scholarly journals Erythema induratum of Bazin as an indicative manifestation of cavitary tuberculosis in an adolescent: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kun Yang ◽  
Tingying Li ◽  
Xiaomei Zhu ◽  
Yun Zou ◽  
Dongxian Liu
Keyword(s):  
Skin Diseases ◽  
Clinical Manifestations ◽  
Posterior Part ◽  
Underlying Disease ◽  
Clinical Indicators ◽  
Cutaneous Manifestations ◽  
Old Chinese ◽  
Atypical Symptoms ◽  
Computed Tomography Scanning ◽  
Chinese Girl

Abstract Background Erythema induratum of Bazin (EIB) is a rare cutaneous manifestation of tuberculosis (TB) that frequently occurs in middle-aged women. The clinical manifestations of EIB can mimic various skin diseases, easily leading to misdiagnosis or underdiagnosis. We report a case of a 16-year-old Chinese girl who initially presented with EIB and was subsequently diagnosed with cavitary TB. Case presentation The patient is a 16-year-old Chinese girl who presented with clusters of erythematous subcutaneous nodules on the posterior part of her right lower leg matching the clinical manifestations of EIB but was otherwise asymptomatic. The patient was subsequently diagnosed with cavitary TB on the basis of a positive result from a T-SPOT.TB test and the observation of cavitary lung lesions in chest computed tomography scanning. A good clinical response was observed in the patient after the initial phase of a standard 6-month antibiotic regimen. Conclusions Adolescents infected with Mycobacterium tuberculosis frequently present atypical symptoms. Cutaneous manifestations of tuberculosis in adolescents can be considered good clinical indicators to predict the underlying disease. Strong clinical suspicion is required for a prompt diagnosis in adolescents with EIB.

scholarly journals Secondary Syphilis in Patients Treated at the City Institute for Skin and Venereal Diseases in Belgrade from 2010 to 2014

2015 ◽  
Vol 7 (2) ◽  
pp. 53-60
Author(s):  
Milan Bjekić
Keyword(s):  
Skin Diseases ◽  
Clinical Manifestations ◽  
Secondary Syphilis ◽  
Hiv Positive ◽  
Venereal Diseases ◽  
Cutaneous Manifestations ◽  
Source Of Infection ◽  
Sex With Men ◽  
The City ◽  
Hiv Negative

AbstractThe aim of this study was to analyze the characteristics and clinical manifestations of secondary syphilis among patients registered at the City Institute for Skin and Venereal Diseases in Belgrade, during the period from 2010 to 2014. The study was designed as a case-note review. In the five-year period, a total of 62 patients with secondary syphilis were registered. The average patient age was 32 years. There were 45 (72.6%) HIV-negative, and 17 (27.4%) HIV-positive patients. The incidence of HIV–positive patients was significantly different from random distribution (p = 0.016). All HIV-positive patients were unmarried men. A significant percentage of HIV-positive patients were unemployed (p < 0.001), reported unknown source of infection (p = 0.002) and were all homosexuall (p = 0.026). More than 25% of all patients with syphilis had a history of chancres, and it was still present at the time of examination in 11.3% of all patients. The majority of cases (87.1%) had a rash, and lymphadenopathy was found in 20% of patients. However, syphilitic alopecia was detected only in HIV-positive cases (p = 0.004). There were no statistically significant differences between HIV-positive and HIV-negative patients in regard to other clinical manifestations, such as mucous patches and condylomata lata. Being a great imitator, secondary syphilis may manifest in a myriad of diverse morphological entities and clinical manifestations. We review a range of cutaneous manifestations of secondary syphilis and skin diseases it may mimic. Clinicians must be vigilant and consider syphilis in differential diagnosis, and maintain a high index of suspicion, especially when assessing vulnerable populations, such as men who have sex with men and HIV-infected individuals.

Mycobacteriosis as a Healthcare-Associated Infection: A Review of Epidemiologic Studies

2020 ◽  
pp. 37-41
Author(s):  
IV Petrov ◽  
TKh Amirova ◽  
LV Petrova ◽  
FS Petrova
Keyword(s):  
Skin Diseases ◽  
Nontuberculous Mycobacteria ◽  
Clinical Manifestations ◽  
Mycobacterial Infection ◽  
Epidemiologic Studies ◽  
Health Facilities ◽  
Water Supply Systems ◽  
Healthcare Associated Infections ◽  
Healthcare Associated Infection ◽  
Healthcare Associated

