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PubMed2002

Common skin problems.

Dermatological problems manifesting as primary and secondary cutaneous complaints, constitute at least 30% of all outpatient visits to a pediatrician and 30% of all visits to dermatologists involve patients of pediatric age group. There is, however, a paucity of data about pediatric dermatoses in India, which has been reviewed to the extent possible. A brief account of common dermatological problems in India mainly infestations (pediculosis capitis, scabies) and infections (pyoderma, molluscum contagiosum, warts, herpes simplex infection, varicella, herpes zoster, tinea capitis and corporis, tinea versicolor, and candidiasis) has been given. At the end, common pediatric dermatological emergencies have been short-listed. Erythema multiforme and its variants and acrodermatitis enteropathica are discussed briefly.

Child↗
PubMed1994

The role of the pancreas in the regulation of zinc status.

A low Zn diet resulted in subacute Zn deficiency in young rats. Thirty minutes after the intubation of a trace 65-Zn we determined the total tissue Zn activity in plasma, erythrocytes, liver, pancreas, bone, muscle, and proximal jejunum. Assuming the body behaved like a closed multicompartmental system in steady state, we estimated the initial Zn exchange between plasma, and the erythrocytes or these tissues. In comparison with control animals the exchanges between plasma and erythrocytes or pancreas increased threefold during subacute Zn deficiency. In the pancreas the ratio also reversed from < 1.0 to > 1.0. This confirmed earlier observations that the specific activity (kBq 65-Zn/mol Zn) increased mostly in the pancreas. By increased net Zn uptake during subacute deficiency, the pancreas Zn content remained constant in chronic Zn deficiency. We discussed the regulation of the Zn status by the pancreas. We hypothesize that the exocrine pancreas modulates Zn absorption by an exocrine ligand that enhances absorption in the jejunum during subacute deficiency: Unsaturated with Zn it binds dietary intraluminal Zn and increases the Zn absorption. The literature provides evidence in confirmation. This hypothesis explains also conflicting data on the inherited Zn malabsorption syndrome Acrodermatitis Enteropathica.

Animals↗
PubMed1996

Nystatin affects zinc uptake in human fibroblasts.

The mechanism(s) by which zinc is transported into cells has not been identified. Since zinc uptake is inhibited by reducing the temperature, zinc uptake may depend on the movement of plasma membrane micoenvironments, such as endocytosis or potocytosis. We investigated the potential role of potocytosis in cellular zinc uptake by incubating normal and acrodermatitis enteropathica fibroblasts with nystatin, a sterol-binding drug previously shown to inhibit potocytosis. Zinc uptake was determined during initial rates of uptake (10 min) following incubation of the fibroblasts in 50 micrograms nystatin/mL or 0.1% dimethylsulfoxide for 10 min at 37 degrees C. The cells were then incubated with 1 to 30 microM 65zinc. Michaelis-Menten kinetics were observed for zinc uptake. Nystatin inhibited zinc uptake in both the normal and AE fibroblasts. Reduced cellular uptake of zinc was associated with its internalization, not its external binding. In normal fibroblasts, nystatin significantly reduced the K(m) 56% and the Vmax 69%. In the AE fibroblasts, nystatin treatment significantly reduced the Vmax 59%, but did not significantly affect the K(m). The AE mutation alone affected the Vmax for cellular zinc uptake. The control AE fibroblasts exhibited a 40% reduction in Vmax compared to control normal fibroblasts. We conclude that nystatin exerts its effect on zinc uptake by reducing the velocity at which zinc traverses the cell membrane, possibly through potocytosis. Furthermore, the AE mutation also affects zinc transport by reducing zinc transport.

3-O-Methylglucose↗
PubMedDate not supplied

Zinc in human health and disease.

The importance of zinc in human health and disease has been reviewed by reporting data from the recent literature. The role of zinc in human nutrition, general health, skin diseases, acrodermatitis enteropathica, reproductive physiology and pathophysiology, pregnancy, non-insulin-dependent diabetes mellitus as well as atherosclerosis is discussed. The consequences of zinc deficiency and toxicity are also illustrated.

