AIDS and HIV infections: uncommon presentations

Pockenvirusinfektionen in der Dermatologie: Poxvirus infections in dermatology - the neglected, the notable, and the notorious

Die Familie Poxviridae umfasst derzeit 22 Gattungen, die Wirbeltiere infizieren können. Humanpathogene Pockenviren gehören den Gattungen Ortho‐, Para‐, Mollusci‐ und Yatapoxvirus an. Bis zur Eradikation der Variola vera im Jahr 1979 waren die Pocken, im Volksmund auch Blattern genannt, eine schwerwiegende Gesundheitsbedrohung für die Bevölkerung. Noch heute sind Dermatologen mit zahlreichen Pockenvirusinfektionen konfrontiert, wie den Bauernhofpocken, die als Zoonosen nach Tierkontakten in ländlichen Gebieten oder nach Massenversammlungen auftreten können. In den Tropen können Erkrankungen durch Tanapox‐ oder Vaccinia‐Viren zu den Differenzialdiagnosen gehören. Dellwarzen sind weltweit verbreitet und werden in bestimmten Fällen als sexuell übertragbare Pockenvirusinfektion angesehen. In jüngster Zeit hatten sich Mpox (Affenpocken) zu einer gesundheitlichen Notlage von internationaler Tragweite entwickelt, die eine rasche Identifizierung und angemessene Behandlung durch Dermatologen und Infektiologen erfordert. Fortschritte und neue Erkenntnisse über Epidemiologie, Diagnose, klinische Manifestationen und Komplikationen sowie Behandlung und Prävention von Pockenvirusinfektionen erfordern ein hohes Maß an Fachwissen und interdisziplinärer Zusammenarbeit in den Bereichen Virologie, Infektiologie und Dermatologie. Dieser CME‐Artikel bietet einen aktualisierten systematischen Überblick, um praktizierende Dermatologen bei der Identifizierung, Differenzialdiagnose und Behandlung klinisch relevanter Pockenvirusinfektionen zu unterstützen.

Poxvirus infections in dermatology - the neglected, the notable, and the notorious

The family Poxviridae currently comprises 22 genera that infect vertebrates. Of these, members of the Ortho-, Para-, Mollusci- and Yatapoxvirus genera have been associated with human diseases of high clinical relevance in dermatology. Historically, smallpox had been a notorious health threat until it was declared eradicated by the World Health Organization in 1979. Today, dermatologists are confronted with a variety of poxviral infections, such as farmyard pox, which occurs as a zoonotic infection after contact with animals. In the tropics, tanapox or vaccinia may be in the differential diagnosis as neglected tropical dermatoses. Molluscum contagiosum virus infection accounts for significant disease burden worldwide and is classified as a sexually transmitted infection in certain scenarios. Recently, mpox (monkeypox) has emerged as a public health emergency of international concern, requiring rapid recognition and appropriate management by dermatologists and infectious disease specialists. Advances and new insights into the epidemiology, diagnosis, clinical manifestations and complications, treatment, and prevention of poxviral infections require a high level of expertise and interdisciplinary skills from healthcare professionals linking virology, infectious diseases, and dermatology. This CME article provides a systematic overview and update to assist the practicing dermatologist in the identification, differential diagnosis, and management of poxviral infections.

British Association for Sexual Health and HIV national guideline for the management of Genital Molluscum in adults (2021)

This guideline offers recommendations on diagnosis, treatment regimens and health promotion principles needed for the effective management of genital molluscum, including management of the initial presentation and recurrences. The Primary focus of the guideline is on infection which affects the genital area and has a sexual mode of transmission. This is an update to the guideline previously published in this journal in 2014.

Antibiotic sensitivity profile of Staphylococcus aureus isolated from HIV/AIDS patients presenting with pyoderma, at the Yaounde Central Hospital, Cameroon

Introduction

the purpose of this study was to evaluate the in vitro activity of several antibiotics against strains of Staphylococcus aureus isolated from pyoderma in people living with Human Immunodeficiency Virus (HIV), consulting at the day clinic of the Yaoundé Central Hospital.

Methods

this was a prospective, cross-sectional study which was carried out in five months (November 2013-March 2014). Fifty-three (53) pus specimens were collected; from which the isolation of Staphylococcus aureus was made using Chapman agar. Mannitol fermentation, catalase, coagulase and DNase tests were used for species identification. Antibiotic sensitivity of each strain was determined by the agar diffusion method.

