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Margheim A, Malone JC, Owen C. Onset of disseminated cutaneous nodules following toe amputation in heart transplant patient. Dermatol Online J 2019; 25:13030/qt89b0f7z6. [PMID: 32045165] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023] Open
Abstract
Alternaria spp. infections are rare, but organ transplant recipients and immunosuppressed patients are particularly at risk of developing cutaneous alternariosis. Although cutaneous alternariosis is well-defined, instances of disseminated infection are exceedingly rare. We report a case of disseminated Alternaria infection in an immunocompromised patient from a primary focus of ungual phaeohyphomycosis.
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Affiliation(s)
| | | | - Cindy Owen
- Division of Dermatology, University of Louisville, Louisville, KY.
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2
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Goiset A, Milpied B, Marti A, Marie J, Leroy-Colavolpe V, Pham-Ledard A, Chosidow O, Beylot-Barry M. Characteristics, Associated Diseases, and Management of Gram-negative Toe-web Infection: A French Experience. Acta Derm Venereol 2019; 99:1121-1126. [PMID: 31502652 DOI: 10.2340/00015555-3315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Gram-negative toe-web infection can cause pain and disability, be complicated by a long healing time, management failure, and cellulitis, and recur due to persistent predisposing factors. To describe the clinical features and management of Gram-negative toe-web infection and evaluate predisposing factors and associated diseases, their management, and the effect of controlling them on the rate of recurrence, we conducted a retrospective real-life study of patients with Gram-negative toe-web infection. Among the 62 patients (sex ratio 9:1), 31 experienced more than one episode of Gram-negative toe-web infection. Pseudomonas aeruginosa was the most prominent bacteria. Predisposing factors/associated diseases were eczema (66%), suspected Tinea pedis (58%), humidity (42%), hyperhidrosis (16%), psoriasis (11%), and vascular disorders (40%). Patients in whom associated diseases, such as eczema or psoriasis, were controlled did not relapse, suggesting the benefit of management of such conditions. We suggest that management of Gram-negative toe-web infection be standardised, with a focus on diagnosis and treatment of associated diseases.
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Affiliation(s)
- Anne Goiset
- Department of Dermatology, Bordeaux University Hospital, 33000 Bordeaux, France
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3
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Krasaeath R, Elizondo J. Topical Antifungals for Treatment of Onychomycosis. Am Fam Physician 2016; 94:734. [PMID: 27929250] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Rebecca Krasaeath
- Advocate Illinois Masonic Medical Center, Department of Family Medicine, Chicago, IL, USA
| | - Jose Elizondo
- Advocate Illinois Masonic Medical Center, Department of Family Medicine, Chicago, IL, USA
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4
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Borenstein TR, Johnson JP, Cohen B, Kane P. High-Pressure Injection to the Great Toe with River Water. R I Med J (2013) 2015; 98:38-41. [PMID: 26517255] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
CASE A 53-year-old male sustained a high-pressure water injection injury to his foot while working in a river. He was taken to the operating room for emergent irrigation and debridement of copious riverbed sediment. Cultures taken from the operating room were positive for multiple anaerobes, fungus and mold and he was treated with appropriate antibiotics. To date, his only residual deficit is a 1 cm area of numbness at the entrance wound. CONCLUSION High-pressure water injections to the foot are uncommon injuries. These are serious injuries that require emergent antibiotics, tetanus and surgical debridement.
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Affiliation(s)
- Todd R Borenstein
- Department of Orthopedics, Warren Alpert Medical School, Brown University, Providence, RI
| | - Joey P Johnson
- Department of Orthopedics Warren Alpert Medical School, Brown University, Providence, RI
| | - Brian Cohen
- Department of Orthopedics Warren Alpert Medical School, Brown University, Providence, RI
| | - Patrick Kane
- Department of Orthopedics, Clinical Instructor, Warren Alpert Medical School, Brown University, Providence, RI
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5
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Abdul Rahim NR, Koehler AP, Shaw DD, Graham CR. Toxigenic cutaneous diphtheria in a returned traveller. Commun Dis Intell (2018) 2014; 38:E298-E300. [PMID: 25631591] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Diphtheria is rarely reported in Australia. A case of cutaneous diphtheria was reported to the South Australian Department for Health and Ageing in April 2013 in an Australian-born 18-year-old female following travel in India. The case presented with a skin ulcer on her toe. Toxigenic Corynebacterium diphtheriae was isolated from a swab of the lesion. The case was treated with antibiotics. The public health response included infection control advice, assessing the case and household contacts for organism carriage and providing antimicrobial chemoprophylaxis to contacts. Although cutaneous diphtheria is not included as part of the Australian communicable disease surveillance case definition, this may be an oversight as international evidence demonstrates that it is a source of organism transmission and can potentially result in outbreaks among susceptible populations. This formed the rationale for the public health response to this particular case. The protocol for the public health management of diphtheria in South Australia has since been revised to include cutaneous lesions caused by the toxigenic strain of the organism as part of the surveillance case definition.
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Affiliation(s)
- Nur R Abdul Rahim
- Public Health Medicine Registrar, Department of Health, South Australia
| | - Ann P Koehler
- Director, Communicable Disease Control Branch, Department of Health, South Australia
| | - Doug D Shaw
- Medical Consultant, Public Health, Communicable Disease Control Branch, Department of Health, South Australia
| | - Caitlin R Graham
- Public Health Officer, Communicable Disease Control Branch, Department of Health, South Australia
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Leelavathi M, Azimah MN, Kharuddin NF, Tzar MN. Prevalence of toenail onychomycosis among diabetics at a primary care facility in Malaysia. Southeast Asian J Trop Med Public Health 2013; 44:479-483. [PMID: 24050080] [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] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Onychomycosis increases the risk of developing secondary bacterial infection and cellulitis if left untreated. The aim of this study was to determine the prevalence of onychomycosis among diabetics and its associated factors. A cross sectional study using universal sampling of all type 1 and 2 diabetic patients attending a primary care facility of the Universiti Kebangsaan Malaysia (UKM) from January to March 2011 was conducted. Samples were taken from clinically abnormal nails and from the first right toenail in the absence of nail abnormalities and cultured for fungal elements. A total of 151 diabetics participated in the study. The mean patient age was 60.7 +/- 9.1 years. A total of 123 nail samples (81.5%) were culture positive for fungal elements. A positive correlation was found between onychomycosis and increasing age (p = 0.011) and clinically abnormal nails (p < 0.05). There were no significant correlations with gender, ethnic group, duration of diabetes, types of diabetes or glycemic control. The prevalence of onychomycosis among diabetics in our study was high.
