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Al-Tawfiq JA, Spinola SM. Infections caused by Haemophilus ducreyi: one organism, two stories. Clin Microbiol Rev 2024:e0013524. [PMID: 39287406 DOI: 10.1128/cmr.00135-24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2024] Open
Abstract
SUMMARYChancroid, a sexually transmitted infection caused by Haemophilus ducreyi, is characterized by painful genital ulcers (GU) and inguinal lymphadenitis. H. ducreyi was recently described as a major cause of non-sexually transmitted cutaneous ulcers (CU) on the lower legs in children in yaws-endemic regions. This review explores the relationship between CU and GU strains of H. ducreyi; their clinical presentation, diagnosis, epidemiology, and treatment; and how findings from a human challenge model relate to GU and CU. We contrast the decline of GU with the persistence of CU caused by H. ducreyi. Factors such as transmission dynamics, control, and elimination efforts are discussed. Syndromic management and targeted treatment of sex workers can eradicate chancroid, while skin colonization by CU strains and environmental factors may necessitate topical treatments or vaccination for CU eradication. Efforts should focus on identifying additional reservoirs of CU strains, improving hygiene, and eliminating asymptomatic colonization to eradicate this painful infection in children.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Division of Infectious Diseases, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stanley M Spinola
- Department of Medicine, Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Microbiology and Immunology, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indiana University, Indianapolis, Indiana, USA
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2
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Ko YK, Kim E, Lee EJ, Nam SJ, Kim Y, Kim S, Choi SY, Kim HY, Choi Y. Enrichment of infection-associated bacteria in the low biomass brain bacteriota of Alzheimer's disease patients. PLoS One 2024; 19:e0296307. [PMID: 38335187 PMCID: PMC10857729 DOI: 10.1371/journal.pone.0296307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/08/2023] [Indexed: 02/12/2024] Open
Abstract
Alzheimer's disease (AD) is a neurodegenerative disease accompanied by neuroimmune inflammation in the frontal cortex and hippocampus. Recently, the presence of bacteria in AD-affected brains has been documented, prompting speculation about their potential role in AD-associated neuroinflammation. However, the characterization of bacteriota in human brains affected by AD remains inconclusive. This study aimed to investigate potential associations between specific bacteria and AD pathology by examining brain tissues from AD-associated neurodegenerative regions (frontal cortex and hippocampus) and the non-AD-associated hypothalamus. Employing 16S rRNA gene sequencing, 30 postmortem brain tissue samples from four individuals with normal brain histology (N) and four AD patients were analyzed, along with three blank controls. A remarkably low biomass characterized the brain bacteriota, with their overall structures delineated primarily by brain regions rather than the presence of AD. While most analyzed parameters exhibited no significant distinction in the brain bacteriota between the N and AD groups, the unique detection of Cloacibacterium normanense in the AD-associated neurodegenerative regions stood out. Additionally, infection-associated bacteria, as opposed to periodontal pathogens, were notably enriched in AD brains. This study's findings provide valuable insights into potential link between bacterial infection and neuroinflammation in AD.
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Affiliation(s)
- Yeon Kyeong Ko
- Department of Immunology and Molecular Microbiology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Eunbi Kim
- Department of Immunology and Molecular Microbiology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Soo Jeong Nam
- Department of Pathology, Asan Medical Center, Seoul, Republic of Korea
| | - Yeshin Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Seongheon Kim
- Department of Neurology, Kangwon National University Hospital, Kangwon National University College of Medicine, Chuncheon, Republic of Korea
| | - Se-Young Choi
- Department of Physiology, Dental Research Institute, Seoul National University School of Dentistry, Seoul, Republic of Korea
| | - Hyun Young Kim
- Department of Immunology and Molecular Microbiology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
| | - Youngnim Choi
- Department of Immunology and Molecular Microbiology, School of Dentistry and Dental Research Institute, Seoul National University, Seoul, Republic of Korea
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3
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Asymptomatic Exophytic Plaques on the Penis of a Patient With HIV Infection: Answer. Am J Dermatopathol 2020; 42:218-219. [PMID: 32079819 DOI: 10.1097/dad.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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4
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Muller EE, Kularatne R. The changing epidemiology of genital ulcer disease in South Africa: has donovanosis been eliminated? Sex Transm Infect 2020; 96:596-600. [PMID: 32075875 DOI: 10.1136/sextrans-2019-054316] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/27/2020] [Accepted: 02/06/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES We used an in-house molecular assay for the detection of Klebsiella granulomatis in ulcer specimens collected over a 12-year surveillance period in order to determine whether a diagnosis of donovanosis could be ascribed to genital ulcer disease (GUD) of unknown aetiology in our setting. METHODS Between 2007 and 2018, a total of 974 genital ulcer specimens with no previously identified sexually transmitted (STI) pathogens were selected from STI aetiological surveys conducted in all nine provinces of South Africa. Giemsa-stained ulcer smears from the same participants had previously been routinely analysed for the presence of typical Donovan bodies within large mononuclear cells. A Klebsiella screening assay targeting the phoE (phosphate porin) gene was used in combination with restriction digest analysis and sequencing to confirm the presence of K. granulomatis. RESULTS The Klebsiella screening assay tested positive in 19/974 (2.0%) genital ulcer specimens. Restriction digest analysis and nucleotide sequencing of the phoE gene confirmed that none of these specimens was positive for K. granulomatis DNA. Similarly, Donovan bodies were not identified in the Giemsa stained ulcer smears of these specimens. CONCLUSIONS This is the first study to assess K. granulomatis as a cause of genital ulceration in South Africa over a 12-year surveillance period using molecular methods. The results demonstrate that K. granulomatis is no longer a prevalent cause of GUD in our population.
