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de Jong E, Genders R, Harwood CA, Green AC, Plasmeijer EI, Proby C, Geissler E, Ferrándiz-Pulido C, Ducroux E, Euvrard S, Geusau A, Jahn-Bassler K, Borik-Heil L, Rácz E, Nägeli M, Hofbauer GFL, Piaserico S, Russo I, Mackintosh L, Borges-Costa J, Angeliki-Gkini M, Zavattaro E, Savoia P, Imko-Walszuk B, Dębska-Slizień A, Garmyn M, van Kelst S, Ricar J, Cetkovska P, Matin R, Güleç AT, Seçkin D, Anene CA, Oliveira WRP, Rademaker M, Goeman J, van Geloven N, Ruiz E, Murad F, Karn E, Schmults CD, Bouwes Bavinck JN. Cumulative incidence and risk factors for cutaneous squamous cell carcinoma metastases in organ transplant recipients: The Skin Care in Organ Transplant Patients in Europe-International Transplant Skin Cancer Collaborative metastases study, a prospective multicenter study. J Am Acad Dermatol 2024:S0190-9622(24)00157-9. [PMID: 38301923 DOI: 10.1016/j.jaad.2024.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 11/23/2023] [Accepted: 01/07/2024] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Solid organ transplant recipients (SOTRs) are believed to have an increased risk of metastatic cutaneous squamous cell carcinoma (cSCC), but reliable data are lacking regarding the precise incidence and associated risk factors. METHODS In a prospective cohort study, including 19 specialist dermatology outpatient clinics in 15 countries, patient and tumor characteristics were collected using standardized questionnaires when SOTRs presented with a new cSCC. After a minimum of 2 years of follow-up, relevant data for all SOTRs were collected. Cumulative incidence of metastases was calculated by the Aalen-Johansen estimator. Fine and Gray models were used to assess multiple risk factors for metastases. RESULTS Of 514 SOTRs who presented with 623 primary cSCCs, metastases developed in 37 with a 2-year patient-based cumulative incidence of 6.2%. Risk factors for metastases included location in the head and neck area, local recurrence, size > 2 cm, clinical ulceration, poor differentiation grade, perineural invasion, and deep invasion. A high-stage tumor that is also ulcerated showed the highest risk of metastasis, with a 2-year cumulative incidence of 46.2% (31.9%-68.4%). CONCLUSIONS SOTRs have a high risk of cSCC metastases and well-established clinical and histologic risk factors have been confirmed. High-stage, ulcerated cSCCs have the highest risk of metastasis.
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Affiliation(s)
- Estella de Jong
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | - Roel Genders
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Catherine A Harwood
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Adèle C Green
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Elsemieke I Plasmeijer
- Department of Dermatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands; Department of Dermatology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Charlotte Proby
- Molecular and Clinical Medicine, School of Medicine, University of Dundee, Dundee, United Kingdom
| | - Edward Geissler
- Division of Experimental Surgery, Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | | | - Emilie Ducroux
- Department of Dermatology, Edouard Herriot Hospital, Lyon, France
| | - Sylvie Euvrard
- Department of Dermatology, Edouard Herriot Hospital, Lyon, France
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Karin Jahn-Bassler
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Liliane Borik-Heil
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Emõke Rácz
- Department of Dermatology, University Medical Centre Groningen (UMCG), University of Groningen, Groningen, The Netherlands
| | - Mirjam Nägeli
- Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Günther F L Hofbauer
- Department of Dermatology, University Hospital of Zürich, University of Zürich, Zürich, Switzerland
| | - Stefano Piaserico
- Unit of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Irene Russo
- Unit of Dermatology, Department of Medicine (DIMED), University of Padua, Padua, Italy; Soft-Tissue, Peritoneum and Melanoma Surgical Oncology Unit, IOV-IRCSS, Padua, Italy
| | - Lorna Mackintosh
- Department of Dermatology, NHS Greater Glasgow and Clyde, Glasgow, United Kingdom
| | - João Borges-Costa
- Department of Dermatology, Hospital de Santa Maria and Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Maria Angeliki-Gkini
- Department of Dermatology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Elisa Zavattaro
- Dermatology Unit, Departments of Translational Medicine and Health Science, University of Eastern Piedmont, Novara, Italy
| | - Paola Savoia
- Dermatology Unit, Departments of Translational Medicine and Health Science, University of Eastern Piedmont, Novara, Italy
| | - Beata Imko-Walszuk
- N Dermatology and STD Outpatient Clinic, Copernicus Medical Centre, Gdansk, Poland
| | - Alicja Dębska-Slizień
- Department of Nephrology, Transplantology and Internal Medicine, Faculty of Medicine, Medical University of Gdansk, Gdansk, Poland
| | - Marjan Garmyn
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Sofie van Kelst
- Department of Dermatology, University Hospitals Leuven, Leuven, Belgium
| | - Jan Ricar
- Department of Dermatovenereology, Charles University Hospital, Pilsen, Czech Republic
| | - Petra Cetkovska
- Department of Dermatovenereology, Charles University Hospital, Pilsen, Czech Republic
| | - Rubeta Matin
- Department of Dermatology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Ayşe Tülin Güleç
- Department of Dermatology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Deniz Seçkin
- Department of Dermatology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Chinedu Anthony Anene
- Centre for Cancer Genomics and Computational Biology, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Centre for Cancer Biology and Therapy, School of Applied Sciences, London South Bank University, London, United Kingdom
| | | | - Marius Rademaker
- Department of Dermatology, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
| | - Jelle Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Nan van Geloven
- Department of Biomedical Data Sciences, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - Emily Ruiz
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Fadi Murad
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Emily Karn
- Department of Dermatology, Brigham and Women's Hospital, Boston, Massachusetts
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Ferrándiz-Pulido C, Leiter U, Harwood C, Proby CM, Guthoff M, Scheel CH, Westhoff TH, Bouwes Bavinck JN, Meyer T, Nägeli MC, Del Marmol V, Lebbé C, Geusau A. Immune Checkpoint Inhibitors in Solid Organ Transplant Recipients With Advanced Skin Cancers-Emerging Strategies for Clinical Management. Transplantation 2023; 107:1452-1462. [PMID: 36706163 DOI: 10.1097/tp.0000000000004459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Use of immune checkpoint inhibitors (ICIs) in solid organ transplant recipients (SOTRs) with advanced skin cancers presents a significant clinical management dilemma. SOTRs and other immunosuppressed patients have been routinely excluded from ICI clinical trials with good reason: immune checkpoints play an important role in self- and allograft-tolerance and risk of acute allograft rejection reported in retrospective studies affects 10% to 65% of cases. These reports also confirm that cutaneous squamous cell carcinoma and melanoma respond to ICI therapy, although response rates are generally lower than those observed in immunocompetent populations. Prospective trials are now of critical importance in further establishing ICI efficacy and safety. However, based on current knowledge, we recommend that ICIs should be offered to kidney transplant recipients with advanced cutaneous squamous cell carcinoma, melanoma, or Merkel cell carcinoma if surgery and/or radiotherapy have failed. For kidney transplant recipients, this should be first line ahead of chemotherapy and targeted therapies. In SOTRs, the use of ICIs should be carefully considered with the benefits of ICIs versus risks of allograft rejection weighed up on a case-by-case basis as part of shared decision-making with patients. In all cases, parallel management of immunosuppression may be key to ICI responsiveness. We recommend maintaining immunosuppression before ICI initiation with a dual immunosuppressive regimen combining mammalian target of rapamycin inhibitors and either corticosteroids or calcineurin inhibitors. Such modification of immunosuppression must be considered in the context of allograft risk (both rejection and also its subsequent treatment) and risk of tumor progression. Ultimately, a multidisciplinary approach should underpin all clinical decision-making in this challenging scenario.
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Affiliation(s)
- Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ulrike Leiter
- Department of Dermatology, Eberhard-Karls University of Tuebingen, Tuebingen, Germany
| | - Catherine Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Charlotte M Proby
- Department of Dermatology, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Martina Guthoff
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, Eberhard-Karls-University, Tuebingen, Germany
| | - Christina H Scheel
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Timm H Westhoff
- Medical Department I, University Hospital Marien Hospital Herne, Ruhr-University Bochum, Bochum, Germany
| | | | - Thomas Meyer
- Department of Dermatology, Skin Cancer Center, Ruhr-University Bochum, Bochum, Germany
| | - Mirjam C Nägeli
- Department of Dermatology, University Hospital of Zurich, Switzerland
| | - Veronique Del Marmol
- Service de Dermatologie, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Celeste Lebbé
- Dermato-Oncology Department, Université Paris Cite, AP-HP Hôpital Saint Louis, Cancer Institute APHP. Nord-Université Paris CiteINSERM U976, HIPI, Paris, France
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Sunder-Plassmann R, Geusau A, Endler G, Weninger W, Wielscher M. Identification of Genetic Risk Factors for Keratinocyte Cancer in Immunosuppressed Solid Organ Transplant Recipients: A Case-Control Study. Cancers (Basel) 2023; 15:3354. [PMID: 37444464 DOI: 10.3390/cancers15133354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Because of long-term immunosuppression, solid organ transplant recipients are at increased risk for keratinocyte cancer. We matched solid organ transplant patients (n = 150), cases with keratinocyte cancers and tumor-free controls, considering the most important risk factors for keratinocyte cancer in solid organ transplant recipients. Using whole exome data of germline DNA from this patient cohort, we identified several genetic loci associated with the occurrence of multiple keratinocyte cancers. We found one genome-wide significant association of a common single nucleotide polymorphism located in EXOC3 (rs72698504). In addition, we found several variants with a p-value of less than 10-5 associated with the number of keratinocyte cancers. These variants were located in the genes CYB561, WASHC1, PITRM1-AS1, MUC8, ABI3BP, and THBS2-AS1. Using whole exome sequencing data, we performed groupwise tests for rare missense variants in our dataset and found robust associations (p < 10-6, Burden Zeggini test) between MC1R, EPHA8, EPO, MYCT1, ADGRG3, and MGME1 and keratinocyte cancer. Thus, overall, we detected genes involved in pigmentation/UV protection, tumor suppression, immunomodulation, intracellular traffic, and response to UV as genetic risk factors for multiple keratinocyte cancers in solid organ transplant recipients. We also grouped selected genes to pathways and found a selection of genes involved in the "cellular response to UV" to be significantly associated with multiple keratinocyte cancers.
