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[Adaptation of ecthyma contagiosum virus to cell culture].

Series of attempts were made to adapt the Phylaxia vaccinal strain (Hungary) to various cell cultures in vitro. The work with twenty-one successive passages of the virus in a culture of lamb testis resulted in the production of an adapted strain that could produce a characteristic cytopathic effect at the 24th--48th hour of the infection, reaching a titer of 10(4.5) ID/cm3. Cytologic and electron-microscope investigations confirmed the fact that this cell strain belonged to the Parapoxvirus genus. The experimental infection of 4-5-month-old lambs showed that the virus strain retained its capacity to cause typical clinical signs of infectious ectyma. It could be used in the production of a cell-cultural vaccine.

Animals↗

Characterisation of parapoxviruses isolated from Norwegian semi-domesticated reindeer (Rangifer tarandus tarandus).

BACKGROUND: Two outbreaks of the disease contagious ecthyma were reported in 1999 and 2000 in Norwegian semi-domesticated reindeer (Rangifer tarandus tarandus). Contagious ecthyma is an epidermal disease of sheep and goats worldwide, which is caused by the zoonotic parapoxvirus orf virus. Characterisation of clinical samples from the two outbreaks in semi-domesticated reindeer in Norway by electron microscopy and PCR (B2L) revealed typical parapoxvirus particles and partial gene sequences corresponding to parapoxvirus, respectively. If contagious ecthyma in reindeer is caused by orf virus, the virus may be transferred from sheep and goats, via people, equipment and common use of pastures and corrals, to reindeer. Another possibility is that contagious ecthyma in reindeer is caused by a hitherto unclassified member of the parapoxvirus genus that circulates among reindeer herds and remains endemic in Norway. RESULTS: Genomic comparisons of one standard orf strain (orf NZ2) and the reindeer isolates, employing restriction fragment length polymorphism (RFLP) and random amplified polymorphic DNA (RAPD) analysis, demonstrated high similarity between the reindeer viruses and known orf virus strains. Partial DNA sequences of two different viral genes were determined for the different isolates and compared with corresponding parapoxvirus genebank sequences. The comparison/alignment and construction of phylogenetic trees also point to an affiliation of the reindeer viruses to the species orf virus. CONCLUSION: The results of this work imply that the parapoxvirus causing contagious ecthyma in Norwegian semi-domesticated reindeer belongs to the species orf virus and that the orf virus crosses the host species barrier from sheep and goat to semi-domesticated reindeer.

Animals↗

Child neglect followed by marked thymic involution and fatal systemic pseudomonas infection.

The case of a 9-month-old baby girl who failed to develop normally due to nutritional neglect and secondary immunodeficiency characterized by marked thymic involution is reported. The child died of systemic Pseudomonas aeruginosa (P. aeruginosa) infection manifested in pneumonia, lung abscesses, bacterial endocarditis and ecthyma gangrenosum. At autopsy the child was 64 cm in height (normal for a 4- to 5-month-old child) and 5.1 kg in weight (normal for a 2- to 3-month-old child). Multiple gangrenous ecthymas, consisting of deep ulcers, induration and inflammation, were observed in the skin over the entire body. The lungs showed hemorrhagic pneumonia, multiple lung abscesses, and necrotizing arteritis in the abscesses and surrounding areas. The thymus weighed 2.3 g and showed marked involution. Histological examination showed so-called nutritional thymectomy characterized by severe cortical atrophy and clustering, cystic dilation and amorphous changes of the Hassall's corpuscles. In the heart, dark brown verrucae were present at the attachment sites of the tendinous cords of the papillary muscle in the anterior and posterior cusps of the mitral valve, suggesting infectious endocarditis. Bacteriological examination demonstrated P. aeruginosa in the ecthymas, lung abscesses and blood. As primary immunodeficiency was considered unlikely, immunodeficiency secondary to thymic involution following malnutrition seemed to have led to a fatal systemic infection with P. aeruginosa, whose virulence is generally weak. This suggests a close association of the development of such infection and immunodeficiency with child neglect.

Child Abuse↗

Community acquired fulminant Pseudomonas infection of the gastrointestinal tract in previously healthy infants.

