Association between filaggrin gene mutations and the clinical features of molluscum contagiosum: The Yamanashi Adjunct Study of the Japan Environment and Children's Study

Previous studies have reported swimming, atopic dermatitis, and filaggrin (FLG) gene mutations as risk factors for molluscum contagiosum (MC) infection. FLG gene mutations impair skin barrier function. The aim of this study was to determine the impact of FLG mutations on the incidence and clinical features of MC. We used data from 2036 children who participated in the Yamanashi Adjunct Study of the Japan Environment and Children's Study, a prospective, birth cohort study. A questionnaire for caregivers (when children were 4 and 8 years of age) asked about clinical features including previous MC incidence and treatment, number of MC lesions at first visit, and time to resolution. Participants underwent genotyping to detect six FLG mutations that are common in the Japanese population. A logistic regression model was used to analyze the association between MC incidence and FLG mutations, adjusted for potential confounders. The cumulative incidence of MC at age 8 years was 47.1%. Among participants with a history of MC, 67.6% had undergone curettage. FLG mutation was a significant risk factor for MC incidence (adjusted odds ratio [aOR] 1.69, 95% confidence interval [CI] 1.18-2.42). Swimming and atopic dermatitis were also significant risk factors for MC. There was no significant association between FLG mutation and the number of MC lesions at the first visit or the time to resolution of lesions. FLG mutation is a risk factor for MC incidence; however, FLG mutations do not affect the number of MC lesions at presentation or the time to resolution.

Molluscum Contagiosum Virus Evasion of Immune Surveillance: A Review

BACKGROUND

Molluscum contagiosum (MC) is an acute infection caused by the molluscum contagiosum virus (MCV) with a worldwide incidence of approximately 8,000 cases per 100,000 individuals annually. Greater than 90% of MC cases occur in the pediatric population, and affected adults are more likely to be younger or immunocompromised. MC has minimal inflammation initially; however, a strong inflammatory response can occur during resolution of the infection, termed the beginning of the end (BOTE). MC infections may last months to years, and it is hypothesized that persistent infections may be due to suppression of immunity by MCV proteins, thus affecting MC’s clinical progression.

OBJECTIVE

We reviewed the current proposed mechanisms of MCV immune evasion and discuss potential therapeutic options for MC treatment.

METHODS

A literature search was conducted using electronic databases (Pubmed, Google Scholar, Medline).

RESULTS

We compiled 18 original research articles and identified 11 proteins produced by MCV that are postulated to participate in evasion of host immunity through various molecular pathways. These proteins and/or their downstream pathways may be influenced by MC treatments in phase 3 development, including berdazimer gel 10.3% and VP-102 cantharidin, 0.7%.

CONCLUSION

MCV is distinctive in evading immune surveillance by inhibiting or dampening several immune pathways via the production of viral proteins. The result is decreasing local inflammatory response which contributes to the prolonged survival of MCV in the epidermis. Persistent MC can be a nuisance for some patients and treatment may be desired. Currently, no treatment has been approved by the US Food and Drug Administration (FDA). Two approaches in the pipeline may affect the immune avoidance mechanisms; nevertheless, their exact mechanisms between the potential therapeutics and viral proteins remain enigmatic. J Drugs Dermatol. 2023;22(2):182-189. doi:10.36849/JDD.7230.

Infectious Disease in Contact Sports

CONTEXT:

Infections are common in contact sports. This review aims to describe the epidemiology, presenting signs and symptoms, treatment guidelines, and regulations for several common infections seen in contact sport athletes. The conditions discussed include bacterial skin infections, herpes simplex virus, molluscum contagiosum, common warts, tinea, scabies, head lice, conjunctivitis, human immunodeficiency virus, hepatitis C virus, and vaccine-preventable illnesses.

EVIDENCE ACQUISITION:

Searches were performed across PubMed and MEDLINE research databases. In addition, general internet search engine results and reviews of reference lists of relevant papers were used to identify additional sources of evidence.

STUDY DESIGN:

Clinical review.

LEVEL OF EVIDENCE:

Level 4.

RESULTS:

The most common infections seen in contact sport athletes include bacterial skin infections, herpes simplex virus, molluscum contagiosum, common warts, tinea, scabies, head lice, conjunctivitis, and vaccine-preventable illnesses. Other infections, including human immunodeficiency virus and hepatitis C, are uncommon but potentially life threatening.

CONCLUSION:

Infections are common in contact sport athletes. The provider who cares for these athletes should be aware of the most common infections and their appropriate management. Early diagnosis and appropriate clinical management are important for treating the infected athlete, minimizing risk of transmission, minimizing time lost from competition, and preventing large outbreaks.

