Climate, soil type, and geographic distribution of actinomycetoma cases in Northeast Mexico: A cross-sectional study

Background

Mycetoma is a chronic, granulomatous infection of subcutaneous tissue, that may involve deep structures and bone. It can be caused by bacteria (actinomycetoma) or fungi (eumycetoma). There is an epidemiological association between mycetoma and the environment, including rainfall, temperature and humidity but there are still many knowledge gaps in the identification of the natural habitat of actinomycetes, their primary reservoir, and their precise geographical distribution. Knowing the potential distribution of this infection and its ecological niche in endemic areas is relevant to determine disease management strategies and etiological agent habitat or reservoirs.

Methodology/principal findings

This was an ambispective descriptive study of 31 patients with actinomycetoma. We determined the biophysical characteristics including temperature, precipitation, soil type, vegetation, etiological agents, and mapped actinomycetoma cases in Northeast Mexico. We identified two disease cluster areas. One in Nuevo Leon, with a predominantly kastanozems soil type, with a mean annual temperature of 22°, and a mean annual precipitation of 585.2 mm. Herein, mycetoma cases were produced by Actinomadura pelletieri, Actinomadura madurae, Nocardia brasiliensis, and Nocardia spp. The second cluster was in San Luis Potosí, where lithosols soil type predominates, with a mean annual temperature of 23.5° and a mean annual precipitation of 635.4 mm. In this area, all the cases were caused by N. brasiliensis. A. madurae cases were identified in rendzinas, kastanozems, vertisols, and lithosols soils, and A. pelletieri cases in xerosols, kastanozems, and rendzinas soils. Previous thorn trauma with Acacia or Prosopis plants was referred by 35.4% of subjects. In these states, the presence of thorny plants, such as Acacia spp., Prosopis spp., Senegalia greggi, Vachellia farnesiana and Vachellia rigidula, are common.

Conclusions/significance

Mapping this neglected tropical infection aids in the detection of disease cluster areas, the development of public health strategies for early diagnosis and disease prediction models; this paves the way for more ecological niche etiological agent research.

Expression of melanocortin 1 receptor before and after narrowband UVB phototherapy treatment in patients with stable vitiligo: A prospective study

Vitiligo is a disease characterized by skin depigmentation caused by the selective destruction of melanocytes. The melanocortin system participates as a regulator of melanogenesis and skin pigmentation. Narrowband UVB phototherapy (nb-UVB) is currently considered to be the gold standard and first choice treatment method for vitiligo vulgaris. The aim of the present study was to analyze the clinical and biochemical parameters of vitiligo, as well as to determine the expression of proopiomelanocortin (POMC), melanocortin 1 receptor (MC1R) and melanocortin 4 receptor (MC4R) genes in the skin of patients with stable vitiligo receiving nb-UVB phototherapy. Patient clinical and biochemical parameters, and the skin biopsies of 22 patients with stable vitiligo were analyzed. These biopsies were obtained before and after nb-UVB phototherapy. The genetic expression analysis of POMC, MC1R and MC4R genes was performed via RNA-Sequence analysis. A statistical evaluation of the clinical and biochemical parameters, the degree of response to treatment and the expression profiles of the melanocortin system genes were performed to identify their association with treatment response. A two-sided P≤0.05 value was considered to indicate a statistically significant difference. Alterations were observed in the expression profiles of MC1R following nb-UVB phototherapy (P≤0.05). In addition, elevated levels of triiodothyronine were associated with a poor response to nb-UVB phototherapy. In conclusion the current study revealed that nb-UVB phototherapy altered the expression profile of the MC1R gene.