Three previously healthy infants presented with diarrhoea and pyrexia and deteriorated rapidly. Two patients had necrotizing bowel disease requiring aggressive surgical intervention. All survived. P. aeruginosa gastrointestinal infection in previously healthy children is an extremely rare condition with a high mortality. Ecthyma gangrenosum was present in over 60% of reported cases although often not recognized initially. A high index of clinical suspicion, including prompt recognition of ecthyma gangrenosum, is mandatory for an early diagnosis of P. aeruginosa gastrointestinal infection. Early diagnosis and treatment may improve the prognosis.

Communicable Diseases↗

Cutaneous manifestations of bacterial sepsis.

In short, bacterial sepsis is associated with a number of peripheral manifestations involving the skin and soft tissues. The pathogenesis of the lesions observed is not fully understood and is almost certainly multifactorial. In ecthyma gangrenosum, the presence of large numbers of gram-negative bacilli in the walls of small blood vessels without a substantial inflammatory response suggests that either the bacteria themselves or bacterial products are responsible for tissue damage. Endotoxin probably plays a prominent role in producing these lesions. That Pseudomonas and Aeromonas species seem to cause ecthyma out of proportion to their prevalence as a cause of bacteremia might suggest that the endotoxin of these organisms has a special predilection for skin and subcutaneous structures. More likely, it indicates that other bacterial substances, such as exotoxins or proteases, are involved. The absence of PMN leukocytes is thought to play a permissive role, allowing unopposed bacterial proliferation. Lesions of symmetric peripheral gangrene characteristically do not have bacteria present. The presence of intravascular fibrin accumulation probably resembles the generalized Shwartzman phenomenon. However, the gangrenous lesions themselves more likely result from systemic hypotension and the resulting hypoperfusion of the tissues than from vessel obstruction. In lesions associated with vigorous inflammatory response, bacterial products may damage tissue either directly or by attracting leukocytes that, in turn, release substances that cause further tissue damage. An etiologic role for endotoxin or the gram-positive bacterial cell wall is likely, since endotoxin is known to produce similar lesions in the localized Shwartzman reaction. Favoring a role for other bacterial substances is the predisposition of V. vulnificus to cause cellulitis or of C. fetus to cause inflammation of the major vessels during sepsis; the mechanisms for these reactions are entirely unknown. It is interesting that in most instances in which peripheral lesions are caused by sepsis, either a large number of bacteria or an intense inflammatory response by PMNs is present, but not both. In both kinds of lesion, the tendency to involve blood vessels by different pathogenetic mechanisms contributes to the evolution of the disease process. In intensely inflamed lesions, veins and arteries can be shown histologically to be occluded. In the absence of inflammation, bacterial invasion of vessel walls or simply the presence of bacterial products adjacent to the vessel may produce spasm. As noted, the pathogenetic significance of thrombosis observed in the lesions of DIC remains unclear.(ABSTRACT TRUNCATED AT 400 WORDS)

Ecthyma↗

Disseminated fusariosis.

A 7-year-old boy with T cell acute lymphoblastic leukemia developed disseminated hyalohyphomycosis due to Fusarium solani. The clinical features included fever, severe myalgia, documented fungemia with F. solani, an ecthyma gangrenosum-like lesion next to a peripheral venous catheter, and disseminated pustules. Severe neutropenia due to chemotherapy was the most relevant risk factor. Histopathologic study of the ecthyma gangrenosum-like lesion, as well as pustular lesions, revealed epidermal necrosis and an inflammatory infiltrate in the upper dermis, with numerous septate hyphae demonstrated by periodic acid-Schiff stain. Clinical resolution was achieved with granulocyte colony-stimulating factor and amphotericin B administration. Our case suggests that the peripheral venous access was probably the portal of entry of the fungus.

Amphotericin B↗

Common bacterial skin infections.

Skin infections account for a significant portion of dermatologic disease, often resulting in or as a consequence of a disruption in the skin's integrity. This article covers the presentation, diagnosis, and treatment of the more common bacterial infections. The infections presented herein include impetigo, ecthyma, folliculitis, carbuncles/furuncles, cellulitis, toxic shock syndrome, and ecthyma gangrenosum. Once a diagnosis is made, treatment is based on the culture and antibiotic sensitivities of the offending organisms.