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Affiliation(s)
- M Leelavathi
- Department of Family Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
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7
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8
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Schneider J, LaCasse A. What is your diagnosis? Tinea nigra. Cutis 2009; 84:292-300. [PMID: 20166569] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- Joseph Schneider
- Botsford General Hospital, Michigan State University, Farmington Hills, USA
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9
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Tilak R, Prakash P, Nigam C, Tilak V, Gambhir IS, Gulati AK. Cryptococcal meningitis with an antecedent cutaneous Cryptococcal lesion. Dermatol Online J 2009; 15:12. [PMID: 19930999] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Cutaneous cryptococcosis, caused by an encapsulated yeast, Cryptococcus neoformans, is generally associated with concomitant systemic infection. Here we report a case of primary cutaneous cryptococcosis with spread to central nervous system in an HIV seronegative young boy. In the present case, a 17-year-old boy who was suffering from a non-healing ulcer on his right great toe for 5 months, presented with the signs and symptoms of meningitis. Cryptococcus neoformans var. gattii was isolated from the CSF of the patient. Amphotericin B administration produced recovery from the meningitis as well as from the ulcer. This case study suggests that primary cutaneous cryptococcosis can be diagnosed provisionally by a simple Gram stained smear and India ink examination in order to avoid occurrence of disseminated cryptococcosis, including meningial involvement, which may have a fatal outcome.
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Affiliation(s)
- Ragini Tilak
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi.
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10
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Altunay ZT, Ilkit M, Denli Y. [Investigation of tinea pedis and toenail onychomycosis prevalence in patients with psoriasis]. MIKROBIYOL BUL 2009; 43:439-447. [PMID: 19795619] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The data about the prevalence of onychomycosis in patients with psoriasis is contradictory. In this study, we investigated the prevalence of onychomycosis and tinea pedis in patients with psoriasis compared to control group. A total of 60 patients with psoriasis (27 male, 33 female; mean age: 40.8 +/- 17.6 years) and 60 subjects without psoriasis (27 male, 33 female; mean age: 42.8 +/- 17.3 years) who were admitted to dermatology outpatient clinics of our hospital were included to the study. Scrapings from both normal and abnormal toenails as well as toewebs were examined using microscopy and fungal culture. Foot dermatomycosis was diagnosed in 6 (5 onychomycosis and 1 tinea pedis) patients with psoriasis (10%) and in 8 (5 onychomycosis and 3 tinea pedis) control subjects (13.3%) (p > 0.05). The only dermatophyte fungi isolated in both patients with psoriasis and control group were Trichophyton rubrum (75%) and Trichophyton interdigitale (25%). Onychomycosis was more predominant in male psoriatic patients (p = 0.01). Both distero-lateral subungual onychomycosis (DLSO) and total dystrophic onychomycosis were detected in patients with psoriasis, however, DLSO, was the only clinical type in the control group. Pitting is the most typical lesions in nails in patients with psoriasis (p = 0.04). The use of common showers play a role in transmission of foot dermatomycosis (p = 0.04). In this study, psoriasis was not found as a risk factor for onychomycosis. However, onychomycosis is a major problem in psoriatic nails, and mycological methods would be useful in differential diagnosis. Since dermatomycosis is still an important public health problem, it may be controlled by education of the patient about proper foot hygiene and avoiding walking barefooted in shower areas.
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Affiliation(s)
- Zeynep Tülay Altunay
- Cukurova Universitesi Tip Fakültesi, Mikrobiyoloji Anabilim Dali, Mikoloji Bilim Dali, Adana
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Abstract
We report a case of onychomycosis caused by Aspergillus versicolor in a 66-year-old female patient. The infection was characterised clinically by yellowish pigmentation of the nail plate and mild nail bed hyperkeratosis of the first left toe. All other nails were normal. Three direct microscopical examinations of nail samples revealed the presence of hyaline hyphae as well as conidiophores. Pure colonies of A. versicolor were found in three cultures. The patient was successfully treated with oral itraconazole.
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Hernández-Salazar A, Carbajal-Pruneda P, Fernández Martínez R, Arenas R. [Dermatophytosis due to Trichophyton rubrum. Ten-year period (1996-2006) data collection in a Dermatology Department in Mexico City]. Rev Iberoam Micol 2007; 24:122-4. [PMID: 17604430 DOI: 10.1016/s1130-1406(07)70026-8] [Citation(s) in RCA: 9] [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: 11/25/2022] Open
Abstract
Dermatophytosis is the most common mycosis in the world up to 80% caused by Trichophyton rubrum. The aim of the present study was to describe the clinical characteristics of the dermatophytosis caused by T. rubrum in a dermatological outpatient clinic during a ten years period, from 1996 to 2005. We collected the data from patients with a dermatophytosis from which we have isolated T. rubrum. A total of 776 patients with dermatophytosis caused by T. rubrum were found. A slight predominance of female patients (56.2%) was observed. The most commonly affected age group was those in the third to the fifth decade of life, and house working women (33.5%) were predominant. Onychomycosis was found in 63% of the cases, tinea pedis in 22.7%, tinea corporis in 5.2% and tinea cruris in 2.8%. In onychomycosis, the first toe nail was the most commonly affected (58.9%) and the dystrophic type was seen in 50.7% of them.
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Affiliation(s)
- Amparo Hernández-Salazar
- Sección de Micología, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14000 México D.F., México
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Hilmarsdóttir I, Valsdóttir F. Molecular typing of Beta-hemolytic streptococci from two patients with lower-limb cellulitis: identical isolates from toe web and blood specimens. J Clin Microbiol 2007; 45:3131-2. [PMID: 17609319 PMCID: PMC2045304 DOI: 10.1128/jcm.00532-07] [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: 11/20/2022] Open
Abstract
Intertriginous toe webs harboring cellulitis-causing bacteria constitute a risk factor for lower-limb cellulitis. Molecular typing of Streptococcus pyogenes and S. dysgalactiae subsp. equisimilis isolates from blood and toe webs of two cellulitis patients revealed identical strains for each species. This finding supports the role of toe webs as a potential site of entry for cellulitis pathogens.
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Affiliation(s)
- Ingibjörg Hilmarsdóttir
- Department of Microbiology, Barónsstigur, Landspítali University Hospital, 101 Reykjavík, Iceland.