Local secretion of stress hormones increases in alopecia areata lesions after treatment with UVA-1 phototherapy

Alopecia areata (AA) is an autoimmune disease of the hair follicle. Keratinocytes of the hair follicle generate an immunosuppressive environment by the local secretion of hormones of the hypothalamic-pituitary-adrenal axis of the skin (skin HPA analog). Our objective was to measure the local production of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ACTH), and α-melanocyte-stimulating hormone (α-MSH) in the scalp tissue of patients with AA before and after ultraviolet A1 (UVA-1) phototherapy to determine their role in the pathogenesis of AA and the effect of UVA-1 on the AA hormonal environment. This was a retrospective and descriptive study of skin samples from 22 patients with AA before and after UVA-1 treatment. We compared the changes in the local hormonal environment by measuring CRH, ACTH, type 2 melanocortin receptor (ACTH receptor) and α-MSH with immunohistochemical stains. The positivity of MSH was significantly higher (P = .037) in the post-treatment samples compared with the baseline value. ACTH was significantly higher in intensity (P = .032) in the post-treatment samples compared with the initial value. CRH was significantly higher in intensity (P = .013) in baseline samples compared with the final biopsies. The positivity of the ACTH receptor MC2R was not different between the two groups (P = .626). In AA, an interruption in the signalling of CRH could decrease the local concentration of ACTH and MSH, and consequently, the immunosuppressive effect of these hormones. This phenomenon is normalized in the skin treated with UVA-1. A defective signalling system in the cutaneous HPA axis may be involved in the pathogenesis of AA.

Clinical characteristics and treatment of actinomycetoma in northeast Mexico: A case series

Background

Mycetoma is a neglected tropical disease characterized by nodules, scars, abscesses, and fistulae that drain serous or purulent material containing the etiological agent. Mycetoma may be caused by true fungi (eumycetoma) or filamentous aerobic bacteria (actinomycetoma). Mycetoma is more frequent in the so-called mycetoma belt (latitude 15° south and 30° north around the Tropic of Cancer), especially in Sudan, Nigeria, Somalia, India, Mexico, and Venezuela. The introduction of new antibiotics with fewer side effects, broader susceptibility profiles, and different administration routes has made information on actinomycetoma treatment and outcomes necessary. The objective of this report was to provide an update on clinical, therapeutic, and outcome data for patients with actinomycetoma attending a reference center in northeast Mexico.

Methodology/principal findings

This was a retrospective, cross-sectional, descriptive study of 31 patients (male to female ratio 3.4:1) diagnosed with actinomycetoma by direct grain examination, histopathology, culture, or serology from January 2009 to September 2018. Most lesions were caused by Nocardia brasiliensis (83.9%) followed by Actinomadura madurae (12.9%) and Actinomadura pelletieri (3.2%). About 50% of patients had bone involvement, and the right leg was the most commonly affected region in 38.7% of cases. Farmers/agriculture workers were most commonly affected, representing 41.9% of patients. The most commonly used treatment regimen was the Welsh regimen (35.5% of cases), a combination of trimethoprim/sulfamethoxazole (TMP/SMX) plus amikacin, which had a 90% cure rate, followed by TMP/SMX plus amoxicillin/clavulanic acid in 19.4% of cases with a cure rate of 100%. In our setting, 28 (90.3%) patients were completely cured and three (9.7%) were lost to follow-up. Four patients required multiple antibiotic regimens due to recurrences and adverse effects.

Conclusions/significance

In our sample, actinomycetoma was predominantly caused by N. brasiliensis. Most cases responded well to therapy with a combination of TMP/SMX with amikacin or TMP/SMX and amoxicillin/clavulanic acid. Four patients required multiple antibiotics and intrahospital care.

Mycetoma is a chronic skin disease that can invade bone or underlying organs. Inadequate treatment may lead to long-lasting disability. Information about treatment is scarce. We report the outcomes of 31 patients with a diagnosis of bacterial actinomycetoma attending a tertiary care hospital in northeast Mexico. Most cases were treated with a combination of antibiotics including TMP/SMX plus amikacin or TMP/SMX plus amoxicillin/clavulanic acid. Cure was achieved in 90% of patients and only one required surgery.