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Affiliation(s)
- Etienne E Muller
- STI Section, Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Ranmini Kularatne
- STI Section, Centre for HIV & STIs, National Institute for Communicable Diseases, Johannesburg, South Africa.,Department of Clinical Microbiology & Infectious Diseases, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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5
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Donovanosis, Chancroid, and Endemic Treponematoses: Clinical Features and Control. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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6
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Sambri V. The Laboratory Diagnosis of Bacterial Sexually Transmitted Diseases. Sex Transm Infect 2020. [DOI: 10.1007/978-3-030-02200-6_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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7
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Shaharoona B, Al-Ismaily S, Al-Mayahi A, Al-Harrasi N, Al-Kindi R, Al-Sulaimi A, Al-Busaidi H, Al-Abri M. The role of urbanization in soil and groundwater contamination by heavy metals and pathogenic bacteria: A case study from Oman. Heliyon 2019; 5:e01771. [PMID: 31193711 PMCID: PMC6540334 DOI: 10.1016/j.heliyon.2019.e01771] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 04/29/2019] [Accepted: 05/16/2019] [Indexed: 01/29/2023] Open
Abstract
This study assessed the perception of urban residents of A'Seeb city, Oman, about the impact of their activities on environment. A sociological survey using questionnaire was used to know the residents' perceptions about urban gardening, municipal-waste disposal, and soil and water contamination. Viable pathogenic bacteria, water soluble metals, basic cations, salinity, and texture were quantified and identified in soil and groundwater in proximity of urban gardens and municipal-waste disposal sites. The majority of surveyed residents are not paying attention to the negative consequences of their activities on soil and environment. Although the measured heavy metals concentrations in some of the contaminated sites were significant but still below the international standards. Fecal contaminants reported in in some samples from gardens, garbage-disposal sites and groundwater. Human pathogens belonging to risk group-2 including Klebsiella pneumonia, Shigella spp and E. Coil were identified. More socio-environmental studies required to correlate the behavior of urban residents and pollution and to delineate the sources of the detected pathogenic bacteria. Our results set a foundation for future studies on urban soils and associated residence behaviors and practices in Oman and the neighboring Gulf countries.
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Affiliation(s)
- Baby Shaharoona
- Department of Soils, Water, and Agricultural Engineering, Sultan Qaboos University, Oman
| | - Said Al-Ismaily
- Department of Soils, Water, and Agricultural Engineering, Sultan Qaboos University, Oman
| | - Ahmed Al-Mayahi
- Department of Soils, Water, and Agricultural Engineering, Sultan Qaboos University, Oman
| | - Nadhira Al-Harrasi
- Department of Soils, Water, and Agricultural Engineering, Sultan Qaboos University, Oman
| | - Ruqaiya Al-Kindi
- Department of Soils, Water, and Agricultural Engineering, Sultan Qaboos University, Oman
| | - Abdullah Al-Sulaimi
- Department of Soils, Water, and Agricultural Engineering, Sultan Qaboos University, Oman
| | - Hamad Al-Busaidi
- Department of Soils, Water, and Agricultural Engineering, Sultan Qaboos University, Oman
| | - Mohammed Al-Abri
- Department of Animal and Veterinary Sciences; Sultan Qaboos University, Oman
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8
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O'Farrell N, Hoosen A, Kingston M. 2018 UK national guideline for the management of donovanosis. Int J STD AIDS 2018; 29:946-948. [PMID: 29743002 DOI: 10.1177/0956462418770319] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The objective of this guideline is to provide guidance for the diagnosis and management of donovanosis, a now rare sexually transmitted infection. This guidance is primarily for professionals working in UK Sexual Health services (although others may find it useful) and refers to the management of individuals presenting with possible symptoms of donovanosis who are over the age of 16. An updated literature review since the last Clinical Effectiveness Group (CEG) guideline produced for this condition in 2011 has shown few new developments. Most reports in the literature relate to cases of unusual presentations of the condition.