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Affiliation(s)
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Endler
- Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Wolfgang Weninger
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Matthias Wielscher
- Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
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Chromy D, Urban N, Grabmeier-Pfistershammer K, Touzeau-Roemer V, Skoll M, Geusau A, Stary G, Reiberger T, Strassl R, Willinger B, Weninger W, Rieger A, Bauer WM. High Prevalence of Asymptomatic Sexually Transmitted Infections in Austrian Pre-Exposure Prophylaxis Users: A Prospective Observational Study. AIDS Patient Care STDS 2023; 37:115-118. [PMID: 36827331 DOI: 10.1089/apc.2022.0154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- David Chromy
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Nikolaus Urban
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | | | - Michael Skoll
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Georg Stary
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Reiberger
- Division of Gastroenterology and Hepatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| | - Robert Strassl
- Department of Laboratory Medicine, Institute of Clinical Virology, Medical University of Vienna, Vienna, Austria
| | - Birgit Willinger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Wolfgang Weninger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Armin Rieger
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Borik-Heil L, Endler G, Parson W, Zuckermann A, Schnaller L, Uyanik-Ünal K, Jaksch P, Böhmig G, Cejka D, Staufer K, Hielle-Wittmann E, Rasoul-Rockenschaub S, Wolf P, Sunder-Plassmann R, Geusau A. Cumulative UV Exposure or a Modified SCINEXA™-Skin Aging Score Do Not Play a Substantial Role in Predicting the Risk of Developing Keratinocyte Cancers after Solid Organ Transplantation-A Case Control Study. Cancers (Basel) 2023; 15:cancers15030864. [PMID: 36765822 PMCID: PMC9913211 DOI: 10.3390/cancers15030864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/03/2023] Open
Abstract
The risk of keratinocyte cancer is determined by intrinsic and extrinsic factors, which also influence skin aging. Few studies have linked skin aging and UV exposure with the incidence of non-melanoma skin cancer (NMSC). We evaluated signs of actinic skin damage and aging, individual UV burden, and melanocortin-1 receptor (MC1R) variants. A total of 194 organ transplant recipients (OTR) who suffered from NMSC were compared to 194 tumor-free controls matched for gender, age, type of transplanted organ, post-transplantation (TX) period, and immunosuppressive therapy. Compared with the cases, the controls scored higher in all skin aging scores and there were no differences in UV burden except for intentional whole-body UV exposure for specific UV scenarios and periods of life in favor of cases. The number of NMSCs correlated with all types of skin aging scores, the extent of intentional sun exposure, older age, longer post-TX period, shorter interval from TX to first NMSC, and specific MC1R risk groups. Multivariable models revealed a 7.5-fold risk of developing NMSC in individuals with actinic keratosis; 4.1- or 3.6-fold in those with green or blue eyes, respectively; and a 1.9-fold increased risk in the MC1R medium- + high-risk group. In the absence of skin aging contributing to NMSC development, certain MC1R risk types may identify OTR at risk for high tumor burden.
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Affiliation(s)
- Liliane Borik-Heil
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Endler
- Department of Laboratory Medicine, Medical University of Vienna, 1090 Vienna, Austria
| | - Walther Parson
- Institute of Legal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
- Forensic Science Program, The Pennsylvania State University, University Park, PA 16801, USA
| | - Andreas Zuckermann
- Department of Cardiac Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Lisa Schnaller
- Institute of Legal Medicine, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Keziban Uyanik-Ünal
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Peter Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Georg Böhmig
- Department of Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria
| | - Daniel Cejka
- Department of Nephrology, Ordensklinikum Barmherzige Schwestern Linz, 4020 Linz, Austria
| | - Katharina Staufer
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, 1090 Vienna, Austria
| | - Elisabeth Hielle-Wittmann
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, 1090 Vienna, Austria
| | - Susanne Rasoul-Rockenschaub
- Department of General Surgery, Division of Transplantation, Medical University of Vienna, 1090 Vienna, Austria
| | - Peter Wolf
- Department of Dermatology, Medical University of Graz, 8036 Graz, Austria
| | | | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, 1090 Vienna, Austria
- Correspondence: ; Tel.: +43-1-40400-77690
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Chromy D, Urban N, Grabmeier-Pfistershammer K, Touzeau-Roemer V, Geusau A, Stary G, Willinger B, Weninger W, Rieger A, Bauer W. 136 Asymptomatic Sexually Transmitted Infections Are Commonly Detected in Austrian PrEP-Users. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Geusau A, Chromy D, Heissenberger D, Lippert K, Eder C, Heger F, Indra A, Willinger B, Pleininger S. Resistance profiles of Neisseria gonorrhoeae isolates in Vienna, Austria: a phenotypic and genetic characterization from 2013 to 2020. Int J Antimicrob Agents 2022; 60:106656. [PMID: 35988663 DOI: 10.1016/j.ijantimicag.2022.106656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/29/2022] [Accepted: 08/11/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES International surveillance data show a constant rise in the number of Neisseria gonorrhoeae infections and an increase in drug resistance of N. gonorrhoeae. As recent N. gonorrhoeae surveillance data in Austria are scarce, this study investigated phenotypic and genotypic antimicrobial resistance in N. gonorrhoeae isolates. METHODS In total, 440 N. gonorrhoeae samples were collected at the Medical University of Vienna, and the minimal inhibitory concentrations (MICs) for a range of different antibiotics were determined. Sampling sites and treatments were recorded, and whole-genome sequencing of N. gonorrhoeae isolates was performed using allele libraries to determine genotypic resistance. RESULTS The median MICs for ceftriaxone, cefixime, azithromycin, ciprofloxacin, tetracycline and penicillin were <0.002 µg/mL, <0.016 µg/mL, 0.25 µg/mL, 2.0 µg/mL, 1.5 µg/mL and 0.25 µg/mL, respectively. Annual comparison showed that MICs were generally stable for all antimicrobial agents except azithromycin, for which an increase in median MIC was observed from 2017 (0.25 µg/mL). There was no genetic resistance to ceftriaxone; 8% of samples displayed resistance mutations against cefixime, primarily located in the penA gene. Resistance to azithromycin increased from 2% in 2013 to 12% in 2020. MtrD mosaic had the highest impact on azithromycin susceptibility; 47% of the resistant isolates showed this mutation. The majority of cases of gonorrhoea were treated successfully with either ceftriaxone or a ceftriaxone/azithromycin regime. Two treatment failures occurred under monotherapy with doxycycline. Overall, genotypic resistance corresponded significantly to all respective MICs. CONCLUSIONS The resistance rate of N. gonorrhoeae to antibiotics has remained stable in Vienna over the last decade, except for azithromycin. The strong correlation found between genetic and phenotypic patterns in this study holds promise for future diagnostics of N. gonorrhoeae resistance based on genotypes.
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Affiliation(s)
- Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria.
| | - David Chromy
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | | | - Kathrin Lippert
- Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Claudia Eder
- Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Florian Heger
- Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Vienna, Austria
| | - Alexander Indra
- Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Vienna, Austria; Paracelsus Medical University of Salzburg, Salzburg, Austria
| | - Birgit Willinger
- Department of Hygiene and Medical Microbiology, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Sonja Pleininger
- Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Vienna, Austria
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8
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Ferrándiz‐Pulido C, Gómez‐Tomás A, Llombart B, Mendoza D, Marcoval J, Piaserico S, Baykal C, Bouwes‐Bavinck J, Rácz E, Kanitakis J, Harwood C, Cetkovská P, Geusau A, del Marmol V, Masferrer E, Orte Cano C, Ricar J, de Oliveira W, Salido‐Vallejo R, Ducroux E, Gkini M, López‐Guerrero J, Kutzner H, Kempf W, Seçkin D. Clinicopathological features, MCPyV status and outcomes of Merkel cell carcinoma in solid-organ transplant recipients: a retrospective, multicentre cohort study. J Eur Acad Dermatol Venereol 2022; 36:1991-2001. [PMID: 35607918 PMCID: PMC9796956 DOI: 10.1111/jdv.18256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 04/13/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND The proportion of Merkel cell carcinomas (MCCs) in solid-organ transplant recipients (SOTR) harbouring Merkel cell polyomavirus (MCPyV) is unknown, as are factors affecting their outcomes. OBJECTIVE To describe clinicopathological features of MCC in SOTR, investigate the tumoral MCPyV-status and identify factors associated with tumour outcomes. METHODS Retrospective, international, cohort-study. MCPyV-status was investigated by immunohistochemistry and polymerase chain reaction. RESULTS A total of 30 SOTR and 44 consecutive immunocompetent patients with MCC were enrolled. SOTR were younger at diagnosis (69 vs. 78 years, P < 0.001). Thirty-three percent of SOTR MCCs were MCPyV-positive vs. 91% of immunocompetent MCCs (P = 0.001). Solid-organ transplantation was associated with an increased cumulative incidence of progression (SHR: 3.35 [1.57-7.14], P = 0.002), MCC-specific mortality (SHR: 2.55 [1.07-6.06], P = 0.034) and overall mortality (HR: 3.26 [1.54-6.9], P = 0.002). MCPyV-positivity and switching to an mTOR inhibitor (mTORi) after MCC diagnosis were associated with an increased incidence of progression (SHR: 4.3 [1.5-13], P = 0.008 and SHR: 3.6 [1.1-12], P = 0.032 respectively) in SOTR. LIMITATIONS Retrospective design and heterogeneity of SOTR cohort. CONCLUSIONS MCPyV appears to play a less prominent role in the aetiopathogenesis of MCC in SOTR. SOTR have a worse prognosis than their immunocompetent counterparts and switching to an mTORi after the diagnosis of MCC does not improve progression.
