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1.
J Pak Med Assoc ; 69(8): 1175-1180, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31431774

RESUMO

OBJECTIVE: To identify the prevalent skin disorders among primary school children, awareness of its risk factors and to assess the socio-demographic determinants associated with their development. METHODS: The cross-sectional observational study was conducted in September-December 2016 comprising children from six public and private schools in Wadi Al Dawaser region of Eastern Saudi Arabia. A self-generated self-administered questionnaire was sent through the children to be filled up by their parents. Details on sociodemographic and skin dermatoses conditions were collected. Data were analyzed using SPSS 16.. RESULTS: Of the 710 students approached, 499(70.2%) responded. Of them, 151(30.2%) were boys and 348(69.7%) were girls. The overall mean age was 10.3}1.4 years (range: 3-15 years). The overall prevalence of skin disorders was 118(23.6%). Allergic dermatoses 11(11.3%) and eczema 4(11.8%) were the commonest conditions. Lichen planus 6(5%), acne 9(7.6%), allergic rashes 4(3.3%), and psoriasis 3(2.5%) were also recorded. Sociodemographic and hygiene factors were significantly associated with the disease (p<0.05 each). CONCLUSIONS: A high prevalence of skin disorders was encountered among primary school children in the region studied.


Assuntos
Dermatopatias/epidemiologia , Acne Vulgar/epidemiologia , Adolescente , Animais , Criança , Pré-Escolar , Estudos Transversais , Dermatite Alérgica de Contato/epidemiologia , Dermatite Atópica/epidemiologia , Eczema/epidemiologia , Feminino , Humanos , Líquen Plano/epidemiologia , Masculino , Animais de Estimação , Prevalência , Arábia Saudita/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Fatores Socioeconômicos , Vitiligo/epidemiologia
2.
J Hand Surg Asian Pac Vol ; 24(2): 129-137, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31035877

RESUMO

Background: Community Acquired Methicillin Resistant Staphylococcus aureus (CA-MRSA) rates have been increasing worldwide and contribute to a growing "global health security threat" as reported by the WHO. Our group previously reported an overall rate of 7% in CA-MRSA upper extremity infections between 2004-2009 at the Auckland Regional Hand Unit. This fell below the Center for Disease Control (CDC) recommendation for empiric antimicrobial cover once local rates exceed 10-15%. We examined prevalence and characteristics of CA-MRSA upper extremity infections in our region over a subsequent 5-year period. Methods: One thousand two hundred and fifty-two patients with upper extremity infections requiring operative management between 2011 and 2015 inclusive were included in this study. Associated clinical characteristics were recorded including ethnicity, cultured organisms, antibiotic sensitivities, infection rate, and treatment practice. Results: One hundred and fifty (12%) of patients had culture positive CA-MRSA upper extremity infections. There was an increasing annual trend. Of note, rates of CA-MRSA in the Maori and Pacific Island ethnic subpopulations exceeded 15% in 2014 and 2015. Susceptibilities, associated factors and patient demographics are reported. Conclusions: Our unit enjoys significantly lower rates of CA-MRSA upper extremity infections than has been reported internationally. However, trends are increasing relative to our prior 6-year report, and the threshold for empiric treatment has been met within the Maori and Pacific Island ethnic subpopulations. This evolving threat is also highlighted by increasing cases of multi-drug resistant CA-MRSA. Evolving regional guidelines for empiric coverage of CA-MRSA among high-risk ethnic subpopulations identified by this study are underway.


Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/epidemiologia , Extremidade Superior/microbiologia , Adulto , Artrite Infecciosa/epidemiologia , Artrite Infecciosa/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Feminino , Humanos , Masculino , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos , Prevalência , Dermatopatias Infecciosas/epidemiologia , Dermatopatias Infecciosas/microbiologia , Infecções dos Tecidos Moles/epidemiologia , Infecções dos Tecidos Moles/microbiologia
3.
Am J Clin Dermatol ; 20(3): 443-456, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31066001

RESUMO

BACKGROUND: Patients with moderate-to-severe atopic dermatitis (AD) have increased infection risk, including skin infections and systemic infections. Immunomodulators (e.g., anti-tumor necrosis factors, anti-interleukin [anti-IL]-23, anti-IL-17, Janus kinase inhibitors) increase risk of infections. Dupilumab (a monoclonal antibody blocking the shared receptor component for IL-4 and IL-13) is approved for inadequately controlled moderate-to-severe AD and for moderate-to-severe eosinophilic or oral corticosteroid-dependent asthma. OBJECTIVE: The aim was to determine the impact of dupilumab on infection rates in patients with moderate-to-severe AD. METHODS: This analysis pooled data from seven randomized, placebo-controlled dupilumab trials in adults with moderate-to-severe AD. Exposure-adjusted analyses assessed infection rates. RESULTS: Of 2932 patients, 1091 received placebo, 1095 dupilumab 300 mg weekly, and 746 dupilumab 300 mg every 2 weeks. Treatment groups had similar infection rates overall per 100 patient-years (placebo, 155; dupilumab weekly, 150; dupilumab every 2 weeks, 156; dupilumab combined, 152), and similar non-skin infection rates. Serious/severe infections were reduced with dupilumab (risk ratio 0.43; p < 0.05), as were bacterial and other non-herpetic skin infections (risk ratio 0.44; p < 0.001). Although herpesviral infection rates overall were slightly higher with dupilumab than placebo, clinically important herpesviral infections (eczema herpeticum, herpes zoster) were less common with dupilumab (risk ratio 0.31; p < 0.01). Systemic anti-infective medication use was lower with dupilumab. CONCLUSIONS: Dupilumab is associated with reduced risk of serious/severe infections and non-herpetic skin infections and does not increase overall infection rates versus placebo in patients with moderate-to-severe AD. CLINICALTRIALS. GOV IDENTIFIERS: NCT01548404, NCT02210780, NCT01859988, NCT02277743, NCT02277769, NCT02260986, and NCT02755649.


