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McGowan D, Kermani A, Sheagren J. Investigating and Summarizing Information Resources Related to the Clinical Presentation and Diagnosis of Cutaneous Manifestations of Infectious Diseases in Patients With Skin of Color. Open Forum Infect Dis 2024; 11:ofad692. [PMID: 38390461 PMCID: PMC10883730 DOI: 10.1093/ofid/ofad692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/27/2023] [Indexed: 02/24/2024] Open
Abstract
Patients with skin of color (SOC) present diseases differently in many circumstances, yet there is a lack of information regarding the presentation and diagnosis of cutaneous manifestations in such patients experiencing infectious diseases. Therefore, we conducted a scoping review to investigate and summarize information pertaining to the clinical presentation and diagnosis of cutaneous manifestations of infectious diseases in patients with SOC focusing on the following viral, bacterial, toxin-mediated, and infestation diseases and fungal infections: human immunodeficiency virus, shingles, impetigo, scarlet fever, Lyme disease, toxic shock syndrome, scabies, rickettsioses, and cutaneous fungal infections. This scoping review identified literature gaps regarding cutaneous manifestations of infectious diseases in patients with SOC such as a lack of visual examples and more precise descriptions of common infectious diseases. The lack of better-quality literature and educational resources describing cutaneous manifestations of infectious diseases in patients with SOC may contribute to care barriers; therefore, more research and collaboration are needed in the specialties of both infectious diseases and dermatology.
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Affiliation(s)
- Dorothea McGowan
- Infectious Disease, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - Anosh Kermani
- Infectious Disease, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
| | - John Sheagren
- Infectious Disease, College of Human Medicine, Michigan State University, Grand Rapids, MI, USA
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Gonçalves Maciel LH, Vieira da Rocha Neto C, Ferreira Martins Y, de Azevedo Furtado F, Cunha Teixeira P, Oliveira Dias MY, Batista Rodrigues YK, Ribeiro Piauilino IC, Damasceno Pinto S, Côrte Alencar AC, de Lima Gimaque JB, Gomes Mourão MP, Guimarães Lacerda MV, da Costa Castilho M, Bôtto-Menezes C. Prevalence of arboviruses and other infectious causes of skin rash in patients treated at a tertiary health unit in the Brazilian Amazon. PLoS Negl Trop Dis 2022; 16:e0010727. [PMID: 36228027 PMCID: PMC9560595 DOI: 10.1371/journal.pntd.0010727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 08/10/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In the clinical course of diseases such as arboviruses, skin rashes may appear, as is often seen in other infectious diseases. The aim of this study was to estimate the prevalence of arboviruses and other infectious causes of skin rash in a tertiary health unit in Manaus, Amazonas state, Western Brazilian Amazon. METHODOLOGY/PRINCIPAL FINDINGS This was a cross-sectional study of patients presenting with rash who sought care at Fundação de Medicina Tropical Dr. Heitor Vieira Dourado (FMT-HVD) from February 2018 to May 2019. Individuals of either gender, aged over 18 years, were invited to participate voluntarily. Infection by Zika virus (ZIKV), dengue virus (DENV), chikungunya virus (CHIKV), Mayaro virus (MAYV), Oropouche virus (OROV) and measles was evaluated using RT-qPCR (real-time polymerase chain reaction). Immunodiagnostic tests for EBV, CMV, HIV, syphilis, rubella and measles were also performed. A total of 340 participants were included, most were female (228, 67.1%) with an average age of 36.5 years (SD ± 12.2 years). The highest prevalence was of ZIKV monoinfections (65.3%, 222/340), followed by DENV (0.9%, 3/340) and CHIKV infection (0.3%, 1/340). No cases of MAYV, OROV or rubella were found. Other causes of skin rash were detected: measles (2.9%, 10/340), parvovirus B19 (0.9% 3/340), HIV (0.3%, 1/340) and syphilis 0.6% (2/340). The co-infections identified were ZIKV+HIV (0.3%, 1/340), ZIKV+measles (0.3%, 1/340), ZIKV+parvovirus B19 (0.3%, 1/340), ZIKV+EBV (0.3%, 1/340), EBV+parvovirus B19 (0.3%, 1/340), CMV+parvovirus B19 (0.6%, 2/340), CMV+syphilis (0.3%, 1/340), ZIKV+EBV+parvovirus B19 (0.3%, 1/340) and CMV+EBV+parvovirus B19 (0.9%, 3/340). Approximately one quarter of patients had no defined cause for their skin rash (25.3%, 86/340). CONCLUSIONS Despite the benign clinical evolution of most of the diseases diagnosed in this series of cases, syndromic surveillance of diseases such as syphilis and HIV are of utmost importance. Periodic serosurveillance might also aid in evaluating the trends of endemic diseases and eventual outbreaks.
