Furunculosis and its complications: A cause of morbidity in renal transplant recipients: A retrospective observational study from Sindh Institute of Urology and Transplantation Karachi.

Furunculosis in renal transplant recipients may be associated with increased morbidity. With the aim to study the presentation, morbidity, and risk factors for furunculosis, this observational study was conducted at the Sindh Institute of Urology and Transplantation, between January to December 2014. All patients with furuncles or abscesses were included. The clinical presentation and risk factors were recorded. A morbidity scale of 0 and 1 was made on the basis of hospital stay for ≥7 days, bacteraemia, large abscesses and repeated furunculosis. Out of 38 patients, 29 (76%) had large abscesses and 9 (24%) had furuncles, with gluteal region being the most common site. Twelve (32%) had severe disease; 29 (76%) had morbidity scale of ≥1. High dose immunosuppression was significantly associated with severe disease while repeated furunculosis had significantly more risk factors. Furunculosis is a severe disease with high morbidity in renal transplant recipients and more studies are needed on skin colonisation and preventive strategies.

Prevalence of skin infections, infestations, and papular urticaria among adolescents in secondary schools in Calabar, Nigeria.

BACKGROUND: Acne is an inflammatory disorder of the pilosebaceous gland, and the most common dermatosis in adolescents globally. Infectious dermatoses are common in the tropics, but due to the paucity of epidemiologic surveys, not much is known about the prevalence and common types found in different sub-populations including adolescents. It is however presumed that the prevalence will be high and the pattern diverse. We therefore conducted a school-based survey to ascertain the prevalence and pattern of infectious dermatoses, infestations, and papular urticaria (insect bite reactions) in teenage adolescents in Calabar, Nigeria. METHODS: A cross sectional observational survey of adolescents aged 13-19 years attending randomly selected secondary schools in Calabar, Nigeria. It involved the use of questionnaires and subsequent whole body examination. RESULTS: A total of 1447 senior secondary school students were examined. Infectious dermatoses, infestations, and papular urticaria (IDIP) were observed in 505 (34.9%) persons, among whom were 269 (53.3%) males, and 236 (46.7%) females (X2=34.87, p=<0.001). Fungal dermatoses constituted more than 90% of the diseases, the bulk of which was contributed by pityriasis versicolor [430 (79.6%)]. The six most common dermatoses in descending order of frequencies were Pityriasis versicolor, tinea, papular urticaria, candidiasis, furuncles, and viral warts. CONCLUSION: A high prevalence of cutaneous infections exists among teenage adolescents in Calabar, Nigeria. Males have a higher predisposition to fungal dermatoses. Control of the predominant cause of cutaneous infections - pityriasis versicolor, will significantly affect the prevalence of infectious dermatoses, and invariably, the burden of skin disorders in adolescents in Calabar, Nigeria. FUNDING: Self sponsored.

A historical review of the key bacterial and viral pathogens of Scottish wild fish.

Thousands of Scottish wild fish were screened for pathogens by Marine Scotland Science. A systematic review of published and unpublished data on six key pathogens (Renibacterium salmoninarum, Aeromonas salmonicida, IPNV, ISAV, SAV and VHSV) found in Scottish wild and farmed fish was undertaken. Despite many reported cases in farmed fish, there was a limited number of positive samples from Scottish wild fish, however, there was evidence for interactions between wild and farmed fish. A slightly elevated IPNV prevalence was reported in wild marine fish caught close to Atlantic salmon, Salmo salar L., farms that had undergone clinical IPN. Salmonid alphavirus was isolated from wild marine fish caught near Atlantic salmon farms with a SAV infection history. Isolations of VHSV were made from cleaner wrasse (Labridae) used on Scottish Atlantic salmon farms and VHSV was detected in local wild marine fish. However, these pathogens have been detected in wild marine fish caught remotely from aquaculture sites. These data suggest that despite the large number of samples taken, there is limited evidence for clinical disease in wild fish due to these pathogens (although BKD and furunculosis historically occurred) and they are likely to have had a minimal impact on Scottish wild fish.

Teething.