Assuntos
Anticorpos Monoclonais/administração & dosagem , Dermatite Atópica/tratamento farmacológico , Dermatopatias Infecciosas/epidemiologia , Adulto , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Dermatite Atópica/complicações , Dermatite Atópica/diagnóstico , Método Duplo-Cego , Humanos , Incidência , Injeções Subcutâneas , Placebos/administração & dosagem , Placebos/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Dermatopatias Infecciosas/etiologia , Dermatopatias Infecciosas/prevenção & controle , Resultado do Tratamento
4.
Int J Dermatol ; 58(8): 953-960, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30888053

RESUMO

INTRODUCTION: Individuals infected with the human T-cell lymphotropic virus type 1 (HTLV-1) commonly present skin lesions, which may be a warning sign for the diagnosis of infection. This study describes the most prevalent skin manifestations in HTLV carriers attended at the clinic of Núcleo de Medicina Tropical (NMT) of the Universidade Federal do Pará (UFPA) in Belém, Pará, Brazil. METHODS: This is a study of a series of cases of patients infected with human T-cell lymphotropic virus types 1 and 2 (HTLV-1/2) treated at NMT UFPA between 1999 and 2016. A descriptive analysis of data was applied. RESULTS: Among 788 surveyed medical records in the service, 15.10% (n = 119) were referred to the dermatology clinic. From the series of cases that presented with skin lesions, 66.39% were female and 33.61% were male, and the average age of this group was 48 years. There was a predominance of patients with noninfectious inflammatory manifestations (64.2%), followed by infectious ones (24.6%), and 1.58% with lymphoproliferative diseases. As for the group of lesions, 45.26% of the erythematous-squamous type were observed, followed by dyschromia (24.21%), and eczematous (14.74%). One patient with a diagnosis of adult T-cell leukemia/lymphoma, another with parapsoriasis, and four with infective dermatitis are highlighted. CONCLUSION: Skin disorders in the HLTV positive patient are important causes of referral to the dermatologist with etiological and skin lesions groups diversity. In the series of cases studied, lymphoproliferatives diseases and infective dermatitis associated with HTLV-1 were presented as a challenge for the diagnosis and clinical management of these patients.


Assuntos
Portador Sadio/epidemiologia , Infecções por HTLV-I/epidemiologia , Infecções por HTLV-II/epidemiologia , Encaminhamento e Consulta/estatística & dados numéricos , Dermatopatias Infecciosas/epidemiologia , Adolescente , Adulto , Fatores Etários , Brasil/epidemiologia , Portador Sadio/virologia , Dermatologia/estatística & dados numéricos , Feminino , Infecções por HTLV-I/virologia , Infecções por HTLV-II/virologia , Vírus Linfotrópico T Tipo 1 Humano/isolamento & purificação , Vírus Linfotrópico T Tipo 2 Humano/isolamento & purificação , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Dermatopatias Infecciosas/virologia , Adulto Jovem
5.
Int J Infect Dis ; 81: 52-56, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30684741

RESUMO

OBJECTIVES: The aim was to characterize the clinical features, outcomes, and strain diversity of laboratory-confirmed Streptococcus pyogenes (group A Streptococcus, GAS) infections among inpatients hospitalized at a tertiary level hospital in Brussels, Belgium, according to the patients' housing status (homeless vs. not homeless). METHODS: Between August 2016 and January 2018, all patients hospitalized with a laboratory-confirmed GAS infection were prospectively enrolled and risk factors were recorded. GAS strains were characterized using emm-typing and emm-clustering in both inpatients and outpatients. Analyses were performed according to homelessness status. RESULTS: During the study period, 48% (28/58) of adults hospitalized with a GAS infection at the tertiary hospital were homeless. The estimated incidence rate was 100 times higher for homeless persons. Skin abscesses were more frequent in the homeless group (21.4% vs. 3.3%) and mortality was high (10.7%). Limited emm-type diversity was found in this group, with four emm-types (64, 77, 83, and 101) accounting for 76.1% of the infections, and the majority of these emm-types belonged to the D4 emm-cluster. Pooled analyses of inpatient and outpatient strains indicated lower diversity in the homeless group. CONCLUSIONS: The homeless are disproportionately affected by GAS and have a higher rate of abscesses and high mortality. The lower emm-type diversity and preferential infection with four emm-types likely reflects endemic circulation of GAS in this population. Preventive strategies are warranted in this fragile population.


