Anti-Acne Effects of Cembrene Diterpenoids from the Cultured Soft Coral Sinularia flexibilis

Acne is a skin disease common in adolescents and increasingly common in the adult population. The major pathologic events of acne vulgaris include increased sebum production, retention hyperkeratosis, carrying commensal skin microbiota, and inflammation. In recent years, more than 10,000 compounds have been isolated and identified from marine organisms. The aim of this study was to discover the potential anti-acne activity of fraction 9 + 10 (SF-E) of Sinularia flexibilis extract and six cembrene diterpenoids. We found that the SF-E significantly reduced Cutibacterium acnes-induced edema in Wistar rat ears. The cembrene diterpenoids including 11-dehydrosinulariolide (SC-2), 3,4:8,11-bisepoxy-7-acetoxycembra-15(17)-en-1,12-olide (SC-7), and sinularin (SC-9) reduced nitric oxide (NO) production with 50% inhibitory concentration of 5.66 ± 0.19, 15.25 ± 0.25, and 3.85 ± 0.25 μM, respectively, and inducible NO synthase expression in RAW 264.7 cells. Moreover, treatment with SC-2, SC-7, and SC-9 significantly suppressed lipopolysaccharide- and heat-killed C. acnes-induced expression of proteins involved in mitogen-activated protein kinase pathway in both RAW 264.7 and HaCaT cells. After treatment with SC-2, SC-7, and SC-9, over-proliferation of HaCaT cells was significantly terminated. In summary, SC-2, SC-7, and SC-9 showed anti-inflammatory effects in RAW 264.7 cells, suggesting that these cembrene diterpenoids obtained from S. flexibilis are natural marine products with potential anti-acne activities.

Polymorphism of the alpha-1-fucosyltransferase (FUT1) gene in several wild boar (Sus scrofa) populations in France and link to edema disease

BACKGROUND

In 2013, an outbreak of edema disease in a population of wild boars (Sus scrofa) took place. This was the first described case as reported worldwide. An enterotoxigenic Escherichia coli (presenting the Stx2e and F18 virulence factors) is the main pathogen for this disease in wild boar. The alpha-1-fucosyltransferase gene (FUT1) has been identified as the gene regulating the expression of the receptor for E. coli stx2e F18 bacteria in domestic pigs affected by the disease. The genotypic frequencies of the FUT1 gene in European wild boars have not yet been investigated. The genotypes of wild boars for this gene were determined in four French departments with or without edema diseases cases.

RESULTS

All of the wild boars analyzed had a genotype susceptible to the disease (GG or AG). The recessive, resistant A allele was found for the first time in wild boars, but in a very small proportion of individuals (7/222). No statistical differences were found between healthy hunted wild boars versus wild boars found dead by edema disease or among the four French departments.

CONCLUSIONS

These results suggest that further mortality due to edema disease remains possible in wild boars in France.

Anti-inflammatory, anti-pyretic and analgesic activities of Tamarix dioica

Medicinal and aromatic plants contribute to major portion of the flora. The plant materials obtained from these plants are used in the pharmaceuticals, cosmetics, and drug industries. Tamarix dioica is locally used in the management of splenic and hepatic inflammation as well as diuretic and carminative. It also possesses cytotoxic, antimicrobial, antifungal and anti-inflammatory activity. The present study investigates the anti-inflammatory, anti-pyretic and analgesic activities of the crude methanolic extract from Tamarix dioica. Anti-inflammatory activity was measured by Carrageenan Induced Paw Edema and Xylene Induced Ear Edema methods. Pyrexia induction with Brewer's yeast assay was used to determine antipyretic activity and analgesic activity was estimated by acetic acid induced writhing and hot plate methods. The data indicated that anti-inflammatory, anti-pyretic and analgesic activities of the crude methanolic extract from Tamarix dioica was dose and time dependent when measured by different assays. Exposure of model animal to increasing concentrations of the plant extract for longer period increased their anti-inflammatory, anti-pyretic and analgesic activities. Significantly highest anti-inflammatory, anti-pyretic and analgesic activities were noted at highest doses of the crude methanolic extract for longer exposure compared with their respective controls.

Shiga toxin 2 from enterohemorrhagic Escherichia coli induces reactive glial cells and neurovascular disarrangements including edema and lipid peroxidation in the murine brain hippocampus

BACKGROUND

Shiga toxin 2 from enterohemorrhagic Escherichia coli is the etiologic agent of bloody diarrhea, hemolytic uremic syndrome and derived encephalopathies that may result to death in patients. Being a Gram negative bacterium, lipopolysaccharide is also released. Particularly, the hippocampus has been found affected in patients intoxicated with Shiga toxin 2. In the current work, the deleterious effects of Shiga toxin 2 and lipopolysaccharide are investigated in detail in hippocampal cells for the first time in a translational murine model, providing conclusive evidences on how these toxins may damage in the observed clinic cases.