Anti-Bacterial Agents↗

A study of nineteen immunocompromised patients with extensive skin lesions caused by Pseudomonas aeruginosa with and without bacteremia.

Nineteen immunocompromised patients with extensive skin lesions caused by Pseudomonas aeruginosa with or without P. aeruginosa bacteremia were analysed. Patients whose lesions originated in the skin were in the majority (14 patients). Skin lesions were located at the site of entry of bacteria (apocrine areas in 12 patients). Cutaneous lesions were pleomorphic but the typical picture of ecthyma gangrenosum was common in this group of patients. Only 2 of them developed P. aeruginosa septicemia and the prognosis was relatively good (7.5% mortality rate). These observations confirm that ecthyma gangrenosum may be a primary cutaneous disorder not systematically associated with bacteremia.

Acquired Immunodeficiency Syndrome↗

Molecular genetic analyses of parapoxviruses pathogenic for humans.

The current members of the genus parapoxvirus are orf virus (ORFV), bovine papular stomatitis virus (BPSV), pseudocowpoxvirus (PCPV) and parapoxvirus of red deer in New Zealand (PVNZ). BPSV and PCPV are maintained in cattle while ORFV is maintained in sheep and goats, but all three are zoonoses. Only the recently reported PVNZ has yet to be recorded as infecting humans. Tentative members of the genus are camel contagious ecthyma virus, chamois contagious ecthyma virus and sealpoxvirus. The separation of the parapoxviruses into 4 distinct groups has been based on natural host range, pathology and, more recently, on restriction endonuclease and DNA/DNA hybridisation analyses. The latter studies have shown that the parapoxviruses share extensive homology between central regions of their genomes, but much lower levels of relatedness within the genome termini. The high G + C content of parapoxvirus DNA is in contrast to most other poxviruses and suggests that a significant genetic divergence from other genera of this family has occurred. DNA sequencing of portions of the genome of ORFV, the type species of the genus, has allowed a detailed comparison with the fully sequenced genome of the orthopoxvirus, vaccinia virus (VACV). These studies have provided a genetic map of ORFV and revealed a central core of 88 kbp within which the genomic content was strikingly similar to that of VACV. This conservation is not maintained in the genome termini where insertions, deletions and translocations have occurred. The characterisation of specific ORFV genes may lead to the construction of attenuated vaccine strains in which genes such as those with the potential to interfere with the immune response of the host have been deleted. The current ORFV vaccines are living unattenuated virus and vaccination lesions produce virus which contaminates the environment in a manner similar to natural infection. The virus in scab material is relatively resistant to inactivation and this virus both perpetuates the disease in sheep and provides the most likely source of human infections. A vaccine which immunises animals without perpetuating the disease could be the best way of reducing the incidence of ORFV infection of humans. It is likely that protection against infection by ORFV is cell mediated and will require the endogenous production of relevant antigens. We have recently constructed a series of VACV recombinants each of which contains a large multigene fragment of ORFV DNA. Together the recombinants represent essentially all of the ORFV genome in an overlapping manner. Vaccination of sheep with the recombinant library provided protection against challenge with virulent ORFV. Further studies with this library may enable dominant protective antigens of ORFV to be identified and lead to their incorporation into a subunit vaccine.

Animals↗

Bacterial diseases of the skin.