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Affiliation(s)
| | - Cosmo Vieira da Rocha Neto
- Programa de Iniciação Científica, Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brasil
| | - Yasmin Ferreira Martins
- Programa de Iniciação Científica, Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brasil
| | | | - Pâmela Cunha Teixeira
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil
| | - Maianne Yasmin Oliveira Dias
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
| | | | | | - Sérgio Damasceno Pinto
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil
| | | | | | - Maria Paula Gomes Mourão
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
| | - Marcus Vinicius Guimarães Lacerda
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Instituto Leônidas e Maria Deane (ILMD–Fiocruz Amazônia), Manaus, Amazonas, Brazil
| | | | - Camila Bôtto-Menezes
- Programa de Pós-graduação em Medicina Tropical, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- Fundação de Medicina Tropical Doutor Heitor Viera Dourado (FMT-HVD), Manaus, Amazonas, Brazil
- Escola Superior de Ciências da Saúde, Universidade do Estado do Amazonas (UEA), Manaus, Amazonas, Brazil
- * E-mail:
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Draganescu M, Baroiu L, Iancu A, Dumitru C, Radaschin D, Polea ED, Bobeica C, Tatu AL, Niculet E, Fekete GL. Perspectives on skin disorder diagnosis among people living with HIV in southeastern Romania. Exp Ther Med 2020; 21:97. [PMID: 33363608 DOI: 10.3892/etm.2020.9529] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 10/21/2020] [Indexed: 12/13/2022] Open
Abstract
The beginnings of the human immunodeficiency virus (HIV) pandemic are closely linked to dermatological conditions. A large part of the population living with HIV (PLWH) has a series of skin conditions that determine at some point, a visit to the dermatologist. The introduction of highly active antiretroviral therapy (HAART) more than 20 years ago has diminished the range of dermatological conditions, with improved immunosuppression of CD4 lymphocytes. The study aimed to describe the prevalence of the diagnosed type of skin changes in PLWH receiving antiretroviral therapy and their stratification according to the degree of immunodeficiency. A prospective study was conducted on 57 PLWH evaluated monthly at an HIV outpatient clinic, from a tertiary hospital in southeastern Romania. Clinical examination and dermoscopy revealed the existence of a wide range of dermatological conditions; all 57 patients (100%) being diagnosed with one or more dermatological conditions. As our study shows, the prevalence of different dermatoses among PLWH varies depending on the geographical region. At the same time, under HAART, the image of dermatoses associated with decreased immunity from HIV infection has changed. The skin changes of PLWH no longer fully follow the classical staging, based on the degree of immunosuppression.
