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Salle R, Del Giudice P, Skayem C, Hua C, Chosidow O. Secondary Bacterial Infections in Patients with Atopic Dermatitis or Other Common Dermatoses. Am J Clin Dermatol 2024; 25:623-637. [PMID: 38578398 DOI: 10.1007/s40257-024-00856-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 04/06/2024]
Abstract
Secondary bacterial infections of common dermatoses such as atopic dermatitis, ectoparasitosis, and varicella zoster virus infections are frequent, with Staphylococcus aureus and Streptococcus pyogenes being the bacteria most involved. There are also Gram-negative infections secondary to common dermatoses such as foot dyshidrotic eczema and tinea pedis. Factors favoring secondary bacterial infections in atopic dermatitis, ectoparasitosis, and varicella zoster virus infections mainly include an epidermal barrier alteration as well as itch. Mite-bacteria interaction is also involved in scabies and some environmental factors can promote Gram-negative bacterial infections of the feet. Furthermore, the bacterial ecology of these superinfections may depend on the geographical origin of the patients, especially in ectoparasitosis. Bacterial superinfections can also have different clinical aspects depending on the underlying dermatoses. Subsequently, the choice of class, course, and duration of antibiotic treatment depends on the severity of the infection and the suspected bacteria, primarily targeting S. aureus. Prevention of these secondary bacterial infections depends first and foremost on the management of the underlying skin disorder. At the same time, educating the patient on maintaining good skin hygiene and reporting changes in the primary lesions is crucial. In the case of recurrent secondary infections, decolonization of S. aureus is deemed necessary, particularly in atopic dermatitis.
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Affiliation(s)
- Romain Salle
- Service de Dermatologie Générale et Oncologique, UVSQ, EA4340-BECCOH, AP-HP, Hôpital Ambroise-Paré, Université Paris-Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France.
| | - Pascal Del Giudice
- Unité D'Infectiologie et Dermatologie, Centre Hospitalier Intercommunal de Fréjus-Saint-Raphaël, Fréjus, France
| | - Charbel Skayem
- Service de Dermatologie Générale et Oncologique, UVSQ, EA4340-BECCOH, AP-HP, Hôpital Ambroise-Paré, Université Paris-Saclay, 9 Avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France
| | - Camille Hua
- AP-HP, Service de Dermatologie, Hôpital Henri Mondor, Créteil, France
| | - Olivier Chosidow
- Consultation Dermatoses Faciales, Service d'ORL, AP-HP, Hôpital Universitaire Pitié-Salpêtrière, Paris, France
- UPEC Créteil, Créteil, France
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Williame I, George M, Shah HA, Homer N, Alderson D, Jamet N. Healthcare resource use and costs of varicella and its complications: A systematic literature review. Hum Vaccin Immunother 2023; 19:2266225. [PMID: 37885425 PMCID: PMC10760364 DOI: 10.1080/21645515.2023.2266225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2023] Open
Abstract
Varicella is a highly contagious disease caused by the varicella zoster virus (VZV). While the disease is usually mild, severe complications can occur requiring costly hospitalization. A thorough understanding of the healthcare resource use (HCRU) and costs of varicella is needed to inform health-economic models of preventive strategies. A systematic literature review was carried out to retrieve relevant publications between 1999 and 2021, reporting HCRU and cost outcomes for varicella and its complications. Data were extracted and stratified according to pre-specified age groups and complication categories. Costs were re-based to a $US2020 footing using both purchasing power parity and the medical component of consumer price indexes. Data were summarized descriptively due to high heterogeneity in study design and outcome reporting. Forty-four publications fulfilled the inclusion and exclusion criteria of which 28 were conducted in Europe, 6 in Middle East and Asia, 5 in South America, 3 in North America, and 2 in multiple regions. Primary healthcare visits accounted for 30% to 85% of total direct costs. Hospitalization costs varied between $1,308 and $38,268 per episode depending on country, complication type, and length of stay, contributing between 2% and 60% to total direct costs. Indirect costs, mostly driven by workdays lost, accounted for approximately two-thirds of total costs due to varicella. The management of varicella and related complications can lead to substantial HCRU and costs for patients and the healthcare system. Additional research is needed to further characterize the varicella-associated economic burden and its broader impact from a societal standpoint.
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Alfroukh K, Abu Sabha MR, Bairmani ZA, Tomizi MG, Abuturki AA. A Rare Case of Chickenpox Infection Complicated by Hip Septic Arthritis. Cureus 2023; 15:e45930. [PMID: 37885533 PMCID: PMC10599406 DOI: 10.7759/cureus.45930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2023] [Indexed: 10/28/2023] Open
Abstract
Chickenpox represents a viral malady characterized by the emergence of vesicular skin eruptions. This ailment is frequently encountered during childhood and typically manifests a benign course devoid of complications. Among the prevalent complications, secondary bacterial skin infections ranging from superficial impetigo to subcutaneous abscesses are most frequently observed. Instances of musculoskeletal complications, such as septic arthritis and osteomyelitis, are rarely observed. In any patient presenting complaints of bone pain or arthralgia, either during varicella eruptions or during the healing process, it is imperative to maintain a vigilant consideration for the potential manifestation of septic arthritis and osteomyelitis. Timely diagnosis holds paramount importance, as the administration of appropriate antibiotics can effectively forestall the necessity for surgical interventions and mitigate the risk of sequela. In this context, we present a case wherein chickenpox resulted in the complication of right hip septic arthritis.
