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PubMed2004

Group A streptococcal puerperal sepsis with retroperitoneal involvement developing in a late postpartum woman: case report.

Group A beta-hemolytic streptococci cause a wide range of infectious diseases such as pharyngitis, impetigo, rheumatic fever, and even septic shock. Group A streptococcal puerperal sepsis is uncommon today, but recent reports indicate a reemergence of virulent strains can cause toxic-mediated shock and multiple organ failure. We present a case report of a 29-year-old postpartum woman after cesarean section who presented group A streptococcal puerperal sepsis. Furthermore, we discuss the GAS strain in this patient and its relation with close contact among family members. The group A streptococci (GAS) were isolated from the patient's retroperitoneal fluid and from her husband's throat swab, respectively. Both isolates were shown to be identical: M type 1. It is well known that exotoxin A produced by M1 or M3 serotypes of the organisms plays a crucial role in streptococcal toxic shock syndrome (STSS). We conclude that in this patient, close contacts of persons with GAS appear to be at risk for colonization with identical strains of STSS-causing GAS such as M1 or M3 serotypes. Therefore, the appropriate antibiotic including antibiotic prophylaxis for close contact should be considered.

Adult↗
PubMed1992

Staphylococcal toxin-mediated syndromes in childhood.

Staphylococcal toxic shock syndrome (TSS) and staphylococcal scalded skin syndrome (SSSS) are two distinct toxin-mediated syndromes with prominent cutaneous features. The exanthematous presentation of these syndromes places them in the broad category of childhood exanthems, and the ability to recognize these potentially devastating illnesses is essential for pediatricians and dermatologists who may encounter children with fever and rash. Recent advances in the understanding of the pathogenesis of these entities has helped to explain the distinctive clinical presentations of TSS and SSSS. Toxic shock syndrome toxin-1 (TSST-1) and enterotoxins are the secretory products of Staphylococcus aureus that lead to TSS. Many of the clinical features of TSS (fever, shock, multiple organ dysfunction) can be explained by the effects of cytokines (especially interleukin-1 and tumor necrosis factor) induced by TSST-1. TSS is not an exclusively menstrual event associated with tampon use. Nonmenstrual pediatric TSS may be associated with a wide variety of staphylococcal infections. Infected burn wounds in hospitalized children and bacterial tracheitis (in some cases following influenza B infection) are relatively high-risk settings for pediatric TSS. The epidermolytic toxins (A and B) directly produce subgranular epidermolysis leading to SSSS. SSSS encompasses a clinical spectrum from bullous impetigo to the widespread exfoliation of the Ritter disease variant of SSSS. This entity usually occurs in children under 5 years of age, and is primarily explained by lack of immunity to the toxins as well as renal immaturity leading to poor clearance of toxin. The newborn nursery is an important setting where epidemics of SSSS have occurred.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1978

Common skin problems in the pediatric office.

Skin diseases represent a major problem in everyday practice. This article discusses the most common dermatological entities as seen in the pediatrician's office with practical guidelines for their therapy. Acne, eczema, diaper rash, verruca vulgaris, impetigo and skin infestations are among those topics discussed.

Acne Vulgaris↗
PubMed2005

Prospects for a group A streptococcal vaccine.

Group A streptococcal (GAS) infections are associated with a number of human diseases, including pharyngitis, impetigo, necrotizing fasciitis, streptococcal toxic shock syndrome and rheumatic heart disease. An increase in the incidence of severe GAS infections in Western countries, and the awareness of the burden of GAS-associated diseases in developing nations, which remains high in spite of the availability of antibiotics, has provided the impetus for development of a safe and efficacious GAS vaccine. This has focused on the M protein, a major GAS virulence factor, however, with the publication of several GAS genomes, a number of non-M vaccine candidates are now under investigation.

Animals↗
PubMed2005

[Dermatoses specific for pregnancy period].

The study presents dermatoses specific to the pregnancy period, like intrahepatic cholestasis of pregnancy, pruritic urticarial papules and plaques of pregnancy (PUPPP), impetigo herpetiformis, gestational pemphigoid, papulous and papulo-pustulous dermatitis.

Adult↗
PubMed2005

[Dermatologic problems arising during foreign travel].