Assuntos
Pessoas em Situação de Rua/estatística & dados numéricos , Dermatopatias Infecciosas/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/patogenicidade , Adulto , Proteínas da Membrana Bacteriana Externa , Bélgica , Análise por Conglomerados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dermatopatias Infecciosas/epidemiologia , Infecções Estreptocócicas/epidemiologia
6.
Int J Dermatol ; 58(4): 440-448, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30565651

RESUMO

BACKGROUND: Skin lesions are very common among organ transplant recipients (OTR), particularly infections and tumors, because of the immunosuppressive state these patients are put in. METHODS: 177 OTR were examined. Skin lesions were categorized into neoplastic, infectious, and inflammatory diseases. RESULTS: The mean age of OTR was 52 years, the mean age at transplantation was 42.7 years, and kidney was the most common organ transplanted (72%). Skin lesions were found in 147 patients (83%). Cutaneous infections were seen in 106 patients (60%). Warts (30%) had the larger incidence and were associated with azathioprine (P = 0.026), cyclosporine (P = 0.006), and tacrolimus (P = 0.009). Superficial mycoses occurred in 16% of OTR, mostly onychomycosis, which was associated with tacrolimus (P = 0.040). Actinic keratosis (AK) occurred in 31% of patients and cutaneous tumors in 56%. Squamous cell carcinoma (SCC) was the most common tumor type affecting 36% of OTR (n = 64), with invasive SCC predominating over in situ SCC, whereas basal cell carcinoma (BCC) accounted for 17%. Both SCC and BCC were more numerous in patients' skin type I (P < 0.05). SCC was more frequent (36%) in combined kidney and liver recipients (P = 0.004), and BCC was associated with cyclosporine (P = 0.047). Inflammatory complications (acne, alopecia, hypertrichosis, and gingival overgrowth) were observed in 17.5% of patients. CONCLUSIONS: Organ transplant recipients must be regularly evaluated by dermatologists, who should be alert to the onset of infections and skin (pre)malignant diseases in these patients.


Assuntos
Carcinoma Basocelular/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Ceratose Actínica/epidemiologia , Transplante de Órgãos/estatística & dados numéricos , Dermatopatias Infecciosas/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adolescente , Adulto , Idoso , Azatioprina/uso terapêutico , Brasil/epidemiologia , Carcinoma de Células Escamosas/patologia , Criança , Ciclosporina/uso terapêutico , Dermatomicoses/epidemiologia , Feminino , Humanos , Imunossupressão , Imunossupressores/uso terapêutico , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Neoplasias Cutâneas/patologia , Tacrolimo/uso terapêutico , Verrugas/epidemiologia , Adulto Jovem
7.
Am J Emerg Med ; 37(1): 48-52, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29716798

RESUMO

PURPOSE: The purpose was to determine significant predictors of treatment failure of skin and soft tissue infections (SSTI) in the inpatient and outpatient setting. METHODS: A retrospective chart review of patients treated between January 1, 2005 to July 1, 2016 with ICD-9 or ICD-10 code of cellulitis or abscess. The primary outcome was failure defined as an additional prescription or subsequent hospital admission within 30 days of treatment. Risk factors for failure were identified through multivariate logistic regression. RESULTS: A total of 541 patients were included. Seventeen percent failed treatment. In the outpatient group, 24% failed treatment compared to 9% for inpatients. Overweight/obesity (body mass index (BMI) > 25 kg/m2) was identified in 80%, with 15% having a BMI >40 kg/m2. BMI, heart failure, and outpatient treatment were determined to be significant predictors of failure. The unit odds ratio for failure with BMI was 1.04 (95% [Cl] = 1.01 to 1.1, p = 0.0042). Heart failure increased odds by 2.48 (95% [Cl] = 1.3 to 4.7, p = 0.0056). Outpatients were more likely to fail with an odds ratio of 3.36. CONCLUSION: Patients with an elevated BMI and heart failure were found to have increased odds of failure with treatment for SSTIs. However, inpatients had considerably less risk of failure than outpatients. These risk factors are important to note when making the decision whether to admit a patient who presents with SSTI in the emergency department. Thoughtful strategies are needed with this at-risk population to prevent subsequent admission.


Assuntos
Antibacterianos/uso terapêutico , Dermatopatias Infecciosas/fisiopatologia , Infecções dos Tecidos Moles/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Comorbidade , Serviço Hospitalar de Emergência , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Dermatopatias Infecciosas/tratamento farmacológico , Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/tratamento farmacológico , Infecções dos Tecidos Moles/epidemiologia , Falha de Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
8.
J Cosmet Dermatol ; 18(1): 258-262, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29781249

