães com SS grave foi 0,850 para a PCR (P = 0,0001, valor de corte > 61,3 mg/L com sensibilidade de 69,29% e especificidade de 90,91%). Conclusões - Os achados mais singulares deste estudo foram de que as concentrações séricas de ASA são relacionadas à severidade da SS e que as concentrações séricas de PCR são correlacionadas com a presença de piodermite em cães com SS grave.

Rifampicin treatment of canine multidrug-resistant meticillin-resistant staphylococcal pyoderma: A retrospective study of 51 cases.

BACKGROUND: Rifampicin (RFP) is a potential treatment for canine multidrug-resistant (MDR) meticillin-resistant staphylococci (MRS), yet the use of lower doses based on recent MIC data has not been evaluated in vivo. HYPOTHESIS/OBJECTIVES: To provide information on the efficacy and safety of low-dose range RFP (≤6 mg/kg/day) for the treatment of canine MDR MRS pyoderma. ANIMALS: Fifty-one client-owned dogs. MATERIALS AND METHODS: Retrospective review of dogs medical records. Dogs were from 11 US dermatology referral practices and had oral RFP at ≤6 mg/kg/day. Data evaluated included response to treatment, adverse events, and serum changes in alanine aminotransferase (ALT) and alkaline phosphatase (ALP). RESULTS: Complete resolution of pyoderma occurred in 39 of 51 dogs (76.5%). Topical antimicrobials were used concurrently in most cases (47 of 51; 92.2%). ALP elevation >1.5-fold of baseline or the high end of the reference range occurred in nine of 37 (24.3%) dogs, while ALT elevation above baseline and the high end of the reference range occurred in two of 36 (5.6%). Only six of 51 (11.8%) had clinical adverse events during treatment; five of six (83.3%) were mild reactions consisting of lethargy and gastrointestinal signs, while one dog had a possible cutaneous adverse drug reaction. Of those that experienced clinical adverse events, four of six (66.7%) did not have concurrent increased liver enzyme activity, while two of six (33.3%) had elevations in ALP alone. CONCLUSIONS AND CLINICAL RELEVANCE: Low-dose RFP (≤6 mg/kg/day) appears to be a relatively safe and effective single-agent systemic antibiotic in combination with topical antimicrobials for canine MDR MRS pyoderma.

CONTEXTE: La rifampicine (RFP) est un traitement potentiel des staphylocoques canins multirésistants (MDR) résistants à la méticilline (MRS), mais l'utilisation de doses plus faibles sur la base de données récentes sur la CMI n'a pas été évaluée in vivo. Hypothèse/Objectifs : Fournir des informations sur l'efficacité et l'innocuité des RFP à faible dose (≤ 6 mg/kg/jour) pour le traitement de la pyodermite MDR-MR canine. Animaux : Cinquante et un chiens de propriétaires. Matériels et méthodes : Revue rétrospective de chiens ayant reçu RFP par voie orale à des doses ≤ 6 mg/kg/jour provenant des dossiers médicaux de 11 centres de référés en dermatologie aux États-Unis. Les données évaluées comprenaient la réponse au traitement, les événements indésirables et les modifications sériques de l'alanine aminotransférase (ALT) et de la phosphatase alcaline (ALP). Résultats : Une résolution complète de la pyodermite s'est produite chez 39 des 51 chiens (76,5 %). Des antimicrobiens topiques ont été utilisés simultanément dans la plupart des cas (47 sur 51 ; 92,2 %). Une élévation de l'ALP> 1,5 fois la ligne de base ou l'extrémité supérieure de la plage de référence s'est produite chez neuf des 37 (24,3%) chiens, tandis qu'une élévation de l'ALT au-dessus de la ligne de base et de l'extrémité supérieure de la plage de référence s'est produite chez deux des 36 (5,6%). Seuls six sur 51 (11,8 %) ont eu des événements indésirables cliniques pendant le traitement ; cinq des six (83,3 %) étaient des réactions bénignes consistant en une léthargie et des signes gastro-intestinaux, tandis qu'un chien a eu un possible effet indésirable cutané au médicament. Parmi ceux qui ont subi des événements indésirables cliniques, quatre sur six (66,7 %) n'ont pas eu d'augmentation simultanée de l'activité des enzymes hépatiques, tandis que deux sur six (33,3 %) ont présenté des élévations de l'ALP seule. Conclusions et pertinence clinique : La RFP à faible dose (≤ 6 mg/kg/jour) semble être un antibiotique systémique à agent unique relativement sûr et efficace en association avec des antimicrobiens topiques pour la pyodermite MDR MRS canine.