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Affiliation(s)
- Nigel O'Farrell
- 1 London North West Healthcare University NHS Trust, Ealing Hospital, London, UK
| | - Anwar Hoosen
- 2 Medical Microbiology, University of Free State, Bloemfontein, South Africa
| | - Margaret Kingston
- 3 The Northern Sexual Health, Contraception and HIV Service, The Hathersage Centre, Manchester, UK
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9
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Houinei W, Godornes C, Kapa A, Knauf S, Mooring EQ, González-Beiras C, Watup R, Paru R, Advent P, Bieb S, Sanz S, Bassat Q, Spinola SM, Lukehart SA, Mitjà O. Haemophilus ducreyi DNA is detectable on the skin of asymptomatic children, flies and fomites in villages of Papua New Guinea. PLoS Negl Trop Dis 2017; 11:e0004958. [PMID: 28489855 PMCID: PMC5425006 DOI: 10.1371/journal.pntd.0004958] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 08/08/2016] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Haemophilus ducreyi and Treponema pallidum subsp. pertenue are major causes of leg ulcers in children in Africa and the Pacific Region. We investigated the presence of DNA (PCR positivity) from these bacteria on asymptomatic people, flies, and household linens in an endemic setting. METHODOLOGY/PRINCIPAL FINDINGS We performed a cross-sectional study in rural villages of Lihir Island, Papua New Guinea during a yaws elimination campaign. Participants were asymptomatic subjects recruited from households with cases of leg ulcers, and from households without cases of leg ulcers. We rubbed swabs on the intact skin of the leg of asymptomatic individuals, and collected flies and swabs of environmental surfaces. All specimens were tested by PCR for H. ducreyi and T. p. pertenue DNA. Of 78 asymptomatic participants that had an adequate specimen for DNA detection, H. ducreyi-PCR positivity was identified in 16 (21%) and T. p. pertenue-PCR positivity in 1 (1%). In subgroup analyses, H. ducreyi-PCR positivity did not differ in participants exposed or not exposed to a case of H. ducreyi ulcer in the household (24% vs 18%; p = 0.76). Of 17 cultures obtained from asymptomatic participants, 2 (12%) yielded a definitive diagnosis of H. ducreyi, proving skin colonization. Of 10 flies tested, 9 (90%) had H. ducreyi DNA and 5 (50%) had T. p. pertenue DNA. Of 6 bed sheets sampled, 2 (33%) had H. ducreyi DNA and 1 (17%) had T. p. pertenue DNA. CONCLUSIONS/SIGNIFICANCE This is the first time that H. ducreyi DNA and colonization has been demonstrated on the skin of asymptomatic children and that H. ducreyi DNA and T. p. pertenue DNA has been identified in flies and on fomites. The ubiquity of H. ducreyi in the environment is a contributing factor to the spread of the organism.
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Affiliation(s)
- Wendy Houinei
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Charmie Godornes
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| | - August Kapa
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sascha Knauf
- German Primate Center, Leibniz-Institute for Primate Research, Pathology Unit, Working Group Neglected Tropical Diseases, Göttingen, Germany
| | - Eric Q. Mooring
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Ronald Watup
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Raymond Paru
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Paul Advent
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
| | - Sivauk Bieb
- Disease Control Branch, National Department of Health, Port Moresby, Papua New Guinea
| | - Sergi Sanz
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
| | - Quique Bassat
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique
- Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Stanley M. Spinola
- Departments of Microbiology and Immunology, Medicine, and Pathology and Laboratory Medicine Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Sheila A. Lukehart
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
| | - Oriol Mitjà
- Lihir Medical Centre– International SOS, Newcrest Mining, Lihir Island, Papua New Guinea
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic-University of Barcelona, Barcelona, Spain
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
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Lautenschlager S, Kemp M, Christensen JJ, Mayans MV, Moi H. 2017 European guideline for the management of chancroid. Int J STD AIDS 2017; 28:324-329. [PMID: 28081686 DOI: 10.1177/0956462416687913] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chancroid is a sexually acquired infection caused by Haemophilus ducreyi. The infection is characterized by one or more genital ulcers, which are soft and painful, and regional lymphadenitis, which may develop into buboes. The infection may easily be misidentified due to its rare occurrence in Europe and difficulties in detecting the causative pathogen. H. ducreyi is difficult to culture. Nucleic acid amplification tests can demonstrate the bacterium in suspected cases. Antibiotics are usually effective in curing chancroid.
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Affiliation(s)
- Stephan Lautenschlager
- 1 Outpatient Clinic of Dermatology & Venereology, City Hospital Triemli, Zurich, Switzerland
| | - Michael Kemp
- 2 Department of Clinical Microbiology, Odense University Hospital, University of Southern Denmark, Denmark
| | | | - Marti Vall Mayans
- 4 STI Unit Vall d'Hebron-Drassanes, Hospital Vall d'Hebron, Barcelona, Spain
| | - Harald Moi
- 5 Section of STI, Olafia Clinic, Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway
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Jaishankar D, Shukla D. Genital Herpes: Insights into Sexually Transmitted Infectious Disease. MICROBIAL CELL (GRAZ, AUSTRIA) 2016; 3:438-450. [PMID: 28357380 PMCID: PMC5354570 DOI: 10.15698/mic2016.09.528] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 01/07/2016] [Indexed: 12/20/2022]
Abstract
Etiology, transmission and protection: Herpes simplex virus-2 (HSV-2) is a leading cause of sexually transmitted infections with recurring manifestations throughout the lifetime of infected hosts. Currently no effective vaccines or prophylactics exist that provide complete protection or immunity from the virus, which is endemic throughout the world. Pathology/Symptomatology: Primary and recurrent infections result in lesions and inflammation around the genital area and the latter accounts for majority of genital herpes instances. Immunocompromised patients including neonates are susceptible to additional systemic infections including debilitating consequences of nervous system inflammation. Epidemiology, incidence and prevalence: More than 500 million people are infected worldwide and most reported cases involve the age groups between 16-40 years, which coincides with an increase in sexual activity among this age group. While these numbers are an estimate, the actual numbers may be underestimated as many people are asymptomatic or do not report the symptoms. Treatment and curability: Currently prescribed medications, mostly nucleoside analogs, only reduce the symptoms caused by an active infection, but do not eliminate the virus or reduce latency. Therefore, no cure exists against genital herpes and infected patients suffer from periodic recurrences of disease symptoms for their entire lives. Molecular mechanisms of infection: The last few decades have generated many new advances in our understanding of the mechanisms that drive HSV infection. The viral entry receptors such as nectin-1 and HVEM have been identified, cytoskeletal signaling and membrane structures such as filopodia have been directly implicated in viral entry, host motor proteins and their viral ligands have been shown to facilitate capsid transport and many host and HSV proteins have been identified that help with viral replication and pathogenesis. New understanding has emerged on the role of autophagy and other innate immune mechanisms that are subverted to enhance HSV pathogenesis. This review summarizes our current understanding of HSV-2 and associated diseases and available or upcoming new treatments.