RESUMO

BACKGROUND/OBJECTIVES: Injection drug use is one of the major public health problems in Iran. Injection drug use is associated with numerous negative health outcomes, such as blood-borne infections (HIV, HCV) and injection site skin infections (abscesses, cellulitis). The aim of this study was to determine prevalence of injection site skin infections and its associated risk factors among people who inject drugs (PWID) in Tehran, Iran. METHODS: The cross-sectional study was conducted from March to August 2016 in Tehran province. A total of 500 PWID were recruited by convenience and snowball sampling from Drop-in Centers (DIC) in the South of Tehran. Our primary outcomes were self-report of ever having injection sites skin infections and receiving treatment for them. We first examined associations between individual variables and lifetime history of having injection site infections in bivariate analysis using the chi-square or Fisher's exact tests, as appropriate. Variables with P-value <.2 were included in a multiple logistic regression model. RESULTS: Overall, 40% (CI95%: 30.3%, 52.2%) of participants reported ever having an injection site infection. In the multivariable model, those with low socioeconomic status (AOR = 2.4, P = .03), self-reported as HIV positive (AOR =1.6, P = .01), reporting more than 3 injections per day (AOR = 4.1, P = .03) and reuse of their own syringes (AOR = 8.5, P = .03) were more likely to have injection sites skin infections. PWID who used needle and syringe program (NSP) services were less likely to report injection site infections (AOR = 0.5, P = .04). CONCLUSION: We have identified several risk factors for injection sites infections among PWID, including frequency of injection per day, reuse of their own syringes, not using NSP services, HIV status, socioeconomic status with skin infections in PWID. Prevention strategies to reduce skin infections should focus on high-risk injection behaviors and improving access to NSP services.


Assuntos
Soroprevalência de HIV , Reação no Local da Injeção/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Estudos Transversais , Humanos , Irã (Geográfico)/epidemiologia , Masculino , Programas de Troca de Agulhas , Prevalência , Fatores de Proteção , Fatores de Risco , Autorrelato , Dermatopatias Infecciosas/prevenção & controle , Classe Social , Seringas , Adulto Jovem
9.
Int J Dermatol ; 58(3): 288-295, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30246865

RESUMO

BACKGROUND: Infectious skin disorders (ISDs) are commonly seen in pediatric emergency departments (PED), however the exact frequency is unknown. We provide an accurate evaluation of the incidence and characteristics of ISDs diagnosed in a PED from Buenos Aires, Argentina, over a 1-year period. METHODS: Prospectively, descriptive study of children evaluated in the PED with ISDs during 2016. ISDs were analyzed on the basis of their incidence, patient demographics, seasonal variations, and hospitalization rates. RESULTS: ISDs were diagnosed in 1680 (67.9%) of the skin consultations (M/F: 1.1; mean age: 4.4 ± 3.7 years). Bacterial infections were observed in 932 (55.5%) cases. Viral infections were seen in 604 patients (35.9%). Fungal and parasite skin infections were diagnosed in 33 (2%) and 111 (6.6%) children, respectively. The most frequent ISDs according to the etiology group were impetigo 377 (22.4%), varicella 397 (23.6%), tinea capitis 10 (0.6%), and scabies 109 (6.5%). A higher frequency of ISDs were reported during the summer (38.4%) and spring (38.2%) months. Bacterial skin infections were more frequent during the summer months, while viral skin infections were more prevalent during spring. Parasitic skin infections were diagnosed more frequently during the winter months. No differences were seen for mycotic skin infections. Hospitalization rate was 1% (all for bacterial skin infections). CONCLUSION: Our data reveal the extremely high frequency of ISDs seen at the PED, underlying the need for closer cooperation between dermatologists and pediatricians.


Assuntos
Hospitalização/estatística & dados numéricos , Estações do Ano , Dermatopatias Infecciosas/epidemiologia , Dermatopatias Infecciosas/etiologia , Argentina/epidemiologia , Varicela/epidemiologia , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Hospitais Pediátricos , Humanos , Impetigo/epidemiologia , Incidência , Lactente , Masculino , Estudos Prospectivos , Escabiose/epidemiologia , Centros de Atenção Terciária , Tinha do Couro Cabeludo/epidemiologia
10.
Microb Drug Resist ; 25(2): 241-250, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30096257

RESUMO

Genetic background and molecular characteristics of Staphylococcus aureus collected from patients with skin and soft tissue infections were studied in the North-Central region of Bangladesh from 2015 to 2016. Among 430 clinical isolates, methicillin-resistant S. aureus (MRSA) accounted for 31% having SCCmec type IV (73%) and V (14%), and belonged mostly to coagulase (coa) genotypes IIa, IIIa, IVb, and XIa, while dominant coa type in methicillin-susceptible S. aureus (MSSA) was IIIa, followed by Va, IIa, and VIa. Panton-Valentine Leukocidin genes (pvl) were detected at higher rate in MSSA (54%) than in MRSA (24%). Based on multilocus sequence typing, pvl-positive MRSA isolates were classified into clonal complex 88 (CC88) (ST88, ST2884, ST4345), CC6 (ST6, ST4350), and CC1 (ST1, ST772), while pvl-negative MRSA into CC5, CC22, CC80, CC121, and CC672. The pvl-negative ST80 MRSA isolates had SCCmec-IVa (agr-III/coa-XIc, etd/edinB-positive, fusB-negative), indicating that they belong to the novel CC80 clade related to the European community-acquired MRSA clone. Among MSSA, genotypes ST121/spa-t645/coa-Va and ST2884 (CC88)/spa-t2393/coa-IIIa were identified in both pvl-positive and negative isolates, and all the ST772 isolates harbored pvl. All the ST121 isolates had a variant of elastin-binding protein gene (ebpS-v) with internal 180-nucleotide deletion. The present study suggested that CC88 (ST88, ST2884) and ST772 are the putative dominant lineages of pvl-positive MRSA/MSSA, while novel CC80 clade is one of the main pvl-negative MRSA lineages distributed endemically in Bangladesh.