METHODS

Male NIH mice (25 g) were injected intravenously with saline solution, lipopolysaccharide, Shiga toxin 2 or a combination of Shiga toxin 2 with lipopolysaccharide. Brain water content assay was made to determine brain edema. Another set of animals were intracardially perfused with a fixative solution and their brains were subjected to immunofluorescence with lectins to determine the microvasculature profile, and anti-GFAP, anti-NeuN, anti-MBP and anti-Iba1 to study reactive astrocytes, neuronal damage, myelin dysarrangements and microglial state respectively. Finally, the Thiobarbituric Acid Reactive Substances Assay was made to determine lipid peroxidation. In all assays, statistical significance was performed using the One-way analysis of variance followed by Bonferroni post hoc test.

RESULTS

Systemic sublethal administration of Shiga toxin 2 increased the expressions of astrocytic GFAP and microglial Iba1, and decreased the expressions of endothelial glycocalyx, NeuN neurons from CA1 pyramidal layer and oligodendrocytic MBP myelin sheath from the fimbria of the hippocampus. In addition, increased interstitial fluids and Thiobarbituric Acid Reactive Substances-derived lipid peroxidation were also found. The observed outcomes were enhanced when sublethal administration of Shiga toxin 2 was co-administered together with lipopolysaccharide.

CONCLUSION

Systemic sublethal administration of Shiga toxin 2 produced a deterioration of the cells that integrate the vascular unit displaying astrocytic and microglial reactive profiles, while edema and lipid peroxidation were also observed. The contribution of lipopolysaccharide to pathogenicity caused by Shiga toxin 2 resulted to enhance the observed hippocampal damage.

Severe Lower Body Swelling and Bacteremia Secondary to Shewanella algae Bacteremia During Basic Underwater Demolition SEAL Training

Shewanella algae is a unique bacterium largely documented in skin and soft tissue infections (SSTIs) with a wide range of presentations from gas-producing necrotizing fasciitis to osteomyelitis. Seawater exposure to lower extremity ulcers and wounds is most often correlated with infection, which has been documented in causing complications of bacteremia, sepsis, and infective endocarditis. Further complicating treatment is poor response to most empiric regimens prior to definitive diagnosis and an uneven response to antibiotics, including documented resistance to carbapenem. This case documents the presentation of a Basic Underwater Demolition SEAL (BUD/S) training candidate who presented acutely for complaints of severe lower body swelling and abrasions during "Hell Week" and was found to have polymicrobial bacteremia with Staphylococcus aureus, Enterococcus, and S algae.

Ethanolic Extract of Origanum vulgare Suppresses Propionibacterium acnes-Induced Inflammatory Responses in Human Monocyte and Mouse Ear Edema Models

Acne vulgaris (acne) is a common inflammatory skin disorder, and Propionibacterium acnes plays a major role in the development and progression of acne inflammation. Herbs possessing antimicrobial and anti-inflammatory activity have been applied as a medical option for centuries. In this study, we examined the suppressive effect of ethanolic oregano (Origanum vulgare) extract on live P. acnes-induced in vivo and in vitro inflammation. Following ethanol extraction of oregano leaves, four compounds with strong antioxidant activity, including rosmarinic acid, quercetin, apigenin, and carvacrol, were identified by high-performance liquid chromatography. Using the mouse ear edema model, we demonstrated that ethanol oregano extracts (EOE) significantly suppressed P. acnes-induced skin inflammation, as measured by ear thickness (32%) and biopsy weight (37%). In a separate study, using the co-culture of P. acnes and human THP-1 monocytes, EOE reduced the production of interleukin (IL)-8, IL-1β and tumor necrosis factor (TNF)-α up to 40%, 37%, and 18%, respectively, as well as the expression of these three pro-inflammatory mediators at the transcriptional level. Furthermore, EOE inhibited the translocation of nuclear factor-kappa B (NF-κB) into the nucleus possibly by inactivating toll-like receptor-2 (TLR2). The suppressive effect of EOE on live P. acnes-induced inflammatory responses could be due, in part, to the anti-inflammatory and antioxidant properties, but not the anti-microbial effect of EOE.

A Fatal Case of Super-super Obesity (BMI >80) in a Patient with a Necrotic Soft Tissue Infection

A 35-year-old man (height, 169 cm; body weight, 240 kg; BMI, 84) visited the Department of Dermatology due to left leg pain and swelling. Focused enhanced computed tomography (CT) of the left leg ruled out complications of deep venous thrombosis. Surgical exploration of the left leg resulted in a diagnosis of necrotic soft tissue infection, but amputation was ruled out due to his weight. The patient ultimately died of multiple organ failure on the fourth day of hospitalization. A culture of the surgical material revealed Streptococcus dysgalactiae. The present case suggests that super-obese patients should be aggressively treated before lethal complications occur.

[Sepsis and a swollen hand]

We describe a 53-year-old man presenting at the emergency department with sepsis and a swollen right hand. Over the course of a day a large haemorrhagic bulla developed on the back of the hand. The blood cultures were positive for Streptococcus pyogenes. Our diagnosis was bullous cellulitis leading to S. pyogenes sepsis.