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Affiliation(s)
- Miruna Draganescu
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, Galați 800010, Romania
| | - Liliana Baroiu
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, Galați 800010, Romania
| | - Alina Iancu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, Galați 800010, Romania
| | - Caterina Dumitru
- Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, Galați 800010, Romania
| | - Diana Radaschin
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, Galați 800010, Romania
| | - Eduard Drima Polea
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, Galați 800010, Romania
| | - Carmen Bobeica
- Department of Demato-Venereology, Doctoral School, 'Grigore T. Popa' University of Medicine and Pharmacy, Iași 700115, Romania
| | - Alin Laurentiu Tatu
- Department of Clinical Medicine, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, Galați 800010, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, Galați 800010, Romania
| | - Gyula Laszlo Fekete
- Department of Dermatology, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, Târgu Mureș 540142, Romania
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Mirnezami M, Zarinfar N, Sofian M, Botlani Yadegar B, Rahimi H. Mucocutaneous Manifestations in HIV-Infected Patients and Their Relationship to CD4 Lymphocyte Counts. SCIENTIFICA 2020; 2020:7503756. [PMID: 32850174 PMCID: PMC7439183 DOI: 10.1155/2020/7503756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 04/01/2020] [Accepted: 04/17/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND More than 90% of human immunodeficiency virus- (HIV-) infected patients show at least one mucocutaneous manifestation during the course of their disease. The frequency, pattern, and associated factors of these complications vary among different populations. OBJECTIVE This study was planned to evaluate the frequency of cutaneous presentations in HIV-infected patients and their association with the count of CD4 cells. METHODS A cross-sectional study was conducted on eighty-four HIV-positive patients, who attended the Behavior Consultation Center of Arak University of Medical Sciences. All subjects had a complete physical examination by an expert dermatologist. Further diagnostic procedures were performed, if necessary. Counts of CD4 were determined using flow cytometry. RESULTS From 84 patients who enrolled in this study, 95.2% manifested at least one type of mucocutaneous lesions. The most common presentation was xerosis, followed by seborrheic dermatitis, herpes simplex, and oral candidiasis. Oral candidiasis and furuncle were significantly associated with decrease in CD4 cell counts. CONCLUSIONS Cutaneous manifestations are common in HIV-positive patients, some of which (oral candidiasis and furuncle) could be applicable as useful clinical indicators to predict the immune status of the patients. Therefore, regular skin examinations are recommended as routine HIV-infected patients' healthcare programs.
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Affiliation(s)
- Mina Mirnezami
- Department of Dermatology, Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Nader Zarinfar
- Department of Infectious Diseases, Arak University of Medical Sciences, Arak, Iran
| | - Masoomeh Sofian
- Department of Internal Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Hoda Rahimi
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ramos-E-Silva M, Secchin P, Trope B. The life-threatening eruption in HIV and immunosuppression. Clin Dermatol 2019; 38:52-62. [PMID: 32197749 DOI: 10.1016/j.clindermatol.2019.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Immunosuppressed patients frequently have skin diseases of mild to moderate intensity. Diagnosis as well as treatment should be performed early to avoid important complications for these patients. Skin eruptions are among these problems. Life-threatening eruptions in HIV and other types of immunosuppression range from acute retroviral syndrome to drug eruptions; immune reconstitution inflammatory syndrome; infection by virus, protozoan, bacteria, or fungi; inflammatory and immune dermatoses; and neoplasia. All of these are discussed in this group of patients.
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Affiliation(s)
- Marcia Ramos-E-Silva
- The Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil.
| | - Pedro Secchin
- The Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
| | - Beatriz Trope
- The Sector of Dermatology and Post-Graduation Course in Dermatology, University Hospital and School of Medicine, Federal University of Rio de Janeiro, Brazil
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Karadag AS, Elmas ÖF, Altunay İK. Cutaneous manifestations associated with HIV infections: A great imitator. Clin Dermatol 2019; 38:160-175. [PMID: 32513397 DOI: 10.1016/j.clindermatol.2019.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
HIV is associated with an increased incidence of mucocutaneous disorders, with the overwhelming majority of HIV-infected individuals being afflicted with skin diseases during the course of the infection. Skin diseases in HIV patients are rarely fatal, but they have a significant effect on the quality of life. The immunologic stage of the infection and the use of highly active antiretroviral therapy (HAART) are the main elements that determine the spectrum of the mucocutaneous involvement. Many skin diseases may occur simultaneously in HIV patients, and the course of these diseases may or may not be different than it is in HIV-negative individuals. The unusual, severe, and different presentations of the mucocutaneous involvement make HIV one of the great imitators in dermatology.
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Affiliation(s)
- Ayse Serap Karadag
- Department of Dermatology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ömer Faruk Elmas
- Department of Dermatology, Faculty of Medicine, Ahi Evran University, Kırşehir, Turkey.