Introducción- la rifampicina (RFP) es un tratamiento potencial para los estafilococos resistentes a múltiples fármacos (MDR) y meticilina (MRS), sin embargo, el uso de dosis más bajas basado en datos recientes de MIC no se ha evaluado in vivo. Hipótesis/Objetivos- Proporcionar información sobre la eficacia y seguridad de RFP en el rango de dosis bajas (≤6 mg/kg/día) para el tratamiento de la pioderma canina MDR MRS. Animales- Cincuenta y un perros propietarios particulares. Materiales y métodos- revisión retrospectiva de perros que recibieron RFP oral a dosis ≤6 mg/kg/día obtenida de historiales clínicos de 11 prácticas de referencia de dermatología de los Estados Unidos. Los datos evaluados incluyeron la respuesta al tratamiento, los eventos adversos y los cambios séricos en la alanina aminotransferasa (ALT) y la fosfatasa alcalina (ALP). Resultados- una resolución completa de la pioderma ocurrió en 39 de 51 perros (76,5 %). Antimicrobianos tópicos se usaron al mismo tiempo en la mayoría de los casos (47 de 51; 92,2%). En nueve de 37 (24,3 %) perros se produjo una elevación de ALP >1,5 veces respecto al valor inicial o el extremo superior del rango de referencia, mientras que en dos de 36 (5,6 %) se produjo una elevación de ALT por encima del valor inicial y en el límite superior del rango de referencia. Solo seis de 51 (11,8%) tuvieron eventos adversos clínicos durante el tratamiento; cinco de seis (83,3 %) fueron reacciones leves que consistieron en letargo y signos gastrointestinales, mientras que un perro tuvo una posible reacción cutánea adversa al medicamento. De los que experimentaron eventos adversos clínicos, cuatro de seis (66,7 %) no tuvieron un aumento simultáneo de la actividad de las enzimas hepáticas, mientras que dos de seis (33,3 %) tuvieron elevaciones en la ALP por sí sola. Conclusiones y relevancia clínica- la dosis baja de RFP (≤6 mg/kg/día) parece ser un antibiótico sistémico de uso único relativamente seguro y efectivo en combinación con antimicrobianos tópicos para la pioderma canina MDR MRS.

Contexto - A rifampicina (RFP) é um tratamento potencial para estafilococos resistentes à meticilina (MRS) multirresistentes (MDR) e a utilização de doses mais baixas baseado em dados recentes de MIC não foi avaliada in vivo. Hipótese/Objetivos: Fornecer informações sobre a eficácia e segurança de RFP em menor dosagem (≤6 mg/kg/dia) para o tratamento de piodermite canina por MRS MDR. Animais: Cinquenta e um cães de clientes. Materiais e métodos: Uma revisão retrospectiva dos prontuários de cães que receberam RFP oral na dose de ≤6 mg/kg/dia em 11 clínicas dermatológicas nos Estados Unidos. Os dados avaliados incluíram resposta ao tratamento, eventos adversos, alterações séricas de alanina aminotransferase (ALT) e fosfatase alcalina (FA). Resultados: Resolução completa da piodermite ocorreu em 39 de 51 dos cães (76,5%). Antimicrobianos tópicos foram utilizados concomitantemente na maioria dos casos (47 de 51; 92,2%). Elevação de mais de 1,5 vezes na FA ou para o limite superior do intervalo de referência ocorreu em nove de 37 cães (24,3%), enquanto a elevação de ALT acima do valor inicial e o limite superior do valor de referência ocorreu em dois de 36 (5,6%). Apenas cinco de 51 (11,8%) apresentaram efeitos adversos durante o tratamento; cinco de seis (83,3%) tiveram reações leves caracterizadas por letargia e sinais gastrointestinais, enquanto um cão apresentou uma possível farmacodermia. Dos que apresentaram eventos adversos, quatro de seis (66,7%) não apresentaram aumento concomitante de enzimas hepáticas, enquanto dois de seis (33,3%) tiveram aumento de FA isoladamente. Conclusões e relevância clínica - RFP em baixa dosagem (≤6 mg/kg/dia) aparenta ser relativamente segura e eficaz em monoterapia no tratamento da piodermite canina por MRS MDR por via sistêmica, associada a antimicrobianos tópicos.