The skin is a highly exposed organ during vacation times, especially during travel to countries with subtropical and tropical climates. Prolonged stay in these countries significantly increases the risk of contracting rarely seen dermatoses such as leishmaniasis, larva migrans and myiasis. The bites of various flies may provoke itching and excoriations that may be infected with Staphylococcus aureus and/or hemolytic streptococci, resulting in impetigo, furunculosis or erysipelas. Elderly persons spending weeks in the tropical sun may develop drug-induced phototoxic or photoallergic rash due to concomitant medication for cardiovascular or rheumatic diseases. Acute sunburn is considered a short-lasting problem, but in children it increases the risk of malignant melanoma in later years. Also of concern is chronic UV exposure, which increases the risk of premalignant and malignant skin tumors. Finally, mucocutaneous manifestations arising weeks and months after returning from vacation should raise suspicions of sexually transmitted syphilis and HIV.

Adult↗
PubMedDate not supplied

Update on treating uncomplicated skin and skin structure infections.

Dermatologists treat a variety of uncomplicated skin and skin structure infections (uSSSIs) such as folliculitis, impetigo, erysipelas, cellulitis, furuncles, carbuncles, and non-perirectal abscesses. Most uSSSIs are caused by Staphylococcus aureus and Streptococcus pyogenes. The new extended-spectrum cephalosporins (cefdinir, cefpodoxime) offer efficacy against most Gram-positive and Gram-negative pathogens. Despite recently published guidelines, many physicians do not prescribe cephalosporins for uSSSIs out of concern that these agents will produce a hypersensitivity reaction in patients allergic to penicillin. Although the rate of cephalosporin reaction in penicillin-allergic patients is often quoted as up to 10%, this rate does not take into account the 1% to 3% risk for allergy to cephalosporin alone and the nonspecific increased risk of penicillin-allergic patients to develop hypersensitivity to other drugs. When these additional risks are considered, the likelihood of a reaction in known penicillin-allergic patients, especially to most third-generation and extended spectrum cephalosporins, becomes less than 1%. Cephalosporins with side chains unlike those of penicillin or ampicillin side chains are less likely to result in an allergic reaction in penicillin or ampicillin-allergic patients than cephalosporins with similar side chains. Although both cefdinir and cefpodoxime are considered to carry a very low risk of cross reactivity with penicillin or ampicillin, the former demonstrates better activity against S. aureus. Among the late-generation cephalosporins, cefdinir is the most potent oral agent when tested against oxacillin-susceptible staphylococci, 4- to 16-fold more active than cefprozil and cephalexin, respectively.

Anti-Bacterial Agents↗
PubMed2005

Outbreak of cutaneous Bacillus cereus infections among cadets in a university military program--Georgia, August 2004.

Although Bacillus cereus is known mainly as an agent of food poisoning, other infections caused by this organism have been documented in immunocompromised patients, including sepsis, meningitis, pneumonia, and wound infections. Certain populations are at increased risk for B. cereus infection, including cancer patients, neonates, intravenous drug users, and patients with a history of trauma, surgery, or catheterization. Primary cutaneous disease attributed to B. cereus in immunocompetent persons or in non-health-care settings rarely has been reported. This report is the first to document such an outbreak. On August 24, 2004, a local health department in Georgia received a call from a university health center describing 90 cadets with nonpruritic, impetigo-like lesions on their scalps; B. cereus was the common organism among the three patients whose lesions were cultured. The cases occurred during the freshman military orientation week that preceded the start of the fall term. The Georgia Division of Public Health (GDPH) conducted an investigation to determine the source of the infections, identify associated risk factors, and implement control measures. This report summarizes the results of the outbreak investigation, which identified receiving a short haircut at the start of orientation week, sharing sunscreen during the week, and membership in Company B as strongly associated with having scalp lesions. Recommendations to the university included changing the type of haircut required, increasing time allowed for showering, and issuing individual sunscreen. The results of this investigation underscore the need for military programs to incorporate good hygiene and infection-control measures into school orientation events.

Adult↗
PubMed2006

Community-acquired methicillin-resistant Staphylococcus aureus in Switzerland: first surveillance report.