Red Scrotum Syndrome Treatment with Pregabalin: A Case Series

Red scrotum syndrome (RSS) (also known as male genital dysesthesia) is a rarely recognized entity characterized by scrotal erythema accompanied by a burning sensation, pain, hyperesthesia/dysesthesia, increased temperature and pruritus. Although its physiopathology is unknown, it has increasingly been associated with chronic topical steroid use in the male genital area. Treatment is challenging and no standardized treatment is currently available. Because current treatment relies on case reports and small case series, the need for more information about drug efficacy in RSS is warranted. The aim of this study is to describe the therapeutic response to pregabalin in patients from an outpatient dermatologic clinic in a tertiary-care hospital diagnosed with RSS. Five patients with a confirmed diagnosis of RSS were included. Ages ranged from 28 to 63 years. All patients had chronic steroid use in the genital area, mostly in the form of combined formulations of corticosteroids, antifungals, and antibiotics. Four patients were prescribed pregabalin monotherapy, 150 mg once daily at night. One patient was prescribed pregabalin and doxycycline. Two patients had complete remission after one month of therapy, one at two months and two at three months. None experienced recurrence at an average of 9.4 months' follow-up. One patient experienced morning drowsiness that did not require suspending treatment. Pregabalin is a well-tolerated and effective treatment for RSS.

Clinical spectrum of Lyme disease

Lyme disease (borreliosis) is one of the most common vector-borne diseases worldwide. Its incidence and geographic expansion has been steadily increasing in the last decades. Lyme disease is caused by Borrelia burgdorferi sensu lato, a heterogeneous group of which three genospecies have been systematically associated to Lyme disease: B. burgdorferi sensu stricto Borrelia afzelii and Borrelia garinii. Geographical distribution and clinical manifestations vary according to the species involved. Lyme disease clinical manifestations may be divided into three stages. Early localized stage is characterized by erythema migrans in the tick bite site. Early disseminated stage may present multiple erythema migrans lesions, borrelial lymphocytoma, lyme neuroborreliosis, carditis, or arthritis. The late disseminated stage manifests with acordermatitis chronica atrophicans, lyme arthritis, and neurological symptoms. Diagnosis is challenging due to the varied clinical manifestations it may present and usually involves a two-step serological approach. In the current review, we present a thorough revision of the clinical manifestations Lyme disease may present. Additionally, history, microbiology, diagnosis, post-treatment Lyme disease syndrome, treatment, and prognosis are discussed.

A Case of Bullous Morphea Resistant to Methotrexate and Phototherapy Successfully Treated With Mycophenolate Mofetil

Bullous morphea is rare clinical variant of localized scleroderma characterized by the formation of bullae on sclerotic morphea plaques. Severe disease may be highly disabling and greatly impair quality of life. Current treatment strategies are based on anecdotal reports of clinical experience and include topical corticosteroids, methotrexate and phototherapy. Herein, we describe the case of a 56-year-old woman with progressive bullous sclerotic lesions who was successfully treated with mycophenolate mofetil after treatment failure with psoralen plus ultraviolet A therapy, ultraviolet A1 phototherapy, and methotrexate. Treatment with mycophenolate mofetil halted disease progression after 8 weeks. No major adverse effects were recorded in a 3-year follow-up with continuous treatment. This case suggests mycophenolate mofetil may be considered as an alternative for the treatment of resistant bullous morphea lesions. J Drugs Dermatol. 2018;17(10):1123-1125.

Disseminated actinomycetoma due to Nocardia wallacei

BACKGROUND

Actinomycetoma caused by Nocardia usually responds well to antibiotics. Emerging species of Nocardia, such as N. wallacei, can be a therapeutic challenge.

AIMS

Confirm the therapeutic effectivity of linezolid in multidrug resistant Nocardia Wallacei actinomycetoma.

MATERIALS AND METHODS

We evaluated the medical management of an 18-year-old man with multidrug resistant actinomycetoma of the left leg caused by N. transvalensis complex treated 17 years ago with linezolid 1200 mg a day. This bacteria was recently reclassified as Nocardia Wallacei by specific molecular biology technique.

RESULTS

The infection was cured after 3 months of treatment; the patient remained asymptomatic for the past 17 years. No adverse effects were found.

DISCUSSION

Frequently, strains of N. transvalensis complex have aminoglycoside resistance; in this case, we highlight the effectiveness of linezolid for the successful medical management of multidrug resistant actinomycetoma.

CONCLUSION

Linezolid can be an alternative for the treatment of multidrug resistant Nocardia Wallacei.

