The Correlations between Clinical Features, Dermoscopic and Histopathological Findings, and Treatment Outcomes of Patients with Pitted Keratolysis.

BACKGROUND: Pitted keratolysis (PK) is a superficial bacterial infection diagnosed mainly by clinical manifestations. Current data on its dermoscopic and histopathological findings, and the correlation of those findings, are limited. OBJECTIVES: To evaluate the clinical manifestations, dermoscopic, and histopathological findings of PK and to determine the correlations. METHODS: Forty naval cadets with PK and five cadets with normal feet were enrolled this cohort study and provided informed consent. Dermoscopy was independently applied and evaluated by 2 dermatologists. Shave biopsies were performed on 37 patients with PK. RESULTS: Pits were the most common dermoscopic finding (88.1%). The dermoscope had more sensitivity for the detection of PK than the naked eye examinations. Apart from the pits and the presence of bacteria, the most common histopathological finding for PK was color alteration of keratin. The presence of bacteria correlated with interrupted dermatoglyphic lines and the color alteration of keratin. Moreover, the presence of bacteria at the base of pits was related to worse treatment outcomes. CONCLUSIONS: Dermoscopy is a useful tool for PK diagnosis. Color alteration of keratin is another histopathological finding for PK. The presence of bacteria is associated with worse treatment outcomes.

Positive effects of hyperbaric oxygen therapy in a cat with cutaneous nocardiosis.

Hyperbaric oxygen therapy (HBOT) has been beneficial in treating people with nocardiosis. This report describes Nocardia spp. affecting a cat, with lesions confined to the skin. To the best of the authors' knowledge, this is the first report of HBOT, combined with amikacin, used to successfully treat feline cutaneous nocardiosis.

Le traitement à l'oxygène hyperbar (HBOT) a été bénéfique pour le traitement de la nocardiose chez l'homme. Cet article décrit un chat atteint par Nocardia spp. avec des lésions cantonnées à la peau. A la connaissance des auteurs, ceci est la première description de HBOT, combinée à l'amikacine, utilisée pour traiter avec succès une nocardiose féline.

La terapia con oxígeno hiperbárico (HBOT) ha sido beneficiosa para el tratamiento de personas con nocardiosis. Este informe describe un caso de infección cutánea con Nocardia spp. que afectaba a un gato, con lesiones limitadas a la piel. A entender de los autores, este es el primer informe de HBOT, combinado con amikacina, utilizado para tratar con éxito la nocardiosis cutánea felina.

A oxigenoterapia hiperbárica (OHB) tem sido benéfica no tratamento de pessoas com nocardiose. Este relatório descreve um caso Nocardia spp. afetando um gato, com lesões limitadas à pele. De acordo com o conhecimento dos autores, este é o primeiro relato do uso de OHB, combinado com amicacina, para tratar com sucesso a nocardiose cutânea felina.

A New Approach to Harness Probiotics Against Common Bacterial Skin Pathogens: Towards Living Antimicrobials.

In this study, the potential of certain lactic acid bacteria-classified as probiotics and known to be antimicrobially active against pathogens or food-poisoning microorganisms-was evaluated with respect to their activity against bacterial skin pathogens. The aim of the study was to develop a plaster/bandage for the application of inhibitory substances produced by these probiotics when applied to diseased skin. For this purpose, two Streptococcus salivarius strains and one Lactobacillus plantarum were tested for production of antimicrobials (bacteriocin-like substances) active against Gram-positive and Gram-negative pathogens using established methods. A newly designed membrane test ensured that the probiotics produce antimicrobials diffusible through membranes. Target organisms used were Cutibacterium acnes, Staphylococcus aureus, and Pseudomonas aeruginosa. Moreover, the L. plantarum 8P-A3 strain was tested against additional bacteria involved in skin disorders. The Lactobacillales used were active against all potential skin pathogens tested. These probiotics could be enclosed between polymer membranes-one tight, the other permeable for their products, preserved by vacuum drying, and reactivated after at least three months storage. Importantly, the reactivated pads containing the probiotics demonstrated antibacterial activity on agar plates against all pathogens tested. This suggests that the probiotic containing pads may be topically applied for the treatment of skin disorders without the need for a regular antibiotic treatment or as an adjunctive therapy.

Recent advances in dextran-based drug delivery systems: From fabrication strategies to applications.

As a natural polysaccharide, dextran and its derivatives have gained great attention in the development of delivery systems for pharmaceutical and medical applications. In recent years, numerous dextran-based delivery systems with tailor properties and geometries have been developed, including self-assembled micelles and nanoparticles, nanoemulsions, magnetic nanoparticles, microparticles, and hydrogels. The first part of this review discusses the physicochemical properties of dextran and its various derivatives via chemical modifications, as pertinent to the preparation of delivery systems. Then, the state-of-the-art fabrication strategies of dextran-based delivery systems and their colloidal properties, i.e. particle diameter, surface charge, morphology, as well as release profiles, are highlighted. Lastly, applications of dextran-based drug delivery systems in biomedicine are explicitly summarized with detailed elaborations on their biological efficacy and mechanism of action, including cancer treatment, magnetic resonance imaging, insulin oral delivery, spinal cord injury therapy, and bacterial skin infection treatment.