Introduction: Healthcare-associated infections are of great socio-economic importance and are characterized by a large number of different pathogens. Nontuberculous mycobacteria are ubiquitous microorganisms that can circulate in a medical organization. The purpose of this review of epidemiologic studies was to establish the main features of mycobacteriosis as a healthcare-associated infection, taking into account the significance of the results and the compliance of the reviewed studies with the criteria of evidence-based medicine. Methods: We did a key word search for “nontuberculous mycobacteria”, “healthcare-associated infections”, and “mycobacteriosis” in several electronic bibliographic databases including Web of Science, PubMed, eLIBRARY, and ResearchGate and selected 127 out of 342 search results. Having analyzed the selected articles, we decided to include 34 of them in this study according to the topic of work. We established that nontuberculous mycobacteria can be found in various objects of health facilities, e.g. water supply systems, medical products and equipment. We also found that mycobacterial infection of nosocomial etiology could have various clinical manifestations (arthritis, keratitis, circulatory and skin diseases, etc.) determined by various aspects, such as heterogeneity of the group of nontuberculous mycobacteria, portals of entry (surgical procedures on various organs and systems of the human body, etc.), pathways of exposure and transmission factors. Resistance of nontuberculous mycobacteria to a number of disinfectants is a special question defining the importance of profound research in terms of ensuring sanitary and anti-epidemic (disinfection) safety within health facilities. Conclusions: Our findings indicate that mycobacterial infection can be considered as a healthcare-associated infection requiring an in-depth assessment from various perspectives including a microbiological monitoring of medical objects, statistical accounting of nosocomial infections, and clinical alertness in the diagnosis of mycobacteriosis by attending physicians and bacteriologists, etc.

scholarly journals Facial cleft? The first case of manitoba‐oculo‐tricho‐anal syndrome with novel mutations in China: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shuchen Gu ◽  
Yimin Khoong ◽  
Xin Huang ◽  
Tao Zan
Keyword(s):  
Exome Sequencing ◽  
Whole Exome Sequencing ◽  
Clinical Manifestations ◽  
Sporadic Case ◽  
Facial Cleft ◽  
Ocular Manifestations ◽  
First Case ◽  
Whole Exome ◽  
Chinese Girl ◽  
Low Prevalence

Abstract Background Manitoba-oculo-tricho-anal (MOTA) syndrome is a rare syndrome with only 27 cases reported worldwide so far, but none was reported in the population of Eastern Asia. Such extremely low prevalence might be contributed by misdiagnosis due to its similarities in ocular manifestations with facial cleft. In our study, we discovered the first case of MOTA syndrome in the population of China, with 2 novel FRAS1 related extracellular matrix 1 (FREM1) gene stop-gain mutations confirmed by whole exome sequencing. Case presentation A 12-year-old Chinese girl presented with facial cleft-like deformities including aberrant hairline, blepharon-coloboma and broad bifid nose since birth. Whole exome sequencing resulted in the identification of 2 novel stop-gain mutations in the FREM1 gene. Diagnosis of MOTA syndrome was then established. Conclusions We discovered the first sporadic case of MOTA syndrome according to clinical manifestations and genetic etiology in the Chinese population. We have identified 2 novel stop-gain mutations in FREM1 gene which further expands the spectrum of mutational seen in the MOTA syndrome. Further research should be conducted for better understanding of its mechanism, establishment of an accurate diagnosis, and eventually the exploitation of a more effective and comprehensive therapeutic intervention for MOTA syndrome.

scholarly journals POS1199 CLINICAL MANIFESTATIONS OF SARS-CoV2 INFECTIONS IN CHILDREN AND ADOLESCENTS WITH RHEUMATIC AND MUSCULUSKELETAL DISEASES – SURVEY DATA FROM GERMANY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 882.1-882
Author(s):  
C. Sengler ◽  
S. Eulert ◽  
M. Niewerth ◽  
T. Kallinich ◽  
H. Wittkowski ◽  
...  
Keyword(s):  
Disease Activity ◽  
Children And Adolescents ◽  
Symptom Onset ◽  
Clinical Manifestations ◽  
Virus Detection ◽  
German Society ◽  
Underlying Disease ◽  
Common Symptom ◽  
Disease Course ◽  
Cardiorespiratory Failure