Diabetes Mellitus, Type 2↗
PubMed1985

The effect of zinc on normal and neoplastic T-lymphocyte proliferation.

After 24-72 h of PHA-stimulation, T-cells expressed the transferrin receptor. This receptor facilitates zinc uptake. Zinc transferrin stimulated DNA synthesis in pre-activated or activated, but not in resting T-cells. The regulatory nuclear protein matrix fraction increased from 5 to 40% of the total nuclear protein material in lymphocytes simultaneously with the initiation of DNA synthesis. In contrast, optimal concentration (0.1-0.4 mM) of zinc salts induced a mitogenic response in transferrin-receptor negative resting, but not in PHA-activated or leukemic T-cells. Higher concentrations were toxic. These findings can explain earlier reports on the effect of zinc on immunocompetence in zinc deficient mice and enteropathic acrodermatitis as well as present findings of a normalization of the T-suppressor-cell number in immunosuppressed patients.

DNA Replication↗
PubMed2004

Clinical and epidemiological features of Lyme borreliosis in Bulgaria.

INTRODUCTION: Data on disease expression and epidemiological characteristics of Lyme borreliosis in south-eastern Europe are scarce. PATIENTS: To reveal features of Lyme borreliosis in Bulgaria, clinical data and epidemiological characteristics of 1257 patients reported between 1999 and 2002 were analysed. RESULTS: The most affected age group was 5-9 years, followed by 45-49 years, 50-54 years, and 10-14 years. Most of the patients (68%) lived in a rural area or were attacked by ticks during activities in a rural area. Lyme borreliosis cases occurred throughout the year with two peaks--one in June and second smaller one in September. The most common clinical manifestation was erythema migrans (EM), diagnosed in 868 (69.1%) of the patients. Rashes had a median diameter of 11 cm and were predominantly located on lower extremities. Forty-four per cent of the rashes consisted of homogenous erythema and 56% had central clearing. Multiple EM was detected in 4.3% of the EM cases. Neuroborreliosis was the second most common presentation of Lyme borreliosis, diagnosed in 19% of the patients. Lyme arthritis was found in 8% of the patients. Heart and ocular manifestations were recorded in 1.1% and 0.9% of the patients, respectively. Borrelial lymphocytoma and acrodermatitis chronica atrophicans were very rare (0.3%). Twenty-seven patients (2.1%) had multiple organ involvement. CONCLUSIONS: The results of the study show that the epidemiology and clinical manifestations of Lyme borreliosis in Bulgaria are similar to those in the majority European countries but possess some distinguishing characteristics.

Adolescent↗
PubMed2005

[Lyme borreliosis. Cutaneous manifestation].

Lyme borreliosis is a tick transmitted infectious disease caused by different genospecies of Borrelia burgdorferi sensu lato. In USA only one species B. burgdorferi sensu stricto is prevalent, whereas in Europe at least 5 different pathogenic species could be identified. The most prevalent species are B. afzelii and B. garinii. Infection is not always causing disease. In early infection, a localized skin inflammation, called erythema migrans, occurs around the tick bite, hematogenous dissemination of Borrelia causes flu like symptoms up to meningitis and multiple erythemata migrantia on the skin. In late stage multiple organ systems can be affected, in Europe especially the skin with various forms of acrodermatitis chronica atrophicans, the central and peripheral nervous system, joints and heartmuscle. Lyme borreliosis can be diagnosed by the typical history, the clinical symptoms and the elevated Borrelia specific IgM- and IgG-antibodies in serum and CSF according to the MIQ guidelines, in special cases B. burgdorferi can be cultivated or DNA detected by PCR. Therapy of choice for early infection is oral antibiotics like doxycycline, amoxicillin and cefuroxime for at least 10 days up to 21 days. Late stage infections should be treated for 3-4 weeks. Patients with neurological symptoms should be treated intravenously with ceftriaxone or penicillin G.