Graphene Oxide/Copper Nanoderivatives-Modified Chitosan/Hyaluronic Acid Dressings for Facilitating Wound Healing in Infected Full-Thickness Skin Defects.

PURPOSE: Wound healing, especially of infected wounds, remains a clinical challenge in plastic surgery. This study aimed to manufacture a novel and multifunctional wound dressing by combining graphene oxide/copper nanocomposites (GO/Cu) with chitosan/hyaluronic acid, providing significant opportunities for the therapy of wound repair in wounds with a high risk of bacterial infection. METHODS: In this study, GO/Cu-decorated chitosan/hyaluronic acid dressings (C/H/GO/Cu) were prepared using sodium trimetaphosphate (STMP) crosslinking and the vacuum freeze-drying method, and chitosan/hyaluronic acid dressings (C/H) and GO-incorporated chitosan/hyaluronic acid dressings (C/H/GO) served as controls. The surface characterization, in vitro degradation under various pH values, antimicrobial potential, cytocompatibility and in vivo therapeutic efficacy in a bacteria-infected full-thickness skin defect model were systematically evaluated. RESULTS: Our experimental results indicated that the acidic environment facilitated the release of copper (CuNPs and Cu2+) from the dressings, and prepared C/H/GO/Cu dressings exhibited significant in vitro antimicrobial activities against the two tested bacterial strains (ATCC35984 and ATCC25923). All three dressings showed satisfactory cytocompatibility with mouse fibroblasts (NIH/3T3-L1). Moreover, remarkably accelerated wound healing was found in the C/H/GO/Cu group, with controlled inflammatory infiltration and improved angiogenesis in granulation tissues. In addition, no pathological damage was noted in the tissue structures of the tested organs (heart, lung, liver and kidney) in any of the four groups. CONCLUSION: Collectively, GO/Cu-incorporated chitosan/hyaluronic acid dressings suggested a synergistic antimicrobial efficacy and acceptable biocompatibility both in vitro and in vivo, as well as a significantly accelerated healing process of bacteria-infected wounds. Thus, the multifunctional C/H/GO/Cu composite is expected to be a potential alternative for wound dressings, especially for the management of intractable wounds caused by bacterial infection.

[Severe skin and soft tissue infections. An update]. / Infecciones graves de piel y partes blandas. Puesta al día.

Severe skin and soft tissue infections present a high morbidity and mortality and require a complex surgical treatment. Its estimated annual incidence is 0.3 to 5 cases per 10 000 people. The most common etiologic agents are Streptococcus pyogenes, Staphylococcus aureus, anaerobes and gram-negative bacilli. A prompt diagnosis and the timely initiation of an empirical antibiotic scheme and repeated surgical debridement can avert a worrisome outcome. New therapeutic options are promising, especially for infections caused by multidrug resistant germs. A multidisciplinary approach is fundamental for the correct management of these conditions.

Las infecciones graves de piel y partes blandas presentan una elevada morbimortalidad y requieren un complejo tratamiento quirúrgico. Su incidencia anual está estimada en 0.3 a 5 casos por 10 000 personas. Los agentes etiológicos más comunes son Streptococcus pyogenes, Staphylococcus aureus, anaerobios y bacilos Gram negativos. El diagnóstico precoz y el tratamiento oportuno, tanto empírico antibiótico como quirúrgico, determinan el pronóstico. Existen nuevas opciones terapéuticas para estas infecciones, especialmente las producidas por gérmenes multirresistentes. Un enfoque terapéutico multidisciplinario es fundamental para su correcto manejo.

Characterization of Pathogens Isolated from Cutaneous Abscesses in Patients Evaluated by the Dermatology Service at an Emergency Department.

