Longitudinal whole-genome based comparison of carriage and infection associated Staphylococcus aureus in northern Australian dialysis clinics.

BACKGROUND: The study objective was to reveal reservoirs potentially leading to Staphylococcus aureus infections in haemodialysis clinic clients in the tropical north of the Australian Northern Territory (NT). This client population are primarily Aboriginal Australians who have a greater burden of ill health than other Australians. Reservoir identification will enhance infection control in this client group, including informing potential S. aureus decolonisation strategies. METHODS AND FINDINGS: The study participants were 83 clients of four haemodialysis clinics in the Darwin region of the NT, and 46 clinical staff and researchers who had contact with the clinic clients. The study design was longitudinal, encompassing swabbing of anatomical sites at two month intervals to yield carriage isolates, and also progressive collection of infection isolates. Swab sampling was performed for all participants, and infection isolates collected for dialysis clients only. Analysis was based on the comparison of 139 carriage isolates and 27 infection isolates using whole genome sequencing. Genome comparisons were based on of 20,651 genome-wide orthologous SNPs, presence/absence of the mecA and pvl genes, and inferred multilocus sequence type and clonal complex. Pairs of genomes meeting the definition of "not discriminated" were classed as defining potential transmission events. The primary outcome was instances of potential transmission between a carriage site other than a skin lesion and an infection site, in the same individual. Three such instances were identified. Two involved ST762 (CC1) PVL- MRSA, and one instance ST121 PVL+ MSSA. Three additional instances were identified where the carriage strains were derived from skin lesions. Also identified were six instances of potential transmission of a carriage strains between participants, including transmission of strains between dialysis clients and staff/researchers, and one potential transmission of a clinical strain between participants. There were frequent occurrences of longitudinal persistence of carriage strains in individual participants, and two examples of the same strain causing infection in the same participants at different times. Strains associated with infections and skin lesions were enriched for PVL and mecA in comparison to strains associated with long term carriage. CONCLUSIONS: This study indicated that strains differ with respect to propensity to stably colonise sites such as the nose, and cause skin infections. PVL+ strains were associated with infection and skin lesions and were almost absent from the carriage sites. PVL- MRSA (mainly CC1) strains were associated with infection and also with potential transmission events involving carriage sites, while PVL- MSSA were frequently observed to stably colonise individuals without causing infection, and to be rarely transmitted. Current clinical guidelines for dialysis patients suggest MRSA decolonisation. Implementation in this client group may impact infections by PVL- MRSA, but may have little effect on infection by PVL+ strains. In this study, the PVL+ strains were predominant causes of infection but rarely colonised typical carriage sites such as the nose, and in the case of ST121, were MSSA. The important reservoirs for infection by PVL+ strains appeared to be prior infections.

Infectious Dermatoses in Sport: A Review of Diagnosis, Management, and Return-to-Play Recommendations.

ABSTRACT: Infectious dermatoses represent a significant source of morbidity and missed athletic participation among athletes. Close quarters and skin trauma from contact sports can lead to outbreaks among teams and athletic staff. The National Collegiate Athletic Association and National Federation of State High School Associations have published guidance with recommended management and return-to-play criteria for common fungal, bacterial, viral, and parasitic rashes. In addition to rapidly diagnosing and treating infectious dermatoses, team physicians should counsel athletes and athletic staff on proper equipment care and personal hygiene to reduce infection transmission. Clinicians should always consult sport and athlete governing bodies for sport-specific recommendations.

Recommendations for Best Disinfectant Practices to Reduce the Spread of Infection via Wrestling Mats.

