Methicillin-resistant Staphylococcus aureus and coagulase-negative Staphylococcus produce antimicrobial substances against members of the skin microbiota in children with atopic dermatitis.

Coagulase-negative Staphylococcus (CoNS) species inhibiting Staphylococcus aureus has been described in the skin of atopic dermatitis (AD) patients. This study evaluated whether Staphylococcus spp. from the skin and nares of AD and non-AD children produced antimicrobial substances (AMS). AMS production was screened by an overlay method and tested against NaOH, proteases and 30 indicator strains. Clonality was assessed by pulsed-field gel electrophoresis. Proteinaceous AMS-producers were investigated for autoimmunity by the overlay method and presence of bacteriocin genes by polymerase chain reaction. Two AMS-producers had their genome screened for AMS genes. A methicillin-resistant S. aureus (MRSA) produced proteinaceous AMS that inhibited 51.7% of the staphylococcal indicator strains, and it was active against 60% of the colonies selected from the AD child where it was isolated. On the other hand, 57 (8.8%) CoNS from the nares and skin of AD and non-AD children, most of them S. epidermidis (45.6%), reduced the growth of S. aureus and other CoNS species. Bacteriocin-related genes were detected in the genomes of AMS-producers. AMS production by CoNS inhibited S. aureus and other skin microbiota species from children with AD. Furthermore, an MRSA colonizing a child with AD produced AMS, reinforcing its contribution to dysbiosis and disease severity.

Atopic dermatitis pediatric patients show high rates of nasal and intestinal colonization by methicillin-resistant Staphylococcus aureus and coagulase-negative staphylococci.

BACKGROUND: Atopic dermatitis (AD) patients have high rates of colonization by Staphylococcus aureus, which has been associated with worsening of the disease. This study characterized Staphylococcus spp isolates recovered from nares and feces of pediatric patients with AD in relation to antimicrobial susceptibility, staphylococcal cassette chromosome mec (SCCmec) type, presence of pvl genes and clonality. Besides, gut bacterial community profiles were compared with those of children without AD. RESULTS: All 55 AD patients evaluated had colonization by Staphylococcus spp. Fifty-three (96.4%) patients had colonization in both clinical sites, whereas one patient each was not colonize in the nares or gut. Staphylococcus aureus was identified in the nostrils and feces of 45 (81.8%) and 39 (70.9%) patients, respectively. Methicillin-resistant Staphylococcus spp. isolates were found in 70.9% of the patients, and 24 (43.6%) had methicillin-resistant S. aureus (MRSA). S. aureus (55.6%) and S. epidermidis (26.5%) were the major species found. The prevalent lineages of S. aureus were USA800/SCCmecIV (47.6%) and USA1100/SCCmecIV (21.4%), and 61.9% of the evaluated patients had the same genotype in both sites. Additionally, gut bacterial profile of AD patients exhibits greater dissimilarity from the control group than it does among varying severities of AD. CONCLUSIONS: High rates of nasal and intestinal colonization by S. aureus and methicillin-resistant staphylococci isolates were found in AD patients. Besides, gut bacterial profiles of AD patients were distinctly different from those of the control group, emphasizing the importance of monitoring S. aureus colonization and gut microbiome composition in AD patients.

Methicillin-resistant and methicillin-sensitive Staphylococcus aureus isolates from skin and nares of Brazilian children with atopic dermatitis demonstrate high level of clonal diversity.