Misconceptions about the teething process has led to high infant morbidity and mortality, which was recently experienced in Nigeria due to consumption of an adulterated drug used in the prevention and treatment of teething-related illnesses in infants. It is however, unknown if these misconceptions still persist in a rural town in Nigeria despite oral health awareness campaigns targeted at this. The aim of this study is to assess the beliefs and practices of residents in Igbo Ora, a rural township in Nigeria, regarding the teething process. A descriptive cross-sectional study was conducted among 393 adults in Igbo Ora using a 33-item, semistructured questionnaire. Symptoms such as diarrhea (80.7%), fever (69.2%), and boils (64.4%) were still considered as a must to accompany teething. Teething powder, teething syrup, and traditional concoctions were commonly recommended by (42.0%), (31.6%), and (48.1%) of the respondents, respectively, to treat and prevent teething symptoms. This study revealed that misconceptions about teething are still highly prevalent among the populace in Igbo Ora, and a structured oral health education intervention at the community level is urgently needed.

Detection and quantification of Aeromonas salmonicida in fish tissue by real-time PCR.

Furunculosis, a septicaemic infection caused by the bacterium Aeromonas salmonicida subsp. salmonicida, currently causes problems in Danish seawater rainbow trout production. Detection has mainly been achieved by bacterial culture, but more rapid and sensitive methods are needed. A previously developed real-time PCR assay targeting the plasmid encoded aopP gene of A. salmonicida was, in parallel with culturing, used for the examination of five organs of 40 fish from Danish freshwater and seawater farms. Real-time PCR showed overall a higher frequency of positives than culturing (65% of positive fish by real-time PCR compared to 30% by a culture approach). Also, no real-time PCR-negative samples were found positive by culturing. A. salmonicida was detected by real-time PCR, though not by culturing, in freshwater fish showing no signs of furunculosis, indicating possible presence of carrier fish. In seawater fish examined after an outbreak and antibiotics treatment, real-time PCR showed the presence of the bacterium in all examined organs (1-482 genomic units mg-1 ). With a limit of detection of 40 target copies (1-2 genomic units) per reaction, a high reproducibility and an excellent efficiency, the present real-time PCR assay provides a sensitive tool for the detection of A. salmonicida.

Aeromonas salmonicida infection levels in pre- and post-stocked cleaner fish assessed by culture and an amended qPCR assay.

Due to increasing resistance to chemical therapeutants, the use of 'cleaner fish' (primarily wrasse, Labridae, species) has become popular in European salmon farming for biocontrol of the salmon louse, Lepeophtheirus salmonis (Krøyer). While being efficient de-licers, cleaner fish mortality levels in salmon cages are commonly high, and systemic bacterial infections constitute a major problem. Atypical furunculosis, caused by Aeromonas salmonicida A-layer types V and VI, is among the most common diagnoses reached in clinical investigations. A previously described real-time PCR (qPCR), targeting the A. salmonicida A-layer gene (vapA), was modified and validated for specific and sensitive detection of all presently recognized A-layer types of this bacterium. Before stocking and during episodes of increased mortality in salmon cages, cleaner fish (primarily wild-caught wrasse) were sampled and screened for A. salmonicida by qPCR and culture. Culture indicated that systemic bacterial infections are mainly contracted after salmon farm stocking, and qPCR revealed A. salmonicida prevalences of approximately 4% and 68% in pre- and post-stocked cleaner fish, respectively. This underpins A. salmonicida's relevance as a contributing factor to cleaner fish mortality and emphasizes the need for implementation of preventive measures (e.g. vaccination) if current levels of cleaner fish use are to be continued or expanded.

Incidence and recurrence of boils and abscesses within the first year: a cohort study in UK primary care.