CONTEXT: At the request of the National Wrestling Coaches Association and the head wrestling coach at our university, we conducted a study of infection transmission in collegiate wrestlers. OBJECTIVE: To examine disinfectant effectiveness and develop best-practice guidelines for minimizing the spread of skin infections via wrestling mats. DESIGN: Controlled laboratory study and crossover study. SETTING: Laboratory and two 15-college wrestling invitational meets. PATIENTS OR OTHER PARTICIPANTS: A total of 231 collegiate wrestlers and 8 officials. INTERVENTION(S): In the laboratory-based part of the study, we measured the bacterial load of mats disinfected with 10% bleach, OxiTitan, Benefect, eWater, and KenClean and inoculated with Staphylococcus epidermidis (strain ATCC 12228) at a concentration of 6.5 × 104 bacteria/cm2. In the empirical part of the study, we used these disinfectants during 2 invitational meets and measured mat and participant bacterial load during competition. Participants were swabbed at weigh-in and after their last bout. Mat bacterial load was monitored hourly. MAIN OUTCOME MEASURE(S): We determined total colony counts and species. RESULTS: With controlled testing, we observed that products claiming to have residual activity reduced bacterial load by 63% over the course of competition compared with nonresidual agents. Only 4 of 182 participating wrestlers tested positive for methicillin-resistant Staphylococcus aureus , which is the normal population occurrence. The predominant species on mats were skin bacteria ( Staphylococcus epidermidis ) and substantial levels of respiratory bacteria ( Streptococcus pneumoniae ), as well as several soil species and a surprisingly low incidence of fecal bacteria ( Escherichia coli ). Disinfectant effectiveness during the meets was consistent with controlled study findings. Cleaning mats with residual disinfectants reduced the average bacterial load by 76% compared with nonresidual cleaners. Using a footbath did not reduce the bacterial load compared with a bleach-cleaned mat, but using alcohol-based hand gel reduced it by 78%. CONCLUSIONS: Best practices based on these data include backward mopping of the mats with a residual disinfectant pulled behind the cleaner, allowing mats to dry before walking on them, having wrestlers use hand gel before each bout, and strongly recommending that all wrestlers receive annual influenza vaccinations.

Skin infections in pregnancy.

A wide array of infectious diseases can occur in pregnancy. Their acquisition, clinical presentation, and course during gestation may be altered due to an impairment of the maternal cellular immunity. Some infectious diseases can lead to serious consequences for the mother or the offspring, including congenital malformations. This review describes in detail the clinical presentation, course, management, and associated maternal and fetal risks of selected viral (varicella-zoster virus infections, condylomata acuminata), fungal (candida vulvovaginitis), bacterial (Lyme borreliosis), and parasitic (scabies) infections. The treatment options are critically reviewed. First-line therapies include acyclovir and varicella-zoster virus immunoglobulin for varicella-zoster virus infections, surgical modalities for genital warts, topical clotrimazole and oral fluconazole for Candida vulvovaginitis, amoxicillin and cefuroxime for Lyme borreliosis, and permethrin for scabies. A synopsis of maternal and fetal risks of other important infections is also included.

[Animal Staphylococcus felis with the potential to infect human skin]. / Zwierzecy Staphylococcus felis o potencjale zakazania skóry czlowieka.

INTRODUCTION: Breaking interspecies barrier by microorganisms has become in the recent years an alarming phenomenon that threatens public health worldwide. An important potential interspecies transmission risk factor is close contact animal-human including occupational exposure of pet breeders and veterinarians. MATERIAL AND METHODS: The features of Staphylococcus felis ZMF 13 strain isolated from a swab from a cat's wound connected with potential pathogenicity were investigated. Results: The virulence factors of strain found were hydroxamate siderophores, production of invasins - intracellular proteolytic and lipolytic enzymes and the ability of biofilm production. The ability of bacteriocin-like substance production was also observed. The substance has an antagonistic activity against bacteria belong to physiological flora of the human skin which may be important in breaking the colonization resistance of human organism. Although the strain of S. felis ZMF 13 was methicillin-susceptible it demonstrated the constutive type of MLSB resistance mechanism. The genes ermA, msrB, linA connected with macrolide, lincosamides and streptogramin B resistance were detected. CONCLUSIONS: The current evidence suggest that Staphylococcusfelis has a number of features that can be crucial in its potential interspecies transmission.