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Affiliation(s)
- C. Ferrándiz‐Pulido
- Department of DermatologyHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - A. Gómez‐Tomás
- Department of DermatologyHospital Universitari Vall d'Hebron, Universitat Autònoma de BarcelonaBarcelonaSpain
| | - B. Llombart
- Servicio de DermatologíaInstituto Valenciano de OncologíaValenciaSpain
| | - D. Mendoza
- Department of DermatologyFundación Jiménez DíazMadridSpain
| | - J. Marcoval
- Department of DermatologyHospital de Bellvitge, IDIBELL, University of BarcelonaBarcelonaSpain
| | - S. Piaserico
- Dermatology Unit, Department of MedicineUniversità di PadovaPadovaItaly
| | - C. Baykal
- Department of DermatologyIstanbul University, Istanbul Medical FacultyIstanbulTurkey
| | - J.N. Bouwes‐Bavinck
- Department of DermatologyLeiden University Medical CenterLeidenThe Netherlands
| | - E. Rácz
- Department of DermatologyUniversity of Groningen, University Medical Center GroningenGroningenThe Netherlands
| | - J. Kanitakis
- Department of DermatologyEdouard Herriot Hospital Group, Hospices Civils de LyonLyonFrance
| | - C.A. Harwood
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondonUK
| | - P. Cetkovská
- Department of DermatovenereologyFaculty of Medicine, Charles UniversityPilsenThe Czech Republic
| | - A. Geusau
- Department of DermatologyMedical University of ViennaViennaAustria
| | - V. del Marmol
- Service de DermatologieHôpital Erasme, Université Libre de BruxellesBrusselsBelgium
| | - E. Masferrer
- Department of DermatologyHospital Universitari Mútua de TerrassaBarcelonaSpain
| | - C. Orte Cano
- Service de DermatologieHôpital Erasme, Université Libre de BruxellesBrusselsBelgium
| | - J. Ricar
- Department of DermatovenereologyFaculty of Medicine, Charles UniversityPilsenThe Czech Republic
| | | | - R. Salido‐Vallejo
- Department of DermatologyUniversity Clinic of Navarra, School of Medicine, University of NavarraPamplonaSpain
| | - E. Ducroux
- Department of DermatologyEdouard Herriot Hospital Group, Hospices Civils de LyonLyonFrance
| | - M.A. Gkini
- Centre for Cell Biology and Cutaneous ResearchBlizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of LondonLondonUK
| | - J.A. López‐Guerrero
- Laboratory of Molecular BiologyFundación Instituto Valenciano de OncologíaValenciaSpain,IVO‐CIPF Joint Research Unit of Cancer, Príncipe Felipe Research Center (CIPF)ValenciaSpain,Department of PathologySchool of Medicine, Catholic University of Valencia ‘San Vicente Martir’ValenciaSpain
| | | | - W. Kempf
- Kempf und Pfaltz Histologische Diagnostik and Department of DermatologyUniversity Hospital ZurichZürichSwitzerland
| | - D. Seçkin
- Department of DermatologyBaşkent University Faculty of MedicineAnkaraTurkey
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9
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Schaeffer J, Lippert K, Pleininger S, Stöger A, Hasenberger P, Stadlbauer S, Heger F, Eigentler A, Geusau A, Indra A, Allerberger F, Ruppitsch W. Association of Phylogenomic Relatedness among Neisseria gonorrhoeae Strains with Antimicrobial Resistance, Austria, 2016-2020. Emerg Infect Dis 2022; 28:1694-1698. [PMID: 35876744 PMCID: PMC9328923 DOI: 10.3201/eid2808.220071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We investigated genomic determinants of antimicrobial resistance in 1,318 Neisseria gonorrhoeae strains isolated in Austria during 2016–2020. Sequence type (ST) 9363 and ST11422 isolates had high rates of azithromycin resistance, and ST7363 isolates correlated with cephalosporin resistance. These results underline the benefit of genomic surveillance for antimicrobial resistance monitoring.
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10
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Massey PR, Schmults CD, Li SJ, Arron ST, Asgari MM, Bavinck JNB, Billingsley E, Blalock TW, Blasdale K, Carroll BT, Carucci JA, Chong AH, Christensen SR, Chung CL, DeSimone JA, Ducroux E, Escutia-Muñoz B, Ferrándiz-Pulido C, Fox MC, Genders RE, Geusau A, Gjersvik P, Hanlon AM, Harken EBO, Hofbauer GF, Hopkins RS, Leitenberger JJ, Loss MJ, Del Marmol V, Mascaró JM, Myers SA, Nguyen BT, Oliveira WRP, Otley CC, Proby CM, Rácz E, Ruiz-Salas V, Samie FH, Seçkin D, Shah SN, Shin TM, Shumack SP, Soon SL, Stasko T, Zavattaro E, Zeitouni NC, Zwald FO, Harwood CA, Jambusaria-Pahlajani A. Consensus-Based Recommendations on the Prevention of Squamous Cell Carcinoma in Solid Organ Transplant Recipients: A Delphi Consensus Statement. JAMA Dermatol 2021; 157:1219-1226. [PMID: 34468690 PMCID: PMC9937447 DOI: 10.1001/jamadermatol.2021.3180] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE There is a paucity of evidence to guide physicians regarding prevention strategies for cutaneous squamous cell carcinoma (CSCC) in solid organ transplant recipients (SOTRs). OBJECTIVE To examine the development and results of a Delphi process initiated to identify consensus-based medical management recommendations for prevention of CSCC in SOTRs. EVIDENCE REVIEW Dermatologists with more than 5 years' experience treating SOTRs were invited to participate. A novel actinic damage and skin cancer index (AD-SCI), consisting of 6 ordinal stages corresponding to an increasing burden of actinic damage and CSCC, was used to guide survey design. Three sequential web-based surveys were administered from January 1, 2019, to December 31, 2020. Pursuant to Delphi principles, respondents thoroughly reviewed all peer responses between rounds. Supplemental questions were also asked to better understand panelists' rationale for their responses. FINDINGS The Delphi panel comprised 48 dermatologists. Respondents represented 13 countries, with 27 (56%) from the US. Twenty-nine respondents (60%) were Mohs surgeons. Consensus was reached with 80% or higher concordance among respondents when presented with a statement, question, or management strategy pertaining to prevention of CSCC in SOTRs. A near-consensus category of 70% to less than 80% concordance was also defined. The AD-SCI stage-based recommendations were established if consensus or near-consensus was achieved. The panel was able to make recommendations for 5 of 6 AD-SCI stages. Key recommendations include the following: cryotherapy for scattered actinic keratosis (AK); field therapy for AK when grouped in 1 anatomical area, unless AKs are thick in which case field therapy and cryotherapy were recommended; combination lesion directed and field therapy with fluorouracil for field cancerized skin; and initiation of acitretin therapy and discussion of immunosuppression reduction or modification for patients who develop multiple skin cancers at a high rate (10 CSCCs per year) or develop high-risk CSCC (defined by a tumor with approximately ≥20% risk of nodal metastasis). No consensus recommendation was achieved for SOTRs with a first low risk CSCC. CONCLUSIONS AND RELEVANCE Physicians may consider implementation of panel recommendations for prevention of CSCC in SOTRs while awaiting high-level-of-evidence data. Additional clinical trials are needed in areas where consensus was not reached.
