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PubMed1993

Infection with methicillin-resistant Staphylococcus aureus among hospital employees.

OBJECTIVE: To describe the spectrum of clinical infection caused by methicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers. DESIGN: Case series. SETTING: Two Veterans Affairs hospitals in which methicillin-resistant S aureus (MRSA) is endemic. PATIENTS: Five employees presenting to employee health or infectious disease clinic. RESULTS: All employees had had direct exposure to patients colonized with MRSA. Employee infections included cellulitis, impetigo, folliculitis, paronychia, and conjunctivitis. MRSA was isolated from all clinically infected sites and from the anterior nares of two employees. Three employees received a variety of ineffective oral antimicrobials before MRSA was recognized as the causative agent. All infections responded to appropriate therapy. CONCLUSIONS: Employees of hospitals with endemic MRSA may acquire MRSA infection. Presentation in our employees was that of relatively uncomplicated soft tissue infection, but several employees received inappropriate therapy before bacteriologic diagnosis. We recommend that culture and susceptibility testing be obtained prior to institution of therapy when hospital employees present with soft tissue infection.

Adult↗
PubMed1975

The role of cutaneous diphtheria infections in a diphtheria epidemic.

Twenty-four people with diptheria and 48 carriers were found in an isolated, circumscribed, rural area during a one-month period. Four patients had cutaneous lesions, which were similar to those of typical impetigo, form which Corynebacterium diptheriae was isolated. These cases constituted an epidemiologic focus from which the other cases were infected. Ten of 52 classroom contacts of two patients with skin infections harbored C. diphtheriae in the pharynx, while only eight of 132 classroom contacts of eight respiratory cases were similarly infected. Respiratory carriage of C. diphtheriae in five of 12 Head start classroom contacts of another patient with cutaneous infection with C. diptheriae in the classroom situation. A tendency toward greater environmental contamination by cutaneous diphtheria than by respiratory diptheria might be related to the greater contagiousness cases.

Adolescent↗
PubMed2003

Herbal medicines for treatment of bacterial infections: a review of controlled clinical trials.

OBJECTIVES: Many hundreds of plant extracts have been tested for in vitro antibacterial activity. This review is a critical evaluation of controlled clinical trials of herbal medicines with antibacterial activity. METHODS: Four electronic databases were searched for controlled clinical trials of antibacterial herbal medicines. Data were extracted and validated in a standardized fashion, according to predefined criteria, by two independent reviewers. RESULTS: Seven clinical trials met our inclusion criteria. Four of these studies were randomized. Three trials of garlic and cinnamon treatments for Helicobacter pylori infections reported no significant effect. Bacterial infections of skin were treated in four trials. Positive results were reported for an ointment containing tea leaf extract in impetigo contagiosa infections. Two trials of tea tree oil preparations used for acne and methicillin-resistant Staphylococcus aureus, and one trial of Ocimum gratissimum oil for acne, reported results equivalent to conventional treatments. CONCLUSIONS: Few controlled clinical trials have been published and most are methodologically weak. The clinical efficacy of none of the herbal medicines has so far been demonstrated beyond doubt. This area seems to merit further study through rigorous clinical trials.

Acne Vulgaris↗
PubMed2003

Zinc supplementation and growth of the fetus and low birth weight infant.

Zinc deficiency limits growth in young children, and in animal models it also affects fetal growth. In animals, the effect of severe zinc deficiency on growth is evident. However, controlled trials of zinc supplementation during pregnancy in humans have not demonstrated consistent effects on weight at birth and/or duration of gestation. Those studies that have identified a positive effect of zinc on fetal growth were performed on low-socioeconomic or migrant groups in industrialized countries or in countries where diet and living conditions are improving. In contrast, in studies conducted either on populations with minimal risk of zinc deficiency or those suffering from multiple and severe nutritional deficiencies, no effects have been found. The potential confounding factors that may help explain the contradictory results include the following: age of pregnant women; presence of digestive diseases, other nutritional deficiencies, phytates or other factors that affect bioavailability; timing and duration of zinc supplementation and compliance with supplements. Few studies of zinc supplementation were conducted on infants that were born small for their gestational age or preterm; in this case, a positive effect on growth was shown. A study of zinc supplementation during pregnancy found reduced risk of diseases (diarrhea or impetigo) in small-for-gestational-age but not preterm infants. A second study demonstrated reduced mortality in small-for-gestational-age infants. We conclude that supplementation trials during human pregnancy do not provide conclusive evidence for a beneficial effect of zinc supplementation despite the experimental evidence that zinc deficiency may retard fetal growth or shorten pregnancy. However, early zinc supplementation in low birth weight or small-for-gestational-age infants reveals an effective improvement in growth, which suggests a prenatal depletion or insufficient zinc intake to support catch-up growth postnatally.

