[Comment on the work by H.P. Soyer, J. Smolle, H. Kresbach, S. Hödl, P. Glavanovitz, H. Pachernegg and H. Kerl: Direct light microscopy of pigment tumors of the skin].
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Biomedical subjects
Publications and source records attributed to P Elsner.
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In 589 males, 169 with and 420 without urethritis, urethral swabs were taken and assessed semiquantitatively for the sexually transmittable infectious agents Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis, Trichomonas vaginalis and Candida species. The organisms were isolated in patients with and without urethritis as follows: N. gonorrhoeae with urethritis 19.5%, without 0.0%; C. trachomatis with urethritis 16.0%, without 2.9%; U. urealyticum (high cfu-counts) with urethritis 27.2%, without 11.7%; M. hominis (high cfu) with 4.7%, without 2.9%. Combined infections were more frequent in males with urethritis (20.8%) than in those without (5.4%). None of the investigated pathogenic microorganisms could be demonstrated in 37.9% of males with and in 71.2% of males without urethritis. Using loglinear analysis, a significant coincidence of infections with N. gonorrhoeae and U. urealyticum and of infections with U. urealyticum and M. hominis was found. It is concluded that an asymptomatic infection of the male urethra with sexually transmittable organisms is to be expected in partner's control examinations and in patients presenting for other STD like venereal warts or genital herpes. Therefore in these men, even if they are asymptomatic, a comprehensive microbiological examination is strongly recommended.
A 36-year-old man is presented who suffered from repeated subcutaneous abscesses with septicaemia. After injection sets had been discovered among the patient's belongings, the patient admitted to having provoked the abscesses unintentionally by injecting drugs and spirits subcutaneously.
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Urethral swabs from 322 men without urethritis, 73 of whom had venereal warts (condylomata acuminata, CA) and 249 who had none, were investigated between 1981 and 1984 by microscope and culture for the presence of Neisseria gonorrhoeae, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma species, Trichomonas vaginalis, Garderella vaginalis, B streptococci, aerobic pathogenic bacteria and Candida species. The isolation frequencies in patients with and without CA were as follows: N. gonorrhoea: with CA 0%, without 0.4%; C. trachomatis: with CA 6%, without 4.4%; U. urealyticum in high CFU: with CA 15%, without 17.7%; Mycoplasma spp. in high CFU: with CA 6%, without 4%; T. vaginalis: with CA 0%, without 0.4%; G. vaginalis: with CA 4%, without 5%; B streptococci: with CA 4%, without 6%; Candida spp. only in low CFU: with CA 3%, without 2.4%.--The results indicate that as far as the isolation frequencies of sexually transmittable pathogens in the urethra are concerned, there are no significant differences between patients with CA and asymptomatic patients presenting to an STD department. However, N. gonorrhoeae was significantly less frequently isolated and C. trachomatis and U. urealyticum significantly more frequently isolated in our patients than has been reported in previous studies.
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The in-vivo antibacterial activity of Fabry's tinctura (FT), a 3 w% salicylic acid, 1 w% phenoli liquefacti containing 50 v/v% isopropanol used in dermatology for the treatment of erythrasma, pityriasis versicolor, acne vulgaris a.o. on the human resident skin flora was assessed by a new test method in comparison to 60 v/v% isopropanol. The test method consists of a detergent scrub method (DSM) in combination with the cyanoacrylate method (CAM) thus allowing the quantitative determination of bacterial densities in two depth compartments of human skin, separately for bacterial genera. The most important innovation of this test method is that its arrangement, especially the separate evaluation of the genera of the resident flora, makes it possible to examine the ability of an antimicrobial agent to invade different depth compartments by its bioactivity against the resident flora and to measure short-and-long-term efficacies under physiological conditions. Our findings in 120 volunteers indicate that compared to 60% isopropanol FT is able to reduce bacterial density in superficial and deep skin compartments immediately after a single application equally well, but for a significantly longer period. In repeated applications, 60% isopropanol does not produce a cumulative or long-lasting effect, but it causes an abundant rebound growth of Propionibacterium spp. in the lower skin compartment. FT, however, shows a cumulative antibacterial effect at the surface and in the depth persisting up to four days after the last application. It is concluded that by its salicylic acid and phenolic content FT is an effective drug for the topical antimicrobial therapy of skin diseases.
Acute febrile neutrophilic dermatosis (Sweet's syndrome) was diagnosed on the basis of typical clinical and histological features in a 45-year-old woman. Gastrointestinal symptoms had preceded the dermatosis, and an intestinal infection with Yersinia enterocolitica could be proven by culture and serology. This first report on an association between Yersinia infection and Sweet's syndrome widens the spectrum of both infectious diseases possibly inducing acute febrile neutrophilic dermatosis and dermatological manifestations of yersiniosis.