Results

forty-eight (48) strains of Staphylococcus aureus were isolated (90.56%). A high rate of sensitivity to antibiotics was observed in many strains: vancomycin (100.0%), pristinamycin (100.0%), chloramphenicol (100.0%), oxacillin (97.9%), cefoxitin (97.9%), gentamicin (87.5%), tobramycin (83.3%). However, some strains had strong resistance to penicillin G (89.6%) and cotrimoxazole (64.6%). The proportion of Methicilin Resistant strains of Staphylococcus aureus (MRSA) was low (2.0%). The kanamycin-tobramycin-gentamycin phenotype (KTG) was most common in the aminoglycosides resistant strains; the same as the induced phenotype E stains (iMLSB) in macrolides resistant strains. Conclusion: these results indicate that many of these antibiotics tested are still effective against strains of Staphylococcus aureus.

Molluscum contagiosum and associations with atopic eczema in children: a retrospective longitudinal study in primary care

BACKGROUND

Molluscum contagiosum (MC) is a common skin condition in children. Consultation rates and current management in primary care, and how these have changed over time, are poorly described. An association between the presence of atopic eczema (AE) and MC has been shown, but the subsequent risk of developing MC in children with a diagnosis of AE is not known.

AIM

To describe the consultation rate and management of MC in general practice in the UK over time, and test the hypothesis that a history of AE increases the risk of developing MC in childhood.

DESIGN AND SETTING

Two studies are reported: a retrospective longitudinal study of MC cases and an age-sex matched case-cohort study of AE cases, both datasets being held in the UK Clinical Practice Research Datalink from 2004 to 2013.

METHOD

Data of all recorded MC and AE primary care consultations for children aged 0 to 14 years were collected and two main analyses were conducted using these data: a retrospective longitudinal analysis and an age-sex matched case-cohort analysis.

RESULTS

The rate of MC consultations in primary care for children aged 0 to 14 years is 9.5 per 1000 (95% CI = 9.4 to 9.6). The greatest rate of consultations for both sexes is in children aged 1-4 years and 5-9 years (13.1 to 13.0 (males) and 13.0 to 13.9 (females) per 1000 respectively). Consultation rates for MC have declined by 50% from 2004 to 2013. Children were found to be more likely to have an MC consultation if they had previously consulted a GP with AE (OR 1.13; 95% CI = 1.11 to 1.16; P<0.005).

CONCLUSION

Consultations for MC in primary care are common, especially in 1-9-year-olds, but they declined significantly during the decade under study. A primary care diagnosis of AE is associated with an increased risk of a subsequent primary care diagnosis of MC.

Epidemiology of molluscum contagiosum in children: a systematic review

BACKGROUND

Molluscum contagiosum (MC) is a common skin condition that primarily affects children, a common reason for presenting in primary care and is commonly seen in children presenting with other conditions in primary and secondary care. It is usually asymptomatic but can present with pain, pruritus, erythema and bacterial superinfection. Aim. To synthesize the current epidemiology of MC. Design and setting. A systematic literature review of bibliographical databases on the prevalence, incidence, risk factors, age distribution and association with other conditions for MC in children.

RESULTS

Data on the epidemiology of MC is largely of poor quality. The largest incidence is in children aged between 0 and 14 years, where the incidence rate ranged from 12 to 14 episodes per 1000 children per year. Incidence rates in the UK were highest in those aged 1-4 years. Meta-analysis suggests a point prevalence in children aged 0-16 years of between 5.1% and 11.5%. There is evidence for an association between swimming and having MC and MC is more common in those with eczema; however, there is little evidence for other risk factors.

CONCLUSIONS

MC is a common condition, with the greatest incidence being in those aged 1-4 years. Swimming and eczema are associated with the presence of MC, but the causal relationships are unclear. There is a lack of data regarding the natural history of MC and published data are insufficient to determine temporal or geographic patterns in incidence, risk factors, duration of symptoms or transmission between family members.

[Immigration and HIV Infection. An approximation to parasitic and viral infections]

Highly-active antiretroviral therapy is effective in reducing opportunistic infections in industrialized countries. However, opportunistic parasitic infections remain the leading cause of HIV-related mortality in developing countries. These infections can also affect HIV-positive immigrants residing in Spain, as well as HIV-infected patients traveling to low-income countries. In addition, immigrants often have viral infections caused by herpesvirus, papillomavirus and polyomavirus, which are closely related to risk behaviors and commercial sex. The present article reviews the characteristics of parasitic and viral infections in patients with HIV infection with the aim of improving understanding of this vulnerable population group.

Fatal Cerebral Toxoplasmosis in a Heavily Immune Suppressed Patient with Waldentrom's Disease

A 57 year-old gentleman with Waldenstrom's disease developed ecthyma gangrenosum, molluscum contagiosum and fatal cerebral toxoplasmosis. The emergence of these infections is discussed in the light of drug-induced immune-suppression.