[Compression is important in erysipelas treatment]

Erysipelas is a common skin infection involving the lymphatic vessels, which induces an oedema. This has a tendency of persisting after infection is treated. The lymphatic system plays an important role in the immune system, and the impaired lymph drainage leads to a state of local immune deficiency. This is essential to the pathogenesis of recurrent erysipelas, as each episode of erysipelas further damages the lymphatic system and increases the risk of a new infection. This vicious circle makes it important to treat both erysipelas and oedema appropriately to reduce recurrence and morbidity.

Multiple Activities of Punica granatum Linne against Acne Vulgaris

Acne is a common skin condition with sebum overproduction, hyperkeratosis, Propionibacterium acnes (P. acnes) and Staphylococcus aureus, and inflammation. Punica granatum (pomegranate) is well-known for its anti-inflammatory effects; however, few studies have discussed the anti-acne effects of pomegranate. In this study, we found that pomegranate extract (PG-E) significantly reduced P. acnes-induced edema in Wistar rat ears. Therefore, an evaluation platform using multiple pathogenic mechanisms of acne was established to explore the anti-acne effects of pomegranate. Results showed that PG-E inhibited bacterial growth and lipase activity. Through a bioguided-fractionation-isolation system, four hydrolysable tannins, punicalagin (1), punicalin (2), strictinin A (3), and granatin B (4), were isolated. Compounds 1 and 2 had greater anti-bacterial activities and anti-testosterone-induced HaCaT proliferative effects than the others. Compounds 1, 3, and 4 displayed lipase inhibitory effects. Compound 4 decreased cyclooxygenase-2 expression and downregulated prostaglandin E₂ production in heat-killed P. acnes-treated RAW 246.7 cells. In conclusion, PG-E is abundant in hydrolysable tannins that display multiple anti-acne capacities, including anti-bacterial, anti-lipase, anti-keratinocyte proliferation, and anti-inflammatory actions. Hence, PG-E has great potential in the application of anti-acne and skin-care products, and punicalagin (1), the most effective component in PG-E, can be employed as a quality control marker.

[IMPACT OF THE TISSUES OEDEMA ON THE RESULT OF SURGICAL TREATMENT OF INFLAMMATION]

Significance of the tissues oedema and its elimination in the course of inflammation and the wound healing was investigated. There were analyzed the results of treatment of 68 patients, suffering inflammatory and necrotic affection of soft tissues, including 65 – a lower one, 3 – an upper. In 47 observations the affection course was an acute, while in 18 – chronic. In 36 patients (control group) a local and systemic antibacterial therapy were conducted, and in accordance to indications – surgical interventions; in 32 (main group) this treatment was added with tight bandaging of the extremity, using elastic bandage. Tight squeezing of tissues with the oedema elimination on background of an adequate antibacterial therapy and surgical sanation of purulent-necrotic focus is accompanied by arrest of infiltrative and exudative stages of an acute inflammation, promotes an active course of the inflammation proliferative stage. While treatment of chronic cutaneous defect, the application of tight squeezing have promoted the granulating shaft resolution, the granulation growth in the wound and its boundary epithelization.

Septic Arthritis in Infants Younger Than 3 Months: A Retrospective Review

Septic arthritis in infants is rare and can be difficult to diagnose. This study reviewed a series of patients younger than 3 months to identify factors that may assist in early diagnosis and treatment. A query of records at a large Midwestern pediatric hospital (1994-2010) was performed to identify all patients younger than 3 months at the time of diagnosis. Analysis included birth history, joint involvement, physical examination findings, laboratory results, imaging results, method of treatment, and outcome. In 14 cases (11 boys, 3 girls; mean age at diagnosis, 42.2 days), complete records were available for review. Involved joints included the knee, hip, and shoulder. The most common findings on physical examination were decreased range of motion (100%), tenderness (100%), and swelling (71.4%). Mean temperature was 38.5°C. Mean white blood cell count was 18.5 K/µL, mean erythrocyte sedimentation rate was 48.9 mm/h, and mean C-reactive protein level was 6.1 mg/dL. More than half (57.1%) of joint aspirates grew positive cultures, and 41.7% of blood cultures had positive results. Causative organisms were group B streptococcus, methicillin-sensitive Staphylococcus aureus, Haemophilus influenzae, Streptococcus pneumoniae, Salmonella enterica, and Candida albicans. The most common physical examination findings in infants younger than 3 months with septic arthritis include tenderness, decreased range of motion, and swelling. White blood cell count, C-reactive protein level, and erythrocyte sedimentation rate are likely to be elevated, but these findings should be used in combination with findings on physical examination and radiographic studies to aid in diagnosis.

