Exfoliative dermatitis due to dermatophytosis.

Exfoliative dermatitis (ED) or erythroderma is defined as diffuse erythema and scaling of the skin involving more than 90% of the total body skin surface, which can be caused by variety of systemic and cutaneous diseases, such as infection, including dermatophytosis. Dermatophytosis is a superficial fungal infection of keratinized tissue caused by dermatophytes. There are only few case reports of ED due to dermatophytosis in literature. A 39-year-old male present with history of diffuse erythematous macules and scales almost on entire body due to dermatophytosis was reported. The diagnosis of dermatophytosis was confirmed by direct microscopic examination, fungal culture, and histopathological examination. Patient was treated with 2% ketoconazole shampoo and two pulses of 1-week of 200 mg itraconazole twice a day for each month. Clinical improvement was showed on the 7th day of observation characterized by decreasing of erythematous macules and scales. Mycological and clinical improvements were obtained on the 29th day of observation. The etiology of ED should be determined in order to give an appropiate treatment.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in erythrodermic cutaneous T-cell lymphoma (CTCL) patients.

Erythroderma can occur in cutaneous T-cell lymphoma (CTCL). Staphylococcus aureus (S. aureus) prevalence is increased in CTCL patients and contributes to CTCL disease flares. Our primary aim was to describe S. aureus infections, including resistance patterns and the antibiotic treatment regimens used, in erythrodermic CTCL patients. This was a retrospective chart review of erythrodermic CTCL patients who had S. aureus infection or colonization and were treated at the UT MD Anderson Cancer Center's Melanoma Skin Center between 2012 and 2016. Twenty-six erythrodermic CTCL patients had 50 documented S. aureus colonization or infection events. Patients had an improvement in body surface area (BSA) or modified Severity Weighted Assessment Tool (mSWAT) in 53% events treated for S. aureus. Seventeen of the 50 (34%) events were due to methicillin-resistant S. aureus (MRSA). One-third (33%) of MRSA events were initially treated with dicloxacillin. The MRSA isolates were sensitive to trimethoprim-sulfamethoxazole (92%) and doxycycline (88%). Patients treated in the outpatient setting (OR 0.073; 95% CI 0.008-0.627; p = 0.017) and patients with a previous history of topical anti-S. aureus decolonization treatments before S. aureus event as stand-alone (OR 0.125; 95% CI 0.018-0.887; p = 0.038) or in combination treatment with systemic antibiotics (OR 0.094; 95% CI 0.009-0.944; p = 0.045) were less likely to see improvement in BSA or mSWAT from S. aureus treatment. Treatment of S. aureus improved CTCL skin score in a high number of erythrodermic patients. The MRSA prevalence was high in erythrodermic CTCL patients. Clinicians should consider using empiric MRSA antibiotic coverage for these patients.

Exfoliative erythroderma and palmoplantar hyperkeratosis associated with Majocchi's granuloma by Trichophyton tonsurans in a patient with AIDS / Eritrodermia exfoliativa e hiperqueratosis palmoplantar asociada con granuloma de Majocchi por Trichophyton tonsurans en un paciente con sida

Background. Dermatophytoses are skin superficial mycoses in which clinical manifestations are directly related to the virulence of the infecting microorganism or the host immunity. Case report. We describe a severe case of dermatophytosis associated with exfoliative erythroderma, substantial palmoplantar keratoderma, onychodystrophy affecting all nails, diffuse non-scarring alopecia and tissue fungal invasion by Trichophyton tonsurans, which led us to the diagnosis of AIDS. Direct examination and culture for fungi from skin scraping from two different sites were performed. Biopsy and histopathological exam were also performed on three different sites. Direct examination of the lesions’ scraping revealed septate hyaline hyphae and arthroconidia, identified as Trichophyton tonsurans by culture in glucose Sabouraud agar and Mycosel agar. A scalp biopsy revealed follicular fungal invasion and Majocchi's granuloma. Due to the severity of the presentation we requested an anti-HIV serology, which was positive. The patient was treated with itraconazole, 200mg/day, for 120 days, which promoted a complete regression of the lesions. Conclusions. Severe and atypical forms of dermatophytosis could lead to a diagnosis of AIDS (AU)

