1
|
Ganatra B, Amarnani R, Alfallouji Y, Dear K, Twigg E, Westwood JP, Goulden B, Morris V, Hillman T, Goolamali S, Naderi Z, Sidwell R, Ellery P, Calonje E, Kravvas G, Bunker CB. Patient characteristics in tardive COVID-19 pseudoperniosis: a case series of 16 patients. Clin Exp Dermatol 2021; 47:399-403. [PMID: 34411313 PMCID: PMC8444777 DOI: 10.1111/ced.14891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Accepted: 08/12/2021] [Indexed: 02/05/2023]
Abstract
Background Acute pseudoperniosis (PP) has a recognized association with COVID‐19 and tends to occur without cold precipitation in young, healthy patients, often without a clear history of COVID‐19. These lesions usually resolve within 2 weeks and without long‐term sequelae. In the early months of 2021, patients with delayed and protracted PP began to emerge. We have called this presentation ‘tardive COVID‐19 PP (TCPP)’. Aim To consolidate and expand knowledge on TCPP, we describe the clinical characteristics, treatments and outcomes of 16 patients with TCPP who were reviewed by our outpatient dermatology service. Results The initial clinical manifestations were erythema, swelling and PP of the fingers in 56.2%, and of the toes in 31.2%, desquamation in 56.2% and acrocyanosis in 12.5%. Ten patients had eventual involvement of all acral sites. The median duration of symptoms was 191 days. Six patients reported close contact with a confirmed or suspected case of COVID‐19, but only two had positive COVID‐19 tests. Four patients experienced complete or almost complete resolution of symptoms, while the rest remain under active treatment. Conclusion Unlike acute PP, TCPP has a protracted and delayed presentation that is typically associated with profound acrocyanosis. Patients with TCPP represent a new phenomenon that is part of the post‐COVID‐19 syndrome, with risk factors and pathophysiology that are not yet fully understood. Our data indicate that likely predisposing factors for developing TCPP include young age, a preceding history of cold intolerance and an arachnodactyloid phenotype. Anorexia, connective tissue disorders or sickle cell trait may also predispose to TCPP. In addition, low titre antinuclear antibody positivity, the presence of cryoglobulins, or low complement levels may represent further risk factors. Finally, prolonged low temperatures are also likely to be contributing to the symptoms.
Collapse
Affiliation(s)
- B Ganatra
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - R Amarnani
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Y Alfallouji
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - K Dear
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - E Twigg
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - J P Westwood
- Department of Haematology, University College London Hospitals NHS Foundation Trust, London, UK
| | - B Goulden
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - V Morris
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - T Hillman
- Department of Respiratory Medicine, University College London Hospitals NHS Foundation Trust, London, UK
| | - S Goolamali
- Department of Dermatology, King's College Hospital NHS Foundation Trust, London, UK
| | - Z Naderi
- Department of Dermatology, West Hertfordshire Hospitals NHS Trust, Reading, UK
| | - R Sidwell
- Department of Dermatology, West Hertfordshire Hospitals NHS Trust, Reading, UK.,Department of Dermatology, The Devonshire Clinic, London, UK
| | - P Ellery
- Department of Histopathology, University College London Hospitals NHS Foundation Trust, London, UK
| | - E Calonje
- Department of Histopathology, St John's Institute of Dermatology, London, UK
| | - G Kravvas
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - C B Bunker
- Department of Dermatology, University College London Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
2
|
Ghanbarpour R, Aflatoonian MR, Askari A, Abiri Z, Naderi Z, Bagheri M, Jajarmi M, Shobeiri S, Molaei R, Askari N. Domestic and game pigeons as reservoirs for Escherichia coli harbouring antimicrobial resistance genes. J Glob Antimicrob Resist 2020; 22:571-577. [PMID: 32097757 DOI: 10.1016/j.jgar.2020.02.015] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 02/12/2020] [Accepted: 02/15/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES In Iran, pigeons are kept and bred on the roofs of houses, which indicates the potential significance of pigeons in the dispersal of antimicrobial resistant Escherichia coli strains. Here we characterized antimicrobial resistance genotypes in relation to phenotypic presentations and phylogenetic backgrounds of the E. coli isolates from household pigeons in Kerman in southeast Iran. METHODS Totally, 152 faecal E. coli