BACKGROUND: Atopic dermatitis (AD) primarily affects the pediatric population, which is highly colonized by S. aureus. However, little is known about the genetic features of this microorganism and other staphylococcal species that colonize AD patients. OBJECTIVE: This study aimed to characterize Staphylococcus spp. isolated from the nares and skin (with and without lesion) of 30 AD and 12 non-AD Brazilian children. METHODS: Skin and nasal swabs were cultured onto mannitol salt agar, and bacterial colonies were counted and identified by matrix assisted laser desorption ionization time of flight mass spectrometry and polymerase chain reaction (PCR). Antimicrobial susceptibility was evaluated by phenotypic and genotypic tests. In S. aureus isolates, Panton-Valentine leukocidin genes were detected by PCR, and their clonality was assessed by pulsed-field gel electrophoresis and multilocus sequence typing. RESULTS: S. aureus was more prevalent in the nares (P = 0.005) and lesional skin (P = 0.0002) of children with AD, while S. hominis was more frequent in the skin of non-AD children (P < 0.0001). All children in the study, except one from each group, were colonized by methicillin-resistant coagulase-negative Staphylococcus and 24% by methicillin-resistant S. aureus. Despite the great clonal diversity of S. aureus (18 sequence types identified), most AD children (74.1%) were colonized by the same genotype in both niches. CONCLUSION: High colonization by polyclonal S. aureus isolates was found among children with AD, while S. hominis was more frequent among non-AD children. The high prevalence of methicillin-resistant staphylococcal isolates highlights the importance of continued surveillance, especially when considering empiric antibiotic therapy for the treatment of skin infections in these patients.

Avaliação de informações na internet sobre dermatite atópica pediátrica / Evaluation of internet information on pediatric atopic dermatitis / Evaluación de información en internet sobre dermatitis atópica pediátrica

Objetivo: Avaliar conteúdos apresentados na internet relacionados à Dermatite Atópica em crianças e adolescentes. Método: trata-se de um estudo exploratório, realizado por meio do site de buscas Google®, utilizando-se um questionário semiestruturado para a avaliação. Construiu-se um banco de dados no software Microsoft Excel 2010®. Procedeu-se, após a organização dos dados, à avaliação de cada página, com um roteiro de dez perguntas semiestruturado, com três possíveis respostas. Resultados: avaliaram-se 31 sites. Aponta-se que 29 descrevem o que é a Dermatite Atópica e 25 relatam os sintomas característicos desta doença. Registra-se, quanto ao diagnóstico, que, em 21 sites, não se esclarece a necessidade do diagnóstico clínico por parte de um profissional de saúde e, em 23 páginas, encontram-se orientações quanto ao tratamento. Acrescenta-se que 14 sites não evidenciam a autoria do conteúdo. Conclusão: alerta-se, que os usuários devem estar atentos à autenticidade das informações apresentadas neste meio, visto que informações inconsistentes podem expor o indivíduo a situações de risco. Considera-se importante, por isso, que essa busca seja realizada em fontes confiáveis e não substitua a avaliação e a conduta do profissional de saúde.(AU)

Objective: to evaluate internet contents related to Atopic Dermatitis in children and adolescents. Method: this is an exploratory study, carried out through the Google® search engine, using a semistructured questionnaire for evaluation. A database was built using Microsoft Excel 2010® software. After organizing the data, we proceeded to the evaluation of each page, with a script of ten semistructured questions, with three possible answers. Results: a total of 31 sites were evaluated. It was found that 29 described what atopic dermatitis is and 25 reported the characteristic symptoms of this disease. Regarding diagnosis, 21 sites did not clarify the need for clinical diagnosis by a health professional, and 23 pages provided guidance on treatment. It should be added that 14 sites do not show the authorship of the content. Conclusion: it is warned that users should be aware of the authenticity of the information presented in this medium, since inconsistent information can expose the individual to risky situations. It is considered important, therefore, that this search be conducted in reliable sources and not replace the evaluation and conduct of the health professional.(AU)