Assuntos
Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/genética , Dermatopatias Infecciosas/microbiologia , Infecções dos Tecidos Moles/microbiologia , Adulto , Idoso , Proteínas de Bactérias/genética , Toxinas Bacterianas/genética , Bangladesh/epidemiologia , Farmacorresistência Bacteriana/genética , Exotoxinas/genética , Feminino , Genótipo , Humanos , Leucocidinas/genética , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Epidemiologia Molecular , Tipagem de Sequências Multilocus , Proteínas de Ligação às Penicilinas/genética , Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Fatores de Virulência/genética , Adulto Jovem
11.
BMC Res Notes ; 11(1): 881, 2018 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-30541619

RESUMO

OBJECTIVES: Skin disorders are the most common health problems seen among HIV positive patients. It presents with a variety of manifestations which can cause significant morbidity. This study was aimed to assess the prevalence of common skin problems among children living with HIV/AIDS at Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia, 2017/2018. Hospital based cross-sectional study was conducted among 125 children living with HIV/AIDS who were recruited through simple random sampling techniques from February to April 2017. Pre-tested, structured questionnaires were used to collect the data. RESULT: Among a total of 125 study participants, 72 (57.6%) of the children were males and 97 (77.6%) were in the age range of 10-14 years. 90 (72%) of participants had different kinds of skin problems. Among those who had one kind of common skin infection, 53 (42.4%) were males. Viral skin infections that accounts 48 (53.3%), were the leading cause of skin infections followed by 43 (47.8%), 33(36.7%) and 22 (24.7%) fungal infections, inflammatory and bacterial skin infections respectively. Among all children who were taking ART, only 2.4% of the children had skin related side effects.


Assuntos
Infecções por HIV/complicações , Dermatopatias Infecciosas/complicações , Dermatopatias Infecciosas/epidemiologia , Adolescente , Adulto , Cuidadores , Criança , Cidades , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto Jovem
12.
PLoS One ; 13(11): e0206893, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30383858

RESUMO

OBJECTIVE: The aim of this study was to compare the incidence of skin and soft tissue infections (SSTIs) across healthcare settings and analyze direct healthcare expenditures related to SSTIs in 2000 and 2012 in the United States. METHODS: We performed a retrospective, cross-sectional analysis of nationally representative data from the Medical Expenditure Panel Surveys. Population-based incidence rates were examined for all healthcare settings that include inpatient visits, emergency department visits and ambulatory visits for SSTIs. The direct costs of healthcare services utilization were reported. Population-based prescribing rates for each antimicrobial class during ambulatory visits were compared. RESULTS: A total of 2.4 million patients experienced an SSTI in 2000 compared to 3.3 million in 2012 (40% increase). From 2000 to 2012, the incidence of patients with at least one hospital visit for SSTIs increased 22%, ambulatory care visits increased 30%, and emergency department visits increased 40%. The incidence of SSTIs in children and adolescents declined 50% (from 150 to 76 per 10,000 person; RR = 0.51, 95% CI: 0.38-0.67; p<0.001) whereas SSTIs in older adults (> 65 years of age) increased almost 2-fold (from 67 to 130 per 10,000 person; RR = 1.94, 95% CI: 1.44-2.61; p<0.001). The annual incidence of SSTI in adults did not change significantly from 2000 to 2012 (from 84 to 81 per 10,000 person; RR = 0.96, 95% CI: 0.71-1.31; p = 0.41). The total estimated direct healthcare costs of SSTIs increased 3-fold from $4.8 billion in 2000 to $15.0 billion in 2012, largely driven by an 8-fold increase in ambulatory expenditures for SSTIs. Total population-based antimicrobial prescription rates for SSTIs increased 4-fold from 2000 to 2012 (from 59.5 to 250.4 per 10,000 person). CONCLUSIONS: The highest healthcare utilization for SSTI treatment occurred in the ambulatory care setting and also accounted for the largest increase in overall direct expenditures from 2000 to 2012.


Assuntos
Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Assistência Ambulatorial/economia , Assistência Ambulatorial/estatística & dados numéricos , Assistência Ambulatorial/tendências , Antibacterianos/uso terapêutico , Estudos Transversais , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde/tendências , Gastos em Saúde/tendências , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Dermatopatias Infecciosas/economia , Dermatopatias Infecciosas/terapia , Infecções dos Tecidos Moles/economia , Infecções dos Tecidos Moles/terapia , Estados Unidos/epidemiologia , Adulto Jovem
13.
J Dtsch Dermatol Ges ; 16(10): 1289-1295, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30300491

RESUMO

With an incidence of 1 in 700 births, Down syndrome (DS) is not an uncommon condition. It is associated with various disorders of different organ systems. Serious disorders include cardiac defects and leukemia. With an onset during the newborn period, the latter does not always progress to classic myeloid leukemia (transient myeloproliferative disorder). Skin manifestations in newborns include pustules/vesiculopustules. In individuals with DS, such lesions should not only prompt suspicion for typical neonatal rashes and infections but also for transient myeloproliferative disorder. However, most dermatoses are benign. They essentially comprise disorders of keratinization that present as xerosis, keratosis pilaris, lichenification, and ichthyosis vulgaris. Also typical but not specific is the four-finger palmar crease (simian crease). Patients frequently develop folliculitides, which - due to elastolysis - subsequently progress to anetoderma. The known immune disturbance in DS patients explains the occurrence of autoimmune diseases such as alopecia areata and vitiligo. Typical skin conditions associated with DS include elastosis perforans serpiginosa, syringomas, milia-like calcinosis cutis, and multiple eruptive dermatofibromas.