Animals↗
PubMed1980

Hodgkin's disease with specific bullous lesions.

A variety of bullous eruptions have been reported in patients with Hodgkin's disease, among them erythema multiforme, herpesvirus infections, bullous impetigo, prurigo-like papules with vesicles, drug eruptions, bullous pemphigoid, dermatitis herpetiformis, and acquired epidermolysis bullosa. We now describe a patient whose bullous eruption was thought initially to be bullous pemphigoid. However, histopathologic examination of a bulla showed a lymphomatous infiltrate beneath an intraepidermal and subepidermal blister. These pathological findings seem to be unique and we interpret them to be those of bullous Hodgkin's disease.

Diagnosis, Differential↗
PubMed1988

Bacteremia and ecthyma caused by Streptococcus pyogenes in a patient with acquired immunodeficiency syndrome.

Ecthyma is an ulcerated form of impetigo due to Streptococcus pyogenes, seen primarily in children with poor hygiene. The authors report a homosexual man with acquired immunodeficiency syndrome (AIDS) who developed severe ecthyma and bacteremia caused by S. pyogenes. Opsonizing antibody to the M protein of S. pyogenes is important in immunity to this organism. Patients with AIDS may have defective humoral immunity as well as defective cellular immunity, and such a defect may have rendered this patient abnormally susceptible to severe infection with S. pyogenes.

Acquired Immunodeficiency Syndrome↗
PubMed1980

The relationship of pediatric resident recording behavior across medical conditions.

During the July 1975-June 1976 academic year, nonphysician abstractors collected data on 15,101 ambulatory patient visits managed by 175 residents in five pediatric training programs. The visits included in this study were those on which a general data base should be collected and visits for health maintenance, head trauma, impetigo, otitis media, tonsillopharyngitis and urinary tract infection. These data provided an opportunity to investigate the number of medical record audits required to obtain a stable estimate of resident performance for a given medical condition and the relationship of performance across a number of medical conditions. The standard errors of the mean for 844 distributions of per cent compliance scores for individual residents were calculated. The standard error was less than five in 97 per cent of the instances where ten or more records had been abstracted for a given resident. Although there was some variability of resident performance from case to case, these data indicate that ten records may be a lower bound on the number of abstracts required to provide a stable estimate of performance. The correlations across conditions showed a moderate amount of homogeneity of performance and a clustering of performance for the acute care conditions included in the study. The correlations across acute care conditions were all statistically significant and ranged in magnitude from .52 to .77. Although the relationships between general data base and health maintenance and the acute conditions were statistically significant in some instances, they were all of lower magnitude and ranged from -.20 to .36. Thus, a modest number of abstracts for only a few conditions may provide a reliable estimate of resident day-to-day performance in ambulatory care clinics.

Ambulatory Care↗
PubMedDate not supplied

Skin and soft tissue infections: pharmacologic approaches.

Skin and soft tissue infections are common infectious problems in pediatric practice. Recent clinical and pharmacologic evaluations of several new antimicrobial agents have shed new light on the pathogenesis and management of these infections. Staphylococcus aureus now appears to be the most common bacterial isolate in children with impetigo. In patients hospitalized because of skin and soft tissue infections, S. aureus and Haemophilus influenzae type b remain the predominant pathogens. Rational therapeutic approaches to these infections require a recognition of the interplay among the pharmacodynamic, pharmaceutic and pharmacokinetic determinants of effective antimicrobial therapy. Using this approach the therapeutic questions regarding "what drug," "what dose" and "how long to treat" can be approached. Drugs such as the aminopenicillin-beta-lactamase inhibitor combinations may offer rational outpatient therapeutic alternatives, while parenteral cefuroxime and ceftriaxone are more probably the drugs of choice for parenteral therapy. In an age when cost effectiveness must prevail, strategies using ceftriaxone for both inpatient and outpatient management may provide the safest and most cost-effective therapy.