BACKGROUND: Boils and abscesses are common in primary care but the burden of recurrent infection is unknown. AIM: To investigate the incidence of and risk factors for recurrence of boil or abscess for individuals consulting primary care. DESIGN AND SETTING: Cohort study using electronic health records from primary care in the UK. METHOD: The Health Improvement Network (THIN) database was used to identify patients who had consulted their GP for a boil or abscess. Poisson regression was used to examine the relationship between age, sex, social deprivation, and consultation and to calculate the incidence of, and risk factors for, repeat consultation for a boil or abscess. RESULTS: Overall, 164 461 individuals were identified who consulted their GP for a boil or abscess between 1995 and 2010. The incidence of first consultation for a boil or abscess was 512 (95% CI = 509 to 515) per 100 000 person-years in females and 387 (95% CI = 385 to 390) per 100 000 person-years in males. First consultations were most frequent in younger age groups (16-34 years) and those with the greatest levels of social deprivation. The rate of repeat consultation for a new infection during follow up was 107.5 (95% confidence interval [CI] = 105.6 to 109.4) per 1000 person-years. Obesity (relative risk [RR] 1.3, 95% CI = 1.2 to 1.3), diabetes (RR 1.3, 95% CI = 1.2 to 1.3), smoking (RR 1.3, 95% CI = 1.2 to 1.4), age <30 years (RR 1.2, 95% CI = 1.2 to 1.3), and prior antibiotic use (RR 1.4, 95% CI = 1.3-1.4) were all associated with repeat consultation for a boil or abscess. CONCLUSION: Ten percent of patients with a boil or abscess develop a repeat boil or abscess within 12 months. Obesity, diabetes, young age, smoking, and prescription of an antibiotic in the 6 months before initial presentation were independently associated with recurrent infection, and may represent options for prevention.

Recurrent furunculosis in returning travelers: newly defined entity.

BACKGROUND: Bacterial skin infection is a common dermatologic problem in travelers, which usually resolves without sequela. In contrast, post-travel recurrent furunculosis (PTRF) is a new unique entity of a sequential occurrence of many furuncles seen after returning home from a trip to the Tropics. OBJECTIVE: The objective of this study was to characterize the disease course and possible causes of PTRF. METHODS: A retrospective study was conducted on a group of young, healthy individuals (16 males and 5 females), who presented with PTRF after returning from tropical countries. RESULTS: In all patients, the first furuncle appeared toward the end of the trip and continued for several months after returning home. The average duration of disease was 8.4 months with an average of 4.2 recurrences. Along the disease course, subsequent recurrences became shorter and milder with longer inter-recurrence intervals. Bacterial cultures most commonly grew methicillin-sensitive Staphylococcus aureus (MSSA, 76.5%). Nasal colonization was demonstrated in 47% of patients. There were neither companion travelers nor family members experiencing furuncles. CONCLUSIONS: PTRF should be defined as a clinical entity with prolonged travel to the Tropics being its major risk factor. In the author's opinion, a transient immune change in a subpopulation of travelers ignites a series of recurrent furuncles, resolving upon restoration of normal immunity.

Evidence for increasing severity of community-onset boils and abscesses in UK General Practice.

In England, hospital admissions for severe staphylococcal boils and abscesses trebled between 1989 and 2004. We investigated this trend using routine data from primary and secondary care. We used The Health Improvement Network (THIN), a large primary-care database and national data on hospital admissions from Hospital Episode Statistics (HES). Time trends in the incidence of primary-care consultations for boils and abscesses were estimated for 1995-2010. HES data were used to calculate age-standardized hospital admission rates for boils, abscesses and cellulitis. The incidence of boil or abscess was 450 [95% confidence interval (CI) 447-452] per 100 000 person-years and increased slightly over the study period (incidence rate ratio 1·005, 95% CI 1·004-1·007). The rate of repeat consultation for a boil or abscess increased from 66 (95% CI 59-73) per 100 000 person-years in 1995 to peak at 97 (95% CI 94-101) per 100 000 person-years in 2006, remaining stable thereafter. Hospital admissions for abscesses, carbuncles, furuncles and cellulitis almost doubled, from 123 admissions per 100 000 in 1998/1999 to 236 admissions per 100 000 in 2010/2011. Rising hospitalization and recurrence rates set against a background of stable community incidence suggests increased disease severity. Patients may be experiencing more severe and recurrent staphylococcal skin disease with limited treatment options.

Detection of variants of the pRAS3, pAB5S9, and pSN254 plasmids in Aeromonas salmonicida subsp. salmonicida: multidrug resistance, interspecies exchanges, and plasmid reshaping.