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Abstract
In patients with onychomycosis (OM) 71.5% of them have been reported with plantar fungal infection. The aim of this study was to study the frequency and distribution of plantar and interdigital affection in diabetic patients and in a control group without diabetes, all of them with OM. Diabetic patients with OM were more frequently diagnosed with plantar (61.2%) than interdigital (46.7%) infection. In the control group similar results were obtained; patients with OM in 76.5% had plantar mycotic infection and 67.1% interdigital involvement.
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Affiliation(s)
- Caroline Chanussot
- Sección de Micología, Hospital General Dr. Manuel Gea González, Calzada de Tlalpan 4800, 14000 México D.F., México
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15
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Hyatt AD, Boyle DG, Olsen V, Boyle DB, Berger L, Obendorf D, Dalton A, Kriger K, Heros M, Hines H, Phillott R, Campbell R, Marantelli G, Gleason F, Coiling A. Diagnostic assays and sampling protocols for the detection of Batrachochytrium dendrobatidis. Dis Aquat Organ 2007; 73:175-92. [PMID: 17330737 DOI: 10.3354/dao073175] [Citation(s) in RCA: 477] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Batrachochytrium dendrobatidis is a fungus belonging to the Phylum Chytridiomycota, Class Chytridiomycetes, Order Chytridiales, and is the highly infectious aetiological agent responsible for a potentially fatal disease, chytridiomycosis, which is currently decimating many of the world's amphibian populations. The fungus infects 2 amphibian orders (Anura and Caudata), 14 families and at least 200 species and is responsible for at least 1 species extinction. Whilst the origin of the agent and routes of transmission are being debated, it has been recognised that successful management of the disease will require effective sampling regimes and detection assays. We have developed a range of unique sampling protocols together with diagnostic assays for the detection of B. dendrobatidis in both living and deceased tadpoles and adults. Here, we formally present our data and discuss them in respect to assay sensitivity, specificity, repeatability and reproducibility. We suggest that compliance with the recommended protocols will avoid the generation of spurious results, thereby providing the international scientific and regulatory community with a set of validated procedures which will assist in the successful management of chytridiomycosis in the future.
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Affiliation(s)
- A D Hyatt
- Australian Animal Health Laboratory, CSIRO Livestock Industries, Private Bag 24, Geelong, Victoria 3220, Australia.
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Abstract
We report a case of proximal fold cellulitis in both big toes, associated with a bilateral proximal onychomycosis and an intertrigo of the fourth space due to Fusarium solani. The infection occurred in an immunocompetent man with diabetes mellitus type II. Apparently, the infection was acquired in a tropical country and once the patient was in Spain the infection progressed causing nail detachment (onychomadesis). Seven months later a relapse that affected the left toenail occurred. The patient was treated topically with chemical toenail avulsion contained 40% urea associated with bifonazole followed by ciclopirox-olamine nail lacquer for 12 months. Complete cure without relapse was observed after 10 years of follow-up. In vitro antifungal susceptibility study demonstrated that two of the recovered isolates were both resistant to itraconazole and voriconazole.
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Affiliation(s)
- Josep M Torres-Rodríguez
- URMIM (Unidad de Investigación de Enfermedades Infecciosas y Micología), IMIM, Facultad de Medicina, Universitat Autònoma de Barcelona, c/ Dr. Aiguader, 80, 08003 Barcelona, Spain.
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Singh TN, Devi KM, Devi KS. Ecthyma gangrenosum: a rare cutaneous manifestation caused by pseudomonas aeruginosa without bacteraemia in a leukaemic patient--a case report. Indian J Med Microbiol 2005; 23:262-3. [PMID: 16327125] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Ecthyma gangrenosum is a rare and invasive cutaneous infection caused by Pseudomonas aeruginosa in the majority of cases, typically affecting immunocompromised patients, particularly those with neutropenia. We report a rare case of ecthyma gangrenosum in the absence of bacteraemia presenting as a solitary necrotic ulcer in a female patient with acute lymphoblastic leukaemia. A culture from the ecthyma lesion revealed the presence of Pesudomonas aeruginosa, but the results of repeated blood cultures were negative. The patient responded well to amikacin to which the isolate was susceptible in vitro. Considering high rate of mortality, early diagnosis and prompt effective treatment is mandatory.
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Affiliation(s)
- T N Singh
- Department of Microbiology, Regional Institute of Medical Sciences(RIMS), Imphal-795 004, Manipur, India.
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Affiliation(s)
- James W Brodsky
- Baylor University Medical Center, UTSWMS, Dallas, TX 75246, USA
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Abstract
BACKGROUND Previous studies have demonstrated higher infection rates following orthopaedic procedures on the foot and ankle as compared with procedures involving other areas of the body. Previous studies also have documented the difficulty of eliminating bacteria from the forefoot prior to surgery. The purpose of the present study was to evaluate the efficacy of three different surgical skin-preparation solutions in eliminating potential bacterial pathogens from the foot. METHODS A prospective study was undertaken to evaluate 125 consecutive patients undergoing surgery of the foot and ankle. Each lower extremity was prepared with one of three randomly selected solutions: DuraPrep (0.7% iodine and 74% isopropyl alcohol), Techni-Care (3.0% chloroxylenol), or ChloraPrep (2% chlorhexidine gluconate and 70% isopropyl alcohol). After preparation, quantitative culture specimens were obtained from three locations: the hallux nailfold (the hallux site), the web spaces between the second and third and between the fourth and fifth digits (the toe site), and the anterior part of the tibia (the control site). RESULTS In the Techni-Care group, bacteria grew on culture of specimens obtained from 95% of the hallux sites, 98% of the toe sites, and 35% of the control sites. In the DuraPrep group, bacteria grew on culture of specimens obtained from 65% of the hallux sites, 45% of the toe sites, and 23% of the control sites. In the ChloraPrep group, bacteria grew on culture of specimens from 30% of the hallux sites, 23% of the toe sites, and 10% of the control sites. ChloraPrep was the most effective agent for eliminating bacteria from the halluces and the toes (p < 0.0001). CONCLUSIONS The use of effective preoperative preparation solution is an important step in limiting surgical wound contamination and preventing infection, particularly in foot and ankle surgery. Of the three solutions tested in the present study, the combination of chlorhexidine and alcohol (ChloraPrep) was most effective for eliminating bacteria from the forefoot prior to surgery.