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Affiliation(s)
- Dinesh Jaishankar
- Departments of Bioengineering and Ophthalmology and Visual
Sciences, University of Illinois at Chicago, IL 60612
- Department of Pathology, University of Illinois at Chicago, IL
60612
| | - Deepak Shukla
- Departments of Bioengineering and Ophthalmology and Visual
Sciences, University of Illinois at Chicago, IL 60612
- Department of Microbiology and Immunology, University of Illinois at
Chicago, IL 60612
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12
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O'Farrell N, Moi H. 2016 European guideline on donovanosis. Int J STD AIDS 2016; 27:605-7. [PMID: 26882914 DOI: 10.1177/0956462416633626] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 01/25/2016] [Indexed: 11/17/2022]
Abstract
Donovanosis is a rare sexually transmitted infection now mainly seen in sporadic cases in Papua New Guinea, South Africa, India, Brazil and Australia. The causative organism is Calymmatobacterium granulomatis, though a proposal has been put forward that the organism be reclassified as Klebsiella granulomatis comb nov The incubation period is approximately 50 days with genital papules developing into ulcers that increase in size. Four types of lesions are described - ulcerogranulomatous, hypertrophic, necrotic and sclerotic. The diagnosis is usually confirmed by microscopic identification of characteristic Donovan bodies on stained tissue smears. More recently, polymerase chain reaction methods have been developed. The recommended treatment is azithromycin 1 g weekly until complete healing is achieved.
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Affiliation(s)
| | - Harald Moi
- Olafia Clinic, Oslo University Hospital, Institute of Medicine, University of Oslo, Norway
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13
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Diagnostic Approaches to Genitourinary Tract Infections. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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14
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Glatz M, Juricevic N, Altwegg M, Bruisten S, Komericki P, Lautenschlager S, Weber R, Bosshard P. A multicenter prospective trial to asses a new real-time polymerase chain reaction for detection of Treponema pallidum, herpes simplex-1/2 and Haemophilus ducreyi in genital, anal and oropharyngeal ulcers. Clin Microbiol Infect 2014; 20:O1020-7. [DOI: 10.1111/1469-0691.12710] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 06/03/2014] [Accepted: 06/04/2014] [Indexed: 11/28/2022]
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15
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Lewis DA. Epidemiology, clinical features, diagnosis and treatment of Haemophilus ducreyi - a disappearing pathogen? Expert Rev Anti Infect Ther 2014; 12:687-96. [PMID: 24597521 DOI: 10.1586/14787210.2014.892414] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Chancroid, caused by Haemophilus ducreyi, has declined in importance as a sexually transmitted pathogen in most countries where it was previously endemic. The global prevalence of chancroid is unknown as most countries lack the required laboratory diagnostic capacity and surveillance systems to determine this. H. ducreyi has recently emerged as a cause of chronic skin ulceration in some South Pacific islands. Although no antimicrobial susceptibility data for H. ducreyi have been published for two decades, it is still assumed that the infection will respond successfully to treatment with recommended cephalosporin, macrolide or fluoroquinolone-based regimens. HIV-1-infected patients require careful follow-up due to reports of treatment failure with single dose regimens. Buboes may need additional treatment with either aspiration or excision and drainage.