Anti-Bacterial Agents↗
PubMed1977

Acute glomerulonephritis in children: a review of 153 cases.

Clinical experience with 153 cases of acute glomerulonephritis is recorded. Streptococcal impetigo was the major causative factor in this series. The acute fatality rate was 1.3% (two patients). Of the 151 survivors, 103 patients have been followed up for periods of six months to 11 years. None of these patients have shown any evidence of progression to chronic glomerulonephritis. In this series, as in others previously reported, acute glomerulonephritis in children appears to be self-limited in contrast to the illness in adults, where 25% to 40% of the cases progress to chronic glomerulonephritis. Unusual findings in this survey were ten patients with minimal or no urine abnormalities. Ten patients had normal serum complement values and three patients had well documented second attacks of poststreptococcal glomerulonephritis.

Acute Disease↗
PubMed1983

Chronic bullous dermatosis of childhood.

Chronic blistering dermatosis of childhood (CBDC) in a 1-year-old black girl responded to the administration of sulfapyridine. CBDC is a rare blistering skin disease characterized by the presence of tense bullae and the linear deposition of IgA at the dermal-epidermal junction of lesional and perilesional skin. The disease may resemble bullous impetigo, bullous erythema multiforme, dermatitis herpetiformis, or pemphigus. The treatment involves the use of either dapsone or sulfapyridine.

Chronic Disease↗
PubMed1980

Qualitative and quantitative methods of studying the effect of lipids on bacteria grown on the surface of solid culture media.

New qualitative and quantitative methods are described for the investigation of the antibacterial activity of lipids on solid media by the application of lipid-impregnated filter paper over a lawn of the organisms. The methods have been used to investigate the antibacterial activity of unsaturated fatty acids that are important in skin defence. Oleic and linoleic acids inhibited Streptococcus pyogenes markedly, Staphylococcus aureus and Staph epidermidis to a lesser extent and had no effect on Escherichia coli and Pseudomonas aeruginosa. The inhibition of growth of a strain of Str. pyogenes from a sore throat was greater than that of a strain from an outbreak of impetigo. Linoleic acid was a more potent inhibitor of bacterial growth than oleic acid, and with both acids inhibition was more pronounced under aerobic than under anaerobic conditions of incubation. The methods described could be applied in other fields such as pharmacology, horticulture and industry.

Bacteria↗
PubMed1976

Qualitative and quantitative methods for detecting staphylococcal epidermolytic toxin.

Concentrated supernates of cultures of 98 strains of Staphylococcus aureus were screened for the production of epidermolytic toxin by (1) biological tests in 3-day-old mice, (2) double-diffusion precipitation tests against specific antiserum, and (3) the appearance of characteristic protein bands on thin-layer-gel isoelectric focusing. Positive results were obtained in all three of these tests with supernates from 11 of these cultures; the same 11 strains, and no others, produced epidermal splitting when newborn mice were challenged with viable organisms. Of the 14 phage-group II strains included in the survey, eight (58%) produced epidermolytic toxin. Three toxinogenic strains belonged to phage groups other than group II. A radial-immunodiffusion test employing antiserum to purified epidermolytic toxin proved satisfactory for measuring amounts of epidermolytic toxin in excess of 200 mug per ml. The results of immunodiffusion tests indicated that six of the 11 positive strains produced two serologically distinct forms of epidermolytic toxin and that the remainder produced only one of these. A striking correlation was observed between the presence of toxin of serotypes i and ii and the occurrence of protein bands i and ii in thin-layer isoelectric-focusing gels. These tests should facilitate the qualitative and quantitative assessment of the production of different serotypes of epidermolytic toxin by S. aureus in future surveys of strains isolated from toxic epidermal necrolysis of Ritter's type and impetigo. The two forms of epidermolytic toxin previously designated ETA (pI=7-0) and ETB (pI=6-0) were detected by preparative isoelectric focusing of sero-type-i toxin. Evidence suggests that studies of the effect of heat should provide a means of investigating the relationship between the different molecular forms of epidermolytic toxin.