Inflammatory bowel disease presenting with pyodermatitis-pyostomatitis vegetans in a pediatric patient: A case report and review of the literature.

Pyodermatitis-pyostomatitis vegetans (PD-PSV) is rarely reported in the pediatric population. Here, we provide a review of pediatric PD-PSV in the literature and report a case of widespread PD-PSV in a 15-year-old male without a previous history of inflammatory bowel disease or gastrointestinal symptoms. Clinical, histological, and immunopathological workup established PD-PSV and revealed subclinical Crohn's disease. Treatment with infliximab was effective in inducing rapid resolution of the lesions.

Whole genome sequencing and de novo assembly of Staphylococcus pseudintermedius: a pangenome approach to unravelling pathogenesis of canine pyoderma.

BACKGROUND: Staphylococcus pseudintermedius is the main aetiological agent of canine pyoderma. Whole genome sequencing is the most comprehensive way of obtaining relevant genomic information about micro-organisms. HYPOTHESIS/OBJECTIVES: Oxford Nanopore technology enables quality sequencing and de novo assembly of the whole genome of S. pseudintermedius. Whole genome analysis of S. pseudintermedius may help to better understand the pathogenesis of canine pyodermas. METHODS AND MATERIALS: Twenty-two strains of S. pseudintermedius isolated from the skin of five healthy dogs and 33 strains isolated from skin of 33 dogs with pyoderma were analysed. DNA was extracted and sequenced using Oxford Nanopore MinION, a new technology that delivers longer reads in a hand-held device. The pangenome was analysed and visualised with Anvi'o 6.1. RESULTS: Nanopore technology allowed the sequencing and de novo assembly of the genomes of 55 S. pseudintermedius strains isolated from healthy dogs and from dogs with pyoderma. The average genome size of S. pseudintermedius was 2.62 Mbp, with 48% being core genome. Pyoderma isolates contained a higher number of antimicrobial resistance genes, yet the total number of virulence factors genes did not change between isolates from healthy dogs and from dogs with pyoderma. Genomes of meticillin-resistant S. pseudintermedius (MRSP) strains were larger than those of meticillin-susceptible (MSSP) strains (2.80 Mbp versus 2.59 Mbp), as a consequence of a greater presence of antimicrobial resistance genes, phages and prophages. CONCLUSIONS AND CLINICAL IMPORTANCE: This technique allows much more precise and easier characterisation of canine S. pseudintermedius populations and may lead to a better understanding of the pathogenesis of canine pyodermas.

Efficacy of olanexidine gluconate in canine superficial pyoderma: a randomised, single-blinded controlled trial.

BACKGROUND: Topical treatments can be beneficial for managing canine superficial pyoderma. A novel antiseptic agent, olanexidine gluconate, has become available recently for use in humans, and its efficacy for canine pyoderma as topical therapy is unknown. OBJECTIVE: The antimicrobial effect of olanexidine was evaluated using minimal inhibitory concentration (MIC) towards Staphylococcus pseudintermedius. Furthermore, its clinical efficacy in canine superficial pyoderma was assessed in a randomized, single-blinded study. ANIMALS: Twenty-eight client-owned dogs with atopic dermatitis and superficial pyoderma. METHODS AND MATERIALS: The MIC of olanexidine was determined for S. pseudintermedius isolates (n=73) by serial dilution of 96-well broth microdilution method. Regarding the clinical trial, all recruited dogs were randomized into two groups; one treated with 1.5% olanexidine spray once daily and the other with a 3% chlorhexidine shampoo once a week for 2 times, respectively. Clinical assessment was performed at days 0 and 14 according to the guidelines of the Japanese Society of Antimicrobials for Animals. RESULTS: The MIC values for methicillin-resistant S. pseudintermedius (MRSP) and methicillin-sensitive S. pseudintermedius (MSSP) were 0.23 µg/ml and 0.24 µg/ml (P =0.9), respectively. In clinical trial, olanexidine and chlorhexidine showed substantial improvement in clinical presentation compared to the baseline. CONCLUSIONS AND CLINICAL IMPORTANCE: Olanexidine showed comparable efficacy to chlorhexidine (P=0.73). Moreover, the MIC against S. pseudintermedius indicated high bactericidal activity, which was supported by the topical effectiveness of olanexidine.