Methicillin-resistant Staphylococcus aureus (MRSA) is an emerging community pathogen. Community-acquired MRSA (CA-MRSA) has been associated with virulent strains producing Panton-Valentine leukocidin (PVL) and a variety of other exotoxins. In Geneva, PVL-producing CA-MRSA was first reported in 2002 and a surveillance system based on voluntary reporting was set up. Each MRSA-positive culture result with an antibiotic resistance profile different from the endemic strain prevailing in the Geneva healthcare setting diagnosed in a patient without a history of hospital admission in the previous 12 months was notified to the local health department. A questionnaire was completed by the attending physician with demographic, clinical and exposure information. From January 2002 until December 2004, data on 58 cases were reported, including 26 cases grouped in 13 distinct transmission clusters. Most were family related and for two of them, colonisation persisted over a 12 month period despite treatment. Thirty three patients (57%) were male. Median age was 32 years, 22% being younger than 10 years. Forty one cases (71%) were infected and 17 (29%) colonised. Symptomatic skin lesions such as furunculosis, impetigo or abscess were present in 40 (97%) of the 41 infected cases. Most cases had no underlying disease. Thirty eight cases (65%) had travelled abroad. Forty (69%) of 58 isolates carried the PVL toxin. CA-MRSA infections in Geneva appear to be an emerging problem in the canton. Surveillance should continue and should possibly be extended to other parts of the country to better describe transmission patterns and the spread of this pathogen. Prevention and control of CA-MRSA infections represent a challenge for the future, requiring contact tracing, education and treatment of infected and colonised contacts.

Adolescent↗
PubMed2006

Scabies presenting with bullous pemphigoid-like lesions.

A wide range of clinical manifestations may be seen in scabies, from classic pruritic papules and burrows to secondary features such as impetigo. Bullus lesions are a less frequent. Twenty cases of scabies presenting with bullae have been reported so far in the medical literature. Differentiating this subtype of scabies from the immunobullous disease bullus pemphigoid is a diagnostic challenge. A 42-year-old man was referred to our dermatology outpatient clinic with 3-month history of severe pruritus and tense blisters affecting mainly the lower trunk, arms and legs. An initial biopsy was suggestive for bullous pemphigoid. Close physical examination revealed small excoriated papules and a few burrows on borders of the hands and wrists. Skin scraping of the lesions on wrists was positive for Sarcoptes scabiei. Another biopsy specimen from a recent blister revealed subepidermal bullae with fibrin and inflammatory cells, particularly eosinophils. Direct immunofluorescence exam was negative. The patient was treated with lindane lotion followed by crotamiton cream with near complete resolution of the lesions. Scabies must be considered in patients presenting with recent onset of unexplained pruritic bullous lesions. Biopsy and immunofluorescence studies together with skin scrapings for Sarcoptes scabiei could help to differentiate these cases from bullous pemphigoid. Antiscabietic treatment results in resolution of bullous lesions in the affected patients.

Administration, Topical↗
PubMed2006

Atopic dermatitis in children, part 1: epidemiology, clinical features, and complications.

Atopic dermatitis (AD), also known as eczema, is a chronic skin condition, characterized by itch (pruritus) and dryness (xerosis). AD lesions appear as pruritic red plaques that ooze when scratched. Children with AD are excessively sensitive to irritants such as scented products and dust due to their impaired skin barrier and skin immune responses. AD is among the most common disorders of childhood and its incidence is increasing. AD is an all-encompassing disease that causes sleep disturbances in the affected child, disrupting the entire household. Patients with AD also are prone to bacterial overgrowth, impetigo, and extensive viral infections. Consequently, familiarity with the most recent literature is of utmost importance so that dermatologists and pediatricians can appropriately manage their patients.

Child↗
PubMedDate not supplied

Epidemiology of common transmissible skin diseases among primary school children in north-west Ethiopia.

A total of 1842 school children were examined for the occurrence of common transmissible skin infections in a rural area in North-West Ethiopia. The result showed a prevalence rate of 49.2%. Tinea capitis, impetigo, infected wounds and verrucae vulgaris were common. In addition the overall prevalence rate of lice infestation was 55.4%. The findings indicated the need to develop appropriate intervention programmes both at school and community levels.