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Affiliation(s)
- Paul R. Massey
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Chrysalyne D. Schmults
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sara J. Li
- Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sarah T. Arron
- Sarah Arron MD, A Professional Corporation, San Mateo, California
| | - Maryam M. Asgari
- Department of Dermatology, Massachusetts General Hospital, Boston,Department of Population Medicine, Harvard Pilgrim Healthcare Institute, Boston, Massachusetts
| | | | | | - Travis W. Blalock
- Department of Dermatology, Emory University School of Medicine, Atlanta, Georgia
| | - Katie Blasdale
- Department of Dermatology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Bryan T. Carroll
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio,Department of Dermatology, Case Western Reserve University, Cleveland, Ohio
| | - John A. Carucci
- The Ronald O. Perelman Department of Dermatology, New York University School of Medicine, New York
| | - Alvin H. Chong
- Skin Health Institute, Victoria, Australia,Department of Medicine (Dermatology), St Vincent’s Hospital Clinical School, The University of Melbourne, Victoria, Australia
| | - Sean R. Christensen
- Department of Dermatology, Yale University School of Medicine, New Haven, Connecticut
| | - Christina Lee Chung
- Montgomery Dermatology, King of Prussia, Pennsylvania,Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
| | | | - Emilie Ducroux
- Dermatology Department, Edouard Herriot Hospital, Hospices Civils de Lyon, Université Claude Bernard Lyon I, Lyon, France
| | | | - Carla Ferrándiz-Pulido
- Department of Dermatology, Hospital Universitari Vall d’Hebron, Barcelona, Spain,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Matthew C. Fox
- Division of Dermatology, Dell Medical School, University of Texas at Austin, Austin
| | - Roel E. Genders
- Department of Dermatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
| | - Petter Gjersvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Dermatology, Oslo University Hospital, Oslo, Norway
| | - Allison M. Hanlon
- Department of Dermatology, Vanderbilt University, Nashville, Tennessee
| | | | | | - R. Samuel Hopkins
- Department of Dermatology, Oregon Health and Science University, Portland
| | | | - Manisha J. Loss
- Department of Dermatology, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Veronique Del Marmol
- Department of Dermatology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - José M. Mascaró
- Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Sarah A. Myers
- Department of Dermatology, Duke University, Durham, North Carolina
| | - Bichchau T. Nguyen
- Department of Dermatology, Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts,Department of Dermatology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts
| | - Walmar R. P. Oliveira
- Department of Dermatology, Faculdade de Medicina da Universidade de São Paulo, São Paulo, SP, Brazil
| | - Clark C. Otley
- Department of Dermatology, Mayo Clinic, Rochester, Minnesota
| | - Charlotte M. Proby
- Ninewells Hospital and Medical School, University of Dundee, Dundee, United Kingdom
| | - Emőke Rácz
- Department of Dermatology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Veronica Ruiz-Salas
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Faramarz H. Samie
- Department of Dermatology, Columbia University Irving Medical Center, New York, New York
| | - Deniz Seçkin
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Syed N. Shah
- Department of Dermatology, Norfolk and Norwich University Hospital, Norwich, United Kingdom
| | - Thuzar M. Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | | | - Seaver L. Soon
- Scripps Green Hospital, Private Practice (The Skin Clinic MD), San Diego, California
| | - Thomas Stasko
- Department of Dermatology, University of Oklahoma Health Sciences Center, Oklahoma City
| | - Elisa Zavattaro
- Dermatology Unit, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Nathalie C. Zeitouni
- Medical Dermatology Specialists, Phoenix, Arizona,Division of Dermatology, University of Arizona College of Medicine, Phoenix
| | - Fiona O’Reilly Zwald
- Piedmont Healthcare, Atlanta, Georgia,O’Reilly Comprehensive Dermatology Inc, Atlanta, Georgia,Mount Vernon Medical Center, Atlanta, Georgia
| | - Catherine A. Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts, United Kingdom,The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
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11
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Geusau A, Borik‐Heil L, Skalicky S, Mildner M, Grillari J, Hackl M, Sunder‐Plassmann R. Dysregulation of tissue and serum microRNAs in organ transplant recipients with cutaneous squamous cell carcinomas. Health Sci Rep 2020; 3:e205. [PMID: 33251338 PMCID: PMC7676459 DOI: 10.1002/hsr2.205] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/23/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022] Open
Abstract
Micro RNAs (miRNAs) are considered as promising biomarkers for skin cancer. By next generation sequencing (NGS), we measured and compared miRNA expression profiles of tumor, peri-lesional, and control tissue of immunosuppressed organ transplant recipients (OTR), suffering from localized cutaneous squamous cell carcinoma (cSCC). Out of 490 miRNAs detected in cSCC tissue, 23 significantly regulated miRNAs were selected for quantitative targeted analysis in serum samples of our patients and control sera from OTR without cSCC. Two onco-miRNAs (mir-1290, mir-1246), previously identified as crucial drivers for tumor initiation and cancer progression, were significantly and exclusively upregulated in both tumor tissue and serum. This finding suggests that miRNA dysregulation in cSCC tissue is reflected in serum even in patients without advanced disease and highly differentiated cSCCs.
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Affiliation(s)
- Alexandra Geusau
- Department of DermatologyMedical University of ViennaViennaAustria
| | | | | | - Michael Mildner
- Department of Dermatology, Research Division of Biology and Pathobiology of the SkinMedical University of ViennaViennaAustria
| | - Johannes Grillari
- Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyViennaAustria
- Christian Doppler Laboratory for Biotechnology of Skin Aging, Department of BiotechnologyInstitute for Molecular Biotechnology, BOKU – University of Natural Resources and Life SciencesViennaAustria
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12
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Plasmeijer E, Sachse M, Gebhardt C, Geusau A, Bouwes Bavinck J. Cutaneous squamous cell carcinoma (cSCC) and immunosurveillance – the impact of immunosuppression on frequency of cSCC. J Eur Acad Dermatol Venereol 2019; 33 Suppl 8:33-37. [DOI: 10.1111/jdv.16025] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 10/21/2019] [Indexed: 12/22/2022]
Affiliation(s)
- E.I. Plasmeijer
- Department of Dermatology Erasmus Medical Centre Rotterdam The Netherlands
| | - M.M. Sachse
- Department of Dermatology, Allergy and Phlebology Hospital of Bremerhaven Bremerhaven Germany
| | - C. Gebhardt
- Department of Dermatology and Venerology University Hospital Hamburg‐Eppendorf (UKE) Hamburg Germany
| | - A. Geusau
- Department of Dermatology Medical University of Vienna Vienna Austria
| | - J.N. Bouwes Bavinck
- Department of Dermatology Leiden University Medical Centre Leiden The Netherlands
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13
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Schremser V, Antoniewicz L, Tschachler E, Geusau A. Polymerase chain reaction for the diagnosis of herpesvirus infections in dermatology : Analysis of clinical data. Wien Klin Wochenschr 2019; 132:35-41. [PMID: 31820101 PMCID: PMC6978434 DOI: 10.1007/s00508-019-01585-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 11/15/2019] [Indexed: 11/08/2022]
Abstract
Background Rapid identification of human herpesviruses from lesion swabs is necessary for timely initiation of antiviral treatment, especially with infections involving neonates and immunocompromised individuals. The aim of the study was to investigate the results of an in-house polymerase chain reaction (PCR) test for herpesviruses in patients with symptoms suggestive for a herpesvirus infection. Patients and methods In this single center retrospective study the results of 3677 lesion swab specimens tested for human herpes simplex virus 1 and 2 (HSV 1 and 2) and varicella zoster virus (VZV) were analyzed in the context of data sheets giving details of the suspected diagnosis, medical history as well as the demographic data of the patients. The PCR procedures for cytomegalovirus (CMV), Epstein-Barr virus (EBV) and human herpes virus 8 (HHV-8) were applied on special occasions. Results Of the samples 3369 (91.6%) were swabs and a minority were tissue or blood samples. Of the 3015 samples tested for HSV‑1, HSV‑2 and VZV concomitantly, 52.3% were positive for at least one of these viruses. Clinically distinct conditions, such as herpes zoster and varicella had a high rate of positive PCR results, ranging from 81% to 88%, respectively. Among HSV‑2 positive samples, 23.7% derived from human immunodeficiency virus (HIV) positive patients, in contrast to the 10.8% originating from immunocompetent patients, the difference being statistically significant (p < 0.002). The HSV‑2 was detected more often in women than in men. Conclusion Distinct clinical diagnoses have a high correlation rate with positive PCR results. A significantly higher number of HSV‑2 positive results were found in HIV positive patients and in women.