Objetivo: evaluar los contenidos presentados en internet relacionados con la Dermatitis Atópica en niños y adolescentes. Método: se trata de un estudio exploratorio, realizado a través del buscador Google®, utilizando un cuestionario semiestructurado para la evaluación. Se creó una base de datos con el software Microsoft Excel 2010®. Después de organizar los datos, se evaluó cada página mediante un guión semiestructurado de diez preguntas con tres posibles respuestas. Resultados: se evaluaron 31 sitios. Se señala que 29 describen qué es la Dermatitis Atópica y 25 informan los síntomas característicos de esta enfermedad. En cuanto al diagnóstico, 21 sitios no aclaran la necesidad de un diagnóstico clínico por parte de un profesional de la salud y, en 23 páginas, hay pautas sobre el tratamiento. Además, 14 sitios no muestran la autoría del contenido. Conclusión: se advierte que los usuarios deben ser conscientes de la autenticidad de la información presentada en este medio, ya que información inconsistente puede exponer al individuo a situaciones de riesgo. Por tanto, se considera importante que esta búsqueda se realice a partir de fuentes fiables y no sustituya la valoración y conducta del profesional sanitario.(AU)

Methicillin-resistant Staphylococcus aureus from infected skin lesions present several virulence genes and are associated with the CC30 in Brazilian children with atopic dermatitis.

Atopic dermatitis (AD) is a chronic inflammatory skin disease and colonization by Staphylococcus aureus may affect up to 100% of these patients. Virulent and resistant isolates can worsen AD patient clinical condition and jeopardize the treatment. We aimed to detect virulence genes and to evaluate the biofilm production of S. aureus isolates from infected skin lesions of children with AD. Methicillin resistance was detected by phenotypic and molecular tests and the virulence genes were detected by PCR. Biofilm formation was assessed by bacterial growing on microtiter plates and later stained with safranin. Genotyping was performed by Pulsed-Field Gel Electrophoresis and Multilocus Sequence Typing. Among 106 AD patients, 55 (51.8%) had developed S. aureus cutaneous infections and 23 (41.6%) were methicillin-resistant (MRSA). All 55 isolates carried the fnbA, hla, icaA, sasG, and seu genes, and more than 70% presented cna, eap, ebpS, hlg, and pvl genes. Clonal complex (CC) 30 was the main lineage found (34.5%), especially among MRSA isolates (52.2%). The egc cluster and the bbp gene were significantly the most frequent in MRSA isolates and in USA1100/ST30/CC30 lineage. Most of the isolates (74.5%) were non-biofilm producers and many of them only started to produce it in the presence of fibrinogen. There was no significant association between S. aureus isolates features and the AD severity. This study demonstrated a high frequency of CC30 MRSA isolates presenting several virulence genes in infected skin lesions of AD children in Brazil, that may influence the severity of the disease and the treatments required.

Clinical oral profile of pediatric patients with atopic dermatitis: A cross-sectional study.

OBJECTIVES: This work aims to describe oral health conditions, eating habits, and oral hygiene in pediatric and adolescent patients with atopic dermatitis and correlate them with the severity of the Scoring Atopic Dermatitis (SCORAD). Also, we aim to estimate the effect of several variables on the diagnosis of dental caries in these patients. MATERIAL AND METHODS: A total of 92 children and adolescents with atopic dermatitis had their oral cavities examined. The effect of independent variables on the diagnosis of dental caries (outcome) was assessed using multiple binary logistic regression model. RESULTS: Mild patients presented higher score of decayed, missing, and filled teeth in permanent dentition than moderate patients (p = 0.040). In the multivariable regression final model, the covariates using inhaled corticoid (OR = 6.4; p = 0.003), type of teething [deciduous dentition (OR = 7.9; p = 0.027) and mixed dentition (OR = 10.5; p = 0.007)], and brushing quality [poor mechanical control (OR = 10.6; p < 0.0001)] demonstrated significant direct effect on the diagnosis of dental caries. CONCLUSIONS: Our findings suggest that the presence of dental biofilm, use of inhaled corticoid, and type of teething are related to the presence of caries in atopic dermatitis patients.

Staphylococcus aureus nasal isolates may have the same genetic profile in atopic dermatitis paediatric patients and their close contacts.

