The CD48 receptor mediates Staphylococcus aureus human and murine eosinophil activation.

BACKGROUND: Allergy is characterized by eosinophilia and an increased susceptibility to microbial infection. Atopic dermatitis (AD) is typically associated with Staphylococcus aureus (SA) colonization. Some of the mechanisms by which SA and its exotoxins interact with eosinophils remain elusive. CD48, a glycosylphosphatidylinositol-anchored receptor belonging to the CD2 family, participates in mast cells-SA stimulating cross-talk, facilitates the formation of the mast cell/eosinophils effector unit and as expressed by eosinophils, mediates experimental asthma. OBJECTIVE: To investigate the role of CD48 expressed on human peripheral blood and mouse bone marrow-derived eosinophils (BMEos) in their interaction with heat-killed SA and its three exotoxins, Staphylococcal enterotoxin B (SEB), protein A (PtA) and peptidoglycan (PGN). METHODS: Eosinophils were obtained from human peripheral blood and BM of WT and CD48-/- mice. SA was heat killed and eosinophils-SA/exotoxins interactions were analyzed by confocal microscopy, adhesion and degranulation, cell viability, cytokine release and cell signalling. In addition, peritonitis was induced by SEB injection into CD48-/- and WT mice. CD48 expression was studied in AD patients' skin and as expressed on their leucocytes in the peripheral blood. RESULTS: We provide evidence for the recognition and direct physical interaction between eosinophils and SA/exotoxins. Skin of AD patients showed a striking increase of eosinophil-associated CD48 expression while on peripheral blood leucocytes it was down-regulated. SA/exotoxins enhanced CD48 eosinophil expression, bound to CD48 and caused eosinophil activation and signal transduction. These effects were significantly decreased by blocking CD48 on human eosinophils or in BMEos from CD48-/- mice. We have also explored the role of CD48 in a SEB-induced peritonitis model in CD48-/- mice by evaluating inflammatory peritoneal cells, eosinophil numbers and activation. CONCLUSIONS: These data demonstrate the important role of CD48 in SA/exotoxins-eosinophil activating interactions that can take place during allergic responses and indicate CD48 as a novel therapeutic target for allergy and especially of AD.

Well being, psychopathology and coping strategies in psoriasis compared with atopic dermatitis: a controlled study.

BACKGROUND: There is a vast literature describing the association between psoriasis, atopic dermatitis (AD) and psychological distress. Some of these studies were uncontrolled and others used non-dermatological diseases as control, but only a few used chronic skin diseases as controls. OBJECTIVE: To compare well being, psychopathology and coping strategies of psoriatic, AD and healthy controls in a prospective case-control study. METHODS: Thirty-seven psoriatic patients and 31 AD patients were recruited from the Hadassah Ein Karem Hospital, Jerusalem, Israel, outpatient and inward clinic. The participants in the control group were 31 healthy workers and volunteers with no dermatological diseases from Kaplan Hospital, Rehovot, Israel. We used self-report questionnaires [Mental Health Inventory (MHI) and Adjustment to Chronic Skin Diseases Questionnaire (ACSD)], a projective technique (Hand Test) and assessment tools (Clinical Global Impression). RESULTS: Psoriatic patients experienced reduced well being (P = 0.007) and more anxiety and depression (P = 0.018) than normal controls. Psoriatic patients also displayed more severe psychopathology (P = 0.039) a more passive attitude towards life, and loss of meaning in life (P = 0.001) as measured by the projective technique compared with AD patients and normal controls. CONCLUSIONS: We propose two explanations, derived from the psychological and the psycho-neuro-immunological domains. First, greater mental distress in psoriasis is because of the greater stigma it bears compared with AD. Alternatively, we hypothesize that the psoriatic inflammatory process may possibly have a direct central nervous system effect.

Immunological assessment of familial tinea corporis.

