Topical and intralesional immunotherapy in cutaneous infections

Immunotherapy has revolutionized the treatment of extensive and resistant warts. Promising results have extended the role of immunotherapy to other infections such as extensive molluscum contagiosum, recurrent herpes simplex infections, and cutaneous leishmaniasis, which are resistant to standard treatment. This review focuses on topical and intralesional immunotherapy in the management of cutaneous infections.

Staphylococcus aureus activates the Aryl Hydrocarbon Receptor in Human Keratinocytes

Staphylococcus (S.) aureus is an important pathogen causing various infections including - as most frequently isolated bacterium - cutaneous infections. Keratinocytes as the first barrier cells of the skin respond to S. aureus by the release of defense molecules such as cytokines and antimicrobial peptides. Although several pattern recognition receptors expressed in keratinocytes such as Toll-like and NOD-like receptors have been reported to detect the presence of S. aureus, the mechanisms underlying the interplay between S. aureus and keratinocytes are still emerging. Here we report that S. aureus induced gene expression of CYP1A1 and CYP1B1, responsive genes of the aryl hydrocarbon receptor (AhR). AhR activation by S. aureus was further confirmed by AhR gene reporter assays. AhR activation was mediated by factor(s) < 2 kDa secreted by S. aureus. Whole transcriptome analyses and real-time PCR analyses identified IL-24, IL-6 and IL-1beta as cytokines induced in an AhR-dependent manner in S. aureus-treated keratinocytes. AhR inhibition in a 3D organotypic skin equivalent confirmed the crucial role of the AhR in mediating the induction of IL-24, IL-6 and IL-1beta upon stimulation with living S. aureus. Taken together, we further highlight the important role of the AhR in cutaneous innate defense and identified the AhR as a novel receptor mediating the sensing of the important skin pathogen S. aureus in keratinocytes.

A clinical study of skin manifestations in diabetes at a tertiary hospital in Kerala

<p class="abstract"><strong>Background:</strong> Though extensive data is available on diabetes and its systemic manifestations, research about the skin lesions in those afflicted with diabetes is scarce. The aim of this study was to understand dermatological manifestations in diabetes.</p><p class="abstract"><strong>Methods:</strong> A hospital based cross sectional study was carried out among 100 randomly selected diabetic patients afflicted with skin lesions due to diabetes.<strong></strong></p><p class="abstract"><strong>Results:</strong> Out of 73 patients having cutaneous infections, 71.2% were having fungal infections. Out of 18 having bacterial infections, 38.9% were having furuncles. Out of 52 having fungal infections, 63.5% were having dermatophytosis. Out of 14 cases of candidal infections, the most common was intertrigo in 35.7%. Out of 33 cases of dermatophytosis, <em>T. cruris</em> was the most common in 54.5%. Out of 82 patients in whom we suspected dermatoses strongly associated with diabetes, the most common condition was pruritus in 36.6% of the cases.</p><p class="abstract"><strong>Conclusions:</strong> Bacterial skin infections and dermatophytosis were the most common diabetic dermatological lesions in the present study.</p>

Viral Cutaneous Infections in Swimmers: A Preliminary Study

Molluscum contagiosum (MC) and warts are common viral infections of the skin. Data regarding the prevalence of MC and verruca in swimmers are very poor and lacking in the literature. The purpose of this study was to determine the incidence of Molluscum Contagiosum (MC) and warts cases among young competitive swimmers participating in Greek swimming clubs. Of 244 swimmers enrolled in this study, 12.3% reported MC and 43% warts, during their swimming career, diagnosed and treated by dermatologists. There was no difference between sexes for MC but diagnoses of warts were higher in females. Axillae and trunk were the most common sites of primary infection for MC but warts mainly appeared on the soles. The incidence of MC and warts in swimmers who use outdoor facilities was higher. In our study, the incidence of warts and MC in Greek swimmers is considered high. Moist walking surfaces, placing towels on locker room benches, and sharing equipment are behaviors that cause infections. An early diagnosis of warts and MC lesions must be implemented in every swimmer through dermatological examination. Taking proper measures for reducing the risk of warts and MC transmission in Greek swimmers is mandatory.

Mycobacterium chelonae Cutaneous Infection: A Challenge for an Internist

Cutaneous infections caused by the Mycobacterium chelonae complex show a heterogeneous clinical presentation, which varies according to the patient’s immune status. Most standard antimycobacterials have no effect against these species. Clarithromycin alone was shown to provide adequate treatment, although resistance has been reported. Consequently, the literature supports multi-drug therapy to combat resistant strains. Here, we describe the case of a 59-year-old man under systemic immunosuppressive therapy who developed cutaneous lesions whose evolution was highly suggestive of atypical infection.