Erysipelas in a free-range layer flock with conjunctival oedema as an unusual clinical sign

Erysipelas was diagnosed in a free-range laying flock with a high mortality of up to 7% per day and a severe decrease in egg production to 45%. The disease had a short course and unusual clinical features for erysipelas, including swollen, lacrimating and encrusted eyes. Bacteriologically, trapped poultry red mites and affected animals were culture-positive for Erysipelothrix rhusiopathiae. Isolates from layers and mites were both serotype 1b. Histopathology revealed disseminated intravasal coagulopathy in conjunctival small vessels as the cause of the oedema of the eye adnexes. After treatment with penicillin, mortality and egg production returned to normal levels. Although erysipelas in laying hens is rarely reported, it can develop as an emerging disease in alternative rearing systems and should always be considered if mortality increases in an older flock, especially with a high infestation of poultry red mites.

Non pitting edema, arthritis and ichthyosis; presenting manifestation of leprosy

Leprosy is a chronic granulomatous infection caused by Mycobacterium leprae. Predominantly involving skin and nerves and having classic clinical description, the diagnosis may be clear-cut in majority of patients but may be challenging in others. Non-pitting edema, ichthyosis and arthritis are uncommon in leprosy and very rare in tuberculoid type where the diagnosis may be challenging unlike relatively clear-cut clinical picture in lepromatous type. Musculoskeletal manifestation is seen in 1-5% of cases and usually associated with reactional states where again the diagnosis sometimes becomes evident. High index of suspicion is therefore recommended in patients with unexplained systemic illness especially in endemic areas. Herein we report a young male with non pitting edema and symmetric peripheral arthritis involving all four limbs, and ichthyosis as presenting manifestation of borderline leprosy where the neuro-cutaneous manifestation developed two months after the said presenting features and in absence of a reactional state.

Cytotoxic necrotizing factor 1 and hemolysin from uropathogenic Escherichia coli elicit different host responses in the murine bladder

Cytotoxic necrotizing factor 1 (CNF1) and hemolysin (HlyA1) are toxins produced by uropathogenic Escherichia coli (UPEC). We previously showed that these toxins contribute to the inflammation and tissue damage seen in a mouse model of ascending urinary tract infection. CNF1 constitutively activates small Rho GTPases by deamidation of a conserved glutamine residue, and HlyA1 forms pores in eukaryotic cell membranes. In this study, we used cDNA microarrays of bladder tissue isolated from mice infected intraurethrally with wild-type CP9, CP9cnf1, or CP9ΔhlyA to further evaluate the role that each toxin plays in the host response to UPEC. Regardless of the strain used, we found that UPEC itself elicited a significant change in host gene expression 24 h after inoculation. The largest numbers of upregulated genes were in the cytokine and chemokine signaling and Toll-like receptor signaling pathways. CNF1 exerted a strong positive influence on expression of genes involved in innate immunity and signal transduction and a negative impact on metabolism- and transport-associated genes. HlyA1 evoked an increase in expression of genes that encode innate immunity factors and a decrease in expression of genes involved in cytoskeletal and metabolic processes. Multiplex cytokine and myeloperoxidase assays corroborated our finding that a strong proinflammatory response was elicited by all strains tested. Bladders challenged intraurethrally with purified CNF1 displayed pathology similar to but significantly less intense than the pathology that we observed in CP9-challenged mice. Our data demonstrate substantial roles for CNF1 and HlyA1 in initiation of a strong proinflammatory response to UPEC in the bladder.

Fatal lower limb infection by Trichosporon asahii in an immunocompetent patient

Trichosporon (T.) asahii can cause superficial skin infections and can be an opportunistic pathogen that produces potentially fatal systemic infections in immunocompromised hosts. We report a case of lower limb infection due to T. asahii in an immunocompetent patient who displayed no evidence of underlying disease. There is a strong possibility that our patient had been colonized at the infection site as part of the normal skin flora. After one-month bed rest due to an accidental fall and fracture of the right shoulder blade, a 61-year-old woman experienced severe edema and redness in the right lower limb and received topical treatment with iodine solution and antibiotics without improvement. She presented at our Outpatient Clinic with cellulitis and lymphedema. Samples collected from the affected areas revealed T. asahii and the patient was referred to a hospital for infectious diseases for appropriate therapy. The patient was treated with wound dressings until she was admitted to our intensive care unit when her general condition abruptly deteriorated. Despite in vitro susceptibility results, therapy with liposomal amphotericin and voriconazole could not change the fatal outcome. Nowadays, physicians must suspect this emerging difficult-to-treat fungal pathogen and treatment must start promptly in these infections.

Isolation and characterization of virulent Aeromonas veronii from ascitic fluid of oscar Astronotus ocellatus showing signs of infectious dropsy

The cichlid oscar Astronotus ocellatus has worldwide commercial value in the pet fish industry because of its early maturation, relatively high fecundity, ability to identify its caretaker and also to alter colouration amongst conspecifics. Pathogenic strains of Aeromonas veronii resistant to multiple antibiotics were isolated from A. ocellatus individuals showing signs of infectious abdominal dropsy. The moribund fish showed haemorrhage in all internal organs, and pure cultures could be obtained from the abdominal fluid. The isolates recovered were biochemically identified as A. veronii biovar sobria and genetically confirmed as A. veronii based on 16S rRNA gene sequence analysis (GenBank accession no. FJ573179). The RAPD profile using 3 primers (OPA-3, OPA-4 and OPD-20) generated similar banding patterns for all isolates. They displayed cytotoxic and haemolytic activity and produced several exoenzymes which were responsible for the pathogenic potential of the isolates. In the representative isolate MCCB 137, virulence genes such as enterotoxin act, haemolytic toxin aerA, type 3 secretion genes such as aexT, ascVand ascF-ascG, and gcat (glycerophospholipid-cholesterol acyltransferase) could be amplified. MCCB 137 exhibited a 50% lethal dose (LD50) of 10(5.071) colony-forming units ml(-1) in goldfish and could be subsequently recovered from lesions as well as from the internal organs. This is the first description of a virulent A. veronii from oscar.