Assuntos
Síndrome de Down/diagnóstico , Fidelidade a Diretrizes , Dermatopatias/diagnóstico , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/epidemiologia , Adolescente , Adulto , Anetodermia/diagnóstico , Anetodermia/epidemiologia , Doenças Autoimunes/diagnóstico , Doenças Autoimunes/epidemiologia , Criança , Pré-Escolar , Comorbidade , Estudos Transversais , Doença de Darier/diagnóstico , Doença de Darier/epidemiologia , Síndrome de Down/epidemiologia , Exantema/diagnóstico , Exantema/epidemiologia , Sobrancelhas/anormalidades , Feminino , Alemanha , Humanos , Ictiose/diagnóstico , Ictiose/epidemiologia , Ictiose Vulgar/diagnóstico , Ictiose Vulgar/epidemiologia , Lactente , Recém-Nascido , Líquen Plano/diagnóstico , Líquen Plano/epidemiologia , Masculino , Transtornos Mieloproliferativos/diagnóstico , Transtornos Mieloproliferativos/epidemiologia , Dermatopatias/epidemiologia , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/epidemiologia , Adulto Jovem
14.
Emerg Med Clin North Am ; 36(4): 723-750, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30297001

RESUMO

This article covers the diagnosis and treatment of skin and soft tissue infections commonly encountered in the emergency department: impetigo, cutaneous abscesses, purulent cellulitis, nonpurulent cellulitis, and necrotizing skin and soft tissue infections. Most purulent infections in the United States are caused by methicillin-resistant Staphylococcus aureus. For abscesses, we emphasize the importance of incision and drainage. Nonpurulent infections are usually caused by streptococcal species and initial empiric antibiotics need not cover methicillin-resistant Staphylococcus aureus. For uncommon but potentially lethal necrotizing skin and soft tissue infections, the challenge is rapid diagnosis in the emergency department and prompt surgical exploration and debridement.


Assuntos
Serviço Hospitalar de Emergência , Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Infecções Estafilocócicas/epidemiologia , Humanos , Incidência , Estados Unidos/epidemiologia
15.
Actas Dermosifiliogr ; 109(10): 900-907, 2018 Dec.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30360884

RESUMO

BACKGROUND: Renal transplant recipients (RTR), which are an increasing population, frequently suffer from post-transplant dermatological complications. Despite the well-established role of dermatologists in the outpatient care of these patients, no previous studies were found concerning dermatology consultations for hospitalized RTR. OBJECTIVES: To investigate the epidemiology of dermatological conditions presented by RTR during hospitalization and assess the impact of dermatology consultations performed in the hospital setting. METHODS: Dermatology consultations requested for RTR admitted at a kidney transplantation referral hospital in Brazil over 36 consecutive months were retrospectively included. RESULTS: 176 consultations were included. Infectious dermatoses prevailed (52.3%), followed by inflammatory diseases (14.2%), neoplasms (12.5%) and drug reactions (8.5%). Diagnostic agreement between requesting and consulting teams was 38.1%. Most consultations were motivated by common dermatological conditions, unrelated to admission diagnosis. There were some differences in comparison to previous studies including general inpatients, such as: larger proportion of infectious dermatoses and neoplasms, smaller proportion of inflammatory diseases, higher percentage of patients submitted to skin biopsy, smaller proportion of consultations managed with a single visit and higher probability of a systemic treatment being recommended in this population. CONCLUSION: Hospitalized RTR present distinct dermatological epidemiology and higher level of complexity, when compared to studies including general inpatients. Dermatology interventions during hospitalization may be beneficial in the multidisciplinary care of these patients, either contributing to the investigation of systemic conditions or providing relief for cutaneous comorbidities.


Assuntos
Pacientes Internados/estatística & dados numéricos , Transplante de Rim , Complicações Pós-Operatórias/epidemiologia , Encaminhamento e Consulta , Dermatopatias/epidemiologia , Adulto , Idoso , Brasil/epidemiologia , Erupção por Droga/epidemiologia , Feminino , Hospitais Universitários , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Dermatopatias/etiologia , Dermatopatias Infecciosas/epidemiologia , Neoplasias Cutâneas/epidemiologia
16.
J Dermatol Sci ; 92(2): 127-133, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30241690