The ubiquitous water-borne Gram-negative bacterium Aeromonas salmonicida subsp. salmonicida is the causative agent of furunculosis, a worldwide disease in fish farms. Plasmids carrying antibiotic resistance genes have already been described for this bacterium. The aim of the present study was to identify and characterize additional multidrug resistance plasmids in A. salmonicida subsp. salmonicida. We sequenced the plasmids present in two multiple antibiotic-resistant isolates using high-throughput technologies. We also investigated 19 other isolates with various multidrug resistance profiles by genotyping PCR and assessed their resistance to tetracycline. We identified variants of the pAB5S9 and pSN254 plasmids that carry several antibiotic resistance genes and that have been previously reported in bacteria other than A. salmonicida subsp. salmonicida, which suggests a high level of interspecies exchange. Genotyping analyses and the antibiotic resistance profiles of the 19 other isolates support the idea that multiple versions of pAB5S9 and pSN254 exist in A. salmonicida subsp. salmonicida. We also identified variants of the pRAS3 plasmid. The present study revealed that A. salmonicida subsp. salmonicida harbors a wide variety of plasmids, which suggests that this ubiquitous bacterium may contribute to the spread of antibiotic resistance genes in the environment.

Which patients with dermatological conditions are admitted via the emergency department?

BACKGROUND AND OBJECTIVES: Most dermatology admissions to tertiary hospitals in Australia are initially assessed in the emergency department (ED). This 3-year retrospective study examined the types of dermatological conditions that necessitated admission, the factors that predicted admission and the implications for dermatological resource allocation. METHODS: The ED database was searched using the International Statistical Classification of Diseases, 10(th) revision (ICD-10) diagnosis codes and keywords in the presenting complaint and triage notes fields. The two lists were then merged and duplicates removed. All admissions were analysed and the medical records of admissions to the dermatology unit were reviewed to determine their final diagnosis. RESULTS: In total, 4817 patients with dermatological conditions presented over the 3-year period. Of these, 937 (20%) required admission, of whom 108 (12%) were admitted under the dermatology unit. The most common conditions requiring admission were cellulitis (n = 534, 56%), boils, furuncles and pilonidal sinuses (n = 183, 19%), and non-specific skin infections (n = 32, 3%). The most common conditions admitted under dermatology were psoriasis (n = 27, 25%), eczema (n = 25, 23%), and cellulitis (n = 16, 15%). Key predictors of admission were Australasian triage code, referral by a health-care professional or corrections officer and arrival by ambulance. CONCLUSION: Approximately one-fifth of dermatological presentations required admission, mostly for infective processes that did not require specific dermatological care. The predictors of admission reflect the severity of the condition and patients demonstrating these predictors should be referred to the Dermatology unit for admission.

Polyphasic characterization of Aeromonas salmonicida isolates recovered from salmonid and non-salmonid fish.

Michigan's fisheries rely primarily upon the hatchery propagation of salmonid fish for release in public waters. One limitation on the success of these efforts is the presence of bacterial pathogens, including Aeromonas salmonicida, the causative agent of furunculosis. This study was undertaken to determine the prevalence of A. salmonicida in Michigan fish, as well as to determine whether biochemical or gene sequence variability exists among Michigan isolates. A total of 2202 wild, feral and hatchery-propagated fish from Michigan were examined for the presence of A. salmonicida. The examined fish included Chinook salmon, Oncorhynchus tshawytscha (Walbaum), coho salmon, O. kisutcha (Walbaum), steelhead trout, O. mykiss (Walbaum), Atlantic salmon, Salmo salar L., brook trout, Salvelinus fontinalis (Mitchill), and yellow perch, Perca flavescens (Mitchill). Among these, 234 fish yielded a brown pigment-producing bacterium that was presumptively identified as A. salmonicida. Further phenotypic and phylogenetic analyses identified representative isolates as Aeromonas salmonicida subsp. salmonicida and revealed some genetic and biochemical variability. Logistic regression analyses showed that infection prevalence varied according to fish species/strain, year and gender, whereby Chinook salmon and females had the highest infection prevalence. Moreover, this pathogen was found in six fish species from eight sites, demonstrating its widespread nature within Michigan.

[Studies of prevalence rate of furunculosis caused by infection by Aeromonas salmonicida in salmonids of the southern part of Sakhalin Island].

Ichthyological studies of spawners of salmonids in the south of Sakhalin Island were studied. Cases of furunculosis disease were revealed. The agent of the disease Aeromonas salmonicida was isolated. Its morphological, physiological-biochemical, and antagonistic properties were studied, and the virulence of the isolated strains was determined. For supporting the species status of the studied strains of A. salmonicida, a molecular-genetic analysis was performed.