Isolated tubercular pseudotumour of lateral malleolus

A 22-year-young adult presented with a painless swelling of distal fibula on right side for 3-month duration. He had no constitutional symptoms and there was full range of painfree ankle movement. Radiographs showed cortical breech with an osteolytic lesion in lateral malleolus. Magnetic Resonance Imaging showed T2W hyperintense signal in the distal fibula. It further revealed involvement of tendo Achilles and paroneal tendons. Fine needle aspiration cytology showed epitheloid granuloma and Langhans giant cells. The Mycobacterium tuberculosis DNA could be identified on polymerase chain reaction. The patient received 18 months of antitubercular treatment and the lesion subsided. There is no recurrence even after 3 years of follow up. A strong suspicion of tuberculosis should be considered in any bony swelling of a patient from endemic area, even at atypical sites. Polymerase chain reaction analysis should be performed in addition to radiological and histological examination of the lesion to establish the diagnosis. Early treatment with antitubercular therapy decreases the morbidity and avoids the possibility of surgical intervention.

Chyloma: an uncommon cause of supraclavicular swelling

We report the case of a 46-year-old woman who noticed a swelling of the left supraclavicular fossa of rapid onset soon after a Mycoplasma Pneumoniae upper respiratory infection. On the basis of clinical history, physical examination and imaging findings, a diagnosis of chyloma due to intense non-productive coughing bouts was made. The supraclavicular swelling progressively disappeared after a few days. This observation prompted us to briefly review the pathophysiology of chylomas.

[Pathogenesis of enteral insufficiency in patients with postoperative peritonitis]

Enteral insufficiency is considered to trigger the syndrome of endogenous intoxication and, further, multiple organ failure. Enteral insufficiency often accompanies postoperative septic complications, such as peritonitis. Morphologic changes of the intestinal wall by septic peritonitis consisted of edema, fibrinous degradation of muscular layer and dystrophy of local nervous pathways. Microbiologic analysis of intestinal and gastric contents, peritoneal fluid and blood samples demonstrated a broad spectrum of pathogenic flora. Besides, enterotoxin allocated from blood and intestinal contents coincided in all cases. Adequate algorithm of detoxication, including extracorporal methods, had been worked out.

[Virulence genes of pathogenic Escherichia coli from ill pigs in China and their relationship with O-serogroups]

OBJECTIVE

We determined the distribution of serogroups and virulence factors among Escherichia coli isolates from pigs with diarrhea and/or edema disease from 10 provinces in China between 1998 and 2007.

METHODS

Three hundred E. coli isolates were serogrouped with O-antisera and detected for genes of enterotoxins, shiga-toxin-two-variant (Stx2e), intimin, K88, K99, 987P, F18 and F41 fimbrial antigens by PCR.

RESULTS

Among 300 isolates, 233 were determined to be placed in serogroups, 50 were unable to be serogrouped, and the rest 17 auto-agglutinated. These isolates distributed in 45 serogroups and 57.1% (133/233) belonged to 5 O serogroups: O149, O107, O139, O93 and O91. Several uncommon O serogroups were discovered. PCR analysis confirmed the genes of est I (STa), est II (STb), elt (LT), stx2e (Stx2e) and eaeA (Intimin) within the isolates. There were six pathotypes of porcine E. coli by their pathogenic factors, namely enterotoxigenic E. coli (ETEC), shiga toxin-producing E. coli (STEC), attaching-effacing E. coli (AEEC), ETEC/ STEC, AEEC/ETEC and AEEC/ETEC/STEC. The correlation between pathotypes and serogroups showed that the combinations of O149/K88/estII, O149/K88/est II+elt, O107/F18/est II, 093/est II and O98/est II were common types in ETEC strains, O139/ F18/stx2e for STEC strains, eaeA gene for AEEC strains, O107/F18/estI+stx2e, O107/F18/estII + stx2e and O116/F18/est I +elt+stx2e for ETEC/STEC strains, 091/est I/eaeA and O107/est I /eaeA for AEEC/ETEC/STEC strains".

CONCLUSION

ETEC was commonly associated with swine colibacillosis, whereas the kinds of enteric E. coli pathogens become more complex in China.