Cutaneous mucormycosis

Cutaneous mucormycosis is an emerging fungal infection caused by opportunistic fungi of the phylum Glomeromycota. It is frequent in poorly controlled diabetic patients and individuals with immunosuppression. It is usually acquired by direct inoculation through trauma. The clinical presentation is nonspecific, but an indurated plaque that rapidly evolves to necrosis is a common finding. Diagnosis should be confirmed by demonstration of the etiological agent and new molecular diagnostic tools have recently been described. It is an invasive life-threatening disease and in order to improve survival, a prompt diagnosis and multidisciplinary management should be provided. The treatment of choice is amphotericin B, but new azoles, such as posaconazole and isavuconazole, must be considered.

Phototherapy for alopecia areata

Phototherapy is a useful therapeutic method for various skin diseases due to its modulatory effect on the cutaneous immune system. Alopecia areata is a dermatosis characterized by partial or complete hair loss. Collapse of the immune privilege of the hair follicle, which induces noncicatricial alopecia, is an important factor in its etiology. Several forms of phototherapy are used in dermatology.

Cold subcutaneous abscesses as the first manifestation of disseminated coccidioidomycosis in an immunocompromised host

Coccidioidomycosis is an endemic fungal infection in the southwestern USA and northern Mexico. It is caused by Coccidioides immitis and C. posadasii. This infection occurs due to the inhalation of airborne arthroconidia, causing a mild pulmonary infection, but most cases are asymptomatic. Disseminated coccidioidomycosis (DC) is a rare entity occurring in less than 1% of all cases, usually in immunocompromised patients, and it carries high risks of morbidity and mortality. The skin is one of the most frequently affected organs and in some cases cutaneous lesions may be the first or only sign of infection. A wide spectrum of clinical lesions may develop, including cold abscess. In immunocompromised hosts, DC represents a diagnostic and therapeutic challenge. Treatment is based on antifungal drugs, such as amphotericin B and azoles, administered for long periods of time and under close follow up to monitor the treatment response and to detect relapse. In the following case report, we present a 35-year-old male patient with systemic lupus erythematosus under immunosuppressive therapy who presented with cold subcutaneous abscesses as the first sign of DC.

Human papillomavirus type 2 associated with pyogenic granuloma in patients without clinical evidence of warts

BACKGROUND

Pyogenic granuloma is a non-neoplastic lesion that frequently occurs in the skin and mucous membranes of children and pregnant women. The anatomical sites of pyogenic granulomas overlap with those of wart infections caused by the human papillomavirus (HPV).

OBJECTIVE

This study assessed the presence of HPV DNA in pyogenic granuloma samples by polymerase chain reaction.

METHODS

Eighteen pyogenic granuloma biopsies from patients without a clinical history or evidence of verruca in the studied area were tested for the presence of the HPV genome. The presence of HPV DNA was screened by three independent polymerase chain reaction reactions using standard consensus primer sets targeted to the L1 or E1 consensus regions of HPV genome. The HPV DNA-positive samples were genotyped using methodologies enabling the identification of up to 30 HPVs, including oncogenic, nononcogenic, and cutaneous viral types.

RESULTS

The HPV DNA was detected in 44.4% (eight of 18) of the samples, with HPV-2 being the only type in the eight HPV DNA-positive samples. Contamination with HPV-2 sequences throughout the entire process was reliably eliminated.

CONCLUSION

This report is the first to suggest an association between HPV-2 and pyogenic granuloma. This relationship is similar to that observed between HPV-2 and nongenital warts.

Mycetoma medical therapy

Medical treatment of mycetoma depends on its fungal or bacterial etiology. Clinically, these entities share similar features that can confuse diagnosis, causing a lack of therapeutic response due to inappropriate treatment. This review evaluates the response to available antimicrobial agents in actinomycetoma and the current status of antifungal drugs for treatment of eumycetoma.