[Facial furuncles and carbuncles incidence and morbidity].

The retrospective study included analysis of 5764 hospital records in maxillo-facial surgery unit of Samara State Medical University Clinic to reveal facial furuncles and carbuncles incidence and morbidity. Patients attended in 2007-2010 were included in the study. Treatment options in 380 patients with facial furuncles and carbuncles were also analyzed. The authors recommend early treatment in the in-patient maxillofacial unit and adequate active surgical tactic.

Pedicure-associated rapidly growing mycobacterial infection: an endemic disease.

BACKGROUND: Pedicure-associated nontuberculous mycobacterial furunculosis has been reported in the setting of either outbreaks or sporadic case reports. The epidemiology of these infections is not well understood. METHODS: Systematic surveillance for pedicure-associated nontuberculous mycobacterial furunculosis was conducted in 2 North Carolina counties from 1 January 2005 through 31 December 2008. A subset of implicated nail salons and control salons was inspected and sampled for nontuberculous mycobacteria. RESULTS: Forty cases of suspected or confirmed pedicure-associated nontuberculous mycobacterial furunculosis were reported during the 4-year study period. Furunculosis incidence in the surveillance region was 1.00, 0.96, 0.83, and 0.89 cases per 100,000 population in 2005, 2006, 2007, and 2008, respectively. The responsible organisms primarily belonged to the Mycobacterium chelonae/abscessus group (30 [91%] of 33 isolates). Thirteen implicated salons and 11 control salons were visited and environmentally sampled. An assortment of nontuberculous mycobacteria was cultured from footbaths, but there was no association between the species distribution of the environmental isolates and implication of the salon in human infection. Evidence of suboptimal cleaning (visible debris or surface biofilms) was observed in at least 1 footbath for 11 of 13 implicated salons and 4 of 11 control salons (P = .032). CONCLUSIONS: Pedicure-associated mycobacterial furunculosis was endemic in these 2 North Carolina counties during 2005-2008. Suboptimal footbath cleaning may have contributed to these infections, which suggests straightforward means of potential prevention. The relative rarity of this type of infection in the setting of nearly ubiquitous exposure to these pathogens suggests that as yet undefined host-specific or procedure-related factors may be involved in susceptibility to these infections.

[Outbreak of skin infections due to Staphylococcus aureus carrying Panton-Valentine leukocidin genes in pupils and their relatives]. / Épidémie d'infections cutanées àStaphylococcus aureus porteur des gènes codant la leucocidine de Panton-Valentine en milieu scolaire et familial.

OBJECTIVES: The study objectives were to describe an outbreak of skin infections in school settings, caused by Staphylococcus aureus carrying Panton-Valentine leukocidin genes (Sa PVL(+)), over a 2-year period. Nasal colonization prevalence was assessed in families where new skin infections occurred, despite a prevention and control strategy. PATIENTS AND METHODS: A retrospective investigation of skin infections likely to be related to Sa and prospective monitoring and treatment of new infections occurring in pupils and their family members were implemented in October 2006, following the reporting of Sa PVL(+) abscesses and furuncles in a primary school. Additional nasal screening was performed in families where new skin infections occurred, after an initial systematic screening of Sa PVL(+) nasal carriers. RESULTS: On October 31, 2008, 53 patients, accounting for 30 households, had developed 69 skin infections, in four decreasing outbreaks. The cumulative incidence of a first skin infection was 34.6% in primary classes, 21.3% in nursery schools, and 6.5% in the pupils' family households. Several skin infections were reported in 13 households, and in one of them, all of the seven family members had developed at least one skin infection during follow-up. The estimated frequency of nasal colonization ranged from 14.1% to 19.5% according to successive nasal screenings. CONCLUSION: Early reporting of skin infection clusters is necessary to reinforce the effectiveness of hygiene and prevention measures, and thus limit the risk of a long-lasting outbreak.

Outbreak of community-acquired methicillin-resistant Staphylococcus aureus skin infections among health care workers in a cancer center.