Atopic dermatitis (AD) is a chronic skin disease that affects up to 20 % of the paediatric population worldwide. Staphylococcus aureus colonizes anterior nares and can be transmitted in the home environment, aggravating AD. This study aimed to detect S. aureus from nares of AD patients and their family contacts, as well as to evaluate the antimicrobial resistance, virulence and clonality of these isolates. Among the 48 family groups investigated, 30 groups were selected, as both the child and his/her respective contact had methicillin-sensitive S. aureus (MSSA) (24 cases; 54 MSSA isolates) or methicillin-resistant S. aureus (MRSA) isolates (6 cases; 13 MRSA isolates). All MRSA isolates carried SCCmec IV. S. aureus carrying PVL genes were detected in 60 % of patients. Pulsed-field gel electrophoresis (PFGE) analysis was performed for 31 isolates from 15 family groups: all 6 with MRSA and 9 with MSSA isolates. Similar genotypic profiles between isolates from patients and their family contacts were noted in 10 (66.6 %) family groups, 5 (83.3 %) of the MRSA family groups and 5 (55.5 %) of the MSSA family groups, indicating that the pathogen was transmitted through family contacts.

High incidence of acquiring methicillin-resistant Staphylococcus aureus in Brazilian children with Atopic Dermatitis and associated risk factors.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) colonization in Atopic Dermatitis (AD) patients can contribute to worsening their clinical condition. OBJECTIVE: A cohort study was carried out to determine the incidence of MRSA acquisition and its risk factors in AD children. METHODS: Patients with AD (2 months-14 years old) were followed up for about 1 year at a reference center for AD treatment in Rio de Janeiro, Brazil, from September 2011 to February 2014. Nasal swabs from patients and contacts were collected every 2 months. The SCORAD system assessed the severity of the AD. S. aureus isolates were evaluated to determine the methicillin resistance and the clonal lineages. RESULTS: Among 117 AD patients, 97 (82.9%) were already colonized with S. aureus and 26 (22.2%) had MRSA at the first evaluation. The incidence of MRSA acquisition in the cohort study was 27.47% (n = 25). The SCORAD assessments were: mild (46.15%), moderate (37.36%) or severe (16.48%). Risk factors were: colonized MRSA contacts (HR = 2.27; 95% CI: 1.16-7.54), use of cyclosporine (HR = 5.84; 95% CI: 1.70-19.98), moderate or severe AD (HR = 3.26; 95% CI: 1.13-9.37). Protective factors were: availability of running water (HR = 0.21; 95% CI: 0.049-0.96) and use of antihistamines (HR = 0.21; 95% IC: 0.64-0.75). MRSA isolates carried the SCCmec type IV and most of them were typed as USA800/ST5. CONCLUSIONS: The high incidence of MRSA acquisition found among AD patients and the risk factors associated show that an effective surveillance of MRSA colonization in these patients is needed.

Oral Aspects Identified in Atopic Dermatitis Patients: A Literature Review.

INTRODUCTION: Atopic dermatitis is a chronic inflammatory skin condition that is more prevalent in children (10-20% of the world's population) than in adults. As its etiology is multifactorial, it is important to know the most frequent oral manifestations in atopic dermatitis patients. METHODOLOGY: In the last decades, the correlation between atopic dermatitis and conditions and/or changes in the oral cavity has been demonstrated by several studies. The objective of this paper was to describe, through a review of the literature, the oral health conditions and/or oral aspects identified in patients with atopic dermatitis. SEARCH STRATEGY: A descriptive literature review was carried out through a bibliographical survey based on the last 10 years, in order to answer the study questions. RESULTS: As a result, we found six studies with different sample sizes, ranging from 43 to 468 patients, and the majority of them were of cross-sectional study design. DISCUSSION: Two studies performed their analysis through dental exams and reported that patients with atopic dermatitis tend to have a greater frequency of carious lesions, and two studies correlated Candida with atopic dermatitis through mycological analyzes. CONCLUSION: There are a few studies in the literature that identify the oral aspects of atopic dermatitis. More investigations are needed in order to contribute to the knowledge of such oral aspects and the approach to treat these patients regarding oral health.

What is the role of Staphylococcus aureus and herpes virus infections in the pathogenesis of atopic dermatitis?

