New Developments in Bacterial, Viral, and Fungal Cutaneous Infections

Comparative analysis of the distribution and antifungal susceptibility of yeast species in cat facial hair and human nails

Zoonotic yeast species have been implicated in disease development in both humans and cats. This study analyzed the yeast mycobiota present in feline facial hair and human nails and explored potential interspecies associations. A total of 118 biological specimens were examined, including 59 feline facial hair and 59 human nail samples. DNA extraction and DNA sequencing were performed to identify the specific yeast species. The most predominant yeast species in humans and cats were selected for antifungal susceptibility testing (itraconazole, ketoconazole, miconazole, and terbinafine). The findings unveiled diverse yeast species in cats and humans. Malassezia pachydermatis (45.8%) and Malassezia furfur (30.5%) were the most common yeast species in cats and humans, respectively. However, no significant correlation was detected between the yeast species identified in cats and their owners residing in the same household (p > 0.05). Miconazole exhibited the highest minimum inhibitory concentrations (MICs) against Malassezia pachydermatis and Malassezia furfur in both cat and human isolates, whereas terbinafine showed the lowest MICs against most Malassezia pachydermatis and Malassezia furfur in both cat and human isolates. Diverse yeast species in cat facial hair and human nails suggest possible cross-contamination among humans, pets, and environments.

Alkaline hydrogen peroxide solutions: expectorant, pyolytic, mucolytic, haemolytic, oxygen-releasing, and decolorizing effects

The local action of hydrogen peroxide solutions on such dense biological masses, such as pus, mucus, sputum, and blood clots, is influenced not only by the concentration of the hydrogen peroxide but also by the alkalinity of the solution and the temperature of the interaction medium. Increasing the solutions temperature from 24C26C to 45C55C and its alkalinity from pH 7.0 to 8.48.5 enhances the pyolytic, mucolytic, hemolytic, bleaching, and oxygen-releasing activity of hydrogen peroxide solutions. Simple heating achieves the desired level of hyperthermia, while the addition of sodium bicarbonate provides the indicated alkalinity. Hyperthermia, according to the laws of physics, reduces the viscosity of biological masses, increasing their fluidity, permeability to the antiseptic solution, miscibility, and solubility in it. Furthermore, hyperthermia accelerates the rate of chemical, physicochemical, and biochemical processes, according to the Arrhenius law. The elevated temperature of interacting media speeds up the alkaline saponification process of proteins and protein-lipid complexes, which constitute the colloidal basis of biological masses. Additionally, hyperthermia intensifies the enzymatic decomposition of hydrogen peroxide into water and oxygen gas, facilitated by the enzyme catalase present in most biological masses. The released molecular oxygen generates gas bubbles that mimic cold boiling, leading to the explosion of biological masses, transforming them into a fluffy white foam. Oxygen in an alkaline environment oxidizes biological pigments, including hemoglobin and its metabolites of different colors, resulting in their discoloration.

Antimicrobial Management of Skin and Soft Tissue Infections among Surgical Wards in South Africa: Findings and Implications

Skin and soft tissue infections (SSTIs) are one of the most common infectious diseases requiring antibiotics. However, complications of SSTIs may lead to the overprescribing of antibiotics and to subsequent antibiotic resistance. Consequently, monitoring the prescribing alignment with the current recommendations from the South African Standard Treatment Guidelines (STG) is necessary in order to improve future care. This study involved reviewing pertinent patients with SSTIs who were prescribed antimicrobials in the surgical ward of a leading South African tertiary public hospital from April to June 2021 using an adapted data collection tool. Sixty-seven patient files were reviewed. Among the patients with SSTIs, hypertension and chronic osteomyelitis were the most frequent co-morbidities at 22.4% and 13.4%, respectively. The most diagnosed SSTIs were surgical site infections (35.1%), wound site infections (23%), and major abscesses (16.2%). Blood cultures were performed on 40.3% of patients, with Staphylococcus aureus (32.7%) and Enterococcus spp. (21.2%) being the most cultured pathogens. Cefazolin was prescribed empirically for 46.3% of patients for their SSTIs. In addition, SSTIs were treated with gentamycin, ciprofloxacin, and rifampicin at 17.5%, 11.3%, and 8.8%, respectively, with treatment fully complying with STG recommendations in 55.2% of cases. Overall, the most common cause of SSTIs was Staphylococcus aureus, and empiric treatment is recommended as the initial management. Subsequently, culture sensitivities should be performed to enhance adherence to STGs and to improve future care.

Analysis of Types of Skin Lesions and Diseases in Everyday Infectious Disease Practice-How Experienced Are We?