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Affiliation(s)
- Roger V Ostrander
- Department of Orthopaedics, University of California, San Diego 92103, USA
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Mlinarić-Missoni E, Kalenić S, Vazić-Babić V. Species distribution and frequency of isolation of yeasts and dermatophytes from toe webs of diabetic patients. Acta Dermatovenerol Croat 2005; 13:85-92. [PMID: 16324420] [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] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The paper identifies fungal species, looking at the incidence of fungal isolation and risk factors influencing the development of fungal infection and colonization of interdigital spaces of the feet in 509 diabetic outpatients. Using standard mycologic diagnostic methods, fungi were detected in toe webs of 122 (24%) diabetic patients. The finding of fungi was twice as common in interdigital spaces of one (85/16.7% of the patients) than both feet (37/7.3% of the patients). Yeasts were the most common isolates (95/18.7% of the patients), followed by dermatophytic moulds (24/4.7% of the patients), whereas coexistence of yeasts and dermatophytes was the most infrequent finding (3/0.6% of the patients). From toe webs, 24 fungal species, 21 yeast species belonging to nine genera (Candida, Rhodotorula, Cryptococcus, Trichosporon, Saccharomyces, Blastoschizomyces, Geotrichum, Debaryomyces, and Ustilago) as well as three species of dermatophytes of the genera Trichophyton and Epidermophyton were isolated. The most frequently isolated fungi were Candida parapsilosis (59/11.6% of the patients) and Trichophyton mentagrophytes (16/3.1% of the patients). Although there was no correlation between the incidence of toe web space colonization with yeasts and dermatophytosis with the criteria of patient sex and age, and duration of diabetes, the difference in the incidence according to type of diabetes was statistically significant. In non insulin dependent diabetes mellitus patients, the incidence of fungal isolation from toe webs was statistically significantly higher (30.1%) than in insulin dependent diabetes mellitus patients (19.8%).
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Abstract
The chytrid fungus Batrachochytrium dendrobatidis has been implicated in the decline and extinction of numerous frog species worldwide. In Queensland, Australia, it has been proposed as the cause of the decline or apparent extinction of at least 14 high-elevation rainforest frog species. One of these, Taudactylus eungellensis, disappeared from rainforest streams in Eungella National Park in 1985-1986, but a few remnant populations were subsequently discovered. Here, we report the analysis of B. dendrobatidis infections in toe tips of T. eungellensis and sympatric species collected in a mark-recapture study between 1994 and 1998. This longitudinal study of the fungus in individually marked frogs sheds new light on the effect of this threatening infectious process in field, as distinct from laboratory, conditions. We found a seasonal peak of infection in the cooler months, with no evidence of interannual variation. The overall prevalence of infection was 18% in T. eungellensis and 28% in Litoria wilcoxii/jungguy, a sympatric frog that appeared not to decline in 1985-1986. No infection was found in any of the other sympatric species. Most importantly, we found no consistent evidence of lower survival in T. eungellensis that were infected at the time of first capture, compared with uninfected individuals. These results refute the hypothesis that remnant populations of T. eungellensis recovered after a B. dendrobatidis epidemic because the pathogen had disappeared. They show that populations of T. eungellensis now persist with stable, endemic infections of B. dendrobatidis.
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Affiliation(s)
- Richard W. R Retallick
- 1School of Tropical Biology, James Cook UniversityTownsville, QueenslandAustralia
- 2Department of Zoology and Entomology, University of QueenslandSt Lucia, QueenslandAustralia
- 3School of Life Sciences—Biology, Arizona State UniversityTempe, ArizonaUnited States of America
| | - Hamish McCallum
- 2Department of Zoology and Entomology, University of QueenslandSt Lucia, QueenslandAustralia
| | - Rick Speare
- 4Amphibian Diseases Group, School of Public Health and Tropical Medicine, James Cook UniversityTownsville, QueenslandAustralia
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Agger WA, Andes D, Burgess JW. Exophiala jeanselmei Infection in a Heart Transplant Recipient Successfully Treated with Oral Terbinafine. Clin Infect Dis 2004; 38:e112-5. [PMID: 15156466 DOI: 10.1086/421020] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [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: 11/24/2003] [Accepted: 02/18/2004] [Indexed: 11/03/2022] Open
Abstract
An immunosuppressed heart transplant recipient developed Exophiala jeanselmei infection on the second toe. After unsuccessful treatment with different antifungal drugs, the infection responded to a high-dose regimen of oral terbinafine (an antifungal agent not yet approved in the United States for use against the dematiaceous fungi) and warm packs. This is, to our knowledge, the only known case of successful terbinafine treatment of E. jeanselmei infection.
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Abstract
Salmonella septic arthritis in healthy individuals is a rare phenomenon in the United States. This case report chronicles the clinical course of a 41-year-old male farmworker who presented with a 3-week history of fever, chills, night sweats with pain, and swelling and redness of his left ankle. He had an open fracture of the ankle 2 years earlier that healed and was asymptomatic despite prior radiographic evidence of avascular necrosis of the talar dome. One month before presentation, he had an ipsilateral periungual abscess of the great toe that he opened and drained himself. Joint cultures were positive for Salmonella enteritidis that was successfully treated with a 6-week course of i.v. ceftriaxone.
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Affiliation(s)
- Russell Meldrum
- Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Whipp MJ, Davis JM, Lum G, de Boer J, Zhou Y, Bearden SW, Petersen JM, Chu MC, Hogg G. Characterization of a novicida-like subspecies of Francisella tularensis isolated in Australia. J Med Microbiol 2003; 52:839-842. [PMID: 12909664 DOI: 10.1099/jmm.0.05245-0] [Citation(s) in RCA: 120] [Impact Index Per Article: 5.7] [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] Open
Abstract
Francisella tularensis is found throughout the Northern Hemisphere, where it is associated with the disease of tularaemia in animals and humans. The isolation and identification is reported of a novicida-like subspecies of F. tularensis from a foot wound sustained in brackish water in the Northern Territory of Australia.