BACKGROUND: The mechanisms involved in the immune resistance to fungal infection of the skin are not well understood. We assessed the levels of the various lymphocyte subsets, the HLA haplotypes, the expression of various receptors on natural killer (NK) cells and the serum levels of cytokines, in a family in which four siblings had tinea corporis, while four others were healthy, in order to reveal potential factors of susceptibility to dermatophytes. OBSERVATIONS: Normal numbers of T, B and NK cells were found in the peripheral blood, without significant differences between healthy and infected siblings. The frequency of CD14-positive monocytes was elevated in infected compared with healthy siblings. The proportion of NKG2A(+) NK cells was reduced in the patients compared with healthy siblings (23.8% vs. 33.8%), whereas CXCR3(+) NK cells were increased (41.5% vs. 25.6%, respectively). MHC class I and class II haplotypes were disease independent. Elevated levels of intereron-gamma, interleukin-8 (IL-8), IL-2 and tumour necrosis factor-alpha (TNFalpha) were observed only in part of the infected siblings. The serum level of TNFalpha was strongly correlated with the percentage of CD14(+) monocytes. CONCLUSIONS: We studied here in detail the NK functions of a family of patients suffering from tinea corporis and observed skewed frequencies of specific NK receptors, which imply possible involvement of NK cells in susceptibility to fungal infection.

Treatment with itraconazole of widespread tinea corporis due to Trichophyton rubrum in a bone marrow transplant recipient.

An immunocompromised patient, 6 weeks after bone marrow transplantation, developed extensive skin infection due to Trichophyton rubrum. Because she could not tolerate ketoconazole and was hypersensitive to griseofulvin, she received itraconazole with complete recovery within 30 days. This case demonstrates that itraconazole may be effective treatment for dermatophytosis, even in immunocompromised hosts, and that there is no cross-reactivity between ketoconazole and itraconazole.

An oral zinc loading test in psoriasis.

Changes of zinc in body fluids were evaluated in 12 patients with extensive psoriasis and compared with those of 11 healthy volunteers, using an oral zinc loading test. Plasma zinc levels and urinary zinc excretion were measured by atomic absorption spectrophotometry. No significant difference was found between plasma zinc levels and urinary zinc excretion following an overnight fast. Both groups showed extensive increases in urinary zinc excretion following the loading test. The peak levels of plasma zinc were significantly lower in the psoriatic patients two and four hours after zinc ingestion (P less than .01 and P less than .02, respectively).

Ultrasound-induced hyperthermia in the treatment of cutaneous leishmaniasis.

Local hyperthermia induced by ultrasound was delivered two or three times weekly to twenty-eight lesions of acute cutaneous leishmaniasis in eighteen patients. Twenty-two lesions (78.5 percent) in thirteen patients resolved completely five to ten weeks after the start of treatment. Our results are explained by the thermosensitivity of the parasite and its inability to survive at supranormal temperatures. Ultrasound hyperthermia was tolerated by most of the patients. The results of this study indicate that topical heat is safe and effective for the treatment of patients with acute cutaneous leishmaniasis.

Polymorphous drug eruption due to nifedipine.

A patient who underwent coronary bypass surgery and was treated with nifedipine subsequently developed an erysipelaslike erythematous itching plaque on both shins. Histopathologic examination of a biopsy specimen from the area showed findings compatible with a lichen-planus-like drug eruption. An awareness of varied skin reactions produced by nifedipine may reduce the suffering of patients and help prevent unnecessary local and general treatments.

Cryotherapy in acute cutaneous leishmaniasis.

Fourteen patients with acute cutaneous leishmaniasis entered a study testing the efficacy of liquid nitrogen. All lesions were cured clinically and protozoologically within 3-8 weeks, without noticeable scarring. The patients did not experience adverse side effects, and there was no relapse 4 months after cessation of therapy. The results of this study indicate that cryotherapy is a safe and effective method for treating cutaneous leishmaniasis.

Sweet's syndrome.

Sweet's syndrome (acute neutrophilic dermatosis) is characterized by fever; polymorphonuclear neutrophilic leukocytosis; elevated ESR; and characteristic, raised, painful red plaques on the face and limbs. Since Sweet first described the syndrome in 1964, more than 150 cases have been reported, but it is assumed that the disorder is far more common than this number would indicate.