Borrelia burgdorferi↗
PubMed2002

[Ten clues to the histopathologic diagnosis of infectious skin diseases].

Specific diagnoses of infectious skin diseases can be established in dermatopathology by several methods: by algorithms based on pattern analysis, by differential diagnosis of clinicopathologically similar disorders, by attention to pitfalls, by exceptions to the rules and finally, very elegantly by clues. Ten clues to specific diagnoses of infectious skin diseases which are of importance in routine practice are presented. Clue 1: Features of an angiocentric angiodestructive lymphoma in the centre of a wedge-shaped necrotic insect bite reaction are a clue to a bite by a spider. Clue 2: Parakeratosis with spiky imprints on the surface above features of an insect bite reaction are a clue to scabies. Clue 3: A faintly eosinophilic section of a skin specimen with prominent fibrin thrombi and extravasated erythrocytes are a clue to a septic fungal vasculitis. Clue 4: Infectious agents in association with otherwise typical features of leukocytoclastic vasculitis are a clue to septic vasculitis. Clue 5: Steel-grey nuclei with marginated nucleoplasm of keratinocytes are a clue to the diagnosis of early infection by herpes virus. Clue 6: Owleye-like cells are a clue to infection by cytomegalovirus. Clue 7: Detection of Entamoeba histolytica in perianal and perineal ulcers are a clue to amebiasis. Clue 8: Round-oval to rectangular spaces within the stratum spinosum of the epidermis are a clue to larva migrans. Clue 9: Macrophages and plasma cells in association with otherwise typical features of pityriasis lichenoides are a clue to secondary syphilis. Clue 10: A lichenoid infiltrate of lymphocytes and plasma cells are a clue to acrodermatitis chronica atrophicans.

Animals↗
PubMed2003

[Heterogeneity of Borrelia burgdorferi: etiopathogenetic relevance and clinical implications].

Of the ten different species of Borrelia (B.) burgdorferi sensu lato which have been characterized to date, only B. burgdorferi sensu stricto, B. garinii and B. afzelii have been identified as pathogenic in humans. It was suggested that different species possess different organotropisms and may preferentially cause distinct clinical manifestations of Lyme disease. Molecular analyses revealed a strong association of B. afzelii with the late cutaneous manifestation acrodermatitis chronica atrophicans, whereas B. garinii was predominantly identified in clinical samples from patients with neuroborreliosis. PCR-based analyses of samples from European patients with Lyme arthritis had given controversial results, but B. burgdorferi sensu stricto appears to be the major pathogen. The identity of the infecting species seems to be a major determinant in the pathogenesis of Lyme arthritis, although its complex immunopathological background and its clinical heterogeneity clearly indicate concomitant factors. Thus, characterization of the infecting organism at the species level on the one hand and linkage of clinical data with pathogenetically relevant immune parameters on the other, shall lead to a more precise understanding of the pathogenesis and the individual clinical course of Lyme borrelioses.

Borrelia burgdorferi↗
PubMed2003

[Epidemiology and therapy of Lyme arthritis and other manifestations of Lyme borreliosis in Germany: results of a nation-wide survey].