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Affiliation(s)
- Margaret J Whipp
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Victoria 3010, Australia 2Royal Darwin Hospital, Darwin, Northern Territory of Australia, Australia 3Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Jennifer M Davis
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Victoria 3010, Australia 2Royal Darwin Hospital, Darwin, Northern Territory of Australia, Australia 3Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Gary Lum
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Victoria 3010, Australia 2Royal Darwin Hospital, Darwin, Northern Territory of Australia, Australia 3Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Jim de Boer
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Victoria 3010, Australia 2Royal Darwin Hospital, Darwin, Northern Territory of Australia, Australia 3Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Yan Zhou
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Victoria 3010, Australia 2Royal Darwin Hospital, Darwin, Northern Territory of Australia, Australia 3Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Scott W Bearden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Victoria 3010, Australia 2Royal Darwin Hospital, Darwin, Northern Territory of Australia, Australia 3Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Jeannine M Petersen
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Victoria 3010, Australia 2Royal Darwin Hospital, Darwin, Northern Territory of Australia, Australia 3Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - May C Chu
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Victoria 3010, Australia 2Royal Darwin Hospital, Darwin, Northern Territory of Australia, Australia 3Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
| | - Geoff Hogg
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, University of Melbourne, Victoria 3010, Australia 2Royal Darwin Hospital, Darwin, Northern Territory of Australia, Australia 3Division of Vector-Borne Infectious Diseases, Centers for Disease Control and Prevention, Fort Collins, CO, USA
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Güleç AT, Demirbilek M, Seçkin D, Can F, Saray Y, Sarifakioglu E, Haberal M. Superficial fungal infections in 102 renal transplant recipients: a case-control study. J Am Acad Dermatol 2003; 49:187-92. [PMID: 12894063 DOI: 10.1067/s0190-9622(03)00861-2] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [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: 11/22/2022]
Abstract
BACKGROUND Renal transplant recipients are predisposed to superficial fungal infections caused by graft-preserving immunosuppressive therapy. Reports have documented a wide range of prevalence rates for superficial fungal infections in this patient group. OBJECTIVE The aim of this study was to determine the prevalence and clinical and mycological features of superficial fungal infections in renal transplant recipients at our center. METHODS One hundred two consecutively registered renal transplant recipients (34 women, 68 men) and 88 healthy age- and sex-matched persons acting as controls (30 women, 58 men) underwent screening for the presence of superficial fungal infection. Skin scrapings and swabs were obtained from the dorsum of the tongue, upper part of the back, toe webs, and any suspicious lesions. Nail clippings were also collected. All samples were examined by direct microscopy and were stained with calcofluor white. The samples were cultured in Sabouraud dextrose agar, mycobiotic agar, and dermatophyte test medium. Candida species were identified on the basis of germ-tube production, spore formation in cornmeal agar, and results of biochemical testing. Dermatophytes were identified on the basis of colonial and microscopic morphologic features in conjunction with results of physiologic evaluation (in vitro hair perforation test, urease activity, temperature tolerance test, and nutritional test). RESULTS Sixty-five (63.7%) of the 102 renal transplant recipients had cutaneous-oral candidiasis, dermatophytosis, or pityriasis versicolor, whereas only 27 (30.7%) of controls had fungal infection. Pityriasis versicolor was the most common fungal infection in the patient group (36.3%), followed by cutaneous-oral candidiasis (25.5%), onychomycosis (12.7%), and fungal toe-web infection (11.8%). Pityriasis versicolor and oral candidiasis were significantly more common among the renal transplant recipients, whereas the frequency of dermatophytosis in patients and controls was similar. Candida albicans was the main agent responsible for oral candidiasis, and Trichophyton rubrum was the most common dermatophyte isolated. Analysis showed that age, sex, and duration of immunosuppression did not significantly affect the prevalence of superficial fungal infection. Cyclosporine treatment and azathioprine therapy were identified as independent risk factors for superficial fungal disease. CONCLUSIONS The prevalence of opportunistic infections with Pityrosporum ovale and C albicans is increased among renal transplant recipients, probably owing to the immunosuppressed state of this patient population. However, renal transplant recipients are not at increased risk of dermatophytosis.
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Affiliation(s)
- A Tülin Güleç
- Departments of Dermatology, Microbiology and General Surgery, Başkent university Faculty of Medicine, Ankara, Turkey
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Abstract
An effective presurgical preparation is an important step in limiting surgical wound contamination and preventing infection. The purpose of this study was to evaluate residual bacterial skin contamination after surgical skin preparation in foot and ankle surgery to determine if current techniques are satisfactory in eliminating harmful pathogens. Fifty consecutive patients having surgical procedures of the foot and ankle were studied. Each lower extremity was prepared randomly with either a one-step povidone-iodine topical gel or a two-step iodophor scrub followed by a povidone-iodine paint. After preparation and draping, cultures were obtained at three locations: the hallux nailfold, web space between the second and third, and fourth and fifth toes, and the anterior ankle (control). In the gel group, positive cultures were obtained from 76% of halluces, 68% of toes, and 16% of controls. In the scrub and paint group, positive cultures were obtained from 84% of halluces, 76% of toes, and 28% of controls. Numerous pathogens were cultured, with Staphylococcus epidermidis being the most prevalent. Based on the findings of the current study, presurgical skin preparation with a povidone-iodine based topical bactericidal agent is not sufficient in eliminating pathogens in foot and ankle surgery. The unique environment of the foot and its resident organisms may play a role in the higher infection rates associated with surgery of the foot and ankle.
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Affiliation(s)
- Roger V Ostrander
- Department of Orthopaedics, University of California-San Diego, 200 West Arbor Drive, #8894, San Diego, CA 92103, USA.
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Abstract
A total of 100 young adults (67 males and 33 females) participated in the study. Clinical evaluation showed that only 10 of the volunteers showed some scaling, fissuring and peeling of the toe webs. Four of these complained of occasional itching. Fourteen different genera of fungi were recovered from 78 of the 100 youths screened. Yeasts were recovered from 21 (27%) of the positive cases, nondermatophytes from 38 (49%) and dermatophytes from 19 (24%). Microsporum gypseum was the most commonly recovered dermatophyte. Rhizopus stolonifer and Trichosporon cutanueum were the most frequently recovered nondermatophytic mould and yeast, respectively. More males (62.8%) harboured these organisms than females (37.2%). The study further showed that human toe webs that are apparently healthy harbour a variety of fungi, that may be potential pathogens.