Merits and pitfalls of currently used diagnostic tools in mycetoma

Treatment of mycetoma depends on the causative organism and since many organisms, both actinomycetes (actinomycetoma) and fungi (eumycetoma), are capable of producing mycetoma, an accurate diagnosis is crucial. Currently, multiple diagnostic tools are used to determine the extent of infections and to identify the causative agents of mycetoma. These include various imaging, cytological, histopathological, serological, and culture techniques; phenotypic characterisation; and molecular diagnostics. In this review, we summarize these techniques and identify their merits and pitfalls in the identification of the causative agents of mycetoma and the extent of the disease. We also emphasize the fact that there is no ideal diagnostic tool available to identify the causative agents and that future research should focus on the development of new and reliable diagnostic tools.

IgG anti nocardia brasiliensis antibodies block IgM mediated protective effect in BALB/c mice. (MPF2P.814)

Intracellular bacteria such as, Nocardia brasiliensis, produce a chronic human disease named actinomycetoma. Diagnosis of mycetoma is made on clinical findings as swelling and deformation of infected tissue and confirmed by culturing the offending microbe or by an ELISA test. Pathogenesis of mycetoma is little known and role of antibodies is controversial but it has been published that that cell mediated immunity is responsible of host protection in other intracellular bacterial infections. We used Nocardia brasiliensis to infect BALB/c mice and studied the role of both monoclonal and polyclonal antigen-specific IgM and IgG antibodies. We investigated antibodies role in host protection using passive immunization. Mice recipients of anti N. brasiliensis antibodies were then infected to assess actinomycetoma development. We found that IgM but not IgG anti N. brasiliensis antibodies from sera of infected animals and IgM, but not IgG anti N. brasiliensis monoclonal antibodies were able to confer protection and prevented actinomycetoma infection in experimental animals. IgG antibodies blocked the IgM protective effect in vivo. Implications of these finding in vaccine development are presented.

[Update on the epidemiology of mycetoma in Mexico. A review of 3933 cases]

Mycetoma is one of the most frequent chronic subcutaneous infections in many tropical and subtropical regions.

OBJECTIVE

To update the epidemiological data of mycetoma cases in Mexico.

METHOD

A survey in the main mycological diagnosis centers in this country was performed. Each mycologist was requested for number of diagnosed mycetoma cases, age, sex, occupation, geographic origin, type of mycetoma, and etiological agents.

RESULTS

Until 2012, we have registered 3,933 cases in the last 54 years. Sex distribution corresponds to 75.6% for men and 24.4% for women. In 75.72% is present in adults between 16-50 years old. The predominant work group of patients is farmers (58.41%) followed by housewives (21.79%). Most of patients come from Jalisco, Morelos, Nuevo Leon, Guerrero, Veracruz and Michoacan states. The most affected body areas are limbs (60.29%) and trunk (19.76%). Actinomycetoma has a frequency of 96.52%, and the commonest etiological agent is Nocardia brasiliensis (65.58%). Eumycetoma (3.48%) is mainly caused by Madurella grisea (28.47%) and M. mycetomatis (26.28%).

CONCLUSIONS

Mycetoma is an under-diagnosed pathology representing a health problem in rural regions and must be attended with more interest by the health institutions.

Protothecosis

Protothecosis is a rare infection caused by achlorophyllic algae that are members of the genus Prototheca. They are ubiquitous in nature in organic material. The clinical manifestations can be acute or chronic and local or disseminated. The disease is classified as cutaneous, causing bursitis or disseminated/systemic, affecting both immunocompetent and immunosuppressed patients, with more severe and disseminated infections occurring in immunocompromised individuals. Prototheca wickerhamii and Prototheca zopfii are the most frequent organisms reported in humans. Diagnosis is made by observing asexual sporangia (thecas) on histopathological examination of tissue. Medical and surgical treatment should be considered. Ketoconazole, itraconazole, fluconazole, voriconazole, posaconazole, and amphotericin B are the most commonly used antifungals. Voriconazole and amphotericin B are highly effective against Prototheca spp. Treatment failure is not uncommon because of the comorbidities that limit the therapeutic outcome.