Notes from the field: outbreak of skin lesions among high school wrestlers--Arizona, 2014.

Skin infections are a common problem among athletes at all levels of competition; among wrestlers, 8.5% of all adverse events are caused by skin infections. Wrestlers are at risk because of the constant skin-to-skin contact required during practice and competition. The most common infections transmitted among high school wrestlers include fungal infections (e.g., ringworm), the viral infection herpes gladiatorum caused by herpes simplex virus-1 (HSV-1), and bacterial infections (e.g., impetigo) caused by Staphylococcus or Streptococcus species, including methicillin-resistant Staphylococcal aureus (MRSA). On February 7, 2014, the Maricopa County Department of Public Health was notified of multiple wrestlers who reported skin lesions 2 weeks after participating in a wrestling tournament at school A. The tournament was held on January 24-25 and included 168 wrestlers representing 24 schools. The county health department initiated an investigation to identify cases of skin lesion, determine lesion etiology, identify risks associated with lesion development, and provide guidance for preventing additional cases.

[TIBOLA: an emerging clinically polymorphous rickettsiosis]. / TIBOLA : une rickettsiose en expansion, cliniquement polymorphe.

BACKGROUND: TIBOLA (tick-borne lymphadenopathy) is a rickettsiosis caused chiefly by R. slovaca, transmitted by a Dermacentor tick. We report five cases. PATIENTS AND METHODS: Three patients were diagnosed at the initial inflammatory stage (facial oedema, necrotic eschar, lymphadenopathy, fever) and two at the stage of sequelae (alopecia and fatigue). Microbiological evidence was present in only one case. DISCUSSION: TIBOLA is a form of rickettsiosis that is currently spreading in Europe. Clinical diagnosis is often made late because of the mild symptoms and the lack of knowledge among clinicians concerning the condition. Microbiological tests (serology, PCR, culture of eschar or serum samples) are negative in one third of cases. The reference treatment consists of antibiotics effective against intracellular bacteria, cyclines and macrolides.

Managing skin infections in Aboriginal and Torres Strait Islander children.

BACKGROUND: Skin infections are a cause of significant morbidity in Aboriginal and Torres Strait Islander populations. OBJECTIVE: This article gives an overview of some of the issues to consider when managing a patient with a skin infection. These issues may impact on completion of treatment and development of complications in the long term. DISCUSSION: Management should consist of treatment of the patient through medication and also general measures for the patient, their family and the community as a whole. There are significant health and socioeconomic burdens placed on communities as a result of the high rate of skin disease in some settings.

Warts transmitted in families and schools: a prospective cohort.

BACKGROUND AND OBJECTIVE: Cutaneous warts are common in primary schoolchildren; however, knowledge on the routes of transmission of human papillomavirus (HPV) causing warts is scarce. This study examines the association between the degree of HPV exposure and incidence of warts in primary schoolchildren to support evidence-based recommendations on wart prevention. METHODS: In this prospective cohort study, the hands and feet of all children in grades 1 to 7 (aged 4-12 years) of 3 Dutch primary schools were inspected for the presence of warts at baseline and after 11 to 18 months of follow-up. Data on the degree of HPV exposure included information obtained from parental questionnaires: preexistent warts, warts in family, prevalence of warts at baseline in the class, and use of public places (eg, swimming pools). RESULTS: Of the 1134 eligible children, 97% participated; the response rate from parental questionnaires was 77%, and loss to follow-up was 9%. The incidence for developing warts was 29 per 100 person-years at risk (95% confidence interval [CI] 26-32). Children with a white skin type had an increased risk of developing warts (hazard ratio [HR] 2.3, 95% CI 1.3-3.9). Having family members with warts (HR 2.08, 95% CI 1.52-2.86) and wart prevalence in the class (HR 1.20 per 10% increase, 95% CI 1.03-1.41) were independent environmental risk factors. CONCLUSIONS: The degree of HPV exposure in the family and school class contributes to the development of warts in schoolchildren. Preventive recommendations should focus more on limiting HPV transmission in families and school classes, rather than in public places.