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Affiliation(s)
- C A Oyeka
- Department of Applied Microbiology and Brewing, Faculty of Natural Sciences, Nnamdi Azikiwe University, Awka, Anambra State, Nigeria
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Abstract
To investigate the usefulness of a standard surgical preparation in prevention of surgical site contamination, 49 consecutive patients undergoing foot or ankle surgery were randomly assigned to standard preparation with chlorhexidine gluconate home scrubs and preoperative povidone-iodine or to standard preparation plus preoperative preparation with 70% alcohol. Results were available for all 49 patients. Cultures were positive for normal aerobic bacteria from the toes of nine of 26 patients (35%) receiving standard surgical preparation and from the toes of 13 of 23 patients (57%) receiving standard preparation plus alcohol (P = 0.12). No patient had a positive culture for anaerobic organisms or clinical evidence of infection or wound problems. Standard surgical preparation did not provide a completely sterile field, and the inclusion of alcohol added no benefit.
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Affiliation(s)
- Kurtis R Hort
- Department of Orthopedic Surgery, Mayo Clinic, Jacksonville 32224, USA
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Espinosa Parra FJ, Ramos Rincón JM, Herrero Huerta F, Pretel Serrano L, Lorenzo AA. [Diagnostic utility of Osler's nodules in infectious endocarditis among parenteral drug users]. An Med Interna 2002; 19:299-301. [PMID: 12152389] [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] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Abstract
BACKGROUND The objective of study is to describe of clinic, microbiological and histological data of five cases of infective endocarditis (IE) with Osler's nodes in intravenous drug users. PATIENTS Y METHODS: Prospectively, 43 cases of IE in intravenous drugs users was revised. In 4 patients, a aspirate puncture of Osler's node was performed and in one patient a biopsy of Osler's node was done with Gram's stain and culture of specimen. RESULTS From 43 episodes of IE, 33 were right-side IE, 9 left-side y 1 right and left side. No patients with right-side IE presented Osler's nodes, however five of 10 (50%) patients with left-side endocarditis. In all of cases gram positive cocci were observed in Gram's strain and Staphylococcus aureus growth on culture of lesion with the same antibiotype than isolated from blood culture. One case a cutaneous biopsy was performed, and inflammatory infiltrate with necrosis was found. CONCLUSIONS The Gram's strain and culture of specimen aspirated from Osler's nodes were of high utility in the diagnosis of IE in intravenous drugs users. The presence of Osler's nodes in a patient with infective endocarditis must be suggest that the location in left-side. These data suggest that Osler's nodes in infective endocarditis by S. aureus in intravenous drugs users was originated by microvascular septic emboli.
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Affiliation(s)
- F J Espinosa Parra
- Servicio de Medicina Interna, Hospital General Universitario J.M. Morales Meseguer, Murcia
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31
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Aste N, Atzori L, Zucca M, Pau M, Biggio P. Gram-negative bacterial toe web infection: a survey of 123 cases from the district of Cagliari, Italy. J Am Acad Dermatol 2001; 45:537-41. [PMID: 11568743 DOI: 10.1067/mjd.2001.114747] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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: 11/22/2022]
Abstract
BACKGROUND Foot intertrigo is mostly caused by dermatophytes and yeasts, less frequently by gram-positive and gram-negative bacteria. Nevertheless, the importance of polymicrobial infections and especially colonizations of Pseudomonas aeruginosa can cause therapy problems in relation to antibiotic resistance and the risk of potentially lethal complications. OBJECTIVE The aim of this study was to evaluate the main epidemiologic and clinical features of intertrigo from gram-negative bacteria, the function of promoting factors, and the measures taken to treat and prevent this disorder. METHODS Between 1989 and 1998, 123 cases of intertrigo from gram-negative bacteria were observed at the Cagliari University Dermatology Department. Routine clinical and blood examinations, repeated bacterioscopic and mycologic examinations, cultures aimed at identifying the responsible bacteria, and antibiograms were performed. RESULTS P aeruginosa was found to be the prevailing pathogen, both alone and associated with other gram-negative bacteria (such as Escherichia coli, Proteus mirabilis, Morganella morganii) and gram-positive bacteria. Clinical manifestations were similar in the majority of patients: erythema, vesicopustules, erosions, and marked maceration caused by abundant, malodorous exudate. Lesions affected the interdigital spaces of both feet and frequently extended to the planta and the back of the toes. Patients complained of burning and pain. Successful therapies were achieved with combined topical and systemic treatment; to avoid the risk of antimicrobial resistance, the choice of the active antibiotic was guided by antibiograms. CONCLUSION In all symptomatic toe web infections, the presence of gram-negative germs, such as P aeruginosa, should be investigated to avoid the risk of treatment failures and more severe local or systemic complications.
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Affiliation(s)
- N Aste
- Dermatology Department, Cagliari University Hospital San Giovanni di Dio, Cagliari, Italy
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32
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Abstract
Fifty patients undergoing foot or ankle surgery were randomized into two groups for the purposes of toe preparation. Twenty-four patients underwent a standard preparation which included placing antiseptic between the toes while 26 were additionally cleaned by sliding a gauze swab soaked in topical antiseptic back and forth several times. Povidone iodine followed by chlorhexidine in alcohol was used in both groups. All toes were covered by a sterile glove during surgery unless the toes themselves were to be operated upon. Bacteria were cultured from the toe clefts in 4% of all patients immediately following preoperative disinfection. Significantly fewer patients whose toes had been additionally scrubbed (group 1) showed bacterial recolonization at the end of surgery compared with those undergoing a standard prep (group 2) (7.7% vs 20.8%). We conclude that additional scrubbing of toe clefts prior to surgery reduces the incidence of recolonization of bacteria during the surgical procedure.
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Eady EA, Coates P, Ross JI, Ratyal AH, Cove JH. Antibiotic resistance patterns of aerobic coryneforms and furazolidone-resistant Gram-positive cocci from the skin surface of the human axilla and fourth toe cleft. J Antimicrob Chemother 2000; 46:205-13. [PMID: 10933642 DOI: 10.1093/jac/46.2.205] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [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: 11/15/2022] Open
Abstract
Samples of skin surface bacteria from 28 healthy subjects plated directly on to selective and non-selective media revealed that the proportion of aerobic coryneforms and furazolidone-resistant Gram-positive cocci (FURECs) resistant to erythromycin was significantly greater in the fourth toe cleft than in the axilla (P < 0.05). There were more erythromycin-resistant bacteria than tetracycline-resistant bacteria at both sites (P = 0.001 for the toe cleft; P < 0.01 for the axilla). In total, 160 distinct isolates were obtained, of which 42 were FURECs and 118 were aerobic coryneforms. Of these, 153 (96%) were resistant to erythromycin and 66 (41%) to tetracycline. All except seven of the tetracycline-resistant strains were also resistant to erythromycin. The resistant isolates belonged to a variety of species. CDC group ANF corynebacteria were most numerous and composed 31% of all isolates. The majority (76%) of FURECs were identified as Micrococcus luteus. MIC determinations on selected strains revealed that tetracycline-resistant FURECs were sensitive to doxycycline and minocycline, as were most tetracycline-resistant coryneforms. Nine coryneform isolates were cross-resistant to all three tetracyclines. Only a minority of erythromycin-resistant FURECs (21%) demonstrated a macrolide-lincosamide-streptogramin type B (MLS)-resistant phenotype with inducible or constitutive cross-resistance to clindamycin and the type B streptogramin, pristinamycin IA. Twenty-nine erythromycin-resistant FURECs had a novel phenotype distinct from MLS and macrolide-streptogramin type B resistance. In contrast, most coryneforms (79%) were MLS resistant. Among the remainder, two unusual erythromycin resistance phenotypes were apparent, both of which differed from the unusual phenotype in FURECs. This study has revealed that the non-staphylococcal aerobic flora of skin contains a considerable reservoir of tetracycline and erythromycin resistance determinants. The three unusual macrolide resistance phenotypes may be associated with novel resistance mechanisms.