Child↗
PubMed1991

[Clinical studies on 10% cefdinir granules in pediatric infections].

Ten% cefdinir (CFDN, FK482) granular preparation, a new oral cephalosporin preparation intended for children, was given to children with various infections. The results obtained are summarized as follows. 1. Ten% CFDN granules were administered to a total of 21 children with upper or lower respiratory tract infections, urinary tract infections or infectious impetigo at daily doses of 6.4-18 mg/kg divided into 3 portions. Clinical efficacies were "excellent" in 13 patients, "good" in 7 patients and "unknown" in 1 patient (viral infection), hence an efficacy of 100% was obtained. 2. Bacteria identified in various disease cases included 19 strains of 7 species, and the eradication rate was 100%. 3. No side effects were noted in any of the children. Laboratory test results showed an abnormality in 1 case with eosinophilia. These results suggest that 10% CFDN granules as well as 5% CFDN granules may be a very useful and safe drug for the treatment of pediatric infections.

Administration, Oral↗
PubMed1991

[Pharmacokinetic, bacteriological and clinical evaluations of cefdinir 10% fine granules in pediatrics].

Pharmacokinetic, bacteriological, and clinical studies on cefdinir (CFDN, FK482) (10% fine granules), a new oral cephem, were performed in pediatrics. 1. Bioequivalencies of plasma concentrations and urinary excretions of CFDN 5% and 10% fine granules were investigated on 3 pediatric patients with ages between 5 to 13 years administered with a drug in fasting state at a dose level of 3 mg/kg using a cross over method. Average plasma concentrations in a group of patients administered with 5% fine granules peaked at 3 hours after administration with a level of 1.05 +/- 0.29 micrograms/ml (mean +/- S.E.) and decreased to 0.12 +/- 0.05 micrograms/ml at 8 hours with a half-life of 1.48 +/- 0.09 hours. In the group administered with 10% fine granules, average plasma concentrations peaked at 2 hours after administration with a level of 1.32 +/- 0.12 micrograms/ml, and decreased to 0.20 +/- 0.11 microgram/ml at 8 hours with a half-life of 1.68 +/- 0.28 hours. The first 8-hour urinary recovery rates of CFDN in the 5% and 10% fine granules groups averaged 19.64 +/- 5.69% and 23.37 +/- 2.36%, respectively. Both average and individual plasma concentrations and urinary recovery rates in the patients of the 10% fine granules group were somewhat higher than those of the 5% fine granules group, but no significant differences were observed between the 2 groups including areas under concentrations. 2. CFDN 10% fine granule preparation was administered to 33 pediatric patients with ages between 1 to 13 years with various infections, and its clinical effects, bacteriological effects and safety were assessed. In 31 of the 33 patients (2 patients were excluded since they were with non-bacterial infections) clinical effects were excellent in all of 9 patients with scarlet fever (3), acute pharyngitis (3) or impetigo (3), excellent in 12 and good in 3 of 15 patients with acute purulent tonsillitis, and excellent in 4 and good in 3 of 7 patients with acute pneumonia. The overall efficacy rate was 100%. Bacteriological effects against causative organisms were evaluated. All the identified Staphylococcus aureus (4 strains) and Streptococcus agalactiae (1) were eradicated. Of 10 strains of Streptococcus pyogenes, 9 strains were eradicated and the other one was reduced. Of 7 strains of Haemophilus influenzae 4 were eradicated, 1 persisted and the fate of the remaining 2 were unknown. The overall eradication rate was 90.0%. Microbial substitutions were observed in 5 patients. The new, replacing bacteria were all Haemophilus spp.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗
PubMed1991

[Laboratory and clinical evaluations of flomoxef sodium in neonates].