Animals↗
PubMed1999

Characteristics of Streptococcus species isolated from infectious skin diseases.

During the period from January of 1995 to June of 1998, 27 beta-hemolytic streptococci were isolated from 25 cases of infectious skin diseases including secondary infections, impetigo, phlegmone, and paronychia. The rate of beta-hemolytic streptococci among all kinds of the isolates was found to be similar during those 4 years, ranging from 3.5% to 5.6%. Staphylococcus aureus were found to coexist with beta-hemolytic streptococci in 20 (80%) out of 25 cases. beta-hemolytic streptococci were also often associated with coagulase-negative staphylococci, gram-positive rods, or other species. Twelve cases (48%) carried beta-hemolytic streptococci predominantly. Most beta-hemolytic streptococci showed high susceptibilities to all antimicrobials tested; however S. agalactiae showed no susceptibility to gentamicin. The evaluation of characteristics of Streptococcus species is very important for selecting the right antimicrobial agents and the proper term of chemotherapy.

Adolescent↗
PubMed1999

Clinico-bacteriological study of pyodermas in children.

One hundred cases of pyodermas in children were investigated clinically and bacteriologically. Nasal and throat swabs from all cases were subjected to bacteriological examination. Most of the children (42%) were in the 1-4 year age group. The majority (58%) belonged to lower socio-economic groups with poor standards of hygiene. A history of over-crowding was obtained from 87% of cases, 82% were undernourished. Most of the children (68%) reported during the hot and humid months of June, July, August, and September. Primary pyodermas were observed in 72% of the children, and secondary pyodermas in 28%. Impetigo was the commonest primary pyoderma (48.61%); among secondary pyodermas, infected scabies was noted predominantly (42.86%). The face and legs were more commonly involved. Bacteriological cultures from pyoderma lesions revealed a single microorganism in the majority of the patients (84%). Staphylococcus aureus was isolated in pure culture from 48% and pure beta-hemolytic streptococci from 36%. A combination of both was obtained from 16%. No other organism was isolated from any case. A similar pattern was also observed in cultures from the nose and throat. Only 46 out of the 64 strains (84.3%) of Staphylococcus aureus isolated from pyoderma were typable. The majority (39.1%) showed a mixed pattern of phages; the second commonest was the non-allocated phage type (30.4%). Nasal flora had more of the non-allocated phage type (50%); two out of the three strains (66.6%) isolated from the throat showed a mixed pattern. All the strains of beta hemolytic streptococci, isolated either from lesions of pyoderma, nose, or throat belonged to group A. Staphylococcus aureus and showed a high sensitivity to netilmycin (100%), ofloxacin (98.4%), amoxycillin/clavulanic acid (96.9%), ciprofloxacin (89.1%) and gentamycin (84.4%) but a high resistance to penicillin (85.9%). A greater correlation was noted between nasal flora and organisms causing pyodermas. A change in the pattern of organisms causing pyodermas in children and their antibiotic sensitivities in this part of the globe has been observed in this study. The role of endogenous nasal and throat flora in the causation of pyodermas has also been highlighted.

Anti-Bacterial Agents↗
PubMed1988

Relationship between susceptibility and immune response to staphylococcal exfoliative toxin A in mammalian species.

Staphylococcal exfoliative toxin A (ETA) had a splitting effect at the granular layer of skin in humans and neonatal mice, but not in rabbits, guinea pigs, golden hamsters, or rats. Besides its splitting effect, ETA could stimulate productions of neutralizing antibody to ETA in rabbits, rats and B10D2 mice, but not in golden hamsters, guinea pigs, or ICR, HRS/J, and C57BL/10 mice. In our epidemiological investigation of human sera, the percentage of antibody to ETA in sera obtained from patients with impetigo (8%) was lower than those in sera of healthy males (23%) and females (29%). The relationship between susceptibility and immune response to ETA in these mammalians could be divided into three groups: the possession of resistant skin and high production of antibody to ETA; the possession of resistant skin and low production of antibody to ETA; the possession of sensitive skin and various titers of antibody to ETA.