Clinical and Demographic Characteristics of Patients with Molluscum Contagiosum Treated at the University Dermatology Clinic Maribor in a 5-year period

Molluscum contagiosum virus (MCV) is a common skin pathogen in both adults and children. In this prospective study, we clinically evaluated consecutive patients with molluscum contagiosum (MC) who had been examined during a 5-year period at the second-largest dermatology clinic in Slovenia and described their main demographic and clinical characteristics, concomitant diseases, and treatment success. The study included 188 patients, of which 121 (64%) were men and 67 (36%) were women. A total of 135 (72%) patients were adults, with lesions that were most commonly located in the anogenital region (98%) and were probably sexually acquired. Two adult patients were diagnosed with concurrent human immunodeficiency virus (HIV) infection. Fifty-three (28%) patients were children with a mean age of 5.7 years, most commonly presenting with lesions on the torso and extremities (85%). In adults, the infection most commonly occurred in male patients, while in children it was slightly more common in female patients. At presentation, 58% of patients had more than 5 MC lesions. A total of 30% of the included children had concomitant atopic dermatitis. We did not observe an increased occurrence of MCV infection in patients with atopic dermatitis. All patients were treated with curettage of the lesions. The cure rate at the first follow-up visit after 2 months was relatively high (63%), and recurrences were not associated with the number or site of lesions at presentation or with concomitant atopic dermatitis.

Molluscum contagiosum in a pediatric American Indian population: incidence and risk factors

Background

Molluscum contagiosum virus (MCV) causes an innocuous yet persistent skin infection in immunocompetent individuals and is spread by contact with lesions. Studies point to atopic dermatitis (AD) as a risk factor for MCV infection; however, there are no longitudinal studies that have evaluated this hypothesis.

Methods

Outpatient visit data from fiscal years 2001–2009 for American Indian and Alaska Native (AI/AN) children were examined to describe the incidence of molluscum contagiosum (MC). We conducted a case-control study of patients <5 years old at an Indian Health Service (IHS) clinic to evaluate dermatological risk factors for infection.

Results

The incidence rate for MC in children <5 years old was highest in the West and East regions. MC cases were more likely to have a prior or co-occurring diagnosis of eczema, eczema or dermatitis, impetigo, and scabies (p<0.05) compared to controls; 51.4% of MC cases had a prior or co-occurring diagnosis of eczema or dermatitis.

Conclusions

The present study is the first demonstration of an association between AD and MC using a case-control study design. It is unknown if the concurrent high incidence of eczema and MC is related, and this association deserves further investigation.

Understanding U.S. healthcare providers' practices and experiences with molluscum contagiosum

Introduction

Molluscum contagiosum is a common superficial skin infection caused by the poxvirus, Molluscum Contagiosum virus. The study objective is to obtain a better understanding of physician practices and experiences with molluscum contagiosum in order to focus informational and guidance material.

Methods

A cross-sectional survey to assess medical practitioners’ knowledge and practices with molluscum contagiosum was conducted using the 2009 DocStyles survey. Questions regarding category and number of molluscum contagiosum patients seen, treatments used and advice given to patients were included in the survey.

Results

Dermatologists saw the most cases, with the majority seeing 51–100 molluscum contagiosum cases/year. The most common cases seen were children with multiple lesions and adults with genital lesions. Respondents were most likely to recommend treatment to immunocompromised individuals, HIV patients, adults with genital lesions and children with multiple lesions. Cryotherapy was the top choice for all specialties with the exception of OB/GYNs, whose top choice was curettage. “Avoid intimate contact until lesions resolve”, “Avoid touching lesions to reduce further spread”, and “Don’t be concerned, this will go away” were the top advice choices.

Discussion

Most survey respondents have dealt with molluscum contagiosum in their practice during the previous year. Overall, respondents picked appropriate choices for treatment and advice given; however some ineffective or unnecessary treatments were chosen and recommendations to prevent spread were chosen infrequently. Knowledge gaps for appropriate transmission precaution advice might cause unnecessary spread or autoinoculation. This survey has demonstrated that molluscum contagiosum is a common infection seen by many types of practitioners and therefore guidance on treatment considerations and infection control is valuable.

[Molluscum contagiosum--a common but poorly understood "childhood disease" and sexually transmitted illness]

Molluscum contagiosum is a viral disease of the skin characterized by discrete, multiple, flesh-colored papules. It is caused by a highly infectious, enveloped deoxyribonucleic acid virus, called molluscum contagiosum virus (MCV). Molluscum contagiosum is very common in children, sexually active adults and immunocompromised patients, especially those who are infected with the human immunodeficiency virus. MCV transmission usually takes place through direct skin-to-skin contact. Infections in childhood are often linked to swimming-pool attendance. Adults are infected usually through sexual contact. An intimate skin-to-skin contact is sufficient for transmission of the virus. In immunocompetent adults, the warts remain in the genital area and adjacent regions of the skin. In children and patients with immunocompromised conditions, however, various regions of the body are usually affected. Therapy of molluscum contagiosum should be undertaken in an individualized manner, a specific treatment does not exist. For the treatment, physical methods such as curettage and cryotherapy, topic acids (e. g., acetic acid) and alkalis (e. g., potassium hydroxide), some other topical agents such as cantharidin and imiquimod, as well as several systemic agents the pharmacological treatments is, however, sparse. Effective prevention is problematic due to the high infectivity of the virus. A vaccine is not available.