Antecedentes. Las dermatofitosis son micosis cutáneas superficiales cuyas manifestaciones clínicas están relacionadas directamente con la virulencia del microorganismo involucrado y la inmunidad del huésped. Caso clínico. Se describe un caso grave de dermatofitosis asociado con eritrodermia exfoliativa, con apreciable queratodermia palmoplantar, onicodistrofia de las 20uñas, alopecia no cicatricial difusa e invasión fúngica del tejido por Trichophyton tonsurans, lo cual permitió establecer el diagnóstico de sida. Se llevó a cabo exploración directa y cultivo de hongos de dos muestras tomadas por raspado en dos localizaciones distintas. También se llevaron a cabo una biopsia de piel y un estudio histopatológico de tres localizaciones. En la exploración directa del raspado de las lesiones se observaron hifas tabicadas hialinas y artroconidios; en el cultivo en agar Sabouraud con glucosa y agar Mycosel se aisló Trichophyton tonsurans. La biopsia de cuero cabelludo mostró una invasión fúngica folicular y la existencia de un granuloma de Majocchi. La gravedad del cuadro motivó la solicitud de la serología para el VIH, que fue positiva. Se trató al paciente con 200mg/día de itraconazol durante 120días, lo que llevó a la remisión completa de las lesiones. Conclusiones. Una dermatofitosis grave o atípica podría considerarse enfermedad reveladora de sida (AU)

[Streptococcus dysgalactiae subspecies equisimilis bacteremic erythroderma in a pediatric patient: a case report and review of literature]. / Eritrodermia con bacteriemia por Streptococcus dysgalactiae subespecie equisimilis en un paciente pediátrico: reporte de un caso y revisión de la literatura.

Infections caused by pyogenic streptococci are commons in pediatric ages. However, in the last decades there has been an increase in the isolation of no A or B Streptococci. We report a case of a 6 years old girl, who presents fever for 5 days and erythroderma. Streptococcus dysgalactiae subspecies equisimilis was isolated from blood cultures. She receives antibiotics for 14 days with ß-lactams with a good clinic evolution with normalization of the inflammatory parameters. This agent ß-hemolítico presents antigens of Lancefield groups A, C and G, and a great similitude regarding virulence factors, with Streptococcus pyogenes. Frequently in old patients, few reported cases in pediatric population. First line treatment remains ß-lactam antibiotics for which there are no reports of increasing resistance.

Eritrodermia con bacteriemia por Streptococcus dysgalactiae subespecie equisimilis en un paciente pediátrico: reporte de un caso y revisión de la literatura / Streptococcus dysgalactiae subspecies equisimilis bacteremic erythroderma in a pediatric patient: a case report and review of literature

Infections caused by pyogenic streptococci are commons in pediatric ages. However, in the last decades there has been an increase in the isolation of no A or B Streptococci. We report a case of a 6 years old girl, who presents fever for 5 days and erythroderma. Streptococcus dysgalactiae subspecies equisimilis was isolated from blood cultures. She receives antibiotics for 14 days with ß-lactams with a good clinic evolution with normalization of the inflammatory parameters. This agent ß-hemolítico presents antigens of Lancefield groups A, C and G, and a great similitude regarding virulence factors, with Streptococcus pyogenes. Frequently in old patients, few reported cases in pediatric population. First line treatment remains ß-lactam antibiotics for which there are no reports of increasing resistance.

Las infecciones por estreptococos piógenos, comunes en la edad pediátrica, muestran en los últimos años un aumento en la identificación de grupos no A o B. Presentamos el caso de una niña de 6 años, con historia de fiebre de cinco días de evolución asociado a una lesión eritrodérmica con hemocultivos positivos a Streptococcus dysgalactiae subspecies equisimilis (confirmado por biología molecular-genotipificación). Recibió terapia antimicrobiana por 14 días con ß-lactámicos con una evolución favorable. Este estreptococo ß-hemolítico, presenta antígenos del grupo A, C y G de Lancefield y una gran similitud con Streptococcus pyogenes en relación a los factores de virulencia. Más frecuentemente aislado en adultos mayores, existen pocos casos descritos en población pediátrica. El tratamiento de primera línea es con ß-lactámicos, para los cuales no hay reportes de resistencia antimicrobiana.

Green staining of clothing: a signal for pseudomonal infection.

Anticonvulsant hypersensitivity syndrome (AHS) is a nondose-related idiosyncratic reaction to aromatic antiepileptic drugs and is a cause of drug discontinuation. Pseudomonas aeruginosa is a gram-negative bacillus that can produce infections in many different organs, including the skin and soft tissue. We report a patient with erythroderma and AHS who developed a pseudomonal infection. Green staining of the underwear served as a diagnostic clue for severe P aeruginosa infection that had developed because of a local flexural skin infection that spread due to a damaged skin barrier. Inspection of the patient's clothes may give information about any exudate from the skin and should be done routinely as part of the physical examination.