Systemic increased immune response to Nocardia brasiliensis co-exists with local immunosuppressive microenvironment

Human diseases produced by pathogenic actinomycetes are increasing because they may be present as opportunistic infections. Some of these microbes cause systemic infections associated with immunosuppressive conditions, such as chemotherapy for cancer, immunosuppressive therapy for transplant, autoimmune conditions, and AIDS; while others usually cause localized infection in immunocompetent individuals. Other factors related to this increase in incidence are: antibiotic resistance, not well defined taxonomy, and a delay in isolation and identification of the offending microbe. Examples of these infections are systemic disease and brain abscesses produced by Nocardia asteroides or the located disease by Nocardia brasiliensis, named actinomycetoma. During the Pathogenic Actinomycetes Symposium of the 16th International Symposium on Biology of Actinomycetes (ISBA), held in Puerto Vallarta, Mexico, several authors presented recent research on the mechanisms by which N. brasiliensis modulates the immune system to survive in the host and advances in medical treatment of human actinomycetoma. Antibiotics and antimicrobials that are effective against severe actinomycetoma infections with an excellent therapeutic outcome and experimental studies of drugs that show promising bacterial inhibition in vivo and in vitro were presented. Here we demonstrate a systemic strong acquired immune response in humans and experimental mice at the same time of a local dominance of anti inflammatory cytokines environment. The pathogenic mechanisms of some actinomycetes include generation of an immunosuppressive micro environment to evade the protective immune response. This information will be helpful in understanding pathogenesis and to design new drugs for treatment of actinomycetoma.

Skin manifestations associated with chemotherapy in children with hematologic malignancies

Chemotherapy used in the treatment of malignancies produces multiple mucocutaneous adverse reactions that may be clinically challenging. These mucocutaneous reactions are common and sometimes not diagnosed. The objective of this study was to determine the clinical patterns of the mucocutaneous manifestations during and after chemotherapy in children with a hematologic malignancy and to determine whether nutritional status influences the clinical presentation. We recruited patients aged 6 months to 16 years diagnosed with leukemia and lymphoma from a pediatric hematology outpatient clinic between November 2008 and May 2010. The patients were divided into two groups: Group 1, recently diagnosed patients, included in the study before receiving chemotherapy, and Group 2, patients in surveillance who had not had chemotherapy for at least 3 months. A dermatologic examination was performed, and biopsy and mycological and bacteriological tests were conducted if necessary, with 6 months of follow-up. We evaluated 89 patients and included 65 in the study: 40 boys and 25 girls with an average age of 8.3 years. All patients had skin lesions at some time during their baseline assessment or follow-up. The manifestations found were anagen effluvium, xerosis, and acral hyperpigmentation. To our knowledge, this is the first comparative study of skin manifestations associated with chemotherapy in a Mexican pediatric population. The mucocutaneous manifestations associated with chemotherapy are important causes of morbidity. All of the children in our study had skin lesions on assessment. We did not find an association between skin manifestations and nutritional status.

Actinomycetoma of the scalp after a car accident

BACKGROUND

Actinomycetoma is the most frequent type of mycetoma in Mexico. Localization on the scalp is very rare. Because of this topography and potential spread to the brain, the present case became a diagnostic and therapeutic challenge.

MATERIALS AND METHODS

We report the case of a 44-year-old woman with a 6 × 5 cm red, friable, granulomatous, vascular neoformation on the scalp and eye diagnosed as Nocardia brasiliensis actinomycetoma.

RESULTS

A combination of amikacin and oral trimethoprim-sulfamethoxazole (SXT) was successfully administered with an excellent outcome and no side effects.

CONCLUSIONS

This is a rare presentation of mycetoma of the scalp that was cured in 12 weeks with a combination of amikacin and SXT.

Decrease of virulence for BALB/c mice produced by continuous subculturing of Nocardia brasiliensis

Background

Subculturing has been extensively used to attenuate human pathogens. In this work we studied the effect of continuous subculturing of Nocardia brasiliensis HUJEG-1 on virulence in a murine model.

Methods

Nocardia brasiliensis HUJEG-1 was subcultured up to 130 times on brain heart infusion over four years. BALB/c mice were inoculated in the right foot pad with the bacteria subcultured 0, 40, 80, 100 and 130 times (T₀, T₄₀, T₈₀ T₁₀₀ and T₁₃₀). The induction of resistance was tested by using T₁₃₀ to inoculate a group of mice followed by challenge with T0 12 weeks later. Biopsies were taken from the newly infected foot-pad and immunostained with antibodies against CD4, CD8 and CD14 in order to analyze the in situ immunological changes.