Pediatric molluscum contagiosum: reflections on the last challenging poxvirus infection, Part 1

Molluscum contagiosum (MC) is a common dermatologic infection that usually affects school-aged children, sexually active young adults, and immunocompromised individuals. It is a benign and self-limiting disease, with most cases undergoing spontaneous resolution within 6 to 9 months. However, a more severe and prolonged course is associated with immunosuppression or atopic dermatitis (AD). Management can be challenging; it needs to be decided whether to treat MC or let it run its natural course. It may be managed with reassurance and benign neglect; however, therapeutic intervention may be indicated to prevent autoinoculation and transmission, especially in patients at risk for severe disease. Guardians concerned about cosmesis should understand that therapy may leave pigmentary alterations and sometimes scars. The 3 major therapeutic modalities employed are physical destruction, immunomodulation, and antiviral agents. Combinations of these therapies may be employed. Therapeutic modalities will be discussed in part 2.

The Incidence of Molluscum contagiosum among American Indians and Alaska Natives

Background

The epidemiology of Molluscum contagiosum (MC) in the United States is largely unknown, despite the fact that the virus is directly communicable and large outbreaks occur. This study provides population-based estimates to describe the epidemiology of MC in the United States among American Indian and Alaska Native (AI/AN) persons. This population was selected because of the comprehensiveness and quality of available data describing utilization of out-patient services.

Principal Findings

Outpatient visits listing MC as a diagnosis in the Indian Health Service National Patient Information Reporting System during 2001–2005 were analyzed to assess patient characteristics, visit frequency and concurrent skin conditions. Outpatient visit rates and incidence rates were calculated based on known population denominators (retrospective cohort). Overall outpatient visit rates were also calculated for the general US population using national data. The average annual rate of MC-associated outpatient visits was 20.15/10,000 AI/AN persons for 2001–2005 (13,711 total visits), which was similar to the rate for the general US population (22.0/10,000 [95% CI: 16.9–27.1]). The incidence of MC-associated visits was 15.34/10,000. AI/AN children 1–4 years old had the highest incidence (77.12), more than twice that for children 5–14 years old (30.79); the incidence for infants (<1 year) was higher than that for adults. AI/AN persons living in the West region had the highest incidence, followed by those in the East and Alaska regions (26.96, 22.88 and 21.38, respectively). There were age-specific associations between MC and concurrent skin conditions (e.g., atopic dermatitis, eczema).

Conclusions

This study highlights the need for periodic population-based measurements to assess trends in incidence and healthcare utilization for MC in the United States. High rates of MC were found among AI/AN persons, especially among children <15 years old. The AI/AN population would benefit from greater availability of effective strategies for prevention and treatment of MCV infection.

A prospective randomized trial comparing the efficacy and adverse effects of four recognized treatments of molluscum contagiosum in children

Molluscum contagiosum is a common viral disease of childhood presenting as small, firm, dome-shaped umbilicated papules. Although benign and generally self-limited, this condition is contagious and can lead to complications such as inflammation, pruritus, dermatitis, bacterial superinfection, and scars. No consensus has been established concerning the management of this condition. We conducted a prospective randomized study comparing four common treatments for molluscum contagiosum in 124 children aged 1 to 18 years. One group was treated with curettage, a second with cantharidin, a third with a combination of salicylic acid and lactic acid, and a fourth with imiquimod. Patients needing, respectively, one, two, or three visits for treatment of their mollusca were: 80.6%, 16.1%, and 3.2% for curettage, 36.7%, 43.3%, and 20.0% for cantharidin, 53.6%, 46.4%, and 0% for salicylic acid and glycolic acid, and 55.2%, 41.4%, and 3.4% for imiquimod. The rate of side effects was 4.7% for group 1, 18.6% for group 2, 53.5% for group 3, and 23.3% for group 4. Curettage was found to be the most efficacious treatment and had the lowest rate of side effects. It must be performed with adequate anesthesia and is a time-consuming procedure. Cantharidin is a useful bloodless alternative particularly in the office setting, but has moderate complications due to blisters and necessitated more visits in our experience. The topical keratolytic used was too irritating for children. Topical imiquimod holds promise but the optimum treatment schedule has yet to be determined. Finally, we believe that the ideal treatment for mollusca depends on the individual patient preference, fear, and financial status, distance from the office, and whether they have dermatitis or blood-borne infections.

The incidence of molluscum contagiosum, scabies and lichen planus

We aimed to describe the incidence of new episodes of molluscum contagiosum, scabies and lichen planus presenting to general practitioners in England and Wales. We examined data collected in a sentinel practice network (the Weekly Returns Service of the Royal College of General Practitioners) in which about half a million persons were observed each year over the period 1994-2003. The incidence of molluscum contagiosum in males was 243/100,000 person-years and in females 231; of scabies, males 351, females 437; of lichen planus, males 32, females 37. Incidence varied by year and age. Ninety per cent of molluscum contagiosum episodes were reported in children aged 0-14 years, where incidence in 2000 (midpoint of a 6-year period of stable incidence) was 1265/100,000 (95% CI 1240-1290). Scabies affected all ages and annual incidence ranged between 233 (95% CI 220-246) in 2003 and 470 (95% CI 452-488) in 2000. Lichen planus occurred chiefly in persons aged over 45 years: incidence (all ages) ranged between 27 (95% CI 23-31) in 2003 and 43 (95% CI 37-49) in 1998. The relative risk of female to male incidence (all ages) of molluscum contagiosum was 0.95 (95% CI 0.91-0.99); of scabies 1.25 (95% CI 1.21-1.28); and of lichen planus 1.19 (95% CI 1.08-1.13).