Flomoxef sodium (FMOX) was evaluated experimentally and clinically in neonates. 1. Serum concentrations and urinary excretions of the drug were examined after a bolus intravenous injection at 20 mg/kg to 22 neonates 1-30 days after birth (durations of pregnancy 31-43 weeks, weights at birth 1,650-4,040 g) and 5 infants 50-95 days after birth (durations of pregnancy 33-40 weeks, weights at birth 1,720-3,308 g). Serum concentrations were 10.8-67.6 micrograms/ml (mean 32.7 +/- 2.8 micrograms/ml) and 25.1-52.0 micrograms/ml (mean 38.9 +/- 4.3 micrograms/ml) in the neonates and the infants, respectively, at their peaks (0.5 hour value), decreased thereafter with half-lives of 0.96-5.59 hours (mean 2.20 +/- 0.26 hours value), and 0.97-1.54 hours (mean 1.22 +/- 0.12 hours value), respectively. Serum levels decreased to 0.2-17.1 micrograms/ml (mean 2.9 +/- 0.6 micrograms/ml) and N.D. -1.1 micrograms/ml (mean 0.4 +/- 0.2 micrograms/ml) after 8 hours, respectively. The urinary recovery rates of the drug in the first 8 hours after administration were 15.0-96.0% (mean 53.7 +/- 4.9%) and 29.9-73.3% (mean 62.4 +/- 9.4%) in the neonates and in the infants, respectively. 2. FMOX was administered to 78 neonates (durations of pregnancy 31-42 weeks, weights at birth 1,420-3,860 g) in whom bacterial infections were established or suspected, and clinical, bacteriological, and side effects were evaluated. In 47 neonates examined (1 with sepsis, 3 with acute upper respiratory infections, 18 with acute pneumonia, 1 with umbilical infection, 1 with impetigo, 4 with acute urinary tract infections, 1 with acute otitis externa, 1 with periproctal abscess, and 17 with intrauterine infections), the treatment was markedly effective in 41, and effective in 6, with an overall efficacy rate of 100%. The bacterilogical effects of the drug on 3 strains of Staphylococcus aureus, 1 strain of Streptococcus pneumoniae, 1 strain of Streptococcus agalactiae, 9 strains of Escherichia coli, and 2 strains of Haemophilus influenzae which were responsible for these infections were all rated as "eradicated". Moreover, the drug, administered with or without prophylactic intentions showed complete prophylactic effects in all 27 cases tested. No side effects were observed in any of the patients. Concerning abnormal clinical laboratory results, increases in GOT were noted in 2, eosinophilia in 1, and thrombocytosis in 1, but these abnormalities were invariably mild and the normalized in 1 patient without treatment. The results suggest that FMOX is useful and safe also in neonates.

Bacterial Infections↗
PubMed1991

[Clinical evaluation of flomoxef in neonatal infections].

Serum concentrations, urinary excretion and clinical responses of flomoxef (FMOX) were studied. The results are summarized as follows. 1. Serum concentrations of FMOX were 17.4 micrograms/ml 1-hour after intravenous injection on the average in 5 cases who received approximately 10 mg/kg, 41.8 micrograms/ml in 2 cases given 20 mg/kg, and 69.6 micrograms/ml in 2 cases given 40 mg/kg, indicating that serum concentrations of FMOX changed in a dose-dependent manner in this range. Average serum half-life (T 1/2) in 4 mature babies was 2.48 hours and that in 6 premature babies was 3.17 hours, indicating that elimination rates in premature cases tend to be slower than those in mature cases. Urinary recovery rates averaged 39.2% in the first 6 hours in 5 cases examined. 2. Five newborns or premature babies received FMOX 33.1-80.2 mg/kg (b.i.d. or t.i.d.) via intravenous route for 5 to 8 days. FMOX showed excellent or good clinical effectiveness in the treatment of all patients including 1 case each of sepsis with urinary infection, furunclal otitis, impetigo, uterogenic fetus infection and urinary infection. Bacteriological responses were also studied, and eradication of identified organisms (Escherichia coli 3 strains and Staphylococcus aureus 2 strains) was obtained upon the FMOX treatment, but in 1 strain of S. aureus showed only a decrease. No adverse reactions were observed in any cases, but a slight elevation of eosinophil was noted in 1 patient receiving a dose of 210 mg a day. From the results obtained in these tests, FMOX appears to be very usefull and safe for the treatment of some infectious diseases in neonates.

Bacterial Infections↗
PubMed1990

[Pharmacokinetics and clinical effects of cefdinir 5% fine granules in pediatrics].