BACKGROUND: The incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) soft tissue infections is rising. However, CA-MRSA outbreaks among health care workers (HCWs) are rarely reported. We describe 3 clusters of CA-MRSA soft tissue infections among HCWs and the subsequent transmission to a patient. METHODS: The first cluster of boils occurred in 4 employees who worked in the ambulatory treatment clinic (area A) and 1 patient (PA1) who frequently visited area A. Three employees (EA1, EA2, and EA3) and PA1 had positive cultures. Twelve employees in 2 geographically separate diagnostic imaging areas (areas B and C) reported recent or current boils of whom EB1, EB2, EB3, and EC1 had positive cultures. Molecular subtyping using pulse-field gel electrophoresis (PFGE) was performed on all 8 isolates and confirmed by the Centers for Disease Control and Prevention laboratory. RESULTS: Relatedness of the MRSA strain was confirmed by PFGE in 7 of 8 isolates. Only EB3 was not related to the prototype CA-MRSA strain. All 7 related MRSA strains contained the typical genetic organization of staphylococcal cassette chromosome (SCC)-mec type IVa plus genes encoding Panton-Valentine Leukocidin. EB3's strain contained SCC-mec type II and was Panton-Valentine Leukocidin negative. A total of 171 questionnaires was sent. Nine of the 85 HCWs who responded reported a recent or current history of boils. Infection control conducted an education program for employees in areas A, B, and C. CONCLUSION: Early identification and control of CA-MRSA infections among HCWs is important to limit horizontal transmission to patients. Future efforts should include educational programs and guidelines for reporting and treating HCWs with MRSA infections.

Atypical Aeromonas salmonicida infection in the black rockfish, Sebastes schlegeli Hilgendorf, in Korea.

Cultured black rockfish, Sebastes schlegeli, suffered mass mortalities during winter 2008 and spring 2009 in Korea, showing clinical signs of ulcer lesions and haemorrhages over their body surface. The aetiological agent was identified as Aeromonas salmonicida (strains RFAS-1, -2 and -3), which is a non-pigmented, slow-growing bacterium. Phenotypes of RFAS strains showed variation, while 16S rRNA, gyrB, rpoD, dnaJ and recA gene sequences of all the strains were affiliated to A. salmonicida. In particular, vapA gene sequences of the strains were most closely related to one of the five subspecies of A. salmonicida subsp. masoucida (=KCCM 40239(T) ). LD(50) values of RFAS-1 for intraperitoneal and intramuscular injection were 1.5 × 10(5.25) and 1.5 × 10(6.4) cfu/rockfish, respectively. However, A. salmonicida strains KCCM 40239(T) and SAS-1, which originate from masou and chum salmon, respectively, were not pathogenic to black rockfish. RFAS strains, possessing A-layer protein on their surface, exhibited ß-haemolytic activity against rockfish erythrocytes and capability to survive in rockfish serum, which seem to be associated with virulence.

Association of recurrent furunculosis with Panton-Valentine leukocidin and the genetic background of Staphylococcus aureus.

Staphylococcus aureus is a major cause of skin and soft tissue infections, such as furuncles, carbuncles, and abscesses, but it also frequently colonizes the human skin and mucosa without causing clinical symptoms. Panton-Valentine leukocidin (PVL) is a pore-forming toxin that has been associated with soft tissue infections and necrotizing pneumonia. We have compared the genotypes, virulence gene repertoires, and phage patterns of 74 furunculosis isolates with those of 108 control strains from healthy nasal carriers. The large majority of furunculosis strains were methicillin sensitive. Clonal cluster (CC) 121 (CC121) and CC22 accounted for 70% of the furunculosis strains but for only 8% of the nasal isolates. The PVL-encoding genes luk-PV were detected in 85% of furunculosis strains, while their prevalence among colonizing S. aureus strains was below 1%. luk-PV genes were distributed over several lineages (CCs 5, 8, 22, 30, and 121 and sequence type 59). Even within the same lineages, luk-PV-positive phages characterized furunculosis strains, while their luk-PV-negative variants were frequent among nasal strains. The very tight epidemiological linkage between luk-PV and furunculosis, which could be separated from the genetic background of the S. aureus strain as well as from the gene makeup of the luk-PV-transducing phage, lends support to the notion of an important role for PVL in human furunculosis. These results make a case for the determination of luk-PV in recurrent soft tissue infections with methicillin-sensitive as well as methicillin-resistant S. aureus.