The epidemiology of molluscum contagiosum in children

Molluscum contagiosum (MC) is a viral disorder of the skin and mucous membranes characterized by discrete single or multiple, flesh-colored papules. Although MC as a clinical entity is well defined and commonly observed, few data regarding its epidemiology in the pediatric population exist. Our purpose was to collect epidemiologic data on children with MC with regard to age, gender, ethnicity, degree of involvement, relation to pre-existing atopic dermatitis (AD), and immune status. A retrospective chart review was conducted. All subjects were seen at 3 tertiary pediatric dermatology referral centers with two of the sites based at a Children's Hospital. A total of 302 patient charts with the Current Procedural Terminology code diagnosis of MC seen over a 6- to 8-month period were reviewed. Approximately 80% of the patients were younger than 8 years old. The majority of patients (63%) had more than 15 lesions. All but one patient were otherwise healthy, as determined by history and clinical examination. Approximately 24% of the patients presented with a history of previous or active coexistent AD. However, children with AD were at risk for an increased number of lesions. These data provide valuable updated information on the demographics and clinical presentation of MC in pediatric patients in the United States. Limitations include that this was a retrospective study with a population limited to tertiary pediatric dermatology referral centers.

AIDS and HIV infections: uncommon presentations

Infection with HIV or AIDS has a great impact on skin diseases, not only by affecting the immune system and thereby host defense against bacterial, viral, or mycotic infection, but also by changing tumor immune response and autoimmune reactivity. In the present review, emphasis will be made on infectious diseases, including sexually transmitted disease, inflammatory skin disease, and neoplasias. Knowledge of changing disease pattern with HIV/AIDS may help the clinical dermatologist and venerologist to identify dermatoses and act in the most appropriate manner to support the patient.

[Differential diagnosis of verrucous skin changes. When wild warts grow rapidly...]

This article gives and overview of the various types of verrucous skin changes (viral warts, seborrheic warts).

Epidemiology and impact of childhood molluscum contagiosum: a case series and critical review of the literature

Parents of 30 children with clinically diagnosed molluscum contagiosum were surveyed to assess their perception of the condition, its treatment, its impact on their everyday lives, and on the children themselves. Among parents, 82% reported that molluscum contagiosum concerned them moderately or greatly. Concerns focused on physical issues associated with the infection, such as scarring, itching, chance of spread to peers, pain, and the effects of treatments. Quality of life was not affected. Molluscum contagiosum was most common among school-age children. Eighteen of 29 respondents swam in public pools, a common activity in children of this age. All epidemiologic studies of molluscum contagiosum in otherwise healthy individuals, published since 1966, have been critically reviewed herein. The review confirms an association between swimming pool use and molluscum contagiosum. Age, living in close proximity, skin-to-skin contact, sharing of fomites, and residence in tropical climates were also associated with higher rates of infection while sex, seasonality, and hygiene showed no such association.

Patient demographics and utilization of health care services for molluscum contagiosum

Our objective was to describe the demographics of molluscum contagiosum patients and physician utilization patterns in the United States. We obtained weighted data for office visits throughout the United States for molluscum contagiosum and common warts from the National Ambulatory Medical Care Survey (NAMCS) from 1990 to 1999. Outpatient visit data for patients diagnosed with molluscum contagiosum were analyzed using statistical software and compared to those for patients diagnosed with common warts. The main outcome measures studied were physician office visits by patients with molluscum contagiosum and patient demographic parameters including age, gender, and race. We found that health care utilization for molluscum contagiosum was the greatest for patients <or=9 years of age (51%). Ninety-three percent of patients diagnosed with molluscum contagiosum were white. The number of visits for molluscum contagiosum was evenly divided between males and females. Visits to dermatologists comprised the majority of health care utilization units for molluscum contagiosum (71%). In conclusion, visits for molluscum contagiosum are frequent and are most often handled by dermatologists. When compared to those for common warts, molluscum contagiosum visits are less common and have an age distribution more limited to children.

Pediatric molluscum contagiosum: optimal treatment strategies

Pediatric molluscum contagiosum virus (MCV) is a common pox viridae infection that represents a common public health issue. The spread of the virus among children is rapid and easy. The virus produces a number of substances that block immune response formation in the infected host. Despite the benign and self-limited nature of the condition, one-third of children have symptoms from, or secondary reactions to the infection, including pruritus, erythema and, occasionally, inflammation and pain. Patients with pruritus autoinoculate the virus through scratching, thereby exacerbating their conditions. While adults cope well with unanesthetized curettage of lesions, children require less painful therapeutic options. The options for therapy are manifold. Therapy should begin with gentle skin care and antipruritics to prevent symptoms, and to prevent the spread of the disease. Therapies with good efficacy and low risk of pain for the patient include in-office usage of cantharidin and the use of local anesthetics, such as topical lidocaine (lignocaine) preparations in combination with the curettage of visible lesions. Alternatively, cryosurgery can be performed to eradicate lesions in-office. At-home therapeutics are often preferred by parents and children, and include imiquimod, retinoids, and alpha-hydroxy acids. Although a variety of such at-home therapies are available, none are as effective or as rapid acting as in-office therapy. Further research in large clinical trials is required to increase knowledge on prevention, optimal treatment, and long-term outcome with this disease.