| | - İlknur Kıvanç Altunay
- Department of Dermatology, Şişli Hamidiye Etfal Research and Training Hospital, Health Science University, Istanbul, Turkey
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Bender AM, Tang O, Khanna R, Ständer S, Kang S, Kwatra SG. Racial differences in dermatologic conditions associated with HIV: A cross-sectional study of 4679 patients in an urban tertiary care center. J Am Acad Dermatol 2019; 82:1117-1123. [PMID: 31499147 DOI: 10.1016/j.jaad.2019.08.072] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 08/25/2019] [Accepted: 08/28/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Because of reduced mortality, patients with HIV are living longer and presenting with chronic diseases. Little is known about racial differences in dermatologic conditions associated with HIV infection. OBJECTIVE This study examines associated dermatologic conditions in a large population of patients with HIV at a tertiary care center with a diverse patient population. METHODS Cross-sectional study of patients with HIV seen between July 14, 2013, and July 14, 2018, in a tertiary health care system. The burden of HIV-related dermatologic conditions was collected by using medical records. Patients with HIV were compared with control individuals of the same race, and significance was assessed using the chi-square test. A Bonferroni correction was performed to control for multiple hypothesis testing. RESULTS The study population (N = 4679) was 64.7% male and 69% African American, with 88.7% of patients receiving antiretroviral therapy. African American patients with HIV had a greater risk of oral hairy leukoplakia (odds ratio [OR], 64.49), herpes zoster (OR, 9.27), prurigo nodularis (OR, 8.80), and squamous cell carcinoma (OR, 5.72). LIMITATIONS Our data describe patients seen by 1 health care system. CONCLUSIONS African American patients with HIV may be at increased risk for pruritic disorders compared with race-matched control individuals and white patients with HIV.
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Affiliation(s)
- Alexandra M Bender
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Olive Tang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Raveena Khanna
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sonja Ständer
- Center for Chronic Pruritus, Department of Dermatology, University of Münster, Münster, Germany
| | - Sewon Kang
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Shawn G Kwatra
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
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Ceccarelli M, Venanzi Rullo E, Vaccaro M, Facciolà A, d'Aleo F, Paolucci IA, Cannavò SP, Cacopardo B, Pinzone MR, Pellicanò GF, Condorelli F, Nunnari G, Guarneri C. HIV-associated psoriasis: Epidemiology, pathogenesis, and management. Dermatol Ther 2019; 32:e12806. [PMID: 30588732 DOI: 10.1111/dth.12806] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/15/2018] [Accepted: 12/25/2018] [Indexed: 01/14/2023]
Abstract
People living with HIV (PLWH) are affected by a higher incidence skin disorders, which are often associated with high morbidity and mortality. In particular, psoriasis affects PLWH severely and for a longer time than the general population. Human immunodeficiency virus (HIV) infection is characterized by a progressive decrease in CD4+ T-cell count, and it could seem paradoxical that psoriasis exacerbations are more frequent in this subset of patients than the general population, even though it is commonly observed at any stage of infection. For a long time, there have been limited therapeutic choices for PLWH affected by psoriasis. The introduction of the combined antiretroviral therapy dramatically changed the natural course of both HIV and psoriasis in PLWH, leading to an improvement of quality and duration of life. However, the clinical severity of psoriasis in PLWH often requires the use of immunosuppressant drugs. Knowledge about their safety and efficacy are limited to case-reports, small case-series and studies, therefore their use has not yet entered the routine. Further studies are needed to determine if immunosuppressive drugs can be safely and effectively used in PLWH affected by psoriasis and other autoimmune disorders.
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Affiliation(s)
- Manuela Ceccarelli
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emmanuele Venanzi Rullo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy.,Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mario Vaccaro
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Alessio Facciolà
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco d'Aleo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | | | | | - Bruno Cacopardo
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Marilia Rita Pinzone
- Department of Pathology and Laboratory Medicine, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.,Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Giovanni Francesco Pellicanò
- Department of Human Pathology of the Adult and the Developmental Age "G. Barresi", University of Messina, Messina, Italy
| | - Fabrizio Condorelli
- Department of Pharmacological Sciences, Università del Piemonte Orientale "A. Avogadro", Novara, Italy
| | - Giuseppe Nunnari
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Claudio Guarneri
- Department of Biomedical and Dental Sciences and Morpho Functional Imaging, University of Messina, Messina, Italy
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Abstract
There is a broad differential diagnosis for the presentation of fever and maculopapular rash in an adult. Although some causative conditions are benign, others are medical emergencies that require prompt diagnosis. We describe various conditions that result in a fever and maculopapular rash in adults. These include infectious processes (meningococcemia, infectious mononucleosis, West Nile virus, zika virus, rubella, primary human immunodeficiency virus, parvovirus B19, ebolavirus), tick-borne illnesses (Rocky Mountain spotted fever, ehrlichiosis), and hypersensitivity reactions (exanthematous drug reactions). We also provide an algorithm to aid in the diagnosis of the patient with fever and maculopapular rash. Such conditions that can occur in adults but are seen predominantly in children are discussed in the article "Rash with maculopapules and fever in children" of this issue.