AIM OF THE STUDY: Only little is known about the epidemiology of Lyme borreliosis in Germany. As an example, it is still unclear if there are regional differences in the incidence of Lyme disease in general or of certain clinical manifestations like Lyme arthritis. Moreover, standardization of diagnostic or therapeutic procedures does not exist. Therefore, a Germany-wide questionnaire-based survey was conducted in order to achieve more epidemiological data and to obtain more information about the diagnostic and therapeutic approaches of general practitioners and specialists. METHODS: A self-designed questionnaire was distributed along with two editions of the journal "Deutsches Arzteblatt" (which is delivered to every physician in Germany) and additionally by a pharmaceutical company. During the collection period from March 1, 1998 to February 28, 1999, patients with Lyme disease were reported and information was given about site of infection, diagnostic procedures, clinical symptoms, treatment, and outcome. RESULTS: Altogether 3935 patients were reported. Their mean age was 43.4 years with the peak incidences around the ages of 10 and 60 years. 37.3% of the questionnaires were sent in by general practitioners, 17.6% by dermatologists, 15.7% by pediatricians, 9.7% by internists, and 2.7% by neurologists. 83% of the patients did not have a special infecion risk. The most frequent clinical Lyme manifestation was erythema migrans (EM), which occurred in 50.9% of the patients. 21.3% suffered from general symptoms. Of special interest, 24.5% of the patients had Lyme arthritis (14.7% mon- or oligoarthritis, 9.8% polyarthritis). Therefore, arthritis was more frequently reported than neuroborreliosis (18.4%). Only 16% of the neuroborreliosis patients and 32% of the arthritis patients remembered having had an EM. 189 patients (4.8%) with lymphadenosis cutis benigna and 100 patients (2.5%) with acrodermatitis chronica atrophicans were reported. In 80.4% of the patients, positive Lyme serology was detected. In a few cases, the diagnosis was established by isolation of borreliae, PCR or histology. 3754 patients were treated by antibiotics. The most frequently used compounds were doxycycline (50.4%), followed by ceftriaxone (22.4%), amoxicillin (13.6%), penicillin (7%), and erythromycin (4.2%) with differences depending on clinical manifestations and specialization of the prescribing physician. In less than 10% of the cases, not evaluated or recommended therapeutic procedures were performed. DISCUSSION: Lyme disease is endemic throughuot Germany. The most frequent manifestations are EM, followed by Lyme arthritis and neuroborreliosis. Less than one third of patients suffering from disseminated or chronic Lyme disease remembered an EM. Most of the physicians taking part in this survey follow treatment recommendations concerning choice of antibiotics and treatment durations.

Adolescent↗
PubMed1998

Stages and syndromes of neuroborreliosis.

To ascertain the varieties of neuroborreliosis, 330 patients were identified at the Departments of Neurology in Würzburg and Giessen from 1979 to 1994. Patients who fullfilled at least one of three strict case definitions based on clinical and laboratory criteria were included in the study. Ninety-one per cent of the patients had second-stage neuroborreliosis (duration of symptoms < or = 6 months). The most common syndrome was a painful spinal meningoradiculitis, alone (37%) or in combination with a cranial radiculitis (29%). Meningoradiculitis cranialis (9%), isolated meningitis (4%) and erythema chronica migrans-associated mono/polyneuritis (3%) were further stage II features. Central nervous system involvement occurred either as an acute meningomyelitis or meningomyeloradiculitis (5%) and meningoencephalitis or meningenocephaloradiculitis (4%). Less than 9% of the patients ran a chronic course (stage III) with a disease duration between 6 months and 9 years, either as acrodermatitis chronica atrophicans associated mono- or polyneuritis (2%) or a chronic progressive encephalomyelitis (6%). Cerebrovascular neuroborreliosis (1%) occurred in both stages; however, the primary nature of the course was a chronic one. Involvement of other organs except the skin was rare (joints 3%, heart 1%) but elevated hepatic enzymes were frequent. Our study demonstrates that neuroborreliosis has to be considered in the differential diagnosis of a wide variety of neurological conditions. Cerebrospinal fluid analysis and the search for specific intrathecal antibody production are important diagnostic procedures.

Adolescent↗
PubMed2003

The SLC39 family of metal ion transporters.

SLC39 proteins are members of the broader ZIP family of metal ion transporters found in organisms at all phylogenetic levels. Most ZIP transporters have eight predicted transmembrane domains and a similar predicted topology. Their biochemical mechanism(s) of substrate transport are not yet known. Where characterized, these proteins have been found to transport metal ions from the cell exterior or lumen of intracellular organelles into the cytoplasm. Furthermore, members of the ZIP family have been implicated in the transport of zinc, iron, and/or manganese indicating that these proteins have diverse functions. There are 14 SLC39-related proteins encoded by the human genome. Studies of SLC39A1, SLC39A2, and SLC39A4, encoding the proteins hZip1, hZip2, and hZip4, have indicated roles in zinc uptake across the plasma membrane of various cell types. Genetic studies have specifically implicated SLC39A4 in the uptake of dietary zinc into intestinal enterocytes. Mutations in SLC39A4 have been identified in patients with acrodermatitis enteropathica, a genetic disease of zinc deficiency.