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Affiliation(s)
- E A Eady
- The Skin Research Centre, Division of Microbiology, School of Biochemistry and Molecular Biology, University of Leeds, Leeds LS2 9JT, UK.
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Abstract
BACKGROUND Because of chronic immunosuppressive therapy, the skin of renal transplant recipients (RTR) is considered more liable to fungal infections. AIM The aim of the study was to analyze the prevalence of superficial dermatomycoses in a chronically immunosuppressed group of RTR who live in northern Italy and to verify the eventual relationship between the onset of mycoses, the immunosuppressive regimen and the interval of time elapsed after the transplantation. METHODS 73 RTR were submitted to a complete dermatological examination for fungal infection. Skin scrapings were taken from the upper back, from the 4th toe web of all patients and from any suspicious lesion. RESULTS 31 patients (42.5%) were affected by dermatomycosis. Pityriasis versicolor (PV) was present in 20 RTR (27.4%), fungal infection of the 4th toe web in 10 patients (13.7%) and onychomycosis in 9 RTR (12.3%). Trichophyton mentagrophytes was the most common dermatophyte. The prevalence of dermatomycoses was higher in the group of patients treated with azathioprine-cyclosporine-steroids and in those who had received their renal transplant in the previous 1-5 years. CONCLUSIONS PV was the most frequent dermatomycosis and showed a higher prevalence than in the normal population. The prevalence of fungal infection of the 4th toe web and onychomycosis was similar to that found in the immunocompetent population, but the length of interval after transplantation seemed to increase the probability of their occurrence and of mixed or simultaneous fungal infections in the same patient.
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Affiliation(s)
- A Virgili
- Dipartimento di Medicina Clinica e Sperimentale, Sezione di Dermatologia, Università degli Studi di Ferrara, Ferrara, Italia
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Abstract
The treatment of toenail onychomycosis is reviewed. Onychomycosis contributes to 40% of all nail disorders and appears to be increasing in frequency. Mycotic nail infections are usually caused by dermatophytes, yeasts, and nondermatophyte molds. Most cases of toenail onychomycosis are caused by dermatophytes. Mycotic nail infections do not always resolve spontaneously and may have a substantial impact on the patient's quality of life. Current treatment modalities for onychomycosis include surgery, topical antifungals, and oral antifungals. Surgery is generally not recommended as first-line therapy. Broad-spectrum topical and oral antifungal agents are the most frequently used treatments. Topical treatment is well tolerated but is usually not effective because of poor patient compliance and inadequate penetration of the nail. Oral antifungals are more successful but carry greater risks. Griseofulvin and ketoconazole have been oral antifungals traditionally used for onychomycosis, but these agents are associated with relatively low cure rates. Itraconazole and terbinafine are both safe and effective first-line agents, with reported overall cure rates of 50-90% for dermatophyte-related onychomycosis. Intermittent oral antifungal therapy may reduce the risk of systemic adverse effects and the cost of therapy; more study of this approach is needed. Oral antifungal agents offer patients with toenail onychomycosis greater likelihood of a cure than topical antifungals, but oral therapy carries greater risks and requires closer monitoring.
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Affiliation(s)
- C M Tom
- Thomas Jefferson University Hospital, Philadelphia, PA, USA
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Kimyai-Asadi A, Lin AY, Huang CH, Asghar F, Nousari HC. Toe web infections and prosthetic joints. Orthopedics 1999; 22:381, 389. [PMID: 10220050 DOI: 10.3928/0147-7447-19990401-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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37
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Affiliation(s)
- J O Lopes
- Laboratório de Pesquisas Micológicas, Universidade Federal de Santa Maria, RS, Brasil.
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38
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Ramos-e-Silva M, Marques SA, Gontijo B, Zaitz C, Campbell I, Veloso ST. Efficacy and safety of itraconazole pulse therapy: Brazilian multicentric study on toenail onychomycosis caused by dermatophytes. J Eur Acad Dermatol Venereol 1998; 11:109-16. [PMID: 9784035] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Itraconazole is a large spectrum triazole with known efficacy in both continuous and pulse therapy for various mycoses. OBJECTIVES Evaluate the efficacy and tolerability of itraconazole pulse therapy for onychomycosis of the toenails due to dermatophytes, in a prospective, open, non-comparative and multicentric investigation. Patients and methods The trial was completed by 72 patients of an initial total of 89. Treatment consisted of four cycles of itraconazole, 200 mg twice a day, for seven consecutive days each month. Patients were evaluated clinically, mycologically and biochemically before, during and at the end of the investigation, and were divided into two groups according to the measure of normal portion of the most affected nail (target nail), as follows: Group 1: 0-5.9 mm; and Group 2: more than 6 mm. RESULTS Improvement was satisfactory and progressive. Results were statistically significant, when comparing the three moments of the study: pre-treatment, end of therapy (fourth month) and follow-up (ninth month) in both groups. CONCLUSIONS Itraconazole pulse therapy was efficient and safe for the treatment of onychomycosis caused by dermatophytes, although a much higher daily dosage than the known continuous administration was used. Group 1, with nails initially more extensively affected, had a more evident improvement, by the mean variation in millimeters of normal portion of the target nail. This group showed a very satisfactory response, although not reaching total cure, thus demonstrating the great importance of early treatment of this disease. A residual therapeutic effect is maintained even after suspension of the drug. Group 2 obtained better total cure rates, and four pulses were, in general, sufficient, whereas more cycles would have been beneficial for the Group 1 patients with more extensive involvement.