Clinical profile of molluscum contagiosum in children versus adults

Molluscum contagiosum mainly affects children, but in adults the advent of HIV has modified its clinical spectrum. Our study is designed to ascertain the clinical profile of molluscum contagiosum in children and adults and to discover the effects of underlying HIV infection. During the study period of September 2000 to June 2002, 150 cases of molluscum contagiosum are screened and recruited at the Department of Dermatology and STD, JIPMER, Pondicherry. These include 137 children (85 male, 52 female) and 13 adults (10 male, 3 female). In children molluscum contagiosum is most commonly seen in the 5-10-year age group (58 cases), followed by the 1-5-year age group (53 cases), the 10-14-year age group (23 cases), and the younger-than-1-year age group (3 cases). In adults molluscum contagiosum is most commonly seen in the 14-20-year age group, followed by 2 cases each in the age groups 20-26 years, 26-34 years, and 34-40 years. The male-to-female sex ratio was 1.6:1 in children and 3.3:1 in adults. In both children and adults the most common sites affected are the head and neck, followed by trunk, upper extremity, genitalia, and lower extremity. It appears that the distribution of molluscum in our patients is significantly affected by the high proportion of HIV-positive adults in our sample. Seropositivity for HIV by ELISA is found in 1 of 137 children and 8 of 13 adults. In these HIV-positive patients, 2 cases of giant molluscum and one furuncle-like presentation are seen.

Molluscum contagiosum: the importance of early diagnosis and treatment

Molluscum contagiosum is a viral infection that is becoming an increasing problem in sexually active individuals and in patients with human immunodeficiency virus. Although molluscum contagiosum lesions are generally self-limiting, it may take 6 months to 5 years for lesions to disappear. Furthermore, patients with weakened immune systems have increased difficulty in clearing lesions; therefore lesions typically persist for prolonged periods. Although there has been continued debate about whether molluscum contagiosum lesions should be treated or allowed to resolve spontaneously, many clinicians recommend treatment of genital molluscum contagiosum lesions to reduce the risk of sexual transmission, prevent autoinoculation, and increase patient quality of life. Treatment options for molluscum contagiosum include physician-administered and patient-administered therapies. Novel patient-administered treatment options allow administration in the privacy of a patient's home, providing added convenience and reducing patient embarrassment or stress. With the novel treatment opportunities currently available or in development, physicians are able to improve patient quality of life while providing patients with a convenient, well-tolerated, easily administered treatment regimen. This review summarizes the clinical diagnosis of molluscum contagiosum and provides a critical assessment of several current and emerging treatment options.

Treatment of molluscum contagiosum with the pulsed dye laser over a 28-month period

Although benign, molluscum contagiosum causes cosmetic concern, infection, or transmission to close contacts. Treating patients with multiple lesions, especially children, may be difficult. Complications of treatment include infection, scarring, and limited posttreatment activity. The pulsed dye laser (PDL) has proven safe and effective for the treatment of many skin lesions, but little data exist for its role in the treatment of molluscum contagiosum. The purpose of this study is to describe the use, over a 28-month period, of the 585-nm PDL for the treatment of molluscum contagiosum. The benefits of this treatment are discussed. The charts of 43 patients receiving PDL treatment for molluscum contagiosum between November 1997 and March 2000 were reviewed. Number and location of lesions at initial presentation and on follow-up visits were recorded. Attempts were made to contact patients who were lost to follow-up. All of the approximately 1250 lesions treated resolved, and 35% of patients (n = 15) had no new lesions after 2 treatments. No complications were associated with the procedure. The PDL is a reasonable alternative to traditional treatment modalities for molluscum contagiosum. Benefits to the patient may include prompt response, fewer treatments, and minimal morbidity.

Molluscum contagiosum

Molluscum contagiosum is a disease caused by a poxvirus of the Molluscipox virus genus that produces a benign self-limited papular eruption of multiple umbilicated cutaneous tumors. This common viral disease is confined to the skin and mucous membranes. Transmission requires direct contact with infected hosts or contaminated fomites. It is generally thought to infect humans exclusively, but there are a few isolated reports of Molluscum contagiosum occurring in chickens, sparrows, pigeons, chimpanzees, kangaroos, a dog, and a horse. The infection is found worldwide and has a higher incidence in children, sexually active adults, and those who are immunodeficient.

Molecular epidemiology of molluscum contagiosum virus and analysis of the host-serum antibody response in Spanish HIV-negative patients

Molluscum contagiosum virus (MCV) lesions from Spanish human immunodeficiency virus (HIV)-negative patients were clinically examined and analyzed for virus detection and typing. In a study of 147 patients, 97 (66%) were children under 10 years, of whom 49% had atopic dermatitis. MCV lesions were morphologically indistinguishable among the different age groups, but atopic patients presented larger lesions compared with patients without the disorder. In adults, lesions were observed mainly on the genitals. MCVI was the predominant subtype. The deduced MCVI/MCVII ratio (146:1) was much higher than that found in other geographical areas. Protein preparations of the virus-induced lesions were immunoblotted with sera from 25 MCVI patients. The host-serum antibody response was weak and variable, although no significant differences were found between atopic and nonatopic patients. Three immunoreactive proteins of 74/80, 60, and 35 kDa were detected in almost all the analyzed sera. The 35 and 74/80-kDa proteins were virus specific, whereas the 60-kDa protein band was composed of a mix of human keratins. Immunoblotting of MCV lesions and vaccinia virus-infected cell extracts with either MCV patient serum or a rabbit antiserum against vaccinia virus showed no cross-reactivity of these two human poxviruses at the antigenic level.