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Affiliation(s)
- Verena Schremser
- Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lukasz Antoniewicz
- Dept. of Clinical Sciences, Karolinska Institutet at Danderyds University Hospital, Stockholm, Sweden
| | - Erwin Tschachler
- Research Department of Biology and Pathobiology of the Skin, Medical University of Vienna, Vienna, Austria
| | - Alexandra Geusau
- Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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14
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Oh C, Hofbauer G, Serra A, Harwood C, Mitchell L, Proby C, Olasz E, Mosel D, Piaserico S, Fortina A, Geusau A, Jahn-Bassler K, Gerritsen M, Seçkin D, Güleç A, Cetkovská P, Ricar J, Imko-Walczuk B, Dębska-Ślizień A, Bouwes Bavinck J. Painful skin lesions and squamous cell carcinoma predict overall mortality risk in organ transplant recipients: a cohort study. Br J Dermatol 2017; 176:1179-1186. [DOI: 10.1111/bjd.15269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- C.C. Oh
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - G.F.L. Hofbauer
- Department of Dermatology; University Hospital Zürich; Zürich Switzerland
| | - A.L. Serra
- Epidemiology, Biostatistics and Prevention Institute; University of Zürich; Zürich Switzerland
| | - C.A. Harwood
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London U.K
| | - L. Mitchell
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London U.K
| | - C.M. Proby
- Barts and The London School of Medicine and Dentistry; Queen Mary University of London; London U.K
- Division of Cancer Research; University of Dundee; Ninewells Hospital and Medical School; Dundee U.K
| | - E.B. Olasz
- Medical College of Wisconsin; Milwaukee WI U.S.A
| | - D.D. Mosel
- Medical College of Wisconsin; Milwaukee WI U.S.A
| | - S. Piaserico
- Department of Medicine; University of Padua; Padua Italy
| | - A.B. Fortina
- Department of Medicine; University of Padua; Padua Italy
| | - A. Geusau
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | - K. Jahn-Bassler
- Department of Dermatology; Medical University of Vienna; Vienna Austria
| | | | - D. Seçkin
- Başkent University Faculty of Medicine; Ankara Turkey
| | - A.T. Güleç
- Başkent University Faculty of Medicine; Ankara Turkey
| | - P. Cetkovská
- University Hospital Pilsen; Pilsen Czech Republic
| | - J. Ricar
- University Hospital Pilsen; Pilsen Czech Republic
| | | | - A. Dębska-Ślizień
- Department of Nephrology, Transplantology and Internal Medicine; Medical University of Gdańsk; Gdańsk Poland
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15
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Stary A, Heller-Vitouch C, Binder M, Geusau A, Stary G, Rappersberger K, Komericki P, Hoepfl R, Haller M. Gonococcal infections in Austria: a long-term observation of prevalence and resistance profiles from 1999 to 2014. J Dtsch Dermatol Ges 2016; 13:1136-45. [PMID: 26513072 DOI: 10.1111/ddg.12816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES The increase in minimum inhibitory concentrations (MICs) of cephalosporins for Neisseria gonorrhoeae has given rise to concerns regarding potentially untreatable gonococcal infections. The goal was to ascertain the prevalence of gonorrhea in a Viennese patient group and determine resistance patterns. Another objective was to evaluate resistance profiles and MIC values of gonococcal isolates in an Austria-wide surveillance project. PATIENTS AND METHODS From 1999 to 2014, 350,000 individuals were tested for gonococci at the Viennese Outpatient Clinic. In addition, from 2010 to 2014, the MICs of recommended antibiotics was determined in 3,584 gonococcal isolates, initially by agar dilution and breakpoint determination, and, from 2012 onwards, by Etest®. RESULTS During the observation period, the prevalence of gonorrhea increased eightfold, with a significantly greater number of quinolone, penicillin, and tetracycline- resistant strains. In gonococcal strains isolated from across Austria, there was an increase in cefixime and ceftriaxone MICs toward breakpoints. Twenty-one isolates showed cefixime resistance, and while there was an increase in azithromycin resistance from 0.9 % (2013) to 3.2 % (2014), no resistance to ceftriaxone was observed. CONCLUSION Currently, there is no imminent risk of untreatable gonorrhea in Austria. However, continuing the use of gonococcal cultures as a diagnostic tool for establishing resistance profiles is essential in order to monitor trends in the development of Neisseria (N.) gonorrhoeae resistance.
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Affiliation(s)
- Angelika Stary
- Outpatient Clinic and Other Venereal/Dermatologic Diseases, Vienna, Austria
| | | | - Michael Binder
- Outpatient Clinic for the Diagnosis and Treatment of Sexually Transmitted Diseases - Municipal Department 15, Vienna, Austria
| | - Alexandra Geusau
- Division of Immunology, Allergy, and Infectious Diseases, Department of Dermatology, University Medical Center Vienna, Vienna, Austria
| | - Georg Stary
- Division of Immunology, Allergy, and Infectious Diseases, Department of Dermatology, University Medical Center Vienna, Vienna, Austria
| | | | - Peter Komericki
- Department of Dermatology and Venereology, University Medical Center Graz, Graz, Austria
| | - Reinhard Hoepfl
- Department of Dermatology and Venereology, University Medical Center Innsbruck, Innsbruck, Austria
| | - Maria Haller
- Outpatient Clinic and Other Venereal/Dermatologic Diseases, Vienna, Austria
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16
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Geusau A, Kittler H, Hein U, Dangl-Erlach E, Stingl G, Tschachler E. Biological false-positive tests comprise a high proportion of Venereal Disease Research Laboratory reactions in an analysis of 300,000 sera. Int J STD AIDS 2016; 16:722-6. [PMID: 16303064 DOI: 10.1258/095646205774763207] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This retrospective study on syphilis screening at the sexually transmitted infection (STI) unit of a University Department emphasizes the necessity of a treponemal-specific test as the appropriate screening test. The Venereal Disease Research Laboratory (VDRL) test for syphilis screening may, under certain circumstances, yield positive results in patients not infected with Treponema pallidum, a phenomenon referred to as biological false-positive (BFP) VDRL test. The aim of this study was to determine the frequency of BFP tests in a large sample of sera. In this retrospective study, we analysed the results of parallel VDRL and T. pallidum haemagglutination (TPHA) testing of a total of 514,940 blood samples obtained from patients at the Vienna General Hospital between January 1988 and November 1999. Patients' sera with incomplete data on stage and sex and duplicate sera were excluded, leaving 300,000 sera for analysis. The seroprevalence for syphilis was 1.77% ( n = 5320), as determined by a positive TPHA test. It was significantly higher in male than in female patients (2.03% versus 1.58%, P<0.001). Of the patients reactive in the TPHA test, 3257 (61.2%) were negative in the VDRL. With regard to reactivity in VDRL testing, 2799 patients (0.92%) of the study population were positive, of whom 736 (26%) were biological false positive. BFP reactivity was found in 0.24% of all patients and was significantly higher in women than in men (0.27% versus 0.20%, P<0.001) and in patients over 60 years of age (0.34%) as compared with those under 60 (0.25%, P<0.001). This proportion might be even higher, as reactivity in the VDRL at 1:0 and 1:2 dilutions without a positive treponemal test was not reported. The subgroup of HIV-positive patients ( n = 1415) revealed a 10-fold higher rate of BFP tests (2.1% versus 0.24), an effect being statistically significant. In a low syphilis prevalence population, BFP reactions comprise a high proportion of all VDRL reactors. Therefore, the use of the VDRL as a screening procedure is challenged.
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Affiliation(s)
- Alexandra Geusau
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna.
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18
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Stary A, Heller-Vitouch C, Binder M, Geusau A, Stary G, Rappersberger K, Komericki P, Hoepfl R, Haller M. Die Gonokokkeninfektion in Österreich: Eine Langzeitbeobachtung der Prävalenz und Resistenzentwicklung von 1999 bis 2014. J Dtsch Dermatol Ges 2015. [DOI: 10.1111/ddg.50_12816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Michael Binder
- Ambulatorium für Diagnose und Behandlung sexuell übertragbarer Krankheiten - Magistratsabteilung 15; Wien Österreich
| | - Alexandra Geusau
- Abteilung für Immundermatologie und infektiöse Hautkrankheiten, Universitätsklinik für Dermatologie; Wien Österreich
| | - Georg Stary
- Abteilung für Immundermatologie und infektiöse Hautkrankheiten, Universitätsklinik für Dermatologie; Wien Österreich
| | - Klemens Rappersberger
- Abteilung für Dermatologie und Venerologie, Krankenanstalt Rudolfstiftung; Wien Österreich
| | - Peter Komericki
- Universitätsklinik für Dermatologie und Venerologie; Graz Österreich
| | - Reinhard Hoepfl
- Universitätsklinik für Dermatologie und Venerologie; Innsbruck Österreich
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Geusau A, Antoniewicz L, Poitschek C, Presterl E, Willinger B. In vitro susceptibility of Candida isolates from organ transplant recipients to newer antifungals. Mycopathologia 2014; 177:143-56. [PMID: 24682600 DOI: 10.1007/s11046-014-9738-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2014] [Accepted: 03/21/2014] [Indexed: 11/26/2022]
Abstract
Organ transplant recipients (OTR) are at higher risk of developing life-threatening infections. In this study, we tested 527 Candida isolates obtained from the oral and genital mucosa from OTR and healthy controls in order to monitor antifungal susceptibility patterns in this particular risk group. Testing was carried out in parallel for already marketed azoles and anidulafungin. Minimal inhibitory concentrations (MICs) were determined using the E-test(®) for azoles and CLSI broth microdilution for anidulafungin. Overall, there was no difference in the distribution of Candida spp. for both groups, C. albicans being the most frequently isolated Candida sp. followed by C. glabrata. Also, there were only minor differences in the susceptibility patterns to all antifungal agents. All C. albicans isolates were fully susceptible to fluconazole and voriconazole. In C. glabrata, 2.2% (n = 1) were resistant to fluconazole, and 82.6% (n = 38) to itraconazole, and in C. krusei, 66.7% (n = 2) were resistant in itraconazole. All strains were susceptible to voriconazole. Only fluconazole showed a higher rate of resistant C. glabrata isolates for OTR (3.7%), whereas the control group showed only intermediate susceptible and no resistant isolates. As there are no breakpoints established for posaconazole by CLSI, breakpoints determined by EUCAST were used. A total of 87.9% of C. albicans, 81.3% of C. parapsilosis and 66.7% of C. tropicalis were considered susceptible. C. glabrata and C. krusei showed higher MIC values and thus lesser susceptibility than the other Candida species. There were no differences observed between OTR and control groups. For anidulafungin, 99.8% of C. albicans isolates were susceptible, 0.2% were intermediate, whereas for C. glabrata, only 95.3% were susceptible, 0.2% were resistant and 4.5% were interpreted as intermediate. Interestingly, the two resistant isolates were found in the control group. Also, the controls showed a marginally higher percentage of intermediate strains compared to the transplant patients. All in all, resistant isolates were only observed for C. glabrata of the control group.