Rashes and skin lesions are a common reason for patient visits to emergency departments and physicians’ offices. The differential diagnosis includes a variety of infectious and non-infectious diseases, some of which can be life-threatening. The aim of this retrospective study was to evaluate the quantity and type of skin lesions among outpatients and inpatients at a tertiary care university-affiliated teaching hospital for infectious diseases over a three-year period to assess disease burden and physicians’ experience in diagnosing skin lesions. Diagnoses (by ICD-10 codes) were classified into three groups: infectious diseases that include skin lesions, non-infectious skin lesions and undiagnosed skin lesions. During the observed period, out of the total of 142,416 outpatients, 14.8% presented with some form of skin lesion. Among them, 68% had skin lesions inherent to infectious disease, 10.8% suffered from non-infectious skin lesions and 21.2% remained with undiagnosed skin lesions. The most common infectious diagnoses were chickenpox, herpes zoster and unspecified viral infections characterized by skin and mucous membrane lesions. The most common non-infectious diagnoses were urticaria and atopic dermatitis. Overall, the most common individual diagnosis (ICD-10 code) was “nonspecific skin eruption” (n = 4448, 21.1%), which was followed by chickenpox and herpes zoster. Among the 17,401 patients hospitalized over the observed period, 13.1% had skin lesion as the main reason for hospitalization, almost all (97.5%) of which were infectious in etiology. The most common diagnoses were cellulitis, erysipelas and herpes zoster. The presented data suggest that the burden of diseases presenting with skin lesions is significant in everyday infectious disease practice, but the overwhelming number of undiagnosed patients implies the need for further education in this area.

Intradermal administration of green synthesized nanosilver (NS) through film-coated PEGDA microneedles for potential antibacterial applications

Skin infections caused by pathogens, including bacteria, fungi and viruses, are difficult to completely eliminate through standard topical administration, owing to the restricted drug permeation into the epidermis layer. Herein, we developed a poly(ethylene glycol) diacrylate (PEGDA) microneedle patch with surface coating of a nanosilver (NS) encapsulated gelatin/sucrose film for antibacterial applications, by virtue of enhanced skin permeation by microneedle penetration and efficient drug delivery through rapid film dissolving. NS was facilely synthesized through a green process based on the bioinspired crystallization of ionic state silver in the presence of a silk fibroin (SF) template. A gelatin/sucrose polymeric film encapsulating NS was dressed on the surface of the mold cavity, and film-coated PEGDA (PEGDA/film-NS) microneedles were subsequently fabricated through standard ultraviolet (UV) light-induced polymerization. To demonstrate their advantages for therapeutic applications, the physicochemical properties of the as-developed microneedles were characterized in terms of their morphology, composition, mechanical strength, etc. Moreover, rapid NS release from PEGDA@film-NS microneedles driven by the aqueous environment was demonstrated under physiological conditions. Additionally, such film-coated microneedles exhibited good mechanical strength for skin penetration, and their antibacterial activity against Gram-positive bacteria (Staphylococcus epidermidis and Staphylococcus aureus) as well as Gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa) was verified using bacterial suspension in vitro. Altogether, such a minimally invasive strategy exhibited good potential for realizing a broad-spectrum antibacterial effect, which may provide a practical methodology for the management of polymicrobial skin infection during clinical trials.

Acne in the first three decades of life: An update of a disorder with profound implications for all decades of life

Acne vulgaris is a chronic, inflammatory, skin condition that involves the pilosebaceous follicles and is influenced by a variety of factors including genetics, androgen-stimulation of sebaceous glands with abnormal keratinization, colonization with Cutibacterium acnes (previously called Propionibacterium acnes), and pathological immune response to inflammation. Acne can occur at all ages and this discussion focuses on the first three decades of life. Conditions that are part of the differential diagnosis and/or are co-morbid with acne vulgaris are also considered. Acne in the first year of life includes neonatal acne (acne neonatorum) that presents in the first four weeks of life and infantile acne that usually presents between 3 and 6 months of the first year of life with a range of 3 to 16 months after birth. Acne rosacea is a chronic, inflammatory, skin condition that is distinct from acne vulgaris, typically presents in adults, and has four main types: erythemato-telangiectatic, papulopustular, phymatous and ocular. Treatment options for acne vulgaris include topical retinoids, topical benzoyl peroxide, antibiotics (topical, oral), oral contraceptive pills, isotretinoin, and others. Management must consider the increasing impact of antibiotic resistance in the 21st century. Psychological impact of acne can be quite severe and treatment of acne includes awareness of the potential emotional toll this disease may bring to the person with acne as well as assiduous attention to known side effects of various anti-acne medications (topical and systemic). Efforts should be directed at preventing acne-caused scars and depigmentation on the skin as well as emotional scars within the person suffering from acne.