Drotrecogin alfa (activated) for nonmenstrual toxic shock syndrome associated with methicillin resistant Staphylococcus aureus infection.

Nonmenstrual toxic shock syndrome (TSS) due to Staphylococcus aureus can lead to significant morbidity and mortality. While drotrecogin alfa (DA) has been employed in patients with Methicillin-resistant Staphylococcus aureus (MRSA) severe sepsis and septic shock, its utility in TSS remains unclear. The authors report a case of severe sepsis in the setting of MRSA-associated TSS that responded to treatment with DA. This case illustrates a potential role for DA in the treatment of toxic shock syndromes and emphasizes the importance of aggressive diagnostic and therapeutic modalities in approaching these conditions.

Staphylococcal toxins in patients with psoriasis, atopic dermatitis, and erythroderma, and in healthy control subjects.

BACKGROUND: The aggravating role of Staphylococcus aureus superantigens is well known in atopic dermatitis (AD) but has not yet been proven in psoriasis (PS). OBJECTIVE: We investigated the distribution of S aureus in the skin and nares of patients with AD, PS vulgaris, erythroderma, skin infections, and sepsis, and in healthy control subjects. A Staphylococcal enterotoxin test-reversed passive latex agglutination (SET-RPLAR) test was performed to determine Staphylococcal enterotoxins A, B, C, and D. RESULTS: S aureus was cultivated from lesional skin of 22 of 25 patients with AD and 15 of 25 patients with PS. Isolated strains were toxigenic in 44% for patients with AD and in 36% for patients with PS. The activity of disease in AD and PS according to the Severity Scoring of Atopic Dermatitis (SCORAD) or Psoriasis Area and Severity Index score, respectively, correlated significantly (P = .001) with an isolated toxigenic strain in both diseases. S aureus from skin infections was toxigenic in half of the patients. All patients with erythroderma harbored S aureus, mostly on their skin. In AD, sepsis and skin infections, toxin C and in PS toxin B was most often detected. S aureus was cultured in 12% of healthy persons. These strains were toxin negative. The limitations of these investigations are that other potentially acting enterotoxins, such as toxic shock syndrome toxin-1, which may play a role in aggravating disease, were not investigated with our latex agglutination test. CONCLUSION: In this study, S aureus was present in more than 50% of patients with AD and PS. We found that the severity of AD and PS significantly correlated to enterotoxin production of the isolated S aureus strains.

[New Staphylococcus aureus strains]. / Nouveaux staphylocoques dorés.

Staphylococcus aureus strains are present in the nose of 30% of healthy humans and are responsible for skin and soft tissue infections. Deep seated infections secondarily occurred such as osteomyelitis or infective endocarditis. New toxin-associated clinical entities have been recognized such as the toxin shock syndrome, the staphylococcal scarlet fever, the staphylococcal scalded skin syndrome or the necrotising pneumonia. This later syndrome is associated with Panton Valentine leukocidin producing strains. It occurs mainly in children and has a lethality of 75%. New antibiotic resistances are also emerging, for vancomycin in hospital-acquired infections and for methicillin in community-acquired infections.

Resolution of exfoliative dermatitis and Malassezia pachydermatis overgrowth in a cat after surgical thymoma resection.

A four-year-old, male neutered domestic shorthaired cat was presented with a two-week history of nasal and ocular discharge, generalised exfoliative dermatitis, intense pruritus, polydipsia, polyphagia, weight loss, intermittent hindlimb ataxia and lethargy. Cutaneous populations of Malassezia pachydermatis yeast organisms were found to be elevated. The generalised nature of the disease prompted survey radiography which revealed the presence of a cranial mediastinal mass which was subsequently resected and found to be a thymoma. Within six months of surgery, systemic and cutaneous signs had resolved and yeast counts had returned to normal, suggesting a causal relationship between the thymoma and the skin disease.

Molecular epidemiology of Staphylococcus haemolyticus strains isolated in an Albanian hospital.