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Rockenbach DM, Dallazem LND, Chemello RL, Beber AAC. An exuberant form of disseminated histoplasmosis. Braz J Infect Dis 2018; 22:243-244. [PMID: 29936098 PMCID: PMC9425681 DOI: 10.1016/j.bjid.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 11/18/2022] Open
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12
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Facial skin findings are indicators of human immunodeficiency virus infection and acquired immune deficiency syndrome: a retrospective study. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0750-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Swartz JA. A Multi-Group Latent Class Analysis of Chronic Medical Conditions Among Men Who Have Sex with Men. AIDS Behav 2016; 20:2418-2432. [PMID: 27037547 DOI: 10.1007/s10461-016-1381-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Until recently, research on the health of gay and other men who have sex with men (MSM) has focused on risk for and the health consequences of HIV and other sexually transmitted infections. A multigroup latent class analysis examined a range of lifetime chronic medical conditions (CMCs) among MSM. Covariates included sociodemographics, substance use, psychological distress, and HIV serostatus. A two-class model best fit the medical condition data: a low probabilities class for most CMCs and a moderate to high probabilities (MHP) class. HIV serostatus was associated with increased within-class probabilities for some CMCs, particularly gastrointestinal and skin disorders. Only increasing age and use of erectile dysfunction drugs were directly associated with increased odds of being in the MHP class whereas methamphetamine use, identifying as gay, and lower alcohol use were indirectly associated. Implications of the findings for future research and the health care needs of MSM are discussed.
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Affiliation(s)
- James A Swartz
- Jane Addams College of Social Work, University of Illinois at Chicago, 1040 W. Harrison Street, (M/C 309), Chicago, IL, 60607, USA.
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Thompson RA, Isin EM, Ogese MO, Mettetal JT, Williams DP. Reactive Metabolites: Current and Emerging Risk and Hazard Assessments. Chem Res Toxicol 2016; 29:505-33. [DOI: 10.1021/acs.chemrestox.5b00410] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Richard A. Thompson
- DMPK, Respiratory, Inflammation & Autoimmunity iMed, AstraZeneca R&D, 431 83 Mölndal, Sweden
| | - Emre M. Isin
- DMPK, Cardiovascular & Metabolic Diseases iMed, AstraZeneca R&D, 431 83 Mölndal, Sweden
| | - Monday O. Ogese
- Translational Safety, Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building 310, Cambridge Science Park, Milton Rd, Cambridge CB4 0FZ, United Kingdom
| | - Jerome T. Mettetal
- Translational Safety, Drug Safety and Metabolism, AstraZeneca R&D, 35 Gatehouse Dr, Waltham, Massachusetts 02451, United States
| | - Dominic P. Williams
- Translational Safety, Drug Safety and Metabolism, AstraZeneca R&D, Darwin Building 310, Cambridge Science Park, Milton Rd, Cambridge CB4 0FZ, United Kingdom
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Rodríguez-Estrada E, Fernández-Sánchez M, Muñoz-Delgado J, Fresan-Orellana A, Reyes-Terán G. Sleep and rest activity measured by wrist actigraphy in an HIV-infected patient with Steven–Johnson syndrome. BIOL RHYTHM RES 2015. [DOI: 10.1080/09291016.2015.1088186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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16
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Costa J, Neves R, Delgado M, Lima-Neto R, Morais V, Coêlho M. Dermatophytosis in patients with human immunodeficiency virus infection: clinical aspects and etiologic agents. Acta Trop 2015. [PMID: 26200786 DOI: 10.1016/j.actatropica.2015.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dermatophytosis in individuals with human immunodeficiency virus infection seems to manifest with atypical, multiple, or extensive lesions more frequently. In addition, there are reports of presentations with little inflammation, called anergics. Less common etiologic agents have been isolated in these individuals, such as Microsporum species. To describe clinical aspects and etiologic agents of dermatophytosis in individuals with human immunodeficiency virus (HIV) infection. Patients with clinical diagnosis of dermatophytosis underwent scarification for mycological diagnosis through direct microscopic examination and fungal isolation in culture on Sabouraud dextrose agar. Sixty individuals