Short report: edematous Mycobacterium ulcerans infection (Buruli ulcer) on the face: a case report

We report a case of a four-year-old Angolan boy with the edematous form of Buruli ulcer on the face and scalp, who was treated at a rural hospital in the Bas-Congo Province, Democratic Republic of Congo. Treatment consisted of a series of surgical interventions and antimycobacterial chemotherapy (rifampin and ciprofloxacin) for two months. This case demonstrates the diagnostic and management difficulties of an edematous lesion of BU on the face and suggests an enhancement of healing and limitation of extent of excision by specific antibiotherapy. The outcome in this patient also underscores the importance of prompt referral of suspected cases and training of health professionals in the early diagnosis of BU.

Rhinocerebral mucormycosis acquired after a short course of prednisone therapy

Rhinocerebral mucormycosis is a rapidly progressive and often fatal infection frequently seen in patients with uncontrolled diabetes mellitus and hematologic malignancies. The disease is difficult to diagnose because it often masquerades as bacterial sinusitis. The current report describes a 69-year-old white woman with diabetes mellitus who was prescribed high-dose prednisone therapy for chronic obstructive pulmonary disease. Two weeks after treatment initiation, she presented to the hospital with facial edema on the right side, mouth pain, and general weakness. No black eschars on the nasal mucosae or palates were present on admission. Although bacterial etiology was initially suspected, surgery and tissue samples revealed the presence of rhinocerebral mucormycosis. The patient died at 6 days postadmission despite aggressive medical and surgical intervention. The current report discusses the risk factors associated with rhinocerebral mucormycosis as well as the necessity of early diagnosis and treatment to improve patient outcomes.

Endothelial cells as active participants in veterinary infections and inflammatory disorders

Endothelial cells were once viewed as relatively inert cells lining the vasculature. They are now recognized as active and responsive regulators of coagulation, platelet adhesion, fluid homeostasis, wound healing, leukocyte extravasation and vascular tone. Endothelial cells play a key role in the host response to infectious agents by regulating leukocyte trafficking, producing inflammatory cytokines and presenting antigen in association with major histocompatibility class II (MHC II) molecules. A number of infectious agents have a tropism for endothelial cells. Infection of endothelial cells can promote thrombosis, vascular leakage, and increased adherence and emigration of leukocytes. Furthermore, activation of a systemic inflammatory response, in the absence of direct endothelial cell infection, can also lead to endothelial cell dysfunction. The purpose of this review is to highlight the interactions between endothelial cells and infectious or inflammatory agents that contribute to coagulation disturbances, vasculitis and edema. A select group of viral and bacterial pathogens will be used as examples to demonstrate how endothelial cell dysfunction contributes to the pathogenesis of infectious and inflammatory disorders.

Unusual Presentation of Isolated Sacral Tuberculosis

Tuberculosis is as old as mankind. Vertebral tuberculosis is fairly common form of bone and joint tuberculosis. However, isolated sacral tuberculosis is rare. It may present as an atypical sacral lesion having epidural granuloma without destruction of sacrum on MRI and plain X-rays. This atypical presentation may lead to delay in diagnosis and treatment. This case report intends to emphasize that spinal tuberculosis should be the first and foremost differential diagnosis in the presence of atypical clinical and radiological features of a sacral lesion particularly in developing countries. Early diagnosis and treatment can prevent or minimize the neurological morbidity in such cases.

[Leprosy revealed by oedema of the hands]

BACKGROUND

We reported a case of lepromatous leprosy in a Tunisian woman revealed by a potentially misleading clinical picture involving isolated infiltration of the hands.

PATIENTS AND METHODS

A 37 year-old woman consulted in October 2000 for bilateral edema of the hands associated with paraesthesia that had been present for one month. Screening for Hansen's bacilli confirmed the diagnosis of multibacillary leprosy. Daily therapy with triple anti-leprosy treatment was initiated.

DISCUSSION

The occurrence of edema, which is classically described as a symptom of a reactional state, can occur during the course of leprosy. Where it is a presenting symptom, this unusual heralding sign can be a source of diagnostic error and delay.

Molecular analysis of Filifactor alocis, Tannerella forsythia, and treponema denticola associated with primary endodontic infections and failed endodontic treatment

The aim of this study was to investigate the presence of strict anaerobes such as Filifactor alocis, Tannerella forsythia, and Treponema denticola in primary and secondary root-infected canals with periapical lesions by molecular analysis and the association of these species with specific endodontic signs and symptoms. Microbial samples were taken from 100 root canals, 50 with necrotic pulp tissues (NPT, primary infection), and 50 with failed endodontic treatment (FET, secondary infection). DNA was extracted from the samples, which were analyzed for the presence of three endodontic pathogens using species-specific primers and PCR. F. alocis were isolated from 23 canals with NPT and 12 canals with FET; T. forsythia from 12 canals with NPT and three canals with FET; T. denticola from 19 canals with NPT and 12 canals with TEP. Suggested associations were found between primary infection and the presence of F. alocis and T. forsythia (both p < 0.05). In particular, associations were found between: pain and F. alocis; swelling and F. alocis; tenderness to percussion and T. forsythia; mobility and T. forsythia and T. denticola; wet canals and F. alocis, T. forsythia, and T. denticola; purulent exsudate and F. alocis, T. forsythia and T. denticola; abscess and F. alocis, T. forsythia, and T. denticola (all p < 0.05). The findings of this study indicated that F. alocis, T. forsythia, and T. denticola seem to be associated with endodontic signs and symptoms. Additionally, F. alocis and T. forsythia were detected more frequently in teeth with necrotic pulp than in teeth with failing endodontic treatment.