Prevalence of orodental findings in HIV-infected Romanian children

BACKGROUND

Romania, the pediatric AIDS capital of the world, has tremendous unmet dental care needs for children and adolescents with HIV infection. The purpose of this study was to assess the prevalence of orodental conditions in symptomatic HIV-positive children from Constanta, Romania.

METHODS

The children underwent dental examinations and treatment at Constanta Municipal Hospital by a volunteer team of dental healthcare professionals from the United States. Oral lesions and dental caries were recorded during an 8-day period prior to initiating comprehensive dental care.

RESULTS

The study population consisted of 173 children (88 males; 85 females) with a mean age of 8.8 years (range 6 to 12 years). The primary HIV risk factor was contaminated needle reuse and/or blood products (88%). The most common oral and perioral lesions included: candidiasis (29%), ulcers (15%), salivary gland disease (9%), necrotizing ulcerative gingivitis/periodontitis (5%), linear gingival erythema (4%), labial molluscum contagiosum (3%), oral warts (2%), hairy leukoplakia (2%), and herpes zoster (1%). One or more oral/perioral lesions occurred in 55% of the children. Severe dental caries was noted in the majority of children (dfs/dft 16.9/3.7 and DMFS/DMFT 8.1/3.1). Over-retention of primary teeth (25%) and delayed eruption (42%) were common. Postoperative complications included delayed clotting (common) and thrombocytopenia-induced bleeding disorders (4%).

CONCLUSIONS

The oral healthcare needs of Romanian HIV-infected children are considerable, with the majority living with persistent, symptomatic oral disease.

Antibodies to molluscum contagiosum virus in the general population and susceptible patients

BACKGROUND

Since many attempts to cultivate molluscum contagiosum virus (MCV) in vitro have been unsuccessful, it is difficult to prepare a large quantity of antigens. To assess the seroprevalence of antibodies against MCV in 508 subjects with or without clinical MCV infection, a truncated recombinant protein from open-reading frame MC133L was synthesized using Sendai virus expression system and applied to enzyme-linked immunosorbent assay as an antigen.

OBSERVATIONS

Antibodies to MCV were present in 7 (58%) of 12 patients with molluscum contagiosum, 7 (6%) of 108 healthy controls, 7 (9%) of 76 with atopic dermatitis, and 7 (18%) of 39 patients with systemic lupus erythematosus, although no clinical MCV infection was observed in the latter 3 groups. Of 7 human immunodeficiency virus (HIV)-positive patients with molluscum contagiosum, 1 (14%) was antibody positive, compared with 5 (2%) of 266 HIV-positive patients without molluscum contagiosum. Serum samples from patients with atopic dermatitis and systemic lupus erythematosus showed a higher reactivity (P<.001) than those from healthy controls, while serum samples from HIV-positive subjects showed a lower reactivity (P<. 001).

CONCLUSION

The humoral immune response to MCV is usually confined to patients with molluscum contagiosum and may be affected by the immunological condition of the host.

[Warts and molluscum contagiosum: practical point of view]

Warts and molluscums contagiosums are two benign viral skin diseases that commonly affect children. Contamination occurs by autoinoculation or during skin to skin contact. Molluscums contagiosums are more frequent in immunodeficient and atopic children. Swimming-pool practice and contact sports favour warts transmission. The choice of treatment depends upon the age of the child and the number and location of the lesions. Natural resolution can be awaited when lesions are limited. In first intent, curettage of the lesions under local anesthesia for molluscums contagiosums, salicylic acid preparation or cryotherapy according to location for warts, are the treatment of choice. In neither affection school ousting is necessary.

[Viral sexually transmitted urogenital infections. Increased importance of viral STD in industrial countries]

Sexually transmitted urogenital virus infections have shown in recent decades a growing prevalence worldwide. In the industrial nations, human papilloma virus and herpes simplex virus infections occur more frequently than the typical venereal diseases (syphilis, gonorrhoea and ulcus molle). Molluscum caused by molluscum contagiosum virus (MCV), while frequently found in HIV-infected and AIDS patients (13%), are generally diagnosed decidedly less often than the previously mentioned virus infections. Considering the pathogenetic relationship of several HPV-subtypes with precancerosis and carcinomas in both genders, increasingly greater demands are placed upon the physician today regarding the diagnoses and treatment of virus-associated urogenital STDs. Discussed in this survey are the epidemiology, clinical symptoms, diagnostic and treatment of the three referred to virus infections.