had a clinical hypothesis of dermatophytosis. In 20 (33.3%) of the 60 patients, dermatophytosis was confirmed through a mycological study. Tinea corporis, diagnosed in 14 patients, was the most frequent clinical form, followed by tinea unguium in 7, tinea cruris in 5, and tinea pedis in 1 patient. Most of the lesions of tinea corporis were anergic. Five patients with tinea unguium had involvement of multiple nails, with onychodystrophy as the predominant subtype. Multiple cutaneous lesions occurred in 3 patients and extensive cutaneous lesions in 4. Regarding the agent, Trichophyton rubrum was the most commonly isolated. The high occurrence of anergic skin lesions and involvement of multiple nails, especially as onychodystrophy, corroborates the hypothesis that atypical, disseminated, and more severe presentations are common in individuals with HIV infection. However, no Microsporum species was isolated even in atypical, extensive, or disseminated cases, in disagreement with previous reports. Therefore, the approach of squamous lesions in HIV-positive patients must include a mycological study, in view of the possibility of anergic dermatophytosis, to promote the introduction of a suitable therapeutic agent.
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Maghrabi MM, Lum S, Joba AT, Meier MJ, Holmbeck RJ, Kennedy K. Norwegian crusted scabies: an unusual case presentation. J Foot Ankle Surg 2014; 53:62-6. [PMID: 24370484 DOI: 10.1053/j.jfas.2013.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Indexed: 02/03/2023]
Abstract
Scabies is a contagious condition that is transmitted through direct contact with an infected person and has been frequently associated with institutional and healthcare-facility outbreaks. The subtype Norwegian crusted scabies can masquerade as other dermatologic diseases owing to the heavy plaque formation. Successful treatment has been documented in published reports, including oral ivermectin and topical permethrin. Few case studies documenting the treatment of Norwegian crusted scabies have reported the use of surgical debridement as an aid to topical and/or oral treatment when severe plaque formation has been noted. A nursing home patient was admitted to the hospital for severe plaque formation of both feet. A superficial biopsy was negative for both fungus and scabies because of the severity of the plaque formation on both feet. The patient underwent a surgical, diagnostic biopsy of both feet, leading to the diagnosis of Norwegian crusted scabies. A second surgical debridement was then performed to remove the extensive plaque formation and aid the oral ivermectin and topical permethrin treatment. The patient subsequently made a full recovery and was discharged back to the nursing home. At 2 and 6 months after treatment, the patient remained free of scabies infestation, and the surgical wound had healed uneventfully. The present case presentation has demonstrated that surgical debridement can be complementary to the standard topical and oral medications in the treatment of those with Norwegian crusted scabies infestation.
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Affiliation(s)
- Michael M Maghrabi
- Director of Podiatric Medicine and Surgery Residency Program, Presence Health, Saints Mary and Elizabeth Medical Center, Chicago, IL.
| | - Shireen Lum
- Attending, Presence Health, Saints Mary and Elizabeth Medical Center, Chicago, IL
| | - Ameha T Joba
- Attending, Presence Health, Saints Mary and Elizabeth Medical Center, Chicago, IL
| | - Molly J Meier
- PGY3, Presence Health, Saints Mary and Elizabeth Medical Center, Chicago, IL
| | - Ryan J Holmbeck
- PGY2, Presence Health, Saints Mary and Elizabeth Medical Center, Chicago, IL
| | - Kate Kennedy
- PGY1, Presence Health, Saints Mary and Elizabeth Medical Center, Chicago, IL
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Abstract
Sub-Saharan Africa is the epicenter of the HIV pandemic and HIV-infected people are more susceptible to inflammatory dermatoses, infections, and drug eruptions. Many of the drugs used for HIV-associated opportunistic infections are associated with a higher incidence of drug-related toxicities and drug interactions. This article discusses the epidemiology, pharmacogenetics, and clinical features of idiosyncratic drug reactions in HIV-infected Africans. Special considerations in this population, including immune reconstitution inflammatory syndrome, multiple drug hypersensitivity syndrome, drug reactions in pregnancy, drug rechallenge in lichenoid drug eruptions, and anxiety/depression after cutaneous adverse drug reactions, are also briefly discussed.