Oedema as a risk factor for multiple episodes of cellulitis/erysipelas of the lower leg: a series with community follow-up

BACKGROUND

Cellulitis of the lower leg is a common problem with considerable morbidity. Risk factors are well identified but the relationship between consequences of cellulitis and further episodes is less well understood.

OBJECTIVES

To review risk factors, treatment and complications in patients with lower leg cellulitis, to determine the frequency of long-term complications and of further episodes, and any relationship between them, and to consider the likely impact of preventive strategies based on these results.

METHODS

Patients with ascending, presumed streptococcal, cellulitis of the lower leg were identified retrospectively from hospital coding. Hospital records, together with questionnaires to both general practitioners and patients, were used to record subsequent complications and identifiable risk factors for further episodes.

RESULTS

Of 171 patients, 81 (47%) had recurrent episodes and 79 (46%) had chronic oedema. The concurrence of these two factors was strongly correlated (P < 0.0002). Based on 143 completed questionnaires, oedema was apparently due to or persistently asymmetrical after the cellulitic episode in 52 (37%), and 19 (13%) had ulceration attributed to, rather than causing, cellulitis. Of those with three or more episodes, half did not lead to hospital admission. Toeweb maceration was reported in only 15% of questionnaires. Use of antibiotic treatment for more than 28 days was associated with a reduced risk of leg ulceration or of prolonged oedema compared with shorter courses, but neither difference was statistically significant.

CONCLUSIONS

This study demonstrates that the true frequency of postcellulitic oedema, as well as that of further episodes, is probably underestimated. Furthermore, there is a strong association between these factors, each of which is both a risk factor for, and a consequence of, each other, and for which intervention (reduction of oedema or more prolonged antibiotic therapy) may reduce the risk of recurrent infection. By contrast, self-reporting of toeweb maceration is low, so attempts to reduce the risk of recurrent cellulitis by treatment of tinea pedis or bacterial intertrigo may fail.

Evaluation of the pathogenicity of the Bacteroides fragilis toxin gene subtypes in gnotobiotic mice

Enterotoxigenic Bacteroides fragilis (ETBF) strains produce a metalloprotease toxin (BFT) related to diarrheal disease in animals, young children, and adults. Three different isoforms of the enterotoxin, designated BFT-1, BFT-2, and BFT-3, have been identified and sequenced. In the present study, the pathogenicity of the ETBF strains carrying bft-1 or bft-2 was evaluated. Each toxin gene subtype of ETBF (bft-1 or bft-2) was intragastrically monoassociated to germ-free mice during 10 days and histopathological data from intestines and liver compared with those from mice monoassociated to a non-enterotoxigenic B. fragilis. Histopathological alterations were observed in all groups of animals related to ETBF. These alterations were characterized mainly by ulceration, edema, and inflammatory infiltration in intestine. However, these lesions were slightly more severe in mice monoassociated with bft-2 subtype. No alteration or lesion was observed in animals associated with the non-enterotoxigenic B. fragilis. In conclusion, strains harboring bft-1 or bft-2 gene subtypes were able to induce histopathological alterations in intestine of a gnotobiotic mice model and it could explain the effect produced for the enterotoxin.

Cyclooxygenase 2 expression in vessels and nerves in reversal reaction leprosy

Tissue expression of cyclooxygenase (COX)2, an inducible enzyme synthesizing eicosanoids in inflammation, was studied in reversal reaction (RR) leprosy in comparison with nonreactionary leprosy. COX2 was consistently expressed in cells of the mononuclear-macrophage lineage across the leprosy spectrum. Only in RR, the following two additional sites showed COX2 expression in the dermis and subcutis: 1) microvessels and 2) nerve bundles and isolated nerve fibers. The same sites also express vascular endothelial growth factor (VEGF). This is in keeping with experimental models relating VEGF to COX2 expression, with VEGF enhancing prostaglandin production through COX2 stimulation and prostaglandin synthase expression. We postulate that selective COX2 inhibitors, which are currently used in several inflammatory conditions, could be considered for RR treatment to reduce acute symptoms caused by tissue edema and possibly prevent long-term nerve damage, the main complication of RR.