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Affiliation(s)
| | - Mosa R Abu Sabha
- Department of Internal Medicine, Faculty of Medicine, Al Quds University, Jerusalem, PSE
| | - Zinah A Bairmani
- Department of Pharmacology & Experimental Therapeutics, Thomas Jefferson University, Philadelphia, USA
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Solorzano-Pinot E, Garcia-Cardenas M, Armendariz-Ferrari JC, Fernandez-Badillo V, Keirns C, Espinola-Zavaleta N. Varicella Associated to Acute Myocardial Infarction Caused by Infective Endocarditis. Clin Pediatr (Phila) 2023; 62:942-945. [PMID: 36661085 DOI: 10.1177/00099228221150697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
| | | | | | | | - Candace Keirns
- International Medical Interpreters Association, Woburn, MA, USA
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Purohit SK, Samer C, McWilliam HEG, Traves R, Steain M, McSharry BP, Kinchington PR, Tscharke DC, Villadangos JA, Rossjohn J, Abendroth A, Slobedman B. Varicella Zoster Virus Impairs Expression of the Nonclassical Major Histocompatibility Complex Class I-Related Gene Protein (MR1). J Infect Dis 2021; 227:391-401. [PMID: 34648018 PMCID: PMC9891426 DOI: 10.1093/infdis/jiab526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/13/2021] [Indexed: 02/04/2023] Open
Abstract
The antigen presentation molecule MR1 (major histocompatibility complex, class I-related) presents ligands derived from the riboflavin (vitamin B) synthesis pathway, which is not present in mammalian species or viruses, to mucosal-associated invariant T (MAIT) cells. In this study, we demonstrate that varicella zoster virus (VZV) profoundly suppresses MR1 expression. We show that VZV targets the intracellular reservoir of immature MR1 for degradation, while preexisting, ligand-bound cell surface MR1 is protected from such targeting, thereby highlighting an intricate temporal relationship between infection and ligand availability. We also identify VZV open reading frame (ORF) 66 as functioning to suppress MR1 expression when this viral protein is expressed during transient transfection, but this is not apparent during infection with a VZV mutant virus lacking ORF66 expression. This indicates that VZV is likely to encode multiple viral genes that target MR1. Overall, we identify an immunomodulatory function of VZV whereby infection suppresses the MR1 biosynthesis pathway.
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Affiliation(s)
| | | | - Hamish E G McWilliam
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute of Infection and Immunity, Melbourne, Victoria, Australia,Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Renee Traves
- Infection, Immunity and Inflammation, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Megan Steain
- Infection, Immunity and Inflammation, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Brian P McSharry
- Infection, Immunity and Inflammation, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Paul R Kinchington
- Department of Ophthalmology and Department of Microbiology and Molecular Genetics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - David C Tscharke
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jose A Villadangos
- Department of Microbiology and Immunology, University of Melbourne, Peter Doherty Institute of Infection and Immunity, Melbourne, Victoria, Australia,Department of Biochemistry and Pharmacology, Bio21 Molecular Science and Biotechnology Institute, University of Melbourne, Parkville, Victoria, Australia
| | - Jamie Rossjohn
- Infection and Immunity Program and Department of Biochemistry and Molecular Biology, Biomedicine Discovery Institute, Monash University, Melbourne, Australia,Institute of Infection and Immunity, Cardiff University School of Medicine, Wales, United Kingdom
| | | | - Barry Slobedman
- Correspondence: Barry Slobedman, BSc (Hons), PhD, Infection, Immunity and Inflammation, School of Medical Sciences, Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Camperdown NSW 2006, Australia ()
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Hagemann C, Krämer A, Grote V, Liese JG, Streng A. Specific Varicella-Related Complications and Their Decrease in Hospitalized Children after the Introduction of General Varicella Vaccination: Results from a Multicenter Pediatric Hospital Surveillance Study in Bavaria (Germany). Infect Dis Ther 2019; 8:597-611. [PMID: 31674000 PMCID: PMC6856245 DOI: 10.1007/s40121-019-00273-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Universal varicella vaccination (UVV) for children introduced in Germany in 2004 resulted in a significant overall decline of varicella-related hospitalizations (VRHs). We investigated the incidence of specific types of varicella-related complications (VRCs) in hospitalized children and the impact of UVV on VRCs during the first 7 years of UVV. METHODS Children < 17 years of age hospitalized with an ICD-10-based (International Classification of Diseases, 10th Revision) discharge diagnosis of varicella were identified as VRH in pediatric hospitals in Bavaria by annual standardized data