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Affiliation(s)
- Alexandra Geusau
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Vienna, Austria
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Bouwes Bavinck JN, Harwood CA, Genders RE, Wisgerhof HC, Plasmeijer EI, Mitchell L, Olasz EB, Mosel DD, Pokorney MS, Serra AL, Feldmeyer L, Baumann Conzett K, Piaserico S, Belloni Fortina A, Jahn K, Geusau A, Gerritsen MJP, Seckin D, Gulec AT, Cetkovska P, Ricar J, Imko-Walczuk B, Proby CM, Hofbauer GFL. Pain identifies squamous cell carcinoma in organ transplant recipients: the SCOPE-ITSCC PAIN study. Am J Transplant 2014; 14:668-76. [PMID: 24730051 DOI: 10.1111/ajt.12587] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients (OTR) are at high risk for cutaneous squamous cell carcinomas (SCC). We aimed to define clinically meaningful patient-reported warning signals predicting the presence of invasive SCC.Patient-reported signs and symptoms of 812 consecutively biopsied skin lesions from 410 OTR were determined by questionnaire and physical examination and related to the subsequent biopsy-proven diagnoses. Receiver-operating characteristic (ROC) curve analyses were used as a measure of distinction between the predictive values of patient-reported warning signals and the occurrence of SCC. Pain was an independent predictive patient-reported warning signal for a biopsy-proven invasive SCC. The odds ratio from the fully adjusted model predicting SCC was 4.4(95% confidence interval: 2.4–8.2). Higher scores on the visual analog scale (VAS) for pain were associated witha greater likelihood for the presence of SCC compared to none or mild pain. The for scores on the VAS from 1to 3, 4 to 6 and 7 to 10 were 4.9 (2.2–10.5), 2.3 (0.96–5.5)and 16.5 (3.6–75.8), respectively. Pain is the most powerful patient-reported warning signal for invasive cutaneous SCC in OTR. Empowerment of patients by education could accelerate diagnosis and treatment of cutaneous SCC.
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Schäfer M, Willrodt AH, Kurinna S, Link AS, Farwanah H, Geusau A, Gruber F, Sorg O, Huebner AJ, Roop DR, Sandhoff K, Saurat JH, Tschachler E, Schneider MR, Langbein L, Bloch W, Beer HD, Werner S. Activation of Nrf2 in keratinocytes causes chloracne (MADISH)-like skin disease in mice. EMBO Mol Med 2014; 6:442-57. [PMID: 24503019 PMCID: PMC3992072 DOI: 10.1002/emmm.201303281] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The transcription factor Nrf2 is a key regulator of the cellular stress response, and pharmacological Nrf2 activation is a promising strategy for skin protection and cancer prevention. We show here that prolonged Nrf2 activation in keratinocytes causes sebaceous gland enlargement and seborrhea in mice due to upregulation of the growth factor epigen, which we identified as a novel Nrf2 target. This was accompanied by thickening and hyperkeratosis of hair follicle infundibula. These abnormalities caused dilatation of infundibula, hair loss, and cyst development upon aging. Upregulation of epigen, secretory leukocyte peptidase inhibitor (Slpi), and small proline-rich protein 2d (Sprr2d) in hair follicles was identified as the likely cause of infundibular acanthosis, hyperkeratosis, and cyst formation. These alterations were highly reminiscent to the phenotype of chloracne/“metabolizing acquired dioxin-induced skin hamartomas” (MADISH) patients. Indeed, SLPI, SPRR2, and epigen were strongly expressed in cysts of MADISH patients and upregulated by dioxin in human keratinocytes in an NRF2-dependent manner. These results identify novel Nrf2 activities in the pilosebaceous unit and point to a role of NRF2 in MADISH pathogenesis.
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Affiliation(s)
- Matthias Schäfer
- Department of Biology, Institute of Molecular Health Sciences, ETH Zurich Zurich, Switzerland
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Friedrich F, Aigner M, Fearns N, Friedrich ME, Frey R, Geusau A. Psychosis in neurosyphilis -- clinical aspects and implications. Psychopathology 2014; 47:3-9. [PMID: 23711816 DOI: 10.1159/000350059] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 02/09/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The World Health Organization estimates that 10-12 million new syphilis infections occur each year. Without treatment, years to decades after initial infection, 30% of affected individuals may develop tertiary syphilis, which can manifest as neurosyphilis. The aim of this review is to evaluate the research literature examining the psychopathological manifestations of psychosis in association with neurosyphilis. METHOD The authors performed a systematic electronic search for published studies (1995-2012). The following databases were used: Medline, Embase and the Cochrane Library as well as the search engines Scopus and Google Scholar. RESULTS 61 articles were used for detailed analysis. Psychotic symptoms due to neurosyphilis are numerous and can inform differential diagnosis for many psychotic manifestations according to ICD-10 or DSM-IV. CONCLUSION Due to our results, current epidemiological data, and the difficulties in differential diagnosis of neurosyphilis, routine screening tests are still recommended in the psychiatric field. Long-term psychiatric input, with periodic syphilis titre controls, seems indicated in individuals affected by neurosyphilis with psychiatric symptoms. Furthermore, individuals with mental health problems may be at higher risk of acquiring syphilis.
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Affiliation(s)
- F Friedrich
- Division of Social Psychiatry, Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
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Tittes J, Aichelburg MC, Antoniewicz L, Geusau A. Enhanced therapy for primary and secondary syphilis: a longitudinal retrospective analysis of cure rates and associated factors. Int J STD AIDS 2013; 24:703-11. [PMID: 24026794 DOI: 10.1177/0956462413480721] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
For the treatment of early infectious syphilis, enhanced therapy with three dosages of benzathine penicillin G has been under consideration, particularly in the human immunodeficiency virus type 1 infected population (HIV-1). The serological outcome of 249 patients with primary and secondary syphilis treated with standard or enhanced therapy was analyzed retrospectively; 98% (139/142) achieved serological cure with a single dosage and 92% with enhanced therapy (P=0.033). In HIV-1 infected individuals, cure rates were 88% after a single dosage compared to 97% after three dosages (P=0.18). A fourfold decrease of Venereal Disease Research Laboratory (VDRL) titres was achieved within a median of 102 days after treatment initiation (SD=2; 95% CI=98-106). Patients aged over 40 years were 5.5 times (OR=5.52; 95% CI=1.43-21.32; P=0.013) and patients with low baseline VDRL titres (≤ 1:32) were 4 times (OR=4.25; 95% CI=1.21-14.87; P=0.024) more likely to experience serological failure.
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Affiliation(s)
- Julia Tittes
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Vienna, Austria
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24
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Seçkin D, Barete S, Euvrard S, Francès C, Kanitakis J, Geusau A, Del Marmol V, Harwood CA, Proby CM, Ali I, Güleç AT, Durukan E, Lebbé C, Alaibac M, Laffitte E, Cooper S, Bouwes Bavinck JN, Murphy GM, Ferrándiz C, Mørk C, Cetkovská P, Kempf W, Hofbauer GFL. Primary cutaneous posttransplant lymphoproliferative disorders in solid organ transplant recipients: a multicenter European case series. Am J Transplant 2013; 13:2146-53. [PMID: 23718915 DOI: 10.1111/ajt.12281] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 03/30/2013] [Accepted: 04/08/2013] [Indexed: 01/25/2023]
Abstract
Primary cutaneous posttransplant lymphoproliferative disorders (PTLD) are rare. This retrospective, multicenter study of 35 cases aimed to better describe this entity. Cases were (re)-classified according to the WHO-EORTC or the WHO 2008 classifications of lymphomas. Median interval between first transplantation and diagnosis was 85 months. Fifty-seven percent of patients had a kidney transplant. Twenty-four cases (68.6%) were classified as primary cutaneous T cell lymphoma (CTCL) and 11 (31.4%) as primary cutaneous B cell PTLD. Mycosis fungoides (MF) was the most common (50%) CTCL subtype. Ten (90.9%) cutaneous B cell PTLD cases were classified as EBV-associated B cell lymphoproliferations (including one plasmablastic lymphoma and one lymphomatoid granulomatosis) and one as diffuse large B cell lymphoma, other, that was EBV-negative. Sixteen (45.7%) patients died after a median follow-up of 19.5 months (11 [68.8%] with CTCL [6 of whom had CD30(+) lymphoproliferative disorders (LPD)] and 5 [31.2%] with cutaneous B cell PTLD. Median survival times for all patients, CTCL and cutaneous B cell PTLD subgroups were 93, 93, and 112 months, respectively. Survival rates for MF were higher than those for CD30(+) LPD. The spectrum of primary CTCL in organ transplant recipients (OTR) is similar to that in the general population. The prognosis of posttransplant primary cutaneous CD30(+) LPD is worse than posttransplant MF and than its counterpart in the immunocompetent population. EBV-associated cutaneous B cell LPD predominates in OTR.
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Affiliation(s)
- D Seçkin
- Department of Dermatology, Başkent University Faculty of Medicine, Ankara, Turkey.