When considering common bacterial diseases of the skin, rather distinct clinical responses to a variety of bacterial infections have been identified. In these cases, it is the specific site of infection and the attendant inflammatory responses that provide the characteristic clinical picture. When the pyoderma extends just below the stratum corneum, it is called impetigo. Nonbullous impetigo is the most common pediatric skin infection. It usually starts in a traumatized area. The typical lesion begins as an erythematous papule, after which it becomes a unilocular vesicle. When the subcorneal vesicle becomes pustular, it ruptures and eventually becomes a yellow, golden crust that is a hallmark of the disease process. Bullous impetigo is a less common form of impetigo, accounting for fewer than 30% of all impetigo cases. It occurs in infants and is characterized by rapid progression of vesicles to the formation of bullae measuring larger than 5 mm in diameter in previously untraumatized skin. Treatment of nonbullous impetigo must include intervention against the pathogen as well as improvements in the hygiene and living conditions of the patient. A fundamental tenet is to debride the crust (scab) from the wound surface using poloxamer 188. If the lesions are not widespread, topical mupirocin is the treatment of choice. Treatment of bullous impetigo is similar, except that the local cleansing and topical antibiotic must be complemented by systemic antibiotics if there is evidence of disseminating infections. Ecthyma is usually a consequence of failure to treat effectively impetigo. The untreated infection extends deep into the tissue in shallow ulcerations that often heal without scar. Treatment for ecthyma usually requires systemic antibiotics against either staphylococcus or streptococcus. Folliculitis is a pyoderma located within a hair follicle, secondary to follicular occlusion by keratin, overhydration, or either bacterial or fungal infection. Folliculitis may be divided into either a deep or a superficial type. In the superficial type, the pustule is located at the opening of the hair follicle. In the deep form, the infection may extend beyond the confines of the hair follicle, becoming a furuncle or boil. Carbuncles are aggregates of interconnected furuncles that drain through multiple openings of the skin. Treatment of folliculitis must include searching for and avoiding any factors predisposing to infection. If topical antibiotic therapy is ineffective in controlling the infection, surgical drainage of the infected skin abscess will be necessary. Paronychia is the most common bacterial infection of the hand, which often requires surgical incisional drainage. Similarly, a felon that is an infection of the distal pulp of a finger usually requires surgical drainage. Finally, cellulitis is an acute inflammatory reaction involving the skin and underlying subcutaneous tissue. It usually starts as erysipelas and may advance to lymphangitis, lymphadenitis, or gangrene,which will respond to life-saving interventions in the hospital that usually include systemic antibiotic treatment as well as surgical intervention.

Anti-Bacterial Agents↗

Skin and soft tissue infection.

Abstract. Normal skin is heavily colonized by bacterial flora. The most common are the various nonpathogenic gram-positive bacteria such as Staphylococcus epidermidis (coagulase-negative). Skin and soft tissue infections are usually caused by Staphylococcus aureus (S. aureus) and Streptococcus pyogenes. This article discusses common and some not so common bacterial skin infections, including impetigo, folliculitis, furncles and carbuncles, cellulitis and erysipelas, gangrenous cellulitis, staphylococcal scalded skin syndrome and scarlet fever. Impetigo and ecthyma are common bacterial infections of the skin commonly caused by S. aureus and / or Group A streptoccus. In mild and localized impetigo topical antibiotics whereas in widespread or severe one and in ecthyma systemic antibiotics like, cloxacillin, erythromycin, azithromycin or cephalexin should be used. Folliculitis, furunculosis and carbuncle are folliculocentric infections caused by S. aureus involving the variable depth and extent of the follicle(s) and surrounding tissue. These conditions can be treated with topical or systemic antibiotics like cloxacillin, cephalexin, erythromycin, amoxicillin/clavulanic acid or vancomycin. Staphylococcal scalded skin syndrome is a toxin mediated exfoliative dermatosis caused by S. aureus of phase group II. Intravenous penicillinase-resistant anti-staphylococcal antibiotics like methicillin, cloxacillin, cephalosporin or erythromycin are required. Erysipelas and cellulitis are acute infections of dermal and subcutaneous tissues caused most frequently by Group A beta-hemolytic streptococci (erysipelas) or S. aureus requiring systemic antibiotics like oral or intravenous penicillin, erythromycin, cephalexin, cloxacillin, vacomycin, minocycline or ciprofloxacin depending upon the severity, suspected causative organism and culture/sensitivity results. Gangrenous cellulitis is characterized by infection with necrosis of skin and underlying subcutaneous tissue due to various pathogens occurring at different site. Ampicillin, gentamicin, and either metronidazole or clindamycin intravenously in standard doses are recommended for the treatment.

Cellulitis↗