Leishmania major and Leishmania donovani: effect of LPG-containing and LPG-deficient strains on monocyte chemotaxis and chemiluminescence.

Lipophosphoglycan (LPG) is a major glycolipid present on the membrane of Leishmania promastigotes and amastigotes. We have previously shown that preincubation of peripheral blood monocytes with purified LPG inhibits IL-1 production, chemotactic locomotion, and luminol-dependent chemiluminescence (LDCL). In the present study we tested the effect of LPG present on live parasites on monocyte activity. For this purpose, we used two mutant strains deficient in LPG and two LPG-containing strains. One pair was Leishmania major and the other Leishmania donovani. Monocytes in suspension were infected with the different parasite strains and tested for chemotactic locomotion and LDCL at different times between 1 and 72 hr after infection. In parallel, the percentage of infected monocytes was measured in stained cytospin preparations. The results obtained showed that at 1 hr of incubation only the LPG-containing strains inhibited chemotaxis, while the mutant strains showed a normal response. From 4 hr of incubation onwards, the mutant strains also inhibited monocyte chemotactic locomotion. LDCL was only slightly inhibited by the LPG-containing strains after 1 hr, because of a high level of spontaneous stimulation, probably due to phagocytosis. At 24 and 72 hr all strains inhibited LDCL. These results suggest that LPG is responsible for early inhibition of macrophage activity, but that other factors are responsible for inhibition at later stages of in vitro infection. The model described here might represent a useful tool to further analyze the mechanisms involved in immune evasion of Leishmania parasites.

Superficial actinic porokeratosis and cystic fibrosis.

A 24-year-old woman, presenting with cystic fibrosis, developed superficial actinic porokeratosis. Immunosuppression due to cystic fibrosis may be either the cause of or the exacerbating factor in superficial actinic porokeratosis in our patient.

Generalized morphea and idiopathic thrombocytopenia.

A patient with generalized morphea and thrombocytopenia is reported. The thrombocytopenia responded promptly to corticosteroid and immunosuppressive therapy but recurred when the steroids were discontinued. The occurrence of thrombocytopenia in generalized morphea suggests a common immune mechanism and emphasizes the need to look for concomitant autoimmune hematologic disorders in patients with systemic, as well as localized, scleroderma.

Urticarial vasculitis and recurrent pleural effusion: a systemic manifestation of urticarial vasculitis.

A 62-year-old woman with an 8-year history of urticaria, arthralgia and arthritis developed recurrent pleural effusion. A thorough laboratory workup during repeated attacks of concomitant urticaria and pleural effusion disclosed only hypocomplementemia and the histopathological finding of the skin biopsy revealed leukoclastic vasculitis. These findings are compatible with the entity of urticarial vasculitis. It is thus suggested that pleural effusion can form part of the systemic manifestations of urticarial vasculitis.

Acro-angiodermatitis: review of the literature and report of a case.

Acro-angiodermatitis is a very common disorder, with a close clinical, anatomical and morphological resemblance to Kaposi's sarcoma. Several types of this disorder can be found in different settings. However, these conditions are often misdiagnosed and therefore mistreated. A review of the literature and a classification of all types of acro-angiodermatitis are presented. We also describe a case of a patient with acro-angiodermatitis which completely regressed following a course of dapsone combined with leg elevation and elastic support stockings.

Seasonal variation of UV radiation at the Dead Sea.

Pilot measurements were made of natural UV radiation (UVA and UVB, broad-band and erythemogenic) on the Dead Sea (400 m below sea level) and in Spain at sea level, both at approximately the same geographical latitude. Measurements were made at different times of single days during the 1985/1986 season. The preponderance of UVA over UVB was more pronounced in winter.

Computed tomography in Sjögren-Larsson syndrome.

A family with 12 children, 6 of whom had Sjögren-Larsson syndrome, was studied clinically. On CT, all six siblings with the disease had patchy regions of white matter hypodensity, most marked in the frontal lobes, which were confluent in the more severe cases. The ventricles were not enlarged and no other abnormality was demonstrated. The CTs of the 6 unaffected siblings and the mother, who was also unaffected by the disease, were normal.