Results

When using T₄₀, T₈₀ T₁₀₀ and T₁₃₀ as inoculums we observed lesions in 10, 5, 0 and 0 percent of the animals, respectively, at the end of 12 weeks. In contrast, their controls produced mycetoma in 80, 80, 70 and 60% of the inoculated animals. When studying the protection of T₁₃₀, we observed a partial resistance to the infection. Immunostaining revealed an intense CD4+ lymphocytic and macrophage infiltrate in healing lesions.

Conclusions

After 130 in vitro passages of N. brasiliensis HUJEG-1 a severe decrease in its virulence was observed. Immunization of BALB/c mice, with these attenuated cells, produced a state of partial resistance to infection with the non-subcultured isolate.

Treatment of vitiligo with a melanocyte-keratinocyte cell suspension versus dermabrasion only: a pilot study with a 12-month follow up

BACKGROUND

Dermabrasion is a surgical procedure that has been used for repigmentation; however, autologous transplantation of uncultured melanocytes in a suspension combined with the use of adjunct treatment provides better results.

PURPOSE

To evaluate the clinical effectiveness of dermoabrasion (DA) and melanocyte-keratinocyte cell suspension transplantation (DA+MKT) vs. dermabrasion with no adjunct treatment.

MATERIALS AND METHODS

We selected 11 patients (six women and five men) with stable vitiligo. From these, two achromic maculae of similar size were selected. One macule was treated with DA+MKT and the other with DA only. The main parameter of treatment efficacy was the percentage of repigmentation in the area treated, three and 12 months after implantation.

RESULTS

In seven of the 11 patients, slightly better pigmentation occurred with DA+MKT. Two of these patients had a repigmentation greater than 50 percent and in two other patients, the result was similar for both techniques, although slightly better with MKT. Two more patients showed less than 20 percent repigmentation, but only in the area treated with DA+MKT. One patient showed pigmentation initially after DA+MKT only, and subsequent depigmentation.

CONCLUSION

DA+MKT produced slightly better repigmentation than DA only when given without adjunct treatment in a 12-month follow-up period.

In vitro antimicrobial susceptibility of Propionibacterium acnes isolated from acne patients in northern Mexico

BACKGROUND

Antimicrobials are essential in acne therapy. In the last decades, Propionibacterium acnes has become resistant to different antibiotics.

OBJECTIVE

To determine antimicrobial susceptibility patterns of P. acnes to frequently used drugs.

MATERIALS AND METHODS

Cutaneous lesion samples were obtained from 50 patients with acne vulgaris, which were cultured in anaerobic media to demonstrate the presence of P. acnes. After that, antimicrobial susceptibility tests to tetracycline, minocycline, doxycycline, erythromycin, azithromycin, clindamycin, trimethoprim/sulfamethoxazole (SXT) and levofloxacin were performed.

RESULTS

In the general study group, resistance to azithromycin was 82%, the most prevalent one (P < 0.05), followed by trimethoprim/sulfamethoxazole (68%) and erythromycin (46%). On the other hand, all strains isolated were susceptible to minocycline. Resistance bias were similar when subgroups with and without the previous antimicrobial therapy were performed, finding a low prevalence of resistance to tetracyclines and levofloxacin in both groups.

CONCLUSIONS

In our region, P. acnes is highly resistant to azithromycin, SXT, erythromycin and clindamycin; and being very susceptible to minocycline, levofloxacin and tetracycline, in vitro in both groups: with and without the previous antibiotic use. To our knowledge, high resistance prevalence to azithromycin and SXT has never been reported.

Tinea incognito

Tinea incognito was first described 50 years ago. It is a dermatophytic infection with a clinical presentation modified by previous treatment with topical or systemic corticosteroids, as well as by the topical application of immunomodulators such as pimecrolimus and tacrolimus. Tinea incognito usually resembles neurodermatitis, atopic dermatitis, rosacea, seborrheic dermatitis, lupus erythematosus, or contact dermatitis, and the diagnosis is frequently missed or delayed.