RESUMO

BACKGROUND: Congenital ichthyoses (CIs) adversely affect quality of life (QOL) in patients. However, the effects of CIs on patient QOL have not been studied sufficiently. OBJECTIVE: To investigate the association between disease severity and QOL in patients with harlequin ichthyosis (HI) and ichthyosis: syndromic forms (ISFs) METHODS: Clinical information of patients with HI and ISFs from 2010 to 2015 were obtained from 100 dermatology departments/divisions of principal institutes/hospitals throughout Japan. We examined the relationship between disease severity and QOL in patients with HI and ISFs. Patients who were aged 8 years or older and participated in a multicenter retrospective questionnaire survey in Japan were assessed by dermatology life quality index (DLQI, range of 0-30) and clinical ichthyosis score (range of 0-100). RESULTS: Netherton syndrome patients had a significantly higher risk of allergy to food or environmental allergens than patients with other phenotypes. Keratitis-ichthyosis-deafness (KID) syndrome patients showed a significantly higher risk of skin infections than patients with other phenotypes. Complete data on DLQI were obtained from 13 patients, whose median age was 21 (8-71) years. Nine patients were male, and 4 were female. Systemic retinoids were administrated to 2 of the 3 HI patients. The Spearman's correlation coefficient between the clinical ichthyosis score and DLQI was 0.611 (P < 0.05). CONCLUSION: We confirmed that Netherton syndrome and KID syndrome patients have a higher risk of allergy to food or environmental allergens and of skin infections, respectively. QOL impairment correlates with disease severity in HI and ISFs patients.


Assuntos
Hipersensibilidade Imediata/epidemiologia , Ictiose Lamelar/complicações , Ceratite/complicações , Síndrome de Netherton/complicações , Qualidade de Vida , Dermatopatias Infecciosas/epidemiologia , Adolescente , Adulto , Idoso , Alérgenos/imunologia , Criança , Estudos Transversais , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Ictiose Lamelar/diagnóstico , Japão/epidemiologia , Ceratite/diagnóstico , Masculino , Pessoa de Meia-Idade , Síndrome de Netherton/diagnóstico , Estudos Retrospectivos , Índice de Gravidade de Doença , Adulto Jovem
17.
Clin Dermatol ; 36(5): 631-640, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30217275

RESUMO

Atopic dermatitis is a common chronic pruritic inflammatory skin disorder, characterized by an abnormal skin barrier, immune dysfunction, and an altered skin microbiome. Atopic dermatitis may be seen in conjunction with a variety of other skin disorders due to the complex pathogenesis of atopic dermatitis, involving genetic and environmental factors that are associated with immune dysfunction, barrier defects, and altered skin microbiomes. Skin disorders associated with atopic dermatitis include diseases sharing similar genetic origins like ichthyosis vulgaris, infectious diseases such as impetigo, and eczema herpeticum, in addition to the cutaneous autoimmune diseases, alopecia areata, and vitiligo. Atopic dermatitis is also often linked to such benign conditions as pityriasis alba and keratosis pilaris. This review discusses the cutaneous comorbidities of atopic dermatitis and their relationship via their occurrence in conjunction with atopic dermatitis.


Assuntos
Dermatite Atópica/epidemiologia , Dermatite de Contato/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Vitiligo/epidemiologia , Anormalidades Múltiplas/epidemiologia , Alopecia em Áreas/epidemiologia , Comorbidade , Doença de Darier/epidemiologia , Sobrancelhas/anormalidades , Humanos , Ictiose Vulgar/epidemiologia , Pitiríase/epidemiologia
18.
Br J Dermatol ; 179(6): 1322-1328, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30098016

RESUMO

BACKGROUND: Infections are one of the major causes of death in patients with advanced-stage mycosis fungoides (MF) or Sézary syndrome (SS). However, few recent data are available on the characteristics and risk factors of these infectious events. OBJECTIVES: To describe infectious events occurring in a cohort of patients with MF/SS, and to identify associated clinical and biological risk factors. METHODS: A retrospective cohort study was performed to investigate infectious events and associated factors in patients diagnosed with MF (stage IB and beyond) or SS followed from May 2011 to May 2016 at the University Hospital of Bordeaux, France. RESULTS: Seventy-one patients with complete follow-up were included. Eighty infectious events were recorded in 40 patients, including 28 skin and soft tissue infections and 25 cases of pneumonia. Opportunistic infections, which are usually associated with depleted cell-mediated immunity, were scarce (9%). In multivariate analysis, cardiac, renal or lung comorbidities [odds ratio (OR) 7·2, 95% confidence interval (CI) 3·3-15·9; P = 0·002], SS (OR 8·8, 95% CI 7·7-10·2; P = 0·037) and lymphocyte count < 0·5 × 109 cells L-1 (OR 6·4, 95% CI 1·5-27·4; P = 0·004) were significantly associated with a higher risk of infection. CONCLUSIONS: Opportunistic germs were rarely recorded, but their incidence was probably prevented by adequate prophylaxis (ongoing in 28% of patients). As in patients living with AIDS, pneumonias were frequent. On the other hand, bacterial cutaneous infections represent a specific pattern in patients with MF/SS. Patients with chronic organ failure, lymphocytopenia and SS should be considered as being at high risk for infectious events. Pneumococcal vaccination should be systematically recommended, and prophylaxis with co-trimoxazole and valaciclovir when the CD4 count is < 0·2 × 109 cells L-1 .