Sport and infectious risk: a systematic review of the literature over 20 years.

The development of sports activities promoted as a health factor should not hide the increased risk for diseases, more particularly infections. A review of articles made over the last 20 years was made with a descriptive epidemiological purpose. The most marked risk is skin infection with methicillin-resistant community acquired Staphylococcus aureus (27.4% of the articles), followed by Tinea corporis and capitis (13.7%), and leptospirosis (11.7%). The risk of blood-borne infection seems low, and articles are rare (3.9%). The risk of disease with respiratory transmission (measles, meningococcal meningitis) must be taken into account. The effect of physical activity on the immune system depends on the type and duration of the work out: it seems to be beneficial for a workout of a moderate intensity, and deleterious for a sustained acute work out, or a period of intensive training. These periods of protection or susceptibility to infections are described as "open window" and "J curve". The only recommendations for prevention of sport-related infections arise from the frequency of skin infections and the severity of blood-borne infections. These recommendations are published by American and international sports authorities. The specificity of athletes' management is due to imperatives of competitiveness (maintaining physical performance) and the necessity of temporary eviction from sports, in case of contagiousness. The athletes must make sure their recommended vaccinations are up-to-date.

Topical review: skin infections in the foot and ankle patient.

There are numerous cutaneous disorders that affect the foot, but of these conditions skin infections have the most significant impact on overall patient morbidity and clinical outcome. Skin infections in foot and ankle patients are common, with often devastating consequences if left unrecognized and untreated in both surgical and nonsurgical cases. There is a diverse array of infectious dermatoses that afflict the foot and ankle patient including tinea pedis, onychomycosis, paronychia, pitted keratolysis, verruca, folliculitis, and erysipelas. Prompt diagnosis, treatment, and surveillance of these common infectious conditions are critical in managing these dermatoses that can potentially progress to form deep abscesses and osteomyelitis. Infections can be managed with a combination of ventilated shoewear and synthetic substances to keep the feet dry, topical and oral antimicrobial agents, and patient education regarding preventative hygiene measures. The purpose of this review is to aid foot and ankle surgeons and other physicians in the diagnosis and treatment of infectious dermatoses affecting the foot.

Herpes rugbiorum: a review on scrum pox and rugby player guidelines.

Sports, especially contact ones, have long been associated with an increased risk of contracting a communicable disease. Viral infections, in particular, have had an increased attention, due to their adverse effects on athletes' performance. As world sport events have now become more organised and diverse, athletes are now exposed to a wider range of pathogens. With the upcoming Rugby World Cup in 2011 taking place in New Zealand, team-doctors should keep a 'careful' eye on potential infectious outbreaks and make sure to adhere to guidelines accessed through fact sheets.

[Cutaneous infections related to permanent tattooing]. / Complications infectieuses cutanées associées au tatouage permanent.

Decorative tattooing is made by introducing exogenous pigments and/or dyes into the dermis to permanently mark the body for decorative or other reasons. Unfortunately, this procedure is not harmless and various complications may occur including the potential inoculation of virulent microorganisms in the dermis. Cutaneous infections usually develop within days to weeks after the procedure and may include: pyogenic infections (staphylococcus, streptococcus, Pseudomonas aeruginosa, etc.), but also atypical bacteria (commensal mycobacteria, tuberculosis, leprosy, etc.), viral infections (molluscum contagiosum, verruca vulgaris, herpes, etc.), and also fungal and parasitic infections. This review focuses on dermatological infections occurring on tattoos and their management.

Infectious disease and boxing.

There are no unique boxing diseases but certain factors contributing to the spread of illnesses apply strongly to the boxer, coach, and the training facility. This article examines the nature of the sport of boxing and its surrounding environment, and the likelihood of spread of infection through airborne, contact, or blood-borne routes of transmission. Evidence from other sports such as running, wrestling, and martial arts is included to help elucidate the pathophysiologic elements that could be identified in boxers.