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Stary A, Haller M, Heller-Vitouch C, Hartl N, Vinzelj-Horvath E, Geusau A, Rappersberger K, Komericki P, Auböck J, Hoepfl R. P2.096 Evaluation of Gonococcal Resistance in Austria. Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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26
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Geusau A, Jalili A. P2.115 Genital Ulceration: Infection or Autoinflammatory Disease? Br J Vener Dis 2013. [DOI: 10.1136/sextrans-2013-051184.0379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Geusau A, Mothes-Luksch N, Nahavandi H, Pickl WF, Wise CA, Pourpak Z, Ponweiser E, Eckhart L, Sunder-Plassmann R. Identification of a homozygous PSTPIP1 mutation in a patient with a PAPA-like syndrome responding to canakinumab treatment. JAMA Dermatol 2013; 149:209-15. [PMID: 23426477 DOI: 10.1001/2013.jamadermatol.717] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Pyogenic sterile arthritis, pyoderma gangrenosum, and acne (PAPA) syndrome (OMIM 604416) is a rare autosomal dominant inherited autoinflammatory syndrome characterized by pyogenic sterile arthritis and less frequently accompanied by pyoderma gangrenosum and acne. It is associated with dominant missense mutations in the proline-serine-threonine phosphatase-interacting protein 1 gene (PSTPIP1) located on chromosome 15. The patient was diagnosed as having features of a PAPA-like syndrome in which cutaneous manifestations, such as pyoderma gangrenosum and acne fulminans, predominated. OBSERVATIONS Sequencing of the PSTPIP1 gene was performed in the patient and his extended family. The patient's DNA analysis revealed a homozygous nucleotide exchange c.773G>C in the PSTPIP1 gene, leading to the substitution of glycine 258 by alanine (p.Gly258Ala), a previously reported heterozygous polymorphism. Heterozygous changes were identified in both of the patient's parents and in 7 other family members, all of whom were asymptomatic. The patient was treated with canakinumab, a human anti-interleukin 1β monoclonal antibody, which led to rapid remission of the symptoms. CONCLUSIONS To our knowledge, this is the first reported case of the resolution of dermatological symptoms associated with a PAPA-like syndrome using canakinumab treatment. Further study of the p.Gly258Ala variant is warranted to determine whether this mutation has a role in causing an apparently recessive cutaneous syndrome resembling PAPA syndrome.
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Affiliation(s)
- Alexandra Geusau
- Division of Immunology, Allergy, and Infectious Diseases, Department of Dermatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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Wibmer A, Kölblinger C, Stift A, Wrba F, Stary G, Geusau A. Syphilis: the great mimicker. Int J Dermatol 2012; 53:e166-8. [PMID: 23231700 DOI: 10.1111/j.1365-4632.2012.05760.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Andreas Wibmer
- Departments of Radiology, Medical University of Vienna, Vienna, Austria
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Friedrich F, Geusau A, Friedrich ME, Vyssoki B, Pfleger T, Aigner M. Das Chamäleon der Psychiatrie – Psychiatrische Manifestationsformen der Neurosyphilis. Psychiat Prax 2011; 39:7-13. [DOI: 10.1055/s-0031-1276935] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Jahn K, Heil P, Brunner P, Födinger D, Riedl E, Geusau A. [A liver transplant patient with chronic erosive and scarring lesions on the scalp]. J Dtsch Dermatol Ges 2011; 9:719-20. [PMID: 21884419 DOI: 10.1111/j.1610-0387.2011.07719.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Karin Jahn
- Universitätsklinik für Dermatologie, AKH Wien, Abteilung für Immundermatologie, Allergologie und infektiöse Hautkrankheiten, Österreich
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Mildner M, Stichenwirth M, Abtin A, Eckhart L, Sam C, Gläser R, Schröder JM, Gmeiner R, Mlitz V, Pammer J, Geusau A, Tschachler E. Psoriasin (S100A7) is a major Escherichia coli-cidal factor of the female genital tract. Mucosal Immunol 2010; 3:602-9. [PMID: 20571488 DOI: 10.1038/mi.2010.37] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The female urogenital tract requires an efficient defense against bacteria, potentially derived from the adjacent intestinal tract. We have thus sought to identify the factors that protect against Escherichia coli (E. coli) in the female genital tract. Vaginal fluid from healthy human donors consistently killed E. coli in vitro and vaginal epithelium strongly expressed and secreted psoriasin. Psoriasin was constitutively produced in an organotypic vaginal epithelium model, and exposure of these cells to supernatants of E. coli cultures led to an enhanced psoriasin expression. Secreted psoriasin in vaginal fluids accounted for approximately 2.5-3% of total protein. Fractionation of vaginal fluids by high performance liquid chromatography (HPLC) showed that psoriasin co-eluted with a peak of E. coli killing activity. Our data show that normal vaginal fluid contains a powerful intrinsic antimicrobial defense against E. coli and that psoriasin contributes to the innate immune response of the female genital tract.
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Affiliation(s)
- M Mildner
- Department of Dermatology, Medical University of Vienna, Vienna, Austria
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32
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Stary G, Geusau A, Greinix H, Vormittag L, Stingl G, Rabitsch W. Epstein-Barr virus-associated oral papulosis in graft-versus-host disease. Acta Derm Venereol 2010; 90:542-3. [PMID: 20814644 DOI: 10.2340/00015555-0903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Haidinger M, Hecking M, Weichhart T, Poglitsch M, Enkner W, Vonbank K, Prayer D, Geusau A, Oberbauer R, Zlabinger GJ, Soleiman A, Hörl WH, Säemann MD. Sirolimus in renal transplant recipients with tuberous sclerosis complex: clinical effectiveness and implications for innate immunity. Transpl Int 2010; 23:777-85. [DOI: 10.1111/j.1432-2277.2009.01041.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Friedrich F, Geusau A, Greisenegger S, Ossege M, Aigner M. Manifest psychosis in neurosyphilis. Gen Hosp Psychiatry 2009; 31:379-81. [PMID: 19555800 DOI: 10.1016/j.genhosppsych.2008.09.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Revised: 08/24/2008] [Accepted: 09/04/2008] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Recent surveys have assessed a remarkable increase in the prevalence of infectious syphilis. If left untreated, 30% of patients may develop tertiary syphilis, which can manifest as neurosyphilis. CASE REPORT The authors present a case of an acute psychosis during and after pregnancy in a 37-year-old woman, which was identified as a manifestation of neurosyphilis after admission to a psychiatric ward. The positive screening test for syphilis provided the first hint of syphilis and gave direction for further diagnosis and specific treatment. Subsequently, the patient was treated with psychotropic medication concurrent with an adequate antibiotic treatment for neurosyphilis and was simultaneously psychologically monitored. An improvement of psychotic symptoms during antibiotic therapy was observed. CONCLUSION This case emphasises that neurosyphilis still has to be considered in the differential diagnosis within the context of psychiatric conditions and diseases. Owing to current epidemiological data and difficulties in diagnosing syphilis, routine screening tests in the psychiatric field are necessary.
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Affiliation(s)
- Fabian Friedrich
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna 1090, Austria.
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35
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Pfistershammer K, Petzelbauer P, Stingl G, Mastan P, Chott A, Jäger U, Skrabs C, Geusau A. Methotrexate-induced primary cutaneous diffuse large B-cell lymphoma with an 'angiocentric' histological morphology. Clin Exp Dermatol 2009; 35:59-62. [PMID: 19486063 DOI: 10.1111/j.1365-2230.2009.03293.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A patient with a 25-year history of rheumatoid arthritis and a 3-year history of methotrexate treatment developed a generalized papular rash. The papules rapidly became necrotic and then resolved, leaving a depressed scar. The rapid course of lesion development and regression was reminiscent of pityriasis lichenoides. Histology revealed a nodular infiltrate composed of a mixture of pleomorphic large B cells positive for CD20, CD30 and CD79a, and of small T cells positive for CD3 and CD4. The T cells had a striking angiocentric distribution, with some of the vessels exhibiting fibrinoid necrosis of the vessel wall reminiscent of lymphomatoid granulomatosis. However, B cells were consistently negative for Epstein-Barr virus (EBV) antigen expression. A thorough examination excluded involvement of organs other than the skin. Thus, this patient was classified as having a rare form of an EBV-negative primary cutaneous T-cell-rich B-cell lymphoma in association with methotrexate treatment.
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Affiliation(s)
- K Pfistershammer
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Vienna, Austria
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Antoniewicz L, Relijc D, Poitschek C, Presterl E, Geusau A. Mucosal Candida infection and colonisation as well as associated risk factors in solid organ transplant recipients. Eur J Clin Microbiol Infect Dis 2009; 28:945-57. [PMID: 19340468 DOI: 10.1007/s10096-009-0730-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2008] [Accepted: 03/14/2009] [Indexed: 10/20/2022]
Abstract
More detailed information on Candida colonisation and infection of the mucous membranes in organ transplant recipients (OTR) is of particular interest. Therefore, this issue was prospectively evaluated in 400 different OTR in different posttransplantation periods as well as in 405 healthy age- and sex-matched controls. In addition, possible risk factors and the clinical condition in the OTR were evaluated. Independent of the transplanted organ there is a statistically significant decrease in the number of positive culture results, of symptomatic candidiasis and an increase of isolated non-albicans Candida species corresponding to length of the posttransplantation period. No significant differences could be observed in the OTR in association with different immunosuppressive regimen; however, higher dosages of corticosteroids and tacrolimus correlated with symptomatic candidiasis. As Candida spp. may also cause systemic infection and dissemination, additional knowledge about cofactors and associated strains may have an impact on therapeutic decisions.