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40
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Abstract
This study was to determine whether there is any benefit to wrapping the toes sterilely during orthopaedic procedures not involving the foot but performed on the lower extremity. The group studied consisted of 12 patients who had an orthopaedic procedure performed in which the foot and toes were included in the surgical prep, but not involved in the surgical procedure. Nine of the 12 patients (75%) had positive results from preprocedural aerobic cultures and two of the 12 (16.6%) had positive results from preprocedural fungal cultures. Recolonization of the bacteria between the toes was also demonstrated. Sterile draping of the toes would minimize the risk of infection and also protect against bacteria that recolonize during the procedure.
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Affiliation(s)
- J Zacharias
- Creighton-Nebraska Health Foundation, Orthopaedic Surgery Residency Program, Omaha, USA
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42
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Gullberg RM, Ericson HL, Rearick T, Petrowski S. Pasteurella multocida osteomyelitis by a "cat lick". Wis Med J 1997; 96:45-6. [PMID: 9197200] [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: 02/04/2023]
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43
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Day MR, Day RD, Harkless LB. Cellulitis secondary to web space dermatophytosis. Clin Podiatr Med Surg 1996; 13:759-66. [PMID: 8902342] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cellulitis occurring in the lower extremity is encountered frequently and results from a breach of the skin and inoculation of opportunistic bacteria. It has been shown that when web space dermatophytosis is present, changes may occur in normal skin morphology and bacterial flora that can result in severe infection. Knowledge of the pathophysiology of interdigital dermatophytosis allows the clinician to choose the most appropriate empiric antibiotic therapy when treating a secondarily caused cellulitis of the lower extremity.
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Affiliation(s)
- M R Day
- Department of Orthopedics, University of Texas, Health Science Center at San Antonio, USA
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44
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Affiliation(s)
- G Leigheb
- Department of Dermatology, Ospedale Maggiore della Carità, Novara, Italy
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45
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Rodríguez-Soto ME, Fernández-Andreu CM, Moya Duque S, Rodríguez Díaz RM, Martínez-Machín G. [Clinico-mycological study of onychomycosis in elderly patients]. Rev Inst Med Trop Sao Paulo 1993; 35:213-7. [PMID: 8278750 DOI: 10.1590/s0036-46651993000300001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [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: 01/29/2023] Open
Abstract
Physical examination of nails was carried out in 210 elderly patients and nail scrapings were obtained from onychomycosis suggested lesions in order to determine their causative agents, incidence and clinical characteristics. Diagnostic was confirmed by the isolation of the agents from 74 patients, mainly from toe-nails (incidence 35.2). Tinea pedis occurred in 25% of the cases and Diabetes mellitus was the most prevalent associated disease and the most frequent clinical characteristics were the thickening, the opacity and the presence of longitudinal strias in the surface of the nails. It was compared the results obtained by microscopic examination and by culture. Trichophyton rubrum was the most common dermatophyte isolated; Candida parapsilosis was dominant among Candida species.
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Affiliation(s)
- M E Rodríguez-Soto
- Laboratorio de Micología, Instituto de Medicina Tropical Pedro Kouri (IPK), La Habana, Cuba
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46
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Abstract
Skin scrapings taken from toe spaces of 200 healthy volunteers and from toe webs and groins of 150 pediatric patients were cultured for Candida albicans using the serum germ-tube test. The results showed that Candida albicans can be isolated in about 15% of normal toe spaces and 14% of children with normal groins. Although Candida albicans can be found in various grades of athlete's foot and also in some abnormal groins, we believe that it is not necessarily responsible for these conditions and is often present at these sites only as a saprophyte.
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Affiliation(s)
- R Jaafar
- Department of Medicine, Faculty of Medicine, National University of Malaysia, Kuala Lumpur
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47
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Affiliation(s)
- Y M Clayton
- Institute of Dermatology, St Thomas' Hospital, London, UK
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48
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49
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Soll DR, Galask R, Schmid J, Hanna C, Mac K, Morrow B. Genetic dissimilarity of commensal strains of Candida spp. carried in different anatomical locations of the same healthy women. J Clin Microbiol 1991; 29:1702-10. [PMID: 1761692 PMCID: PMC270187 DOI: 10.1128/jcm.29.8.1702-1710.1991] [Citation(s) in RCA: 135] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Candida spp. carriage and strain relatedness were assessed in 52 healthy women at 17 anatomical locations by using an isolation procedure which assesses carriage intensity and by using a computer-assisted DNA fingerprinting system which computes genetic similarity between strains on the basis of the patterns of Southern blots probed with the moderately repetitive sequence Ca3. Candida spp. were cultured from 73% of the test individuals, most frequently from the oral (56%), vulvovaginal (40%), and anorectal (24%) regions. Half of the test individuals with Candida spp. carried the organism simultaneously in more than one of the three general areas of carriage. Isolates from different body locations of the same individual were either completely unrelated, identical, or highly similar but nonidentical. In 11 cases in which Candida spp. were simultaneously isolated from the oral cavity and vaginal canal, seven pairs of isolates were genetically unrelated and four pairs were similar but nonidentical. In the latter cases, the isolate pairs each appear to have arisen by genetic divergence from a single progenitor. A comparison of the genetic relatedness of isolates from different individuals further uncovered a single strain which was vaginospecific in the Iowa City, Iowa area and reduced genetic diversity among vulvovaginal strains compared with those isolated from other body locations. These results suggest that strains adapt to different anatomical locations and, conversely, that in a healthy individual there is anatomical selection of vaginotropic, anotropic and orotropic strains of Candida spp.
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Affiliation(s)
- D R Soll
- Department of Biology, University of Iowa, Iowa City 52242
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50
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Abstract
The prevalence of Gram-negative bacilli on the toewebs was 8% in normal students, 24% in hospital outpatients with suspected Tinea pedis, 41% in industrial workers wearing protective clothing and 58% in coal miners. Prevalence was greatest in those exposed to wet working conditions. In miners, the presence of Gram-negative bacilli was related to symptoms of itching/soreness and cracking/fissuring, and was negatively related to malodour, but this latter trend was reversed in outpatients and in industrial workers. The feet are a source of many 'enteric' and 'environmental' bacilli and could contribute to infection elsewhere than in the toewebs themselves.
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