Animals↗
PubMed2003

Analysis of zinc transporter, hZnT4 ( Slc30A4), gene expression in a mammary gland disorder leading to reduced zinc secretion into milk.

Zinc deficiency, causing impaired growth and development, may have a nutritional or genetic basis. We investigated two cases of inherited zinc deficiency found in breast-fed neonates, caused by low levels of zinc in the maternal milk. This condition is different from acrodermatitis enteropathica but has similarities to the "lethal milk" mouse, where low levels of zinc in the milk of lactating dams leads to zinc deficiency in pups. The mouse disorder has been attributed to a defect in the ZnT4 gene. Little is known about the expression of the human orthologue, hZnT4 (Slc30A4). Sequence analysis of cDNA, real-time PCR and Western blot analysis of hZnT4, carried out on control cells and cells from unrelated mothers of two infants with zinc deficiency, showed no differences. The hZnT4 gene was highly expressed in mouthwash buccal cells compared with lymphoblasts and fibroblasts. The hZnT4 protein did not co-localise with intracellular free zinc pools, suggesting that hZnT4 is not involved in transport of zinc into vesicles destined for secretion into milk. This observation, combined with phenotypic differences between the "lethal milk" mouse and the human disorder, suggests that the "lethal milk" mouse is not the corresponding model for the human zinc deficiency condition.

Adult↗
PubMed2000

Full spectrum of clinical, serological, and epidemiological features of complicated forms of Lyme borreliosis in the Paris, France, area.

The aim of this study was to report the clinical, serological and epidemiological features of a homogeneous cohort of patients with various forms of Lyme borreliosis, based on recent European case-definition guidelines. Complete clinical and epidemiological reports were requested from the patients' physicians for case definition. Enzyme immunoassay IgG and IgM screening tests were performed. A total of 170 patients (141 adults and 29 children) with the following forms of Lyme borreliosis were included between 1989 and 1997: erythema migrans alone (n = 38), early neuroborreliosis (n = 76), arthritis (n = 34), acrodermatitis chronica atrophicans (n = 12), carditis (n = 2), lymphocytoma (n = 3), chronic neuroborreliosis (n = 2), and miscellaneous disorders (n = 3). On the basis of the occurrence and course of the full spectrum of complicated forms of Lyme borreliosis, the specificity of the clinical and biological presentation of the complicated forms (age, ratio of children/adults, sex ratio, incubation period, time to diagnosis, and serological profiles) was demonstrated, as was the absence of overlap between the clinical presentations. Using these data, an alternative scheme for the natural history of Lyme borreliosis is suggested.

Adolescent↗
PubMed2001

Disease expression of Lyme borreliosis in northeastern France.

Since very little is known about the clinical expression of Lyme borreliosis in Western Europe, a 3-year prospective study was conducted that included all patients seen for suspected Lyme borreliosis at the Strasbourg University Hospital in northeastern France. The diagnosis of Lyme borreliosis was made on the basis of the presence of erythema migrans or on the basis of another suggestive clinical manifestation and laboratory confirmation. A total of 132 patients, 70 women and 62 men, mean age 54 years, had Lyme borreliosis according to these criteria. Within this study group, 77% of the patients were regularly exposed to tick bites and 64% could remember one. Erythema migrans, the most frequent clinical manifestation, occurred in 60% of the patients and was the only sign of Lyme borreliosis in 40%. Lymphocytoma and acrodermatitis chronica atrophicans were rare (1 and 3 patients, respectively). Nervous system involvement (mainly radiculoneuropathy), the second most common clinical manifestation, was found in 40% of the patients and was the only sign of Lyme borreliosis in 22%. Musculoskeletal involvement was present in 26% of the patients and was an isolated finding in 14%. During the study period, no patient was diagnosed with Lyme carditis. There was serological evidence of Lyme borreliosis in 75% of the cases and direct evidence of borrelial infection in 10 (7.5%). The results show that the clinical expression of Lyme borreliosis in northeastern France is similar to that in other European countries but different from that in North America.