Background:Although children and adolescents are less likely to develop COVID-19 and generally show milder disease courses, it is unclear what impact the SARS-CoV2 infection has on children and adolescents with rheumatic and musculoskeletal disease (RMD). Due to their underlying disease as well as therapeutic immunosuppression these patients may be at higher risk of being more severely affected by SARS-CoV2. Furthermore, SARS-CoV2 infection might trigger a flare of the underlying disease.Objectives:To evaluate clinical characteristics and disease course of COVID-19 in children and adolescents with RMD and to analyze possible effects of SARS-CoV2 infection on the underlying disease under different therapeutic regimens.Methods:Data from juvenile patients with RMD recorded via the SARS-CoV2 questionnaire within the National Pediatric Rheumatology Database and the registry for hospitalized children and adolescents with COVID-19 of the German Society for Pediatric Infectious Diseases were analyzed. In addition to age, sex and diagnosis, information was collected about the date and method of a positive SARS-CoV2 testing, reason for testing, on clinical manifestations, disease course, treatment and outcome of COVID-19, on drug therapy at the time of virus detection, on disease activity (NRS 0 – 10, 0 = best) of the underlying disease at the last visit before and after the SARS-CoV2 infection.Results:From April 17th 2020 until January 25th 2021, data of 67 patients with RMD and confirmed SARS-CoV2 infection were collected. Mean age was 13.5 ± 3.9 years with equal sex distribution. The majority of patients were diagnosed with juvenile idiopathic arthritis (JIA, 64%), 12 (18%) patients had an autoinflammatory disease (FMF, CAPS, PFAPA, TRAPS) and 5 (7%) a connective tissue disease. Fifty-two patients (78%) were treated with a disease modifying antirheumatic drug (DMARD), 39% with a biological DMARD and 9% systemic glucocorticoids at the time of SARS-CoV-2 infection. Nineteen patients (28%) were tested for SARS-CoV-2 because of typical symptoms, the majority (67%) because of contact to an infected person. PCR was used most often (in 60 %).52 patients (78%) developed symptoms of COVID-19, 15 patients remained asymptomatic. The most common symptom of COVID-19 was rhinitis (42%) and fever (38%), followed by fatigue (34%), taste/smell disorder (33%), sore throat (27%) and cough (23%).Disease severity was graded as mild in 44 of 52 (85%) symptomatic patients, only two patients were hospitalized, one of whom required intensive care and died of cardiorespiratory failure 3 days after symptom onset. In 22 of 26 (85%) SARS-CoV2-positive patients, no relevant increase in disease activity (difference in NRS ≤ 1 before/after infection) of the underlying disease was observed 31 days after symptom onset (median, IQR 17-52 days). One patient, who had paused tocilizumab for 2 doses, experienced a flare of his seronegative polyarthritis 2 months after asymptomatic SARS-CoV-2 infection.Conclusion:In our cohort, the clinical picture of COVID-19 in children and adolescents with RMD was similar to that of healthy peers. The majority of patients showed mild disease course with good outcome under various medications, however, one patient with a severe course of COVID-19 died. In addition, SARS-CoV2 infection does not appear to have a relevant impact on the underlying disease activity, whereas discontinuation of therapy might pose a risk of flare.Disclosure of Interests:None declared.

scholarly journals The Frequency and Causes of Subepidermal Gaps or Blisters and the Compliance Rate Between Clinical Diagnosis and Pathology Reports from 2015 to 2019

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Abbas Darjani ◽  
Hojat Eftekhari ◽  
Seyedeh Rojin Amini Rad ◽  
Narges Alizadeh ◽  
Rana Rafiee ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Skin Diseases ◽  
Histopathological Examination ◽  
Compliance Rate ◽  
Clinical Manifestations ◽  
Final Diagnosis ◽  
Direct Immunofluorescence ◽  
Diagnostic Challenge ◽  
Cross Sectional ◽  
Pathology Reports

Background: Skin diseases are the fourth most common cause of human illness, and blisters with different clinical manifestations make a diagnostic challenge. Objectives: This study aimed to evaluate the frequency and causes of subepidermal gaps or blisters, as well as the compliance rate between the initial and final clinical diagnoses based on pathology reports. Methods: In this cross-sectional study, pathology reports of subepidermal blisters or gaps were evaluated in the patients referred to the Razi Laboratory of Rasht from 2015 to 2019. The samples were examined by a pathologist after hematoxylin and eosin staining. The reports included demographic information, clinical differential diagnoses, final diagnosis, direct immunofluorescence findings, and salt split results. Finally, the compliance rate of clinical diagnosis with pathology reports was determined. Results: A total of 183 pathology reports were evaluated, 170 of which contained the final diagnosis. Females were more frequently affected by the disease, and pemphigoid bolus and lichen planus were the most prevalent final diagnoses. The compliance rate between the initial and final diagnoses was 94%. About 37.2% of the reports lacked direct immunofluorescence (DIF) and salt split, and only 42.6% of the samples had undergone DIF examination, while 20.2% had both DIF and salt split. There was no significant association between the compliance rate of the final diagnosis with age, sex, and undergoing diagnostic tests. Conclusions: A high incidence of subepidermal gaps or blisters was seen in middle-aged individuals and females. The compliance rate of the initial clinical diagnosis with the final diagnosis based on pathological reports was high. Our findings emphasize the importance of histopathological examination and the complementary role of direct immunofluorescence and salt split in diagnosis.