Gardnerella vaginalis, a sexually transmittable organism, is regarded as the indicator of the so-called "non-specific vaginitis". The isolation rate of G. vaginalis from 72 women attending our out-patient department during one year because of urogenital complaints was higher in pretreated than in untreated patients. In genital swabs taken from untreated patients, G. vaginalis could be isolated only in 17%, whereas this was observed in 38% of the specimens from women pretreated with various antimicrobial agents. In 9% of the women without vaginal discharge G. vaginalis was isolated. In specimens obtained from 53% of the women positive for G. vaginalis further organisms such as Chlamydia trachomatis, Trichomonas vaginalis, Candida albicans, Ureaplasma urealyticum, Mycoplasma spp. and B-Streptococci could be isolated. Asymptomatic infections with Neisseria gonorrhoeae (1) and C. trachomatis (4) were also observed. The present study clearly demonstrates that a broad microbiological examination is essential for specific therapy in vaginitis. Even if unspecific vaginitis is diagnosed by the presence of clue-cells, increased vaginal pH and fishy odour, a combined infection by further sexually transmittable organisms, especially N. gonorrhoeae, is to be excluded.
Screening S. aureus-isolates for the production of exfoliative toxin (ET) and discrimination between its two known variants (ETA, ETB) by immunodiffusion (ID), isoelectric focusing (IEF) and animal experiment were assessed methodologically using isolates from a patient with bullous impetigo and a patient with Ritter von Rittershain's disease. Only by animal assay one of the isolates could be identified as ET-producer. ID was used for the discrimination between ETA and ETB. It is concluded that the in-vivo assay for ET-production using live staphylococci can not yet be replaced by ID and IFE and that in patients with staphylococcal scalded skin syndrome swabs should be taken from multiple lesions und all S. aureus isolates obtained should be screened for ET-production to prevent false-negative results. Lysotyping alone gives no proof of ET-production since types II 55/71 and II 3A/3C do not produce ET in all cases and toxinogenic S. aureus strains of phage groups I and III have been described.
A case of hand-foot-and-mouth disease is reported in a 20-year-old female patient. Infection by Coxsackie A 16-virus was diagnosed by serology.
The currently available methods for the serological and immunological diagnosis of human parapoxvirus infection (milker's nodule, farmyard pox) are demonstrated by the case of a man infected by contact with sheep carrying ecthyma contagiosum lesions. Compared to virus identification by electron microscopy, cell culture and animal experiments, identification of viral antigen in skin biopsies is equally sensitive during the first 2 weeks of the disease, whereas it is far more sensitive afterwards. The diagnosis of a parapoxvirus infection may be confirmed, even after skin lesions have healed, by assays for agglutinating, complement fixing, neutralizing and flocculating antibodies in patients' serum, the most sensitive method currently used being immunofluorescence and enzyme assays (ELISA). Additionally, antibodies on cell surfaces, which are regularly found in parapoxvirus infection, may be used to confirm the diagnosis by testing recall antigens. By means of serological assays used for routine purposes as well as by negative staining, the genus parapoxvirus can be identified, but not the species. Cross immunity between orthopoxvirus and parapoxvirus do not occur. The three species of the genus of parapoxvirus may be differentiated by DNA-hybridization techniques or by surface structure analysis using immunoelectron microscopy. According to clinical, histological, serological and electron microscopical features, the diseases caused by the three parapoxvirus species are identical in humans. The clinical entity in humans should be called farmyard pox regardless of the species of virus isolated.
The Gardnerella vaginalis infection of the urogenital tract, an STD, is of clinical importance in females and of epidemiological importance in males. Females suffer from vulvovaginitis amine colpitis, with a bad-smelling grey vaginal discharge with a pH of 5.0-5.5, which contains "clue cells". The urethra of males is often asymptomatically infected. The identification of G. vaginalis is time-consuming and requires a lot of material. Isolation and identification of G. vaginalis can not yet be made in the routine examination of outpatients suffering from urogenital tract infections. If the diagnosis is based on signs such as bad-smelling grey discharge containing "clue cells", and the increase in pH about 20% false-positive and 20% false-negative results will be obtained. If G. vaginalis is isolated, simultaneous infections with further agents such as Chlamydia trachomatis, Neisseria gonorrhoeae etc., Trichomonas vaginalis, Candida species and HSV 2 should be excluded. Metronidazole (1 g/day for 5 days) is the drug of first choice in G. vaginalis infection.
We report on a case of dermoid and asymptomatic dermal sinus both occurring in an 18-year-old man, a monozygotic twin.
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