Animals↗
PubMed1998

New evidence that the Tyr-157 and Tyr-159 residues of staphylococcal exfoliative toxin B are essential for its toxicity.

To determine the active site of exfoliative toxin B (sETB) of Staphylococcus aureus, the etb gene was cloned from an S. aureus SU strain obtained from a patient with impetigo. We prepared a frame shift mutant protein from a recombinant plasmid with a BglII linker inserted into the Tyr-155 codon of the ETB gene (pETB/BglIIL). The recombinant mutant protein (ETB/BglIIL) obtained from Escherichia coli containing pETB/BgIIIL showed no toxicity in neonatal mice and no agglutination activity. The 20-kDa ETB/BglIIL contained 185 amino acid residues. Site-directed mutagenesis was used to introduce mutations at either Tyr-155, Tyr-157, Tyr-159, or Tyr-162. Substitution of any of the Tyr residues decreased exfoliative activity compared with that of native sETB (4,000 EU/ml). Substitution of Tyr-155 with a Phe (ETBYN155) decreased activity 5-fold (800 EU/ml). Substitution of Tyr-157 with Leu (ETB/Y157) decreased activity 80-fold (50 EU/ml) and decreased agglutination titer 5-fold compared with that of native sETB (400,000). Substitution of Tyr-159 with Leu (ETB/Y159)decreased activity 4-fold (1,000 EU/ml). When both Tyr-157 and Tyr-159 were mutated (ETB/Y157-159), both toxicity and antigenicity were completely lost. On an immunodiffusion test, ETBNY157 showed a faint precipitation line, but ETB/BglIIL and ETB/Y157-159 had no activity, showing that the Tyr-157 and Tyr-159 residues are essential for the toxicity and antigenicity of ETB.

Amino Acid Sequence↗
PubMed2007

Community-acquired methicillin-resistant Staphylococcus aureus skin infections: a review of epidemiology, clinical features, management, and prevention.

Community-acquired methicillin-resistant Staphylococcus aureus (CAMRSA) infection is a global problem of epidemic proportions. Many of the patients who develop CAMRSA skin lesions do not have infection-associated risk factors. Abscess, abscess with accompanying cellulitis, and cellulitis are the most common presentations of cutaneous CAMRSA infection; occasionally, these CARMSA-related lesions are misinterpreted as spider or insect bites. Other manifestations of cutaneous CAMRSA infection include impetigo, folliculitis, and acute paronychia. The management of CAMRSA skin infection includes incision and drainage, systemic antimicrobial therapy, and adjuvant topical antibacterial treatment. In addition, at the initial visit, bacterial culture of the lesion should be considered. Direct skin-to-skin contact, damage to the skin surface, sharing of personal items, and a humid environment are potential mechanisms for the acquisition and transmission of cutaneous CAMRSA infection. Measures that strive to eliminate these causes are useful for preventing the spread of CAMRSA skin infection.

Anti-Bacterial Agents↗
PubMed2006

Tinea incognito in Italy: a 15-year survey.

Tinea incognito or steroid modified tinea is a dermatophytic infection in which topical or systemic steroids, administered as a result of dermatological misdiagnosis or preexisting pathologies, have modified the clinical appearance of the fungal infection, transforming the typical ringworm and mimicking other skin diseases. This is a retrospective study of the agents, clinical aspects, sources of infection of 200 cases (98 males, 102 females, mean age 42 years) of tinea incognito, observed in Siena and Milan, Italy, in the period 1987-2002. In order of decreasing frequency, Trichophyton rubrum, Trichophyton mentagrophytes, Epidermophyton floccosum, Microsporum canis, Microsporum gypseum, Trichophyton violaceum and Trichophyton erinacei were isolated. The clinical appearance of the infection was lupus erythematosus discoid-like, eczema-like, rosacea-like, especially on the face, impetigo-like and eczema-like on trunk and limbs. Less often the dermatophytosis resembled psoriasis, purpura, seborrhoic dermatitis and lichen planus. There was folliculitis in 9% of cases and dermatophytid in 3% of cases. Antimycotic therapy brought about clinical and mycological recovery in all patients except one, who had iatrogenic immunodepression.

Administration, Topical↗