Molluscum contagiosum virus: antibody responses in persons with clinical lesions and seroepidemiology in a representative Australian population

An ELISA for molluscum contagiosum virus (MCV) was used to determine the antibody status of 35 adults with clinical infections and known human immunodeficiency virus (HIV) serology and of 357 persons (ages, 1 week-69 years) considered representative of the Australian population. MCV antibody was identified in 77% of persons with molluscum lesions: in 17 of 24 HIV-1-negative persons and in 10 of 11 who were HIV-1-positive. No relationship was evident between the serologic responses and the number of lesions or the duration of infection. The population survey revealed an overall seropositivity rate of 23%. The lowest antibody prevalence was in children aged 6 months to 2 years (3%), and seropositivity increased with age to reach 39% in persons >/=50 years old. These findings indicate that MCV infections, including very mild or subclinical cases, may be more common in the general community than previously suspected.

[Skin diseases disclosing human immunodeficiency virus infection in Mali]

INTRODUCTION

Several skin diseases are associated with human immunodeficiency virus (HIV) infection. In Africa, due to the difficult access to medical care and complementary examinations, certain diseases are of particular importance. In the present work, we report the skin manifestations observed in a dermatology unit of a large city in Africa over a 3 year period and which were the revealing signs of HIV infection.

PATIENTS AND METHODS

All adult subjects (>15 years) with a positive HIV serology (confirmed by Western blot) that had been revealed by a skin disease seen at the Marchoux Institute at Bamako between June 1991 and September 1994 were included in the study.

RESULTS

Two hundred sixty-three skin diseases revealed 233 cases of HIV infection. Diseases observed were: zoster (n = 71), seborrheic dermatitis (n = 43), Kaposi's sarcoma (n = 34), prurigo (n = 31), sexually transmitted diseases (n = 27), extensive dermatophytosis (n = 12), psoriasis (n = 12), molluscum contagiosum (n = 8), acquired ichthyosis (n = 3), cutaneous leishmaniasis (n = 2) and other skin diseases (n = 10). More than one disease were associated in 28 patients. Certain particular features were noted (superinfection of zoster, papular margin in dermatophytosis).

DISCUSSION

In Africa, certain skin diseases often reveal HIV infection and some diseases have a high positive predictive value for HIV infection (zoster, seborrheic dermatitis, prurigo, Kaposi's sarcoma, extensive dermatophytotis). For prognosis, frequently associated diseases are signs of AIDS (Kaposi's disease, prurigo, molluscum contagiosum).

Recent advances in molluscum contagiosum virus research

Molluscum contagiosum virus (MCV) and variola virus (VAR) are the only two poxviruses that are specific for man. MCV causes skin tumors in humans and primarily in children and immunocompromised individuals. MCV is unable to replicate in tissue culture cells or animals. Recently, the DNA sequence of the 190 kbp MCV genome was reported by Senkevich et al. MCV was predicted to encode 163 proteins of which 103 were clearly related to those of smallpox virus. In contrast, it was found that MCV lacks 83 genes of VAR, including those involved in the suppression of the host response to infection, nucleotide biosynthesis, and cell proliferation. However, MCV possesses 59 genes predicted to code for novel proteins including MHC-class I, chemokine and glutathione peroxidase homologs not found in other poxviruses. The MCV genomic data allow the investigation of novel host defense mechanisms and provide new possibilities for the development of therapeutics for treatment and prevention of the MCV infection.

Skin diseases of children in Mali: a public health problem

In order to estimate the importance as a public health problem of skin diseases, we investigated the prevalence and severity of skin diseases in a representative sample of children in Mali. 1817 children were randomly selected in 30 clusters by probability-proportional-to-size sampling in Koulikoro region. The mean prevalence (+/- 2 SD) of skin diseases was 34 +/- 4%. The most frequent dermatoses were pyoderma (12.3 +/- 1.6%), tinea capitis (9.5 +/- 2.5%), pediculosis capitis (4.7 +/- 1.4%), scabies (4.3 +/- 1.5%), and molluscum contagiosum (3.6 +/- 1%). The most troublesome dermatoses were scabies and severe pyoderma. Pyoderma was the only dermatosis associated with poor individual or household hygiene. Public health services were little used by the population for skin diseases, probably because of the lack of an adequate response by the services and the high cost of treatment. The high prevalence and the severity of many of the lesions, and the discomfort caused, make pyoderma and scabies a significant public health problem in Mali.

Molluscum contagiosum in Dutch general practice

BACKGROUND

While molluscum contagiosum is considered to be a frequently encountered disease, few data on its incidence are known.

AIM

The objective of this study was to describe the incidence of molluscum contagiosum in Dutch general practice and to assess the importance of venereal molluscum contagiosum.

METHOD

Data were taken from the national survey of morbidity and interventions in general practice, drawn from 103 practices across the Netherlands, with a study population of 332300.

RESULTS

The infection appeared to be common in childhood (cumulative incidence 17% in those aged under 15 years); the adult, sexually transmitted, form was rare. Incidence was higher between January and June than between July and December. Cases were unequally divided between recording practices, which is though to have been caused by the occurrence of small epidemics.

CONCLUSION

The incidence of molluscum contagiosum in Dutch general practice was found to be 2.4 per 1000 person years. Molluscum contagiosum should still be considered as a mainly paediatric disease.

[Molluscum contagiosum: one year examination at a health center]

OBJECTIVE

To study the prevalence of Molluscum contagiosum in our environment, in order to understand and control it better.