Zoonoses of dermatologic interest.

Zoonoses are infectious diseases that can be transmitted from animals to humans. Transmission occurs directly or through vectors such as ticks, mosquitoes, or flies. The causative agents include bacteria, parasites, viruses, and fungi. Domestic pets and livestock, as well as wild animals, can be the source of disease. In this summary, we will focus on a number of dermatologically relevant examples.

Cutaneotropic human beta-/gamma-papillomaviruses are rarely shared between family members.

Several cutaneotropic human papillomavirus (HPV) types seem to be involved in the early onset of cutaneous squamous-cell carcinoma. To test the hypothesis that cutaneotropic HPV infections are facilitated because of close and frequent skin contact (for example, between child and mother), we examined HPV prevalence in hair follicle cells from 134 volunteers (1-89 years of age, median 42 years) from 13 families. We used a high-throughput HPV-typing approach with a sensitive beta-/gamma-cutaneous PCR method, followed by reverse line blotting, to detect 30 cutaneotropic HPV types. HPV prevalence in all individuals was 42% and increased with age from 5% at < or =20 years to 27% at 21-40 years, 53% at 41-60 years, and 76% at >60 years. The effect of life age was significant, independent of couples and family members shown by regression analyses (P < or =10(-8)). A higher similarity of HPV infection patterns was observed in couples versus two randomly chosen individuals (P

Cross-infection risk of felt-tipped marker pens in cataract surgery.

PURPOSE: To assess the potential of bacterial transmission using felt-tipped marker pens on forehead skin before cataract surgery. METHODS: A total of 64 marker pens taken from clinical stock were tested. Forty-eight new pens were cultured in the laboratory. They were first left to desiccate for 0, 4, and 16 h, then dipped into solutions of 0.5 Macfarlane's concentration of coagulase negative staphylococci (CNS), methicillin-resistant Staphylococcus aureus (MRSA) and coliforms, and transferred onto the culture medium after 5, 10, 30, and 120 min intervals of exposure to air. A further 16 pens were collected after routine clinical use for 5 working days and cultured. RESULTS: Positive cultures were observed in 100% of pens at 0 min, and 44.4% at 5 min after the organism was exposed to air. Escherichia coli showed least transmissibility with no growth in all plates after 5 min of exposure. Only MRSA showed heavy growth after 10 min of exposure. No pattern emerged with reference to the length of time; each pen was left to desiccate. No growth was observed in the cultures of all 16 marking pens after clinical use. CONCLUSIONS: The potential for transmission of bacteria through felt-tipped marker pens has not been explored in cataract surgery. This study demonstrated that a theoretical risk of transmission exists in a laboratory setting, and survival times of the bacteria decreased with time. This suggests that the interval in which patients are marked with the same pen may play a role in bacterial transmission.

Ecthyma contagiosum (orf)--report of a human case from the United Arab Emirates and review of the literature.

BACKGROUND: Ecthyma contagiosum (orf) is caused by an epitheliotropic parapox virus. It is a zoonosis usually transmitted to humans from affected sheep or goat through direct contact or contaminated fomites. METHODS: We report a 36-year-old patient with multiple skin lesions on his left hand, first observed 5 days before admission followed by red streaks on the forearm and an erythema on the upper arm 1 day prior to admission. The patient reported that he was working on a sheep farm. RESULTS: Histopathologic examination showed evidence of a viral infection. Subsequent transmission electron microscopy showed typical parapox virus particles, predominantly in the scaled-off layers of degenerated keratinocytes and monocytes. The results were verified and specified by two newly established polymerase chain reaction (PCR) assays and subsequent sequencing of the amplicons: one broadly reacting 'general parapox virus PCR', and one assay which allows--following sequencing--discrimination between individual orf virus strains. CONCLUSION: Despite the multiplicity of the lesions, there was a significant improvement after 2 weeks of treatment. Sequencing showed the uniqueness of this virus compared with previously published strains from other countries.