[Prevalence of LEE and HPI pathogenicity islands of Escherichia coli isolates from weaned piglets in China]

To investigate the distribution of LEE pathogenicity island and HPI of Yersinia entercolitica in Escherichia coli isolates from weaned piglets, PCR based on intimin gene (eaeA) of LEE pathogenicity island and high molecular weight protein 2 (HMWP1) gene (irp2) of HPI was developed. A total of 240 isolates from 140 diarrheic, 76 edematous and 24 edematous/diarrheic weaned piglets from different farms were tested for the presence of the two genes. Sequence analysis of randomly selected PCR products showed that eaeA gene of 5 isolates was 100%, irp2 gene of 7 isolates was 98.2%, fyuA gene of 5 isolates was 98.3% and Asn-tRNA-intB of 5 isolates was 95.8% identical to the published sequences. Isolates with LEE + HPI gene were more frequently detected in diarrheic swine than in edematous swine and edematous/diarrheic swine, and isolates with LEE gene were more frequently detected in edematous/diarrheic piglets than in edematous and diarrheic piglets. Furthermore, isolates with LEE or HPI or LEE + HPI were more frequently detected in diarrheic swine. 72.5% of HPI + isolates were fyuA positive and linked to asn-tRNA.

Shiga toxin 2e-producing Escherichia coli isolates from humans and pigs differ in their virulence profiles and interactions with intestinal epithelial cells

Thirteen Escherichia coli strains harboring stx2e were isolated from 11,056 human stools. This frequency corresponded to the presence of the stx2e allele in 1.7% of all Shiga toxin-producing E. coli (STEC) strains. The strains harboring stx2e were associated with mild diarrhea (n = 9) or asymptomatic infections (n = 4). Because STEC isolates possessing stx2e are porcine pathogens, we compared the human STEC isolates with stx2e-harboring E. coli isolated from piglets with edema disease and postweaning diarrhea. All pig isolates possessed the gene encoding the F18 adhesin, and the majority possessed adhesin involved in diffuse adherence; these adhesins were absent from all the human STEC isolates. In contrast, the high-pathogenicity island encoding an iron uptake system was found only in human isolates. Host-specific patterns of interaction with intestinal epithelial cells were observed. All human isolates adhered to human intestinal epithelial cell lines T84 and HCT-8 but not to pig intestinal epithelial cell line IPEC-J2. In contrast, the pig isolates completely lysed human epithelial cells but not IPEC-J2 cells, to which most of them adhered. Our data demonstrate that E. coli isolates producing Shiga toxin 2e have imported specific virulence and fitness determinants which allow them to adapt to the specific hosts in which they cause various forms of disease.

Neonatal haemorrhagic conjunctivitis: a specific sign of chlamydial infection

OBJECTIVE

To review the bacteriological causes and clinical features of acute neonatal conjunctivitis in a local paediatric centre.

DESIGN

Retrospective review.

SETTING

Paediatric unit of a regional hospital, Hong Kong.

PATIENTS

All neonates who presented to Tuen Mun Hospital from 1 January 1996 to 31 December 2002 with persistent eye discharge and a positive eye swab culture.

MAIN OUTCOME MEASURES

Clinical features of neonates with chlamydial and non-chlamydial conjunctivitis.

RESULTS

Of 90 neonates with positive eye swab or conjunctival scraping cultures, Chlamydia trachomatis was the second most common (n=19, 21%) cause of acute neonatal conjunctivitis after Staphylococcus aureus (n=32, 36%). All of the neonates with chlamydial conjunctivitis were delivered vaginally: two of them had concomitant chlamydial pneumonia. Neisseria gonorrhoeae conjunctivitis was rare (n=1, 1%). None of the mothers of neonates with Chlamydia had any history of sexually transmitted disease. The timing of presentation, gestational age, birth weight, and sex of the neonates did not suggest a risk of chlamydial infection. Nonetheless haemorrhagic eye discharge had a specificity of 100% and positive predictive value of 100% for chlamydial infection. There were no adverse ophthalmological consequences or complications of pyloric stenosis in any neonate following treatment with oral erythromycin.

CONCLUSIONS

Haemorrhagic eye discharge is a highly specific sign of neonatal chlamydial conjunctivitis. Early and prompt treatment with oral erythromycin is safe and effective.

An unusual presentation of epidural Acinetobacter infection

OBJECTIVE

We report a case of spinal-cord compression caused by epidural fat infection with Acinetobacter. The initial magnetic resonance imaging (MRI) scan suggested epidural hematoma or abscess, although both were absent at surgery.

CASE REPORT

A 60-year-old man had a thoracic epidural sited at the level of T8/9 for postoperative analgesia after major abdominal surgery. A mixture of bupivacaine 0.1% and fentanyl 2 microg/mL was infused at a rate of 10 mL/h for 48 hours postoperatively. The epidural catheter was then removed, but 24 hours later, the patient still had weakness and numbness in his lower limbs. An MRI scan showed cord compression secondary to a hematoma or abscess from the level of T6 to T11. At laminectomy, no hematoma or abscess was found, but edematous epidural fat was excised. This fat was sent for culture and Acinetobacter was grown. Appropriate antibiotic therapy was given. Over a period of 12 months, the patient has regained near-normal power and sensation.

CONCLUSION

Epidural Acinetobacter infection may present atypically without signs of meningism. MRI imaging may be confusing in these infections and lead to incorrect radiological diagnoses. Spinal-cord compression, as a complication of epidural catheter placement, does not have to be caused by hematoma or abscess.