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Affiliation(s)
- David A Lewis
- Centre for HIV and STIs, National Institute for Communicable Diseases, National Health Laboratory Service, 1 Modderfontein Road, Sandringham 2131, Johannesburg, South Africa
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16
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Muralidhar S, Talwar R, Anil Kumar D, Kumar J, Bala M, Khan N, Ramesh V. Genital Ulcer Disease: How Worrisome Is It Today? A Status Report from New Delhi, India. JOURNAL OF SEXUALLY TRANSMITTED DISEASES 2013; 2013:203636. [PMID: 26316954 PMCID: PMC4437428 DOI: 10.1155/2013/203636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Revised: 03/07/2013] [Accepted: 03/15/2013] [Indexed: 11/30/2022]
Abstract
Background and Objectives. Genital ulcer diseases represent a diagnostic dilemma, especially in India, where few STI clinics have access to reliable laboratory facility. The changing STI trends require that a correct diagnosis be made in order to institute appropriate treatment and formulate control policies. The objective of this study was to determine recent trends in aetiology of genital ulcers, by using accurate diagnostic tools. Methods. Specimens from 90 ulcer patients were processed for dark field microscopy, stained smears, culture for H. ducreyi, and real-time PCR. Blood samples were collected for serological tests. Results. Prevalence of GUD was 7.45 with mean age at initial sexual experience as 19.2 years. Use of condom with regular and nonregular partners was 19.5% and 42.1%, respectively. Sexual orientation was heterosexual (92.2%) or homosexual (2.2%). There were 8 cases positive for HIV (8.9%). Herpes simplex virus ulcers were the commonest, followed by syphilis and chancroid. There were no cases of donovanosis and LGV. Conclusions. A valuable contribution of this study was in validating clinical and syndromic diagnoses of genital ulcers with an accurate aetiological diagnosis. Such reliable data will aid treatment and better define control measures of common agents and help eliminate diseases amenable to elimination, like donovanosis.
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Affiliation(s)
- Sumathi Muralidhar
- Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi 110029, India
| | - Richa Talwar
- Department of Community Medicine, Vardhman Mahavir Medical College, Safdarjang Hospital, New Delhi 110029, India
| | - Deepa Anil Kumar
- Department of Microbiology, Faculty of Dentistry, Jamia Millia Islamia University, New Delhi 110025, India
| | - Joginder Kumar
- Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi 110029, India
| | - Manju Bala
- Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi 110029, India
| | - Nilofar Khan
- Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi 110029, India
| | - V. Ramesh
- Regional STD Teaching, Training & Research Centre, VMMC & Safdarjang Hospital, New Delhi 110029, India
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Protocol for the use of enzyme-linked hybridization assays for genital ulcer disease. Methods Mol Biol 2012; 903:225-33. [PMID: 22782821 DOI: 10.1007/978-1-61779-937-2_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Etiologic agents of genital ulcer disease include herpes simplex 1 and 2, Treponema pallidum pallidum, Haemophilus ducreyi, and Klebsiella granulomatis. The advent of PCR has allowed for more rapid and sensitive detection of microbial pathogens. In this protocol, we describe the simultaneous detection of these five pathogens and an internal control using a single-tube multiplex PCR and colorimetric enzyme-linked amplicon hybridization assay.
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18
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Chen CY, Ballard RC. The molecular diagnosis of sexually transmitted genital ulcer disease. Methods Mol Biol 2012; 903:103-12. [PMID: 22782813 DOI: 10.1007/978-1-61779-937-2_6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Highly sensitive and specific nucleic acid amplification tests (NAATs) have emerged as the gold standard diagnostic tests for many infectious diseases. Real-time PCR has further refined the technology of nucleic acid amplification with detection in a closed system and enabled multiplexing to simultaneously detect multiple pathogens. It is a versatile, fast, and high-throughput system for pathogen detection that has reduced the risk of PCR contamination, eliminated post-PCR manipulations, and improved the cost-effectiveness of testing. In addition, real-time PCR can be applied to self-collected noninvasive specimens. Here, we describe an in-house developed TaqMan-based real-time multiplex PCR (M-PCR) assay for the diagnosis of sexually transmitted genital ulcer disease (GUD) and discuss briefly on issues associated with validation of assay performance.
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Affiliation(s)
- Cheng-Yen Chen
- Laboratory Reference and Research Branch, Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD and Tuberculosis Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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19
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Vazquez F, Otero L, Melón S, de Oña M. Overview of molecular biological methods for the detection of pathogens causing sexually transmitted infections. Methods Mol Biol 2012; 903:1-20. [PMID: 22782808 DOI: 10.1007/978-1-61779-937-2_1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We review here different state-of-the-art molecular methods currently used in the diagnosis of sexually transmitted infections.
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Affiliation(s)
- Fernando Vazquez
- Servicio de Microbiología, Hospital Monte Naranco, Oviedo, Spain.
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20
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Abstract
Genital malodor is a common distressing complaint that brings a woman to her physician's office. Vaginal infections, primarily bacterial vaginosis and trichomoniasis, still remain the commonest causes and are relatively easy to diagnose and treat. However, in approximately one third of women who present with malodor, no cause is identified. Although data on the management of vaginal discharge are extensive, the management of genital odor beyond common vaginal infections remains poorly studied. This presents a frustrating situation for both the patient and her physician. Often, patients resort to home remedies and over-the-counter preparations, which, while providing short-term relief for some women, almost never address the cause and, in some cases, can exacerbate symptoms. In this review, we have attempted to consolidate the known and documented causes of genital malodor including the nonvaginal causes and provide case studies that will help clinicians understand the possible settings for the various causes. We also provide an algorithm for the management of this symptom beyond vaginal infections.