Identification of fusidic acid resistance in clinical isolates of Staphylococcus pseudintermedius from dogs in Korea.

BACKGROUND: Staphylococcus pseudintermedius is a major bacterial species associated with canine pyoderma and otitis. Fusidic acid is used to treat skin infections caused by Gram-positive bacteria. The incidence of resistance to fusidic acid in S. pseudintermedius has importance in terms of limiting treatment options for bacterial infections. HYPOTHESIS/OBJECTIVES: To evaluate the occurrence and mechanisms of fusidic acid resistance in clinical isolates of S. pseudintermedius. ANIMALS: Fifty-two S. pseudintermedius isolates were collected from dogs with pyoderma (n = 36) or otitis (n = 16). METHODS AND MATERIALS: The disk diffusion method determined that isolates <24 mm were resistant to fusidic acid. Minimum inhibitory concentrations (MICs) were measured by the E-test in those with confirmed resistance to fusidic acid by the disk diffusion method. Phenotypically fusidic acid resistant isolates were subjected to PCR to detect the presence of resistance-related genes (fusA, fusB, fusC and fusD) and fusA was further sequenced to identify point mutations. RESULTS: Fourteen of 52 (27%) S. pseudintermedius isolates were resistant to fusidic acid and all of these showed low-level resistance. Among fusidic acid resistant isolates, fusA point mutations were confirmed in 11 isolates and amino acid substitutions were found in five. fusC was detected in seven isolates, but neither fusB nor fusD was detected. CONCLUSIONS AND CLINICAL IMPORTANCE: This study demonstrates the occurrence and resistance mechanisms to fusidic acid in clinical isolates of S. pseudintermedius. Continuous monitoring for fusidic acid resistance is recommended.

Efficacy study of a topical treatment with a plant extract with antibiofilm activities using an in vivo model of canine superficial pyoderma.

BACKGROUND: Canine pyoderma is a common skin infection caused predominantly by staphylococcal bacteria. Because of increasing rates of antimicrobial resistance in bacterial isolates, there is an urgent need for alternative or supplementary treatment options. W16P576, a Water Extract of Complex Mix of Edible Plants (WECMEP), has shown in vitro activity against a variety of bacteria, including Staphylococcus pseudintermedius. A canine model of pyoderma was developed which allows in vivo testing of antimicrobial agents in a controlled environment. OBJECTIVE: To evaluate the antibacterial efficacy of topical application of W16P576 in a model of canine pyoderma. ANIMALS: Nine laboratory housed beagle dogs. METHODS AND MATERIALS: In an evaluator-blinded cross-over study with an eight week washout period, dogs were treated topically twice daily with W16P576 WECMEP or its vehicle, starting three days before bacterial challenge. On the day of challenge, each dog was treated with two concentrations of a clinical S. pseudintermedius strain on opposite sides of the body. Topical treatment was continued for 11 days and lesions of pyoderma were evaluated and scored for 14 days. RESULTS: All dogs developed lesions consistent with bacterial pyoderma. Lesion scores were generally higher on the side inoculated with a higher concentration of bacteria. Treatment with W16P576 significantly reduced lesion development and hastened resolution of lesions, compared to placebo. CONCLUSION: Topical application of W16P576 markedly reduced lesion development in this proof of principle study. Clinical trials are warranted to estimate benefits for dogs with naturally occurring pyoderma under field conditions.