OBJECTIVE: Emergency department (ED) visits for the treatment of skin abscesses have increased with the emergence of community-associated methicillin-resistant Staphylococcus aureus (CAMRSA). There is limited information about the bacteriology of cutaneous abscesses evaluated in ED in Puerto Rico. The purpose of our study was to characterize the pathogens cultured from abscesses of patients in the ED consulted to the Dermatology Service of University of Puerto Rico School of Medicine. METHODS: Patients with skin abscesses consulted to the Dermatology Service by the ED of P.R. Medical Center from 2012 to 2017 were included. Data retrieved included demographic information, past medical history, prior antibiotic use, distribution of lesions, and treatment provided. Bacteriology results and antimicrobial susceptibility patterns from cultured skin lesions were recorded. RESULTS: Ninety patients diagnosed with skin abscess were evaluated. All patients underwent incision and drainage; this was the sole treatment in two patients. The most frequently administered systemic therapy was oral clindamycin in 32 patients (36%). A total of 66 patients (73%) had S. aureus isolates, most of them (85%) MRSA. Among the isolates with MRSA, 14.3% were resistant to clindamycin. All MRSA strains were susceptible to tetracycline and vancomycin. CONCLUSION: There is a high prevalence of MRSA causing abscesses in the Hispanic population evaluated in an ED in Puerto Rico. Systemic antibiotic use for the treatment of skin abscesses after incision and drainage remains high despite published guidelines arguing against their widespread use. Clindamycin resistance in our patient population appears to be more frequent than previously reported.

Infecciones graves de piel y partes blandas. Puesta al día / Severe skin and soft tissue infections. An update

Resumen Las infecciones graves de piel y partes blandas presentan una elevada morbimortalidad y requieren un complejo tratamiento quirúrgico. Su incidencia anual está estimada en 0.3 a 5 casos por 10 000 personas. Los agentes etiológicos más comunes son Streptococcus pyogenes, Staphylococcus aureus, anaerobios y bacilos Gram negativos. El diagnóstico precoz y el tratamiento oportuno, tanto empírico antibiótico como quirúrgico, determinan el pronóstico. Existen nuevas opciones terapéuticas para estas infecciones, especialmente las producidas por gérmenes multirresistentes. Un enfoque terapéutico multidisciplinario es fundamental para su correcto manejo.

Abstract Severe skin and soft tissue infections present a high morbidity and mortality and require a complex surgical treatment. Its estimated annual incidence is 0.3 to 5 cases per 10 000 people. The most common etiologic agents are Streptococcus pyogenes, Staphylococcus aureus, anaerobes and gram-negative bacilli. A prompt diagnosis and the timely initiation of an empirical antibiotic scheme and repeated surgical debridement can avert a worrisome outcome. New therapeutic options are promising, especially for infections caused by multidrug resistant germs. A multidisciplinary approach is fundamental for the correct management of these conditions.

Case of cutaneous botryomycosis in an 8-year-old immunocompetent boy with a review of the published work.

Botryomycosis is a rare chronic suppurative granulomatous infection caused by several genera of non-filamentous bacteria. The clinical and histopathological findings are similar to those of mycetoma caused by true fungi or aerobic actinomycetes. Botryomycosis is divided into cutaneous and visceral disease, with the cutaneous form being more common. Histopathology shows granules of etiologic bacteria called "sulfur granules". Botryomycosis occurs more commonly among immunocompromised patients, although some cases have also been reported in immunocompetent patients. We report the case of an 8-year-old immunocompetent boy who visited our hospital with a 4-mm diameter subcutaneous tumor with mild tenderness on his right heel for several months. We surgically removed the tumor with an initial diagnosis of epidermal cyst. Histopathology showed sulfur granules surrounded by an eosinophilic matrix, indicating the Splendore-Hoeppli phenomenon. The granules consisted of Gram-positive cocci, leading to a diagnosis of botryomycosis. The patient was successfully treated by excision and oral trimethoprim/sulfamethoxazole (240 mg b.i.d.) for 2 weeks as adjuvant therapy. No recurrence was noted following treatment. The subcutaneous tumor in this case was smaller than the typical in botryomycosis infections. We reviewed the infection duration and tumor size in reported cases of botryomycosis in immunocompetent patients. Small tumor size may suggest that the case is in an early stage; therefore, it is important to remove and investigate these lesions proactively.

Delayed septic radiation-induced calcinosis cutis long after cured anorectal cancer.

PURPOSE: Calcinosis cutis is an anecdotal local injury seen long after irradiation in cancer survivors. Our purpose was to shed light on this little studied and potentially serious ulceration. CASES: We report two cases of severe perineal-sacral infection with hard lesions, one decade after anorectal cancer irradiation. CT-scans showed extensive calcification and soft tissue inflammation, but previous radiation therapy was overlooked and the diagnosis was not made for several months after various tests, including biopsy. The two patients had different comorbidities and were managed by multidisciplinary collaboration between specialists. Surgery of the sacral ulcer was limited by the accessibility of non-irradiated tissues. In the absence of current guidelines, after radiopathological expertise, we used a "draining" procedure followed by antifibrotic pentoxifylline-tocopherol-clodronate treatment. CONCLUSION: Long after pelvic radiotherapy, symptomatic subcutaneous macrocalcification is suggestive of radiation-induced calcinosis. Prolonged antibiotic therapy followed by PENTOCLO treatment led to clinical improvement.

Safety of Biweekly Chlorhexidine Gluconate Bathing in Infants 36 To 48 Weeks' Postmenstrual Age.