Cefdinir (CFDN), a newly developed oral cephalosporin in 5% fine granular form, was administered to 10 boys at 1 hour before meal (in the fasting state) and concentrations of the drug in plasma and urine and its urinary recovery rates were determined. The subjects were divided into 2 groups of 5 boys each; one group received 3 mg/kg of CFDN, and the other, 6 mg/kg. To 6 of the 10 children the drug was administered in the two different dose levels using the cross-over method. To study clinical and bacteriological effects of this drug, a mean dose of 4.6 mg/kg t.i.d. was administered for 8 days on the average to 40 children with various infections; pharyngitis (4 cases), tonsillitis (2), acute bronchitis (2), pneumonia (8), scarlet fever (6), acute purulent otitis media (1), urinary tract infection (12), impetigo (2), phlegmon (1), lymphadenitis (1) and subcutaneous abscess (1). MICs were determined for 6 drugs including CFDN, cefaclor, cefixime (CFIX), methicillin, cloxacillin (MCIPC), amoxicillin (AMPC) against 13 strains of 6 species freshly isolated from children receiving CFDN. An inoculum size of 10(6) cfu/ml was used in the MIC-determinations. Adverse reactions and abnormal laboratory findings attributable to this drug were also examined in these patients. The results obtained are summarized as follows. 1. Mean plasma peak levels of CFDN were observed at 3 hours after administration in both the 3 mg/kg and 6 mg/kg groups with mean peak values of 0.68 and 1.35 micrograms/ml, respectively. Mean half-lives were 2.06 hours in the 3 mg/kg group and 1.61 hours in the 6 mg/kg group, and mean AUCs were 3.5 in the former and 6.5 micrograms.hr/ml in the latter. Thus, dose-response between the 2 doses was observed in plasma levels and AUCs. 2. To 3 patients, CFDN was given in the two different doses using the cross-over method. Mean plasma peak levels of CFDN were 0.71 and 1.31 micrograms/ml in the doses of 3 mg/kg and 6 mg/kg, respectively. Half-lives were 1.39-2.90 hours in the 3 mg/kg group and 1.21-1.48 hours in the 6 mg/kg group, with AUCs of 3.4-3.7 and 4.1-7.5 micrograms.hr/ml, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Oral↗
PubMed1990

Topical antibiotic therapy: current status and future prospects.

As we enter a new decade, topical antibiotics are the subject of much renewed interest and are being used on a wider scale than ever before. The reasons for using topical rather than oral therapy for a variety of dermatoses include the reduced risk of systemic side effects, the avoidance of resistance selection in the gut microflora, the higher achievable concentration of antibiotic at the site of action and the overall usage of less drug. Somewhat surprisingly, treatment costs are not reduced by the use of topical therapy. The number of antibiotics licensed for topical use has increased in recent years and now includes representatives of the tetracycline, macrolide, lincosamide, aminoglycoside and peptide families of antibiotics in addition to fusidic acid, chloramphenicol and pseudomonic acid. Opinions regarding the clinical efficacy of topical antibiotics are conflicting, and for most indications alternative oral therapies are available. Topical antibiotics are the drugs of choice for the elimination of nasal carriage of Staphylococcus aureus and for the therapy of eye and external ear infections. They are also effective in the treatment of impetigo and other superficial pyodermas and in the management of localised infected eczema. Topical preparations of erythromycin, clindamycin and tetracycline are widely prescribed for the therapy of acne and are of clinical benefit in mild--moderate cases. However, they are no more effective against inflamed lesions than benzoyl peroxide and are less effective against non-inflamed lesions. They are not as effective as oral tetracycline in moderate to severe acne and should not be considered as a therapy for severe acne, for which 13-cis-retinoic acid is the drug of choice. It is well known that many antibiotics, when used topically, especially for prolonged periods, select for antibiotic-resistant staphylococci at the skin surface. Tetracyclines, erythromycin and clindamycin also select for resistant staphylococci on the surface of intact skin when delivered by the oral route. The contribution of topical antibiotic usage to the current high level of antibiotic resistance in coagulase-negative staphylococci, which are increasingly implicated in infections of compromised hosts, has not been quantified, although it is known that cutaneous staphylococci possess a large pool of transferable resistance genes.(ABSTRACT TRUNCATED AT 400 WORDS)

Administration, Topical↗