scholarly journals Clinical spectrum, geographical variability of COVID-19 and its implications

Coronaviruses ◽  
2020 ◽  
Vol 01 ◽  
Author(s):  
Md. Hasanul Banna Siam ◽  
Abdullah Al Mosabbir ◽  
Nahida Hannan Nishat ◽  
Ahsan Ahmed ◽  
Mohammad Sorowar Hossain
Keyword(s):  
Coming Out ◽  
Clinical Manifestations ◽  
Vital Role ◽  
Clinical Spectrum ◽  
Surveillance Strategy ◽  
Health Crisis ◽  
Atypical Symptoms ◽  
Public Health Crisis ◽  
Number Of Patients ◽  
The Common

: The coronavirus disease 2019 (COVID-19) pandemic has triggered a worldwide unprecedented public health crisis. Initially, COVID-19 was considered as a disease of the respiratory system as fever and at least one respiratory symptom was used to identify a suspected COVID-19 case. But there are now numerous reports of COVID-19 patients presenting with myriads of extrapulmonary symptoms and a substantial number of patients are asymptomatic as well. Additionally, there are significant clinical and epidemiological variations of severe acute respiratory syndrome coronavirus 2 (SARSCOV-2) infection across different geographical locations. The updated research thus challenges the existing surveillance system that is mainly based on fever and respiratory symptoms. As countries are coming out of lockdown to save economic fallout, a revised surveillance strategy is required to effectively identify and isolate the correct patients. Besides, since developing countries are becoming the new epicenters of pandemic and there are limited resources for RT-PCR based tests, so documenting the clinical spectrum can play a vital role in the syndromic clinical diagnosis of COVID-19. A plethora of atypical symptoms also aids in guiding better treatment and remains as a source for further research. It is therefore crucial to understand the common and uncommon clinical manifestations of SARS-COV-2 infection and its variability across different geographic regions.

SALICYLATE INTOXICATION

PEDIATRICS ◽  
1956 ◽  
Vol 18 (4) ◽  
pp. 578-594
Author(s):  
Harris D. Riley ◽  
Lee Worley
Keyword(s):  
Acetylsalicylic Acid ◽  
Renal Excretion ◽  
Clinical Manifestations ◽  
Respiratory Alkalosis ◽  
Underlying Disease ◽  
Hemorrhagic Diathesis ◽  
Older Children ◽  
Acid Base Balance ◽  
Accidental Ingestion ◽  
Salicylate Intoxication

Forty-two cases of salicylate intoxication in infants and children observed over a 10-year-period are reviewed. The majority of the 13 cases of poisoning due to accidental ingestion occurred in the 2- to 4-year age range whereas the 29 intoxications resulting from therapeutic administration of salicylates occurred chiefly in infants. Accumulative therapy intoxication is more likely to occur in infants rather than older children not only because of an unawareness of the dangers and of the proper dose of acetylsalicylic acid, but also because of the decreased renal excretion of salicylates due to renal immaturity, and pre-renal azotemia due to dehydration resulting from the disease for which the drug is given. The marked variability in time response of an individual to salicylates is emphasized. Even in poisoning resulting from accidental ingestion, where the effects of an underlying disease do not have to be considered, the plasma concentration of salicylate, clinical response, degree of toxicity at a given concentration of salicylate, and time required for renal excretion varied greatly for children of time same age and size who ingested comparable amounts of salicylate. Severe intoxication at how concentrations of salicylate in the plasma was observed. Hyperventilation and vomiting are the most common clinical manifestations of salicylism but a hemorrhagic diathesis due to hypoprothrombinemia, hyperpyrexia, delirium or coma, circulatory collapse, and respiratory failure may be observed. The unique effect of salicylates on acid-base balance with an initial respiratory alkalosis progressing to a metabolic acidosis is discussed. A treatment program based on physiologic principles is outlined. The important role of drug ingestion, especially acetylsalicylic acid, as a cause of death is re-emphasized and a plea is made for better education and attention to the potential dangers of salicylates.