BACKGROUND: Little evidence supports use of chlorhexidine gluconate (CHG) baths to reduce health care-associated infections, including central catheter-associated bloodstream infections in infants less than 2 months old. OBJECTIVE: To describe the safety of biweekly CHG baths in infants less than 2 months old by measuring blood levels of CHG, liver and renal function, skin reactions, and adverse events. METHODS: Study participants received twice-weekly 2% CHG baths, weekly blood tests, and twice-daily skin assessments. Adverse events were monitored. RESULTS: Ten infants 36 to 48 weeks' postmenstrual age with central venous catheters admitted to the neonatal or cardiac intensive care unit were enrolled before the study was closed by the Food and Drug Administration. The 9 patients contributing data had 83 CHG exposures; 31 CHG levels were analyzed. All patients had evidence of CHG absorption. Seven patients had CHG levels of 100 ng/mL or greater. Findings did not support accumulation of CHG but did show evidence of higher absorption than previously reported. Results of liver and renal function studies remained within reference limits. No patient had any adverse events, including skin reactions. CONCLUSIONS: Although no adverse events were observed, our patients had evidence of CHG absorption. The effects of this absorption remain unknown. More research is needed to determine safe blood levels of CHG in infants less than 2 months of age.

Cutaneous Mycobacterium haemophilum infection involving the upper extremities: diagnosis and management guidelines.

Mycobacterium haemophilum is a nontuberculous organism that commonly manifests as cutaneous lesions and subcutaneous nodules in immunosuppressed adults. Because M haemophilum infection is rare, the epidemiology, reservoir, and mode of transmission remain largely unknown. Infection presents a challenge to the dermatology community because it is infrequently suspected and commonly misidentified, resulting in delayed diagnosis. We discuss 3 cases of cutaneous M haemophilum infection to better understand clinical presentation, diagnosis, and management.

Engineering Phage Host-Range and Suppressing Bacterial Resistance through Phage Tail Fiber Mutagenesis.

The rapid emergence of antibiotic-resistant infections is prompting increased interest in phage-based antimicrobials. However, acquisition of resistance by bacteria is a major issue in the successful development of phage therapies. Through natural evolution and structural modeling, we identified host-range-determining regions (HRDRs) in the T3 phage tail fiber protein and developed a high-throughput strategy to genetically engineer these regions through site-directed mutagenesis. Inspired by antibody specificity engineering, this approach generates deep functional diversity while minimizing disruptions to the overall tail fiber structure, resulting in synthetic "phagebodies." We showed that mutating HRDRs yields phagebodies with altered host-ranges, and select phagebodies enable long-term suppression of bacterial growth in vitro, by preventing resistance appearance, and are functional in vivo using a murine model. We anticipate that this approach may facilitate the creation of next-generation antimicrobials that slow resistance development and could be extended to other viral scaffolds for a broad range of applications.

Organisational and financial consequences of the early discharge of patients treated for acute bacterial skin and skin structure infection and osteomyelitis in infectious disease departments in Greece, Italy and Spain: a scenario analysis.

OBJECTIVE: The aim of the analysis is to assess the organisational and economic consequences of adopting an early discharge strategy for the treatment of acute bacterial skin and skin structure infection (ABSSSI) and osteomyelitis within infectious disease departments. SETTING: Infectious disease departments in Greece, Italy and Spain. PARTICIPANTS: No patients were involved in the analysis performed. INTERVENTIONS: An analytic framework was developed to consider two alternative scenarios: standard hospitalisation care or an early discharge strategy for patients hospitalised due to ABSSSI and osteomyelitis, from the perspective of the National Health Services of Greece, Italy and Spain. The variables considered were: the number of annual hospitalisations eligible for early discharge, the antibiotic treatments considered (ie, oral antibiotics and intravenous long-acting antibiotics), diagnosis-related group (DRG) reimbursements, number of days of hospitalisation, incidence and costs of hospital-acquired infections, additional follow-up visits and intravenous administrations. Data were based on published literature and expert opinions. PRIMARY AND SECONDARY OUTCOME MEASURES: Number of days of hospitalisation avoided and direct medical costs avoided. RESULTS: The total number of days of hospitalisation avoided on a yearly basis would be between 2216 and 5595 in Greece (-8/-21 hospital beds), between 15 848 and 38 444 in Italy (-57/-135 hospital beds) and between 7529 and 23 520 in Spain (-27/-85 hospital beds). From an economic perspective, the impact of the early discharge scenario is a reduction between €45 036 and €149 552 in Greece, a reduction between €182 132 and €437 990 in Italy and a reduction between €292 284 and €884 035 in Spain. CONCLUSIONS: The early discharge strategy presented would have a positive organisational impact on National Health Services, leading to potential savings in beds, and to a reduction of hospital-acquired infections and costs.