isolates from domestic and household pigeons were screened for 13 antimicrobial resistance genes, blaTEM, blaSHV, blaCTX-M, sulI, sulII, dhfrI, dhfrV, aadA, aac(3)-I, tetA, tetB, floR and qnrA, by conventional polymerase chain reaction (PCR) technique. Clermont phylogenetic background of E. coli strains was studied and antibiotic resistance of all strains was assessed for seven antibiotics. RESULTS The antimicrobial resistance genes blaTEM, tetA, tetB and aadA were detected in 52.6%, 6.5%, 6.5% and 5.9% of the isolates, respectively. PCR phylotyping revealed that a significant number of isolates within A0 (54%), A1 (70%), B1 (57.6%), B22 (75%) and D1 (87.5%) phylogroups were positive for the studied resistance genes. One phenotypic resistance pattern (trimethoprim-sulfamethoxazole) was associated with the presence of the corresponding gene sul2. CONCLUSIONS An alarming rate of phenotypic resistance was observed in this study. Many isolates were positive for the screened resistance genes. According to the phylogenetic background, most resistant isolates belonged to the commensal phylotypes, representing significant role of commensal strains as a source of resistance genes. These findings highlight the role of the pigeon as disseminator of resistant E. coli strains.
Collapse
Affiliation(s)
- Reza Ghanbarpour
- Molecular Microbiology Research Group, Shahid Bahonar University of Kerman, Kerman, Iran; Research Center for Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran.
| | - Mohammad Reza Aflatoonian
- Research Center for Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran; Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Asma Askari
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Zeinab Abiri
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Zahedeh Naderi
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Mahboube Bagheri
- Department of Food Science and Technology, Bardsir Faculty of Agriculture, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Maziar Jajarmi
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Sajad Shobeiri
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Reza Molaei
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Nasrin Askari
- Department of Pathobiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| |
Collapse
|
4
|
Alizade H, Sharifi H, Naderi Z, Ghanbarpour R, Bamorovat M, Aflatoonian MR. High Frequency of Diarrheagenic Escherichia coli in HIV-Infected Patients and Patients with Thalassemia in Kerman, Iran. J Int Assoc Provid AIDS Care 2015; 16:353-358. [PMID: 26590202 DOI: 10.1177/2325957415617831] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [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: 12/30/2022] Open
Abstract
This study was conducted on patients with thalassemia and HIV-infected patients to determine the frequency of diarrheagenic Escherichia coli in Kerman, Iran. We analyzed 68 and 49 E coli isolates isolated from healthy fecal samples of patients with thalassemia and HIV-infected patients, respectively. The E coli isolates were studied using a multiplex polymerase chain reaction to identify the enterotoxigenic E coli (ETEC), enterohemorrhagic E coli (EHEC), and enteropathogenic E coli (EPEC) groups. Statistical analysis was carried out to determine the correlation of diarrheagenic E coli between HIV-infected patients and patients with thalassemia using Stata 11.2 software. The frequency of having at least 1 diarrheagenic E coli was more common in patients with thalassemia (67.64%) than in HIV-infected patients (57.14%; P = .25), including ETEC (67.64% versus 57.14%), EHEC (33.82% versus 26.53%), and EPEC (19.11% versus 16.32%). The results of this study indicate that ETEC, EHEC, and EPEC pathotypes are widespread among diarrheagenic E coli isolates in patients with thalassemia and HIV-infected patients.
Collapse
Affiliation(s)
- Hesam Alizade
- 1 Department of Microbiology, Sirjan Faculty of Medical Sciences, Kerman University of Medical Sciences, Kerman, Iran.,2 Regional Knowledge Hub and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Hamid Sharifi
- 2 Regional Knowledge Hub and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,3 Department of Food Hygiene and Public Health, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Zahedeh Naderi
- 4 Department of Molecular Microbiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Reza Ghanbarpour
- 4 Department of Molecular Microbiology, Faculty of Veterinary Medicine, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Mehdi Bamorovat
- 5 Leishmaniasis Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Aflatoonian
- 6 Research Center for Tropical and Infectious Diseases, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|