Atopic dermatitis (AD) is a chronic, relapsing disease. Genetic, environmental and immunological factors are involved in its pathophysiology. Individuals with AD have an increased predisposition to colonization and/or infection of the skin by various pathogens, especially Staphylococcus aureus and herpes simplex virus. The composition of their skin microbiome is also different, and changes during flares. The disease severity can be related to the degree of colonization by S. aureus. In addition, the presence of this bacterial species can predispose the host to more severe and disseminated viral infections. This article reviews the role of S. aureus and herpes virus infections and the skin microbiome in the pathogenesis of AD and their importance in the treatment and prevention strategies of this dermatosis.

Alopecia Areata-Part III: Prognosis and Treatment.

The prognosis of alopecia areata is better in cases with single and small lesions, and the variability of the extension of the disease is one of the criteria for the choice of treatment modality. Several medications have been described in the literature for the treatment of alopecia areata, including corticosteroids, minoxidil, and diphencyprone. The authors review treatments for alopecia areata.

Peanut allergy as a trigger for the deterioration of atopic dermatitis and precursor of staphylococcal and herpetic associated infections - case report.

Atopic dermatitis (AD) is a multifactorial and chronic disease, with genetic, environmental, immunological and nutritional origins. AD may be aggravated by allergies associated with infections. This study aims to describe a paediatric case of AD in which the peanut allergy was the triggering factor to aggravate the disease, and was also the concomitant precursor of staphylococcal (methicillin-sensitive Staphylococcus aureus, carrier of the Panton-Valentine leukocidine (PVL) genes) and herpetic (Herpes Simplex - HSV) infections. The clinical management approach and nursing strategies promoted a favourable evolution during the hospitalization period, besides the family approach, which was essential to control any flare-up of the disease. Adherence to a recommended diet and the use of strategies to prevent any recurrent infections were important to ensure the patient's quality of life.

Alopecia areata--Part II: diagnosis and pathology.

Alopecia areata is characterized by the abrupt appearance of round or oval, non-scarring, flat, single or multiple areas of alopecia, which may coalesce forming large patches of alopecia. The diagnosis is usually clinical but there are important differentials and dermatopathology may help in this definition.

Alopecia areata--Part I: Background .

Alopecia areata is a trichosis characterized by loss of hair, with the abrupt onset of round or oval, nonscarring, flat, single or multiple areas of alopecia lesions, which can coalesce. Several hypotheses have been raised to explain its etiology, with autoimmunity being accepted until today, along with genetic factors.

HLA antigens in individuals with down syndrome and alopecia areata.

AIM: To describe human leukocyte antigen (HLA) alleles in individuals with Down syndrome and alopecia areata. METHODS: A cross-sectional study was conducted, which evaluated 109 individuals. Ten with down syndrome (DS) and alopecia areata (AA), ten with DS without AA and ten with AA without DS, and their families. The individuals were matched by gender and age. The following data were computed: gender, age, ethnic group, karyotype, clinical presentation and family history of alopecia areata. Descriptive analysis: measures of central tendency and frequency distribution. Inferential analysis: Fisher's exact test to compare categorical data between the three groups and Kruskal-Wallis ANOVA test for numerical data. RESULTS: Seventy per cent of evaluated individuals in the DS and AA group were male; presented mean age of 18.6 (SD ± 7.2) years and 70% were Caucasian. We observed involvement of the scalp, with a single lesion in 10% and multiple in 90% of subjects. It was observed that there is no significant difference in the frequency distributions of the alleles HLA loci A, B, C, DRB1 and DQB1 of subjects studied. However, according to Fisher's exact test, there is a trend (P = 0.089) of DS group to present higher proportions of HLA-A 36 and HLA-B 15 than the AA group and AA and DS group. CONCLUSION: There was a tendency for the DS group, to present proportion of HLA-A 36 and HLA-B 15 higher than the AA group and group of individuals with AA and DS. However, there was no significant difference in the frequency distribution of the alleles.