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21
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Shim BS. Current concepts in bacterial sexually transmitted diseases. Korean J Urol 2011; 52:589-97. [PMID: 22025952 PMCID: PMC3198230 DOI: 10.4111/kju.2011.52.9.589] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 04/28/2011] [Indexed: 11/30/2022] Open
Abstract
Sexually transmitted diseases (STDs) are the most common infectious diseases worldwide, with over 350 million new cases occurring each year, and have far-reaching health, social, and economic consequences. Failure to diagnose and treat STDs at an early stage may result in serious complications and sequelae. STDs are passed from person to person primarily by sexual contact and are classified into varied groups. Some cause mild, acute symptoms and some are life-threatening. They are caused by many different infectious organisms and are treated in different ways. Syphilis and gonorrhea are ancient afflictions. Now, however, Chlamydia is prevalent and has become the most common bacterial STD. Antimicrobial resistance of several sexually transmitted pathogens is increasing, rendering some regimens ineffective, adding to therapeutic problems. A standardized treatment protocol for STDs is recommended to ensure that all patients receive adequate treatment. Appropriate treatment of STDs is an important public health measure.
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Affiliation(s)
- Bong Suk Shim
- Department of Urology, School of Medicine, Ewha Womans University, Seoul, Korea
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22
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Bowden FJ. Eliminating syphilis in remote Aboriginal and Torres Strait Islander communities. Med J Aust 2011; 195:158. [DOI: 10.5694/j.1326-5377.2011.tb03253.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 06/20/2011] [Indexed: 11/17/2022]
Affiliation(s)
- Francis J Bowden
- ANU Medical School, Australian National University, Canberra, ACT
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23
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Kemp M, Christensen JJ, Lautenschlager S, Vall-Mayans M, Moi H. European guideline for the management of chancroid, 2011. Int J STD AIDS 2011; 22:241-4. [DOI: 10.1258/ijsa.2010.010432] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Chancroid is a sexually acquired disease caused by Haemophilus ducreyi. The infection is characterized by one or more genital ulcers, which are soft and painful, and regional lymphadenitis which may develop into buboes. The infection may easily be misidentified due to its rare occurrence in Europe and difficulties in detecting the causative pathogen. H. ducreyi is difficult to culture. Polymerase chain reaction (PCR) can demonstrate the bacterium in suspected cases. Antibiotics will usually be efficient for curing chancroid.
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Affiliation(s)
- M Kemp
- Department of Clinical Microbiology, Odense University Hospital, University of Southern Denmark
| | - J J Christensen
- Slagelse Sygehus, Department of Clinical Microbiology, Denmark
| | - S Lautenschlager
- Outpatient Clinic of Dermatology & Venereology, City Hospital Triemli, Zurich, Switzerland
| | - M Vall-Mayans
- STI Unit CAP Drassanes, Catalan Health Institute Barcelona, Catalonia, Spain
| | - H Moi
- Section of STI, Department of Rheumatology, Dermatology, and Infectious Diseases, Oslo University Hospital, and Faculty of Medicine, University of Oslo, Norway
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Abstract
Donovanosis is a rare sexually transmitted infection now mainly seen in sporadic cases in Papua New Guinea, South Africa, India, Brazil and Australia. The causative organism is Calymmatobacterium granulomatis though a proposal has been put forward that the organism be reclassified as Klebsiella granulomatis comb. nov. The incubation period is approximately 50 days with genital papules developing into ulcers that increase in size. Four types of lesions are described – ulcerogranulomatous, hypertrophic, necrotic and sclerotic. The diagnosis is usually confirmed by microscopic identification of characteristic Donovan bodies on stained tissue smears. More recently, polymerase chain reaction (PCR) methods have been developed. The recommended treatment is azithromycin 1 g weekly until complete healing is achieved.
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Affiliation(s)
| | - H Moi
- Section of STI, Department of Rheumatology, Dermatology and Infectious Diseases, Oslo University Hospital
- Faculty of Medicine, University of Oslo, Norway
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Clinical value of Treponema pallidum real-time PCR for diagnosis of syphilis. J Clin Microbiol 2009; 48:497-502. [PMID: 20007388 DOI: 10.1128/jcm.00720-09] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The diagnosis of syphilis can be complicated when it is based on diverse clinical manifestations, dark-field microscopy, and serology. In the present study, therefore, we examined the additional clinical value of a Treponema pallidum real-time TaqMan PCR for the detection of primary and secondary syphilis. The additional value of the T. pallidum real-time PCR for the diagnosis of primary syphilis was evaluated by the use of three different algorithms: (i) a head-to-head comparison of the dark-field microscopy result and the T. pallidum real-time PCR result, (ii) comparison of the clinical diagnosis made in a sexually transmitted infection clinic (STI) (including by dark-field microscopy) and the T. pallidum real-time PCR result, and (iii) comparison of the clinical diagnosis made in a general practitioner's office (without dark-field microscopy) and the T. pallidum real-time PCR result. A fourth algorithm was used to determine the performance of the T. pallidum real-time PCR regarding the detection of secondary syphilis. From December 2006 to April 2008, 716 patients with suspected cases of primary syphilis and 133 patients with suspected cases of secondary syphilis were included in the study. A kappa value of 0.601 was found for the agreement between dark-field microscopy and the T. pallidum real-time PCR. Good agreement was found between the T. pallidum real-time PCR and both the diagnosis of the general practitioner (kappa = 0.745) and the diagnosis of the STI clinic (kappa = 0.769). The sensitivity with respect to the STI clinic diagnosis was 72.8%, the specificity was 95.5%, the positive predictive value was 89.2%, and the negative predictive value was 95.0%. The T. pallidum real-time PCR is a fast, efficient, and reliable test for the diagnosis of primary syphilis in an STI outpatient clinic and a general practitioner setting, but it has no added diagnostic value for the diagnosis of secondary syphilis.