queries of the hospital databases (2005-2011). For each VRH, the hospitals reported basic demographic data, duration of hospital stay, all diagnostic and procedural codes, and outcome. VRCs were reported overall, per year, and by immune status. Complication rates were calculated as mean number per complication category per hospital and per year; VRC trends over time were assessed by linear regression. RESULTS Between 78% (2005) and 61% (2011) of Bavarian hospitals participated and reported a total of 1263 VRHs. Specific VRCs were reported in 954 (76%) children. Complication rates per hospital and year decreased from 6.7 [95% confidence interval (CI): 5.1-8.3] in 2005 to 1.5 (95% CI: 0.8-2.3) in 2011, with the strongest reduction of 90% in children < 5 years of age from 5.3 (95% CI: 4.0-6.6) in 2005 to 0.5 (95% CI: 0.1-0.9) in 2011. Significant decreases were observed for children with upper respiratory tract (URT, by 97%), lower respiratory tract (LRT, by 90%), skin (by 81%), gastrointestinal (by 78%), and neurologic (by 65%) VRCs. Forty-eight children with VRCs were immunocompromised; their annual rate decreased by 87%. DISCUSSION Corresponding to increasing varicella vaccination coverage in the population, the incidence of VRC decreased by 77% from 2005 to 2011, with the most substantial decrease in the target group for UVV. CONCLUSION Within 7 years, UVV in Germany led to a decrease of about 77% of all types of VRCs, with the highest reductions observed for VRCs of the respiratory tract.
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Affiliation(s)
- Christine Hagemann
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
- School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany
| | - Alexander Krämer
- School of Public Health, Bielefeld University, Universitätsstr. 25, 33615, Bielefeld, Germany.
| | - Veit Grote
- Dr. von Haunersches Children's Hospital, University of Munich, Lindwurmstr. 4, 80337, Munich, Germany
| | - Johannes G Liese
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
| | - Andrea Streng
- Department of Pediatrics, University Hospital of Würzburg, Josef-Schneider-Str. 2, 97080, Würzburg, Germany
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Wellens L, Casteels I, Huygens M. Veillonella parvula periorbital cellulitis: an unusual pathogen causing a common clinical sign. GMS OPHTHALMOLOGY CASES 2019; 9:Doc17. [PMID: 31293873 PMCID: PMC6607445 DOI: 10.3205/oc000106] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We describe the case of a one-year-old boy who presented at the emergency department with a sudden onset of fulminant edema of the right eyelid. He had been suffering from a varicella zoster virus (VZV) infection for 5 days. A secondary bacterial infection of varicella skin lesions was suspected. Computed tomography of the orbit revealed pronounced superficial soft tissue inflammation of the right periorbit, without intraorbital extension. There was a spontaneous rupture of the right upper eyelid and a culture of the released fluid grew the anaerobic organism Veillonella parvula. The patient was treated with clindamycin for 2 months and made a slow, yet full recovery.
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Affiliation(s)
- Liesbeth Wellens
- Department of Ophthalmology, University Hospitals KU Leuven, Belgium
| | - Ingele Casteels
- Department of Ophthalmology, University Hospitals KU Leuven, Belgium
| | - Marc Huygens
- Department of Ophthalmology, AZ Sint-Lucas Brugge, Bruges, Belgium
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Jansen KU, Knirsch C, Anderson AS. The role of vaccines in preventing bacterial antimicrobial resistance. Nat Med 2018; 24:10-19. [DOI: 10.1038/nm.4465] [Citation(s) in RCA: 147] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 12/04/2017] [Indexed: 01/03/2023]
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Avila-Aguero ML, Ulloa-Gutierrez R, Camacho-Badilla K, Soriano-Fallas A, Arroba-Tijerino R, Morice-Trejos A. Varicella prevention in Costa Rica: impact of a one-dose schedule universal vaccination. Expert Rev Vaccines 2016; 16:229-234. [DOI: 10.1080/14760584.2017.1247700] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- María L. Avila-Aguero
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Kattia Camacho-Badilla
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Alejandra Soriano-Fallas
- Servicio de Infectología Pediátrica, Hospital Nacional de Niños “Dr. Carlos Sáenz Herrera”, Centro de Ciencias Médicas, Caja Costarricense del Seguro Social (CCSS), San José, Costa Rica
| | - Roberto Arroba-Tijerino
- Programa Ampliado de Inmunizaciones, Dirección de Vigilancia de la Salud, Ministerio de Salud, San José, Costa Rica
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Esposito S. Infectious Diseases: Pathophysiology, Diagnostics and Prevention. Int J Mol Sci 2016; 17:ijms17091464. [PMID: 27598145 PMCID: PMC5037742 DOI: 10.3390/ijms17091464] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 12/16/2022] Open
Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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