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Naveen KN, Pai VV, Rai V, Athanikar SB. Retrospective analysis of Steven Johnson syndrome and toxic epidermal necrolysis over a period of 5 years from northern Karnataka, India. Indian J Pharmacol 2013; 45:80-2. [PMID: 23543919 PMCID: PMC3608301 DOI: 10.4103/0253-7613.106441] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Revised: 09/28/2012] [Accepted: 10/29/2012] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Cutaneous drug reactions are the most common type of adverse drug reactions. Adverse cutaneous drug reactions form 2-3% of the hospitalized patients. 2% of these are potentially serious. This study aims to detect the drugs commonly implicated in Steven Johnson Syndrome-Toxic Epidermal Necrosis (SJS-TEN). MATERIALS AND METHODS A retrospective analysis was done in all patients admitted in the last five years in SDM hospital with the diagnosis of SJS-TEN. RESULTS A total of 22 patients with SJS-TEN were studied. In 11 patients anti-epileptics was the causal drug and in 7, anti-microbials was the causal drug. Recovery was much faster in case of anti epileptics induced SJS-TEN as compared to that induced by ofloxacin. CONCLUSION SJS-TEN induced by ofloxacin has a higher morbidity and mortality compared to anti convulsants.
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Affiliation(s)
- Kikkeri Narayanasetty Naveen
- Department of Dermatology, Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Dharwad, Karnataka, India
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Baudoux L, Ingen-Housz-Oro S, Corneille J, Sbidian E, Duong T, Valeyrie-Allanore L, Bagot M, Chosidow O, Wolkenstein P. Suspected Viral Maculopapular Eruptions: An Audit of Practice. Dermatology 2013; 227:72-7. [DOI: 10.1159/000352078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 05/15/2013] [Indexed: 11/19/2022] Open
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21
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Klein CN, Mohanraj BS, Musial R, Popnikolov N, Vielemeyer O. Rapidly Progressive Skin Lesions Requiring Admission in a Young, HIV-Infected Man. Clin Infect Dis 2013. [DOI: 10.1093/cid/cis667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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22
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Han J, Lun W, Meng Z, Huang K, Mao Y, Zhu W, Lian S. Mucocutaneous manifestations of HIV-infected patients in the era of HAART in Guangxi Zhuang Autonomous Region, China. J Eur Acad Dermatol Venereol 2012; 27:376-82. [DOI: 10.1111/j.1468-3083.2011.04429.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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23
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Smijs TGM, Pavel S. The susceptibility of dermatophytes to photodynamic treatment with special focus on Trichophyton rubrum. Photochem Photobiol 2010; 87:2-13. [PMID: 21114670 DOI: 10.1111/j.1751-1097.2010.00848.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Owing to the accessibility of skin to light, many applications of photodynamic treatment (PDT) have been developed within dermatology. The recent increase of dermatological antimicrobial PDT investigations is related to the growing problem of bacterial and fungal resistance to antibiotics. This review focuses on the susceptibility of dermatophytic fungi, in particular Trichophyton rubrum, to PDT and shows its potential usefulness in treatment of clinical dermatophytoses. There are no data indicating significant differences in PDT susceptibility between various dermatophytes and it is unlikely that treatment problems of especially T. rubrum with current antimycotics would occur in case of PDT. Red light 5-aminolevulinic acid-mediated PDT is after repeated sessions successful in in vivo treatment of onychomycosis (fungal nail infection) caused by various dermatophytes. Regarding skin dermatophytoses, UVA-1 PDT with cationic porphyrins appears to be safe and efficient. Most effective toward T. rubrum ex vivo is 5,10,15-tris(4-methylpyridinium)-20-phenyl-[21H,23H]-porphine trichloride (Sylsens B) when combined with UVA-1 radiation or red light; this creates the possibility of efficiently treating nail infections and remaining spores in hair follicles. If the promising in vitro and ex vivo results could be transferred to clinical practice, then PDT has a good prospect to become a worthy alternative to established antifungal drugs.
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Affiliation(s)
- Threes G M Smijs
- Department of Environmental Science, Open University Netherlands, Rotterdam, The Netherlands.
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