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Belda Junior W, Shiratsu R, Pinto V. Approach in sexually transmitted diseases. An Bras Dermatol 2009; 84:151-9. [PMID: 19503983 DOI: 10.1590/s0365-05962009000200008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 02/20/2009] [Indexed: 11/22/2022] Open
Abstract
Nowadays, sexually transmitted diseases are one of the most common public health issues. Among its consequences are the possibility of transmission from mother to baby - which may cause miscarriages and congenital disease, male and female infertility, and the increase of HIV infection risk. Therefore, the main goal of these guidelines is to contribute to the improvement of the treatment for sexually transmitted diseases patients by presenting to the medical community how today's science stands on the matter and also what the recommendation for diagnosing and treating a patient are.
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Affiliation(s)
- Walter Belda Junior
- Department of Sexually Transmitted Diseases /AIDS, Brazilian Society of Dermatology, Brazil.
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Molecular characterization of syphilis in patients in Canada: azithromycin resistance and detection of Treponema pallidum DNA in whole-blood samples versus ulcerative swabs. J Clin Microbiol 2009; 47:1668-73. [PMID: 19339468 DOI: 10.1128/jcm.02392-08] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Although detection of Treponema pallidum DNA in whole-blood specimens of syphilis patients has been reported, it is uncertain at what stage of the disease such specimens are most suitable for the molecular diagnosis of syphilis. Also, few studies have directly compared the different gene targets for routine laboratory diagnostic usage in PCR assays. We examined 87 specimens from 68 patients attending two urban sexually transmitted disease clinics in Alberta, Canada. PCR was used to amplify the T. pallidum tpp47, bmp, and polA genes as well as a specific region of the 23S rRNA gene linked to macrolide antibiotic susceptibility. In primary syphilis cases, PCR was positive exclusively (75% sensitivity rate) in ulcerative swabs but not in blood specimens, while in secondary syphilis cases, 50% of the blood specimens were positive by PCR. Four out of 14 (28.6%) of our PCR-positive syphilis cases were found to be caused by an azithromycin-resistant strain(s). Our results confirmed that swabs from primary ulcers are the specimens of choice for laboratory diagnostic purposes. However, further research is required to determine what specimen(s) would be most appropriate for molecular investigation of syphilis in secondary and latent syphilis.
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[Utility of molecular biology techniques in the diagnosis of sexually transmitted diseases and genital infections]. Enferm Infecc Microbiol Clin 2009; 26 Suppl 9:42-9. [PMID: 19195446 DOI: 10.1016/s0213-005x(08)76540-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Historically, the diagnosis of sexually transmitted diseases (STDs) has been difficult. The introduction of molecular biology techniques in microbiological diagnosis and their application to non-invasive samples has produced significant advances in the diagnosis of these diseases. Overall, detection of Neisseria gonorrhoeae by molecular biology techniques provides a presumptive diagnosis and requires confirmation by culture in areas with a low prevalence. For Chlamydia trachomatis infections, these techniques are considered to be the most sensitive and specific procedures for mass screening studies, as well as for the diagnosis of symptomatic patients. Diagnosis of Mycoplasma genitalium infection by culture is very slow and consequently molecular techniques are the only procedures that can provide relevant diagnostic information. For Treponema pallidum, molecular techniques can provide direct benefits in the diagnosis of infection. Molecular techniques are not established for the routine diagnosis of donovanosis, but can be recommended when performed by experts. Molecular methods are advisable in Haemophilus ducreyi, because of the difficulties of culture and its low sensitivity. In genital herpes, molecular techniques have begun to be recommended for routine diagnosis and could soon become the technique of choice. For other genital infections, bacterial vaginosis, vulvovaginal candidosis and trichomoniasis, diagnosis by molecular methods is poorly established. With genital warts, techniques available for screening and genotyping of endocervical samples could be used for certain populations, but are not validated for this purpose.
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Lepe Jiménez JA, Otero Guerra L, Blanco Galán MA, Aznar Martín J, Vázquez Valdés F. [Update on the epidemiology, diagnosis and treatment of sexually-transmitted infections]. Enferm Infecc Microbiol Clin 2008; 26 Suppl 13:25-31. [PMID: 19100164 DOI: 10.1157/13128777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
In the last decade, cases of sexually-transmitted infections (STIs) have progressively increased in Europe. The reasons for this increase are unclear, but may involve changes in social behavior, migration and international travel, coupled with the emergence of risk groups that have not been taken into sufficient consideration to date. The routine use of molecular diagnostic techniques for many of these infections has solved many problems of sensitivity and the suitability of samples for microbiological diagnosis: non-invasive samples can be used, which has undoubtedly contributed to the increase in the number of cases. Moreover, molecular methods have also been introduced for antibiotic and antiviral susceptibility testing, as well as for molecular characterization of clinical isolates. All of these factors, together with the approval of the vaccine against the human papillomavirus, have changed the landscape of STIs across Europe.