DESIGN

A retrospective descriptive study was undertaken.

SETTING

The Dermatology Clinic of the "V Centenario" Health Centre at San Sebastián de los Reyes (Madrid).

PATIENTS

All cases diagnosed during 1991 were selected.

MEASUREMENTS AND MAIN RESULTS

The following variables were analysed: age, sex, date of the consultation, duration of the lesions, family members affected, number and site of the lesions, referral diagnosis and HIV serology. The method of comparing proportions was used for the analysis. Twenty-nine patients (9 female), with an average age of 12 +/- 11 years, were diagnosed: this supposed 0.37% of the patients seen at the clinic over a year. Six patients identified a possible source of contagion. 55.2% had less than 5 lesions. The most common site was the trunk (44.8%) and extremities (48.2%). Only 24% had a correct diagnosis in the interclinic notes. 20.7% were not diagnosed. Two patients were HIV (+); both with numerous lesions in the genital area. All the cases were treated by mechanical means.

CONCLUSIONS

Knowledge of the disease must be improved, to make diagnosis more rapid and thus avoid transmission; given that diagnosis and treatment is simple and completely attainable at the Primary Care level.

Clinical and molecular aspects of molluscum contagiosum infection in HIV-1 positive patients

Molluscum contagiosum virus (MCV) lesions from 31 human immunodeficiency type 1 (HIV-1) positive patients and 54 HIV-1 negative adult control patients were examined for the presence and type of MCV DNA by high stringency Southern hybridization using 32P-labelled or digoxigenin-labelled MCV DNA probes. Of the 83 patients whose lesions contained detectable MCV DNA, 77 were infected with a single type of MCV (16 with MCV 1; 29 with MCV 1v; 30 with MCV 2; and 2 with MCV 2v). Five patients had apparent double infections, with hybridization results indicating the presence of various combinations of MCV 1 or 1v and MCV 2 or 2v. When these results were analysed in the light of clinical data no correlations were found between the MCV type(s) detected and the clinical stage of HIV-1 infection; nor between the MCV types and the anatomical site of the lesions or persistence of infection. However, the HIV-1 positive patients were significantly more likely to be infected with MCV types 2 or 2v than were the controls (17/29, 59% versus 15/48, 31%; P less than 0.05). Since a concurrent study of MCV lesions in children aged 15 years or less has shown that the percentage of infections attributable to MCV 2 or 2v is extremely small (3%), this finding suggests that MCV lesions in HIV-1 positive patients are attributable to adult-acquired MCV infection rather than to reactivation of a childhood infection.

Molecular epidemiological study of molluscum contagiosum virus in two urban areas of western Japan by the in-gel endonuclease digestion method

The in-gel endonuclease digestion method was introduced for the molecular epidemiology of molluscum contagiosum virus (MCV). We obtained clear electrophoretic patterns from 90.3% of single lesions. The distribution of MCV types in Western Japan was revealed to be different from that in other countries.

[Molecular epidemiological study of molluscum contagiosum]

The agarose gel electrophoretic analysis of molluscum contagiosum virus (MCV) DNA obtained from 92 Japanese patients revealed the presence of four different BamHI cleavage patterns of MCV DNAs, classified as MCV-1,2,3 and 4. MCV-1 was found in 69% of the patients, MCV-2 in 4%, MCV-3 in 25%, and MCV-4 in 2%. Almost all the isolates from children and all female adult cases were infected with either MCV-1 or 3. No obvious clinical differences were seen between these two types. MCV-4 was found in only two adult male cases. The sizes of the lesions induced by MCV-4 appeared to be larger than those of other types. Six sets of siblings were shown to be infected with the same types, whereas two sets were infected with the different types. Some different MCV types were found in the cases attending the same swimming pools.

An outbreak of molluscum contagiosum in a kibbutz

Molluscum contagiosum is a viral disease that presents in a primary care setting as single or multiple wart-like lesions. We have seen an outbreak of Molluscum contagiosum in a small rural community, affecting 34 individuals. The most infected were children two-to nine-years-old. The diagnosis was made on clinical grounds. Spread appeared to be as a result of direct contact and by fomites. There was no evidence, in our study, of spread via swimming pool. Cryosurgery was used to treat our patients with Molluscum contagiosum.

Epidemiology of molluscum contagiosum using genetic analysis of the viral DNA

The molecular epidemiology of molluscum contagiosum virus (MCV) infections was investigated by restriction endonuclease analysis of the genomes of 222 separate isolates collected from 147 patients living in Germany (33 patients), Hong Kong (6 patients), and Scotland (108 patients). MCV type 1 (MCV-1) caused 96.6% of the infections, and MCV type 2 (MCV-2) caused 3.4%. However, isolates from four of the 142 MCV-1-infected patients and two of the five MCV-2-infected patients showed minor differences in their DNA restriction patterns because of the loss of a single or very few recognition sites for the enzymes used. No genome variations were detected amongst isolates collected from different sites or on several occasions from individual patients or from closely related patients. Southern blot hybridization revealed a high level of relatedness between MCV-1 and 2. No differences were seen in the appearance or anatomical localization of lesions caused by either virus type. In particular, there was no preferred genital localization for MCV-2 infections.