Assuntos
Micose Fungoide/complicações , Infecções Oportunistas/epidemiologia , Pneumonia/epidemiologia , Síndrome de Sézary/complicações , Dermatopatias Infecciosas/epidemiologia , Neoplasias Cutâneas/complicações , Comorbidade , Feminino , Seguimentos , França/epidemiologia , Humanos , Incidência , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Micose Fungoide/sangue , Micose Fungoide/epidemiologia , Micose Fungoide/imunologia , Estadiamento de Neoplasias , Infecções Oportunistas/imunologia , Pneumonia/imunologia , Estudos Retrospectivos , Fatores de Risco , Síndrome de Sézary/sangue , Síndrome de Sézary/epidemiologia , Síndrome de Sézary/imunologia , Dermatopatias Infecciosas/imunologia , Neoplasias Cutâneas/sangue , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/imunologia
19.
Transplant Proc ; 50(6): 1616-1620, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30056869

RESUMO

INTRODUCTION: Maintenance hemodialysis (HD) patients are potential transplant recipients. One of the most common cancers in the population of kidney recipients is skin neoplasm. Skin infections are also of a particular importance. In this population, especially in patients on the transplant waiting list, full dermatological examination, including dermatoscopy, should be carried out routinely. MATERIALS AND METHODS: The research was comprised of 105 HD patients (57 men, 48 women) with a mean age of 60.8 (range 25-94) years. The patients' skin condition was assessed and a dermatoscopic examination was performed. We compared the incidence of skin diseases in the two subpopulations: HD patients (n = 89) and HD patients active on the transplant waiting list (n = 16). RESULTS: Bacterial, fungal, and viral infections in the group of HD patients occurred in 24.7%, 14.6%, and 6.7% of patients, respectively. In HD patients on the waiting list, bacterial skin diseases were reported in 12.5% of patients, and neither fungal nor viral infections were noticed. Malignant skin lesions and precancerous conditions, such as basal cell carcinoma and keratosis actinic, developed in 4.5% and 3.4% of the HD patients. These malignancies did not occur in HD patients on the waiting list. The results show proper qualification for transplantation in maintenance HD patients before the waiting list. In the group of dialysis patients, 67.4% required dermatological care, while in the HD waiting group only 12.5% required dermatological care. CONCLUSIONS: The presented results prove the necessity of performing dermatological examinations on HD patients. Some dermatological skin lesions, if not diagnosed and treated, could progress to cancer after organ transplantation.


Assuntos
Nefropatias/terapia , Diálise Renal/efeitos adversos , Dermatopatias Infecciosas/etiologia , Neoplasias Cutâneas/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Incidência , Nefropatias/complicações , Transplante de Rim , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Dermatopatias Bacterianas/epidemiologia , Dermatopatias Bacterianas/etiologia , Dermatopatias Infecciosas/epidemiologia , Neoplasias Cutâneas/epidemiologia , Listas de Espera
20.
Harm Reduct J ; 15(1): 23, 2018 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-29739408

RESUMO

BACKGROUND: Skin and soft tissue infections (SSTIs) are a leading cause of morbidity and mortality among people who inject drugs (PWID). International data indicate up to one third of PWID have experienced an SSTI within the past month. Complications include sepsis, endocarditis and amyloid A (AA) amyloidosis. AA amyloidosis is a serious sequela of chronic SSTI among PWID. Though there is a paucity of literature reporting on AA amyloidosis among PWID, what has been published suggests there is likely a causal relationship between AA amyloidosis and injecting-related SSTI. If left untreated, AA amyloidosis can lead to renal failure; premature mortality among diagnosed PWID is high. Early intervention may reverse disease. Despite the high societal and individual burden of SSTI among PWID, empirical evidence on the barriers and facilitators to injecting-related SSTI prevention and care or the feasibility and acceptability of AA amyloidosis screening and treatment referral are limited. This study aims to fill these gaps and assess the prevalence of AA amyloidosis among PWID. METHODS: Care and Prevent is a UK National Institute for Health Research-funded mixed-methods study. In five phases (P1-P5), we aim to assess the evidence for AA amyloidosis among PWID (P1); assess the feasibility of AA amyloidosis screening, diagnostic and treatment referral among PWID in London (P2); investigate the barriers and facilitators to AA amyloidosis care (P3); explore SSTI protection and risk (P4); and co-create harm reduction resources with the affected community (P5). This paper describes the conceptual framework, methodological design and proposed analysis for the mixed-methods multi-phase study. RESULTS: We are implementing the Care and Prevent protocol in London. The systematic review component of the study has been completed and published. Care and Prevent will generate an estimate of AA amyloidosis prevalence among community recruited PWID in London, with implications for the development of screening recommendations and intervention implementation. We aim to recruit 400 PWID from drug treatment services in London, UK. CONCLUSIONS: Care and Prevent is the first study to assess screening feasibility and the prevalence of positive proteinuria, as a marker for AA amyloidosis, among PWID accessing drug treatment services. AA amyloidosis is a serious, yet under-recognised condition for which early intervention is available but not employed.


Assuntos
Amiloidose/epidemiologia , Dermatopatias Infecciosas/epidemiologia , Infecções dos Tecidos Moles/epidemiologia , Abuso de Substâncias por Via Intravenosa/epidemiologia , Diagnóstico Precoce , Estudos de Viabilidade , Humanos , Londres/epidemiologia , Prevalência , Encaminhamento e Consulta , Proteína Amiloide A Sérica/metabolismo
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