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Suntoke TR, Hardick A, Tobian AAR, Mpoza B, Laeyendecker O, Serwadda D, Opendi P, Gaydos CA, Gray RH, Wawer MJ, Quinn TC, Reynolds SJ. Evaluation of multiplex real-time PCR for detection of Haemophilus ducreyi, Treponema pallidum, herpes simplex virus type 1 and 2 in the diagnosis of genital ulcer disease in the Rakai District, Uganda. Sex Transm Infect 2008; 85:97-101. [PMID: 19066198 DOI: 10.1136/sti.2008.034207] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To develop a real-time PCR assay that reliably and accurately detects the predominant sexually transmitted aetiological agents of genital ulcer disease (GUD) (Haemophilus ducreyi, Treponema pallidum and herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2)) and to assess the use of real-time PCR diagnostic testing in a rural African field site. METHODS Two multiplex real-time PCR reactions were used to detect H ducreyi/and HSV-1/HSV-2 in ulcer swabs from 100 people with symptomatic genital ulcers in rural Rakai, Uganda. Results were compared with syphilis, HSV-1 and HSV-2 serology. RESULTS Of 100 GUD samples analysed from 43 HIV positive and 57 HIV negative individuals, 71% were positive for one or more sexually transmitted infection (STI) pathogens by real-time PCR (61% for HSV-2, 5% for T pallidum, 3% for HSV-1, 1% for H ducreyi and 1% for dual H ducreyi/HSV-2). The frequency of HSV in genital ulcers was 56% (32/57) in HIV negative individuals and 77% (33/43) in HIV positive individuals (p = 0.037). Assay reproducibility was evaluated by repeat PCR testing in the USA with 96% agreement (kappa = 0.85). CONCLUSIONS STI pathogens were detected in the majority of GUD swab samples from symptomatic patients in Rakai, Uganda, by real-time PCR. HSV-2 was the predominant cause of genital ulcers. Real-time PCR technology can provide sensitive, rapid and reproducible evaluation of GUD aetiology in a resource-limited setting.
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Affiliation(s)
- T R Suntoke
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA
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31
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[An atypical syphilis diagnosed by universal PCR]. Presse Med 2008; 38:496-8. [PMID: 18834695 DOI: 10.1016/j.lpm.2008.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 06/21/2008] [Accepted: 07/30/2008] [Indexed: 11/20/2022] Open
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McBride WJH, Hannah RCS, Le Cornec GM, Bletchly C. Cutaneous chancroid in a visitor from Vanuatu. Australas J Dermatol 2008; 49:98-9. [PMID: 18412810 DOI: 10.1111/j.1440-0960.2008.00439.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A 23-year-old woman from Vanuatu presented to an Australian hospital with a 3-week history of a non-healing ulcer on the lower leg. A swab was submitted for a multiplex polymerase chain reaction designed to investigate genital ulcerative conditions. Haemophilus ducreyi was detected and the gene product was subsequently sequenced, confirming the diagnosis of cutaneous chancroid. The lesion responded to intramuscular benzathine penicillin. This report adds further evidence that cutaneous chancroid should be considered in the evaluation of skin ulcers in the south Pacific.
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Affiliation(s)
- William J H McBride
- School of Medicine, James Cook University, Cairns Campus, Cairns, Queensland, Australia.
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Gousseff M, Mechaï F, Lecuit M, Lortholary O. [Systemic granulomatosis of infectious origin]. Rev Med Interne 2007; 29:15-27. [PMID: 18054122 DOI: 10.1016/j.revmed.2007.09.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2007] [Accepted: 09/22/2007] [Indexed: 10/22/2022]
Abstract
PURPOSE Granulomatous diseases are defined by specific histological features, following the local recruitment of macrophages and lymphocytes. Many infections can lead to the development of granuloma. CURRENT KNOWLEDGE AND KEY POINTS Microorganisms responsible for granuloma include mainly mycobacteria, many viral and fungal species, as well as schistosoma in endemic areas. Nevertheless, almost all microorganisms can lead to granuloma, especially if their clearance needs macrophages pathway. New immunosuppressive drugs such as tumor necrosis factor antagonists are associated with a high risk of infectious granulomatous complications. All patients with granuloma must be carefully screened to find a potential underlying infection, since an immunosuppressive therapy could be otherwise considered. We here review the general diagnostic process with a specific glance to the main organs. FUTURE PROSPECTS AND PROJECTS Without clinical or epidemiological clue, diagnosis can be very tedious. New molecular tools now assist classical microbiological and histological techniques. Their specificity and sensitivity have recently been better characterized, and their use will probably increase in the near future for the diagnosis of infectious granuloma. They may also lead to discover new infectious aetiologies of granulomatous diseases formerly considered as idiopathic. We describe here the main microorganisms that can be responsible for granuloma, with a specific focus on the use of new diagnostic tools.
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Affiliation(s)
- M Gousseff
- Service des maladies infectieuses et tropicales, université René-Descartes-Paris-5, hôpital Necker-Enfants-Malades, centre d'infectiologie Necker-Pasteur, 149 rue de Sèvres, Paris cedex 15, France
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Affiliation(s)
- A Ghorpade
- Department of Dermatology, Venereology and Leprosy, J.L.N. Hospital & Research Center, Bhilai Steel Plant, Bhilai-India.
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