Adolescent↗
PubMed2001

Extrahepatic manifestations of chronic viral hepatitis.

Hepatitis B (HBV) and C (HCV) viruses are well-recognized causes for chronic hepatitis, cirrhosis, and even for hepatocellular carcinoma. Apart from liver disease, these viral infections are known to be associated with a spectrum of extrahepatic manifestations. The prevalence of clinically significant extrahepatic manifestations is relatively low, but it can be associated with significant morbidity and even mortality. An awareness and recognition of these manifestations is of paramount importance in facilitating early diagnosis and in offering treatment. However, treatments are not necessarily effective, and patients may continue with disabling extrahepatic manifestations. Hepatitis B virus has been well recognized as causing a variety of manifestations that include skin rash, arthritis, arthralgia, glomerulonephritis, polyarteritis nodosa, and papular acrodermatitis. More recently, infection with hepatitis C virus has elicited considerable interest for its role in a spectrum of extrahepatic manifestations. Among the best-reported are cryoglobulinemia, glomerulonephritis, high titer of autoantibodies, idiopathic thrombocytopenic purpura, lichen planus, Mooren's corneal ulcer, Sjögren's syndrome, porphyria cutanea tarda, and necrotizing cutaneous vasculitis. The precise pathogenesis of these extrahepatic complications has not been determined, although the majority represent the clinical expression of autoimmune phenomena.

Cryoglobulinemia↗
PubMed1979

Histologic diagnosis of diseases of malabsorption.

The diagnoses which may be arrived at by examination of peroral small bowel mucosal biopsy specimens are presented. Celiac sprue, unclassified sprue (refractory sprue), infectious gastroenterititis, stasis syndrome and kwashiorkor have a severe mucosal lesion. Other clinical conditions are required to establish the diagnosis in these diseases. A number of diseases have specific diagnostic features. Included are Whipple's disease, abetalipoproteinemia, collagenous sprue, primary intestinal lymphoma, eosinophilic gastroenteritis, giardiasis, coccidiosis, strongyloidiasis, lymphangiectasis and the intestinal immunodeficiency diseases. Mucosal abnormalities may be present in other diseases but the diagnoses are usually made on other criteria than small bowel biopsy. These include vitamin B12 or folic acid deficiency, Crohn's disease, gastrinoma, acrodermatitis enteropathica, amyloidosis, chronic granulomatous disease, lipid storage diseases, histoplasmosis, capillariasis, cytomegalovirus infection, schistosomiasis and macroglobulinemia.

Biopsy↗
PubMed1989

Myositis caused by Borrelia burgdorferi: report of four cases.

Myositis was proven histopathologically in 4 patients (age range 36-66 years) who suffered from early or late stages of Borrelia burgdorferi infection. Muscle weakness was present in 3 patients, 1 complaining of additional myalgias. One man came to medical attention because of skin discoloration and swelling of one leg. Deep biopsy from skin, fascia and muscle revealed acrodermatitis chronica atrophicans, panniculitis, fasciitis, and myositis, respectively. Creatine kinase was slightly elevated in 3 cases and normal in one. Infiltrates were found in the perimysium and within the muscle bundles, mainly around small vessels. The infiltrates consisted of many B cells and T4 lymphocytes with fewer cytotoxic T cells, suggesting that Borrelia myositis might be due to a local immune response to unknown Borrelia antigens. Cultivation of Borrelia from muscle was not successful. Antibiotic therapy cured the myositis.

Adult↗