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Affiliation(s)
- L Antoniewicz
- Department of Dermatology Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Waehringer Gürtel 18-20, 1090 Vienna, Austria
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Jalili A, Kinaciyan T, Barisani T, Peck-Radosavljevic M, Stingl G, Geusau A, Wöhrl S. Successful treatment of refractory Behçet's disease with the TNF-alpha blocker infliximab. Iran J Immunol 2009; 6:55-58. [PMID: 19293479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- Ahmad Jalili
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, Medical University of Vienna, Allgemeines Krankenhaus, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
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Affiliation(s)
- Alexandra Geusau
- Division of Immunology, Department of Dermatology, Allergy and infectious Diseases, Medical University of Vienna, Vienna, Austria
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39
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Geusau A, Dunkler D, Messeritsch E, Sandor N, Heidler G, Rödler S, Ankersmit J, Zuckermann A, Tschachler E. Non-melanoma skin cancer and its risk factors in an Austrian population of heart transplant recipients receiving induction therapy. Int J Dermatol 2008; 47:918-25. [DOI: 10.1111/j.1365-4632.2008.03711.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Matin RN, Mesher D, Proby CM, McGregor JM, Bouwes Bavinck JN, del Marmol V, Euvrard S, Ferrandiz C, Geusau A, Hackethal M, Ho WL, Hofbauer GFL, Imko-Walczuk B, Kanitakis J, Lally A, Lear JT, Lebbe C, Murphy GM, Piaserico S, Seckin D, Stockfleth E, Ulrich C, Wojnarowska FT, Lin HY, Balch C, Harwood CA. Melanoma in organ transplant recipients: clinicopathological features and outcome in 100 cases. Am J Transplant 2008; 8:1891-900. [PMID: 18786232 DOI: 10.1111/j.1600-6143.2008.02326.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Organ transplant recipients have a higher incidence of melanoma compared to the general population but the prognosis of this potentially fatal skin cancer in this group of patients has not yet been established. To address this, we undertook a multicenter retrospective analysis to assess outcome for 100 melanomas (91 posttransplant and 9 pretransplant) in 95 individuals. Data were collected in 14 specialist transplant dermatology clinics across Europe belonging to the Skin Care in Organ Transplant Patients, Europe (SCOPE) Network, and compared with age, sex, tumor thickness and ulceration status-matched controls from the American Joint Committee on Cancer (AJCC) melanoma database. Outcome for posttransplant melanoma was similar to that of the general population for T1 and T2 tumors (< or = 2 mm thickness); but was significantly worse for T3 and T4 tumors (> 2 mm thickness); all nine individuals with a pretransplant melanoma survived without disease recurrence following organ transplantation. These data have implications for both cutaneous surveillance in organ transplant recipients and management of transplant-associated melanoma.
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Affiliation(s)
- R N Matin
- Centre for Cutaneous Research and Department of Dermatology, Institute of Cell and Molecular Science, Barts and The London School of Medicine and Dentistry, 4 Newark Street, London, E1 2AT, UK.
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Brandt O, Rieger A, Geusau A, Stingl G. Erbsen, Bohnen und der Satz des Pythagoras - Bedeutung des Glukose-6-Phosphat-Dehydrogenase-Mangels für die Dermatologie. J Dtsch Dermatol Ges 2008. [DOI: 10.1111/j.1610-0387.2008.06640_supp.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Brandt O, Rieger A, Geusau A, Stingl G. Peas, beans, and the Pythagorean theorem - the relevance of glucose-6-phosphate dehydrogenase deficiency in dermatology. J Dtsch Dermatol Ges 2008; 6:534-9. [PMID: 18397314 DOI: 10.1111/j.1610-0387.2008.06640.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Glucose-6-phosphate (G6PD) deficiency is a common disease characterized by acute hemolysis induced by oxidative stress. More than 400 million subjects throughout the world carry the hereditary enzyme defect with the highest prevalences in Africa, Asia, and the Mediterranean region. In individuals affected by the erythrocytic enzymatic disorder, besides infectious diseases and diet, acute hemolytic crisis can be triggered by numerous drugs frequently used for the treatment of dermatoses. Taking into account the increasing number of immigrants from geographic regions with high prevalences of G6PD deficiency, dermatologists should be alert to the presence of disease.
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Affiliation(s)
- Oliver Brandt
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, Austria.
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Wöhrl S, Schnedl J, Auer H, Walochnik J, Stingl G, Geusau A. Successful treatment of a married couple for American leishmaniasis with miltefosine. J Eur Acad Dermatol Venereol 2008; 22:258-9. [PMID: 18211436 DOI: 10.1111/j.1468-3083.2007.02311.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ulrich C, Hackethal M, Meyer T, Geusau A, Nindl I, Ulrich M, Forschner T, Sterry W, Stockfleth E. Hautinfektionen bei organtransplantierten Patienten. J Dtsch Dermatol Ges 2008. [DOI: 10.1111/j.1610-0387.2007.06431_supp.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kullander J, Handisurya A, Forslund O, Geusau A, Kirnbauer R, Dillner J. Cutaneous human papillomavirus 88: remarkable differences in viral load. Int J Cancer 2008; 122:477-80. [PMID: 17935140 DOI: 10.1002/ijc.23115] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A human papillomavirus (HPV) was cloned from a patient with multiple squamous cell carcinomas (SCCs) and identified as HPV88, recently categorized into a new species within the genus Gamma. The HPV88 viral load in an SCC of the index patient exceeded 1 million copies/cell. By contrast, a survey of 447 skin lesions (79 actinic keratoses, 73 seborrhoeic keratoses, 169 basal cell carcinomas and 126 SCCs) and 362 healthy skin biopsies found detectable HPV88 DNA in only 7 specimens. All these had very low viral loads (<1 copy/10(3) cells) implying extreme biological variability in viral load.
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Affiliation(s)
- Johanna Kullander
- Department of Laboratory Medicine, Division of Medical Microbiology, Lund University, University Hospital, Malmö, Sweden
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Ulrich C, Hackethal M, Meyer T, Geusau A, Nindl I, Ulrich M, Forschner T, Sterry W, Stockfleth E. Skin infections in organ transplant recipients. J Dtsch Dermatol Ges 2007; 6:98-105. [PMID: 17995969 DOI: 10.1111/j.1610-0387.2007.06431.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In contrast to the well-described high risk of skin cancer in organ transplant recipients, skin infections in these patients are not as well explored. Skin infections caused by viruses, bacteria or fungi represent a growing diagnostic and therapeutic challenge in the dermatological aftercare of organ transplant recipients. Differing immunosuppressive drugs and their variable dosage in chronologic sequence after transplantation probably influence the type and appearance of skin infections. The typical chronology of skin infections are wound infections, pyoderma or the reactivation of herpes viruses in the first month post-transplant; the main problems in months 2-5 are opportunistic infections and reactivation of varicella-zoster virus. After 6 months as immunosuppression is reduced, the spectrum of causative organisms approaches that of the general population; mycoses and human papilloma virus (HPV) infections dominate. A causal connection exists between infection with oncogenic viruses such as HPV, Epstein-Barr virus and human herpesvirus 8 and specific skin cancers (squamous cell carcinoma, Kaposi sarcoma and post-transplant lymphoproliferative disorders). Dermatological care of organ transplant recipients using appropriate diagnostic methods adapted to the modified clinical pattern may lead to early adequate treatment.
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Affiliation(s)
- Claas Ulrich
- Department of Dermatology, Allergy, Venereology, Charité University Hospital, Berlin, Germany
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Affiliation(s)
- Stefan Wöhrl
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases, Medical University of Vienna, A-1090 Vienna, Austria.
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Meyer T, Stellbrink H, Fenske S, Stary G, Geusau A, von Krosigk A, Plettenberg A. P1855 Heterogeneity of Chlamydia trachomatis L2 strains involved in the current outbreak of Lymphogranuloma venereum. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)71694-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Patients with latent syphilis or syphilis of unknown duration should be evaluated for tertiary disease and neurosyphilis. The aim of this retrospective study was to determine relevant serological parameters for the identification of those individuals with syphilis who are most likely to have neurosyphilis and who therefore require lumbar puncture. After excluding repeated estimates and patients whose blood syphilis serology had either been negative or not been determined within 3 months of lumbar puncture, 265 out of 710 cerebrospinal fluids from 1988 to 2004 were analysed. In each of those patients the earliest available pairs of serum and cerebrospinal fluid samples were evaluated. The diagnosis of neurosyphilis was based on criteria according to established guidelines. Forty-three of 265 patients (16.2%; 5 women, 38 men; mean age 47+/-16 years) had neurosyphilis. Seven of 72 (9.7%) of those testing HIV-positive, fulfilled the criteria of neurosyphilis. Not a single patient with neurosyphilis tested Venereal Disease Research Laboratory test (VDRL)-negative in peripheral blood, an effect which was highly significant (p < 0.01, chi2-test). The median blood-VDRL titre was significantly higher in patients with neurosyphilis than in those without (1:32 vs. 1:0; p < 0.01, t-test, two-sided). Hence, neurosyphilis is very unlikely in patients with a negative blood-VDRL. Therefore, lumbar puncture is not recommended in these patients.
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Affiliation(s)
- Stefan Wöhrl
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Austria.
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Abstract
BACKGROUND Pemphigoid (herpes) gestationis is a rare blistering disease of pregnancy. Topical and systemic corticosteroids and antihistamines are usually sufficient for treatment. CASE REPORT A patient suffering from severe, therapy-resistant pemphigoid gestationis was successfully treated with the additional use of six sessions of immunoapheresis. Systemic corticosteroids could be tapered and serum autoantibody levels to bullous pemphigoid antigen 2 (BPAG2 = BP180) significantly dropped during this treatment. CONCLUSION Immunoapheresis represents a helpful therapeutic option with few side effects for severe cases of pemphigoid gestationis, unresponsive to conventional treatment.
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Affiliation(s)
- Stefan Wöhrl
- Division of Immunology, Allergy and Infectious Diseases (DIAID), Department of Dermatology, University of Vienna Medical School (AKH Wien), Austria.
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