Two-Year Delayed Healing of an Endovascular Access Site Related to an Unusual Etiology.

In this case report, the authors describe a patient who underwent an endovascular abdominal aortic aneurysm repair complicated by more than a 2-year delay in healing of the left inguinal fold access site. Providers initially suspected a chronic infection or foreign body reaction, but eventually the patient was diagnosed with superficial granulomatous pyoderma. Once the correct etiology was determined and appropriate treatment begun, the access site healed within 3 weeks.

A perplexing case of superficial granulomatous pyoderma with sporotrichoid-like distribution.

Superficial granulomatous pyoderma (SGP) is a rare pyoderma gangrenosum (PG) variant that differs from classic PG in that the ulcers tend to be more superficial, lack a rapidly advancing border, and are not typically associated with an underlying systemic disease. The ulcers are most commonly painless and located on the trunk, with a clean granulating base. They generally do not show undermining but may have a vegetative border. Lesions usually respond well to either topical or intralesional corticosteroids with complete healing. The classic histopathologic finding is a "three-layer granuloma" in the superficial dermis consisting of central neutrophilic inflammation and necrosis, a surrounding layer of histiocytes and multinucleated giant cells, and an outer most layer of plasma cells and eosinophils. Herein, we present a unique case of SGP with sporotrichoid-like distribution on the lower extremity.

Pyodermatitis-pyostomatitis vegetans: a case report and review of literature.

Pyodermatitis-pyostomatitis vegetans is a rare inflammatory dermatosis. There is a strong association between pyodermatitis-pyostomatitis vegetans and inflammatory bowel disease, particularly ulcerative colitis. Herein, we report a case of pyodermatitis-pyostomatitis vegetans with positive direct immunofluorescence staining findings and review the literature for the past 18 years to characterize the disease, its epidemiologic characteristics, its associations, and the pathology and direct and indirect immunofluorescence findings. The total number of cases was 38, including 22 men and 16 women, with an average age of forty. Direct immunofluorescence staining had been performed for 32 patients, of which 12 had positive findings. Of those with positive direct immunofluorescence, 6 patients showed IgA cell surface staining. A recent approach suggests that these immunological findings may not be accidental and indicates a possible overlap with autoimmune bullous diseases discussed in this review.

Genetic resistance determinants to fusidic acid and chlorhexidine in variably susceptible staphylococci from dogs.

BACKGROUND: Concern exists that frequent use of topically-applied fusidic acid (FA) and chlorhexidine (CHX) for canine pyoderma is driving clinically relevant resistance, despite rare description of FA and CHX genetic resistance determinants in canine-derived staphylococci. This study aimed to determine minimum inhibitory concentrations (MICs) and investigate presence of putative resistance determinants for FA and CHX in canine-derived methicillin-resistant (MR) and -susceptible (MS) staphylococci. Plasmid-mediated resistance genes (fusB, fusC, fusD, qacA/B, smr; PCR) and MICs (agar dilution) of FA and CHX were investigated in 578 staphylococci (50 MR S. aureus [SA], 50 MSSA, 259 MR S. pseudintermedius [SP], 219 MSSP) from Finland, U.S.A., North (NUK) and South-East U.K. (SEUK) and Germany. In all isolates with FA MIC ≥64 mg/L (n = 27) fusA and fusE were amplified and sequenced. RESULTS: FA resistance determinants (fusA mutations n = 24, fusB n = 2, fusC n = 36) were found in isolates from all countries bar U.S.A. and correlated with higher MICs (≥1 mg/L), although 4 SP isolates had MICs of 0.06 mg/L despite carrying fusC. CHX MICs did not correlate with qacA/B (n = 2) and smr (n = 5), which were found in SEUK SA, and SP from NUK and U.S.A. CONCLUSIONS: Increased FA MICs were frequently associated with fusA mutations and fusC, and this is the first account of fusB in SP. Despite novel description of qacA/B in SP, gene presence did not correlate with CHX MIC. Selection pressure from clinical use might increase prevalence of these genetic determinants, but clinical significance remains uncertain in relation to high skin concentrations achieved by topical therapy.