A recent outbreak of erythroderma in young children in an Albanian hospital was investigated. The etiology was not established, but Staphylococcus haemolyticus was frequently isolated from the affected children and from staff working in the same unit. Possible relationships among the isolates were investigated by using classical techniques (biotype, antimicrobial susceptibility, and extrachromosomal DNA pattern) and by restriction endonuclease analysis (REA) of total DNA. Control isolates of proven pathogenicity from hospitalized patients in Lyon, France were subjected to the same procedures. Distinct REA patterns were obtained after digestion with two enzymes in 7 of 10 isolates from five affected children. Six distinct patterns were observed in nine isolates from six staff members; two REA patterns from patient isolates and two from staff members were identical, and these were distinguishable by the other markers examined. Only two different REA patterns were found in the pathogenic control isolates despite the use of a third additional enzyme. Again, the isolates with the same REA patterns could be distinguished by their plasmid profile or antimicrobial resistance profile. REA of total DNA used in combination with other markers indicated that the Albanian isolates differed considerably, whereas the French pathogenic isolates showed little variability.

Carp erythrodermatitis (CE) due to an Aeromonas hydrophila infection. Casuistic and experimental results.

In November 1987 high losses of carp (Cyprinus carpio) with the main symptom of skin ulcera were observed in a farm in northern Greece. Sixty-six isolates of bacteria, characterized mainly as Aeromonas hydrophila or Pseudomonas spp. could be isolated from lesions of diseased fish. Transmission experiments with these isolates using mirror carp showed that Aeromonas hydrophila strains induced identical clinical and pathological pictures after intra- or subcutaneous injection. Extracts of these Aeromonas hydrophila isolates, as well as a supernatant of culture bouillon were toxic for carp and mice, indicating the presence of endo- and exotoxins. The results prove that carp erythrodermatitis (CE) may be caused by different bacteria, mainly including A. hydrophila.

Proliferation of HIV in lymphocyte--associated macrophages with cytopathic changes in AIDS erythroderma.

Latency of the Human Immunodeficiency Virus (HIV) has been demonstrated in both helper T-Lymphocytes and cells of the macrophage/monocyte series. Although mitogen-dependent amplification of HIV infection within lymphocytes and monocytes/macrophages has been demonstrated to occur in vitro, in vivo evidence of such a phenomenon has been lacking. We have performed electron microscopic and immunocytochemical evaluation of skin biopsies from a patient with the Acquired Immunodeficiency Syndrome (AIDS) with chronic erythroderma. These biopsies provided evidence of proliferation of HIV in macrophages interacting with activated lymphocytes (CD3+). These macrophages were undergoing morphologic changes characteristic of cytopathicity and contained numerous viral particles, many of which were actively budding from plasma membranes. Cutaneous macrophages which were not interacting with lymphocytes did not demonstrate cytopathicity or evidence of viral multiplication. These in vivo data substantiate the concept that activation of cells which harbour latent HIV promotes viral replication as well as subsequent cytopathicity.

Staphylococcus aureus colonization of burrows in erythrodermic Norwegian scabies. A case study of iatrogenic contagion.

Scanning electron microscopy demonstrated extensive bacterial colonization of scabies burrows honeycombing the stratum corneum of an elderly woman with erythroderma. Cultures of scybala revealed hemolytic Staphylococcus aureus, possibly responsible for the erythroderma. Epidemiologic data revealed a trail of scabies through two nursing homes and one hospital during the 2-year period that physicians believed she had a drug-induced erythroderma.

The spectrum of staphylococcal disease. From Job's boils to toxic shock.

Strains of Staphylococcus aureus are known to differ in their ability to produce a number of toxins and digestive enzymes that may contribute to the organisms's virulence and invasive potential. Independent from these, however, certain strains produce a variety of specific toxins that cause specific clinical diseases, including staphylococcal food poisoning, staphylococcal enterocolitis, exfoliative skin disorders, and most recently, the toxic shock syndrome. This article reviews those diseases known to be mediated by specific staphylococcal toxins.

Nosocomial scalded skin syndrome. Ritter's disease caused by phage group 3 Staphylococcus aureus.

Three cases of generalized exfoliative staphylococcal scalded skin syndrome (SSSS) were encountered during a 25-day period in a nursery for premature infants. A single strain of Staphylococcus aureus, phage type 42E/54/75 (group 3), was recovered from each of the three infants and from no others. Two of the three isolates were tested and both produced epidermolytic toxin (ET). Most cases of SSSS have been associated with phage group 2 strains. To our knowledge, this is the first report of a nursery outbreak caused by a phage group 3 staphylococcus. It illustrates that ET production and not phage type distinguishes S aureus strains that are associated with SSSS.