Clinical and diagnostic manifestations of tickborne mixed infection in combination with COVID-19

2021 ◽  
Vol 66 (11) ◽  
pp. 689-694
Author(s):  
A. L. Shutikova ◽  
G. N. Leonova ◽  
A. F. Popov ◽  
M. Yu. Shchelkanov
Keyword(s):  
Lyme Disease ◽  
Erythema Migrans ◽  
Clinical Manifestations ◽  
Underlying Disease ◽  
Laboratory Diagnostics ◽  
Igg Antibodies ◽  
Serum Samples ◽  
Igm Antibodies ◽  
Chronic Encephalitis ◽  
Tbev Strain

The coexistence of various pathogens inside the patient’s body is one of the poorly studied and current issues. The aim of the study is to identify the relationship between the indicators of complex laboratory diagnostics and the clinical manifestations of a mixed disease during subsequent infection with the SARS-CoV-2 virus using the example of a case of chronic encephalitis-borreliosis infection. Seven blood serum samples were collected from the patient over the course of a year. For the etiological verification of the causative agents of TBE, Lyme disease and COVID-19, the methods of ELISA and PCR diagnostics were used. The patient was diagnosed with Lyme disease on the basis of the detection of IgG antibodies to Borrelia 5 months after the onset of the disease, since she denied the tick bite. In the clinical picture, there was an articular syndrome and erythema migrans. Later, IgG antibodies to the TBEV were found in the blood. Throughout the study, IgM antibodies to Borrelia were not detected. The exacerbation of Lyme disease could be judged by the clinical manifestations of this disease and by the growth of specific IgG antibodies. A feature of this case was that during an exacerbation of the Lyme disease, an infection with the SARS-CoV-2 virus occurred. Treatment (umifenovir, hydroxychloroquine, azithromycin, ceftriaxone) was prescribed, which improved the condition of the underlying disease, decreased joint pain, decreased IgG levels to borrelia. However, during this period, serological markers of TBEV appear: antigen, IgM antibodies, and the titer of IgG antibodies increases. Most likely, this was facilitated by the switching of the immune system to the SARS-CoV-2 virus, with the simultaneous suppression of borrelia with antibiotics and the appointment of hydroxychloroquine, which has an immunosuppressive effect. Despite the activation of the virus, clinical manifestations of TBE were not observed in the patient, which is most likely associated with infection with a weakly virulent TBEV strain. The further course of tick-borne infections revealed the dominant influence of B. burgdorferi in relation to TBEV. Laboratory studies have shown that suppression of the activity of the borreliosis process by etiotropic treatment subsequently led to the activation of the persistent TBEV.

scholarly journals Latest Evidence Regarding the Effects of Photosensitive Drugs on the Skin: Pathogenetic Mechanisms and Clinical Manifestations

Pharmaceutics ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 1104
Author(s):  
Flavia Lozzi ◽  
Cosimo Di Raimondo ◽  
Caterina Lanna ◽  
Laura Diluvio ◽  
Sara Mazzilli ◽  
...  
Keyword(s):  
Adverse Events ◽  
Therapeutic Strategy ◽  
Clinical Manifestations ◽  
Drug Induced ◽  
Cutaneous Manifestations ◽  
Pathogenic Mechanisms ◽  
Common Drug ◽  
Culprit Drug ◽  
Inflammatory Drugs ◽  
Molecule Design

Photosensitivity induced by drugs is a widely experienced problem, concerning both molecule design and clinical practice. Indeed, photo-induced cutaneous eruptions represent one of the most common drug adverse events and are frequently an important issue to consider in the therapeutic management of patients. Phototoxicity and photoallergy are the two different pathogenic mechanisms involved in photosensitization. Related cutaneous manifestations are heterogeneous, depending on the culprit drug and subject susceptibility. Here we report an updated review of the literature with respect to pathogenic mechanisms of photosensitivity, clinical manifestations, patient management, and prediction and evaluation of drug-induced photosensitivity. We present and discuss principal groups of photosensitizing drugs (antimicrobials, nonsteroidal anti-inflammatory drugs, anti-hypertensives, anti-arrhythmics, cholesterol, and glycemia-lowering agents, psychotropic drugs, chemotherapeutics, etc.) and their main damage mechanisms according to recent evidence. The link between the drug and the cutaneous manifestation is not always clear; more investigations would be helpful to better predict drug photosensitizing potential, prevent and manage cutaneous adverse events and find the most appropriate alternative therapeutic strategy.

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