Clinical Relevance and Environmental Prevalence of Mycobacterium fortuitum Group Members. Comment on Mugetti et al. Gene Sequencing and Phylogenetic Analysis: Powerful Tools for an Improved Diagnosis of Fish Mycobacteriosis Caused by Mycobacterium fortuitum Group Members. Microorganisms 2021, 9, 797

Mycobacterium fortuitum group (MFG) members are able to cause clinical mycobacteriosis in fish and other animals including humans. M. alvei, M. arceuilense, M. brisbanense, M. conceptionense, M. fortuitum, M. peregrinum, M. porcinum, M. senegalense, M. septicum, and M. setense were isolated from fish with mycobacteriosis. In other animals only three MFG species have been isolated: M. arceuilense from camels’ milk, M. farcinogenes from cutaneous infections often described as “farcy”, and M. fortuitum from different domestic and wild mammals’ species. Out of 17, only 3 MFG species (M. arceuilense, M. lutetiense and M. montmartrense) have never been reported in humans. A total of eight MFG members (M. alvei, M. brisbanense, M. conceptionense, M. fortuitum subsp. acetamidolyticum, M. houstonense, M. peregrinum, M. porcinum, and M. septicum) have been isolated from both pulmonary and extrathoracic locations. In extrathoracic tissues five MFG species (M. boenickei, M. farcinogenes, M. neworleansense, M. senegalense, and M. setense) have been diagnosed and only one MFG member (M. fortuitum subsp. acetamidolyticum) has been isolated from pulmonary infection.

Apiaceae Essential Oils: Boosters of Terbinafine Activity against Dermatophytes and Potent Anti-Inflammatory Effectors

Dermatophyte infections represent an important public health concern, affecting up to 25% of the world’s population. Trichophyton rubrum and T. mentagrophytes are the predominant dermatophytes in cutaneous infections, with a prevalence accounting for 70% of dermatophytoses. Although terbinafine represents the preferred treatment, its clinical use is hampered by side effects, drug–drug interactions, and the emergence of resistant clinical isolates. Combination therapy, associating terbinafine and essential oils (EOs), represents a promising strategy in the treatment of dermatophytosis. In this study, we screened the potential of selected Apiaceae EOs (ajowan, coriander, caraway, and anise) to improve the antifungal activity of terbinafine against T. rubrum ATCC 28188 and T. mentagrophytes ATCC 9533. The chemical profile of EOs was analyzed by gas chromatography. The minimal inhibitory concentration (MIC) and minimal fungicidal concentration (MFC) of EOs/main compounds were determined according to EUCAST-AFST guidelines, with minor modifications. The checkerboard microtiter method was used to identify putative synergistic combinations of EOs/main constituents with terbinafine. The influence of EOs on the viability and pro-inflammatory cytokine production (IL-1β, IL-8 and TNF-α) was determined using an ex vivo human neutrophils model. The binary associations of tested EOs with terbinafine were found to be synergistic against T. rubrum, with FICI values of 0.26–0.31. At the tested concentrations (6.25–25 mg/L), EOs did not exert cytotoxic effects towards human neutrophils. Anise EO was the most potent inhibitor of IL-1β release (46.49% inhibition at 25 mg/L), while coriander EO displayed the highest inhibition towards IL-8 and TNF-α production (54.15% and 54.91%, respectively). In conclusion, the synergistic combinations of terbinafine and investigated Apiaceae EOs could be a starting point in the development of novel topical therapies against T. rubrum-related dermatophytosis.

Atypical presentations of superficial dermatophytoses associated with Ruocco’s immunocompromised cutaneous district: A case series

An immunocompromised district is an area of irregular immune control of the skin occurring due to cutaneous damage of any sort conducive to the development of infections, immune reactions, and tumors. Superficial dermatophytoses are one of the most commonly encountered cutaneous infections, which, in some cases, may have various atypical presentations. Herein, we present a series of eleven such cases in which the presentation of a superficial dermatophytosis was altered by the concurrent presence of a different unrelated dermatosis on the same anatomical site.

The Statewide Epidemiology of Mucormycosis Among Trauma Patients in Florida

Objectives Mucormycosis is a rare angioinvasive infection caused by filamentous fungi with a high lethality among the immunocompromised. In healthy people, the innate immune system is sufficient to prevent infection. The exception to this is deep tissue exposure seen during trauma. The purpose of this study is to evaluate the epidemiology of mucormycosis using a statewide population-based data set. Methods This is a retrospective cohort study of all hospital admissions for mucormycosis within the state of Florida from 1997 through the beginning of 2020. A distribution map was created to evaluate for geographic variation. Botanical growth zones, based on plant hardiness, used by state environmental agencies and landscapers were also used to detect possible patterns based on climate conditions throughout Florida. A multivariable regression analysis was performed to account for confounders and limit bias. Results A total of 1190 patients were identified for mucormycosis infection. Only 86 of these patients were admitted for trauma. Cutaneous infections were more prevalent among trauma patients while non-trauma patients had more pulmonary infections ( P = .04). Trauma patients with infection tended to be younger and less likely to suffer from comorbidities such as immunosuppression (36% vs 46%, P = .07) and diabetes (22.1% vs 47.1%, P ≤ .0001) as compared to their non-trauma counterparts. Mortality was similar with 17.8% for non-trauma patients and 15.1% for traumatized patients (AOR .80 [.42, 1.52]). Length of stay was longer for trauma patients (37.3 vs 23.0, P < .0001). Infections were less prominent in plant hardiness Zone 9 and Zone 10 as compared to Zone 8 (AOR .71 [.61, .82]; AOR .54 [.46, .64], respectively). Conclusion Trauma patients who develop infection from mucormycosis are at high risk of death despite being a younger and healthier population. Mucormycosis infections were primarily soft tissue based among trauma patients. These infections are more prevalent in colder regions within Florida.

Cutaneous Anthrax on the Upper Eyelid

A 46-year-old female patient, who presented with a black, crusty lesion on the upper eyelid, was diagnosed with cutaneous anthrax after the detection of <i>Bacillus anthracis</i> in the skin culture. It was determined that the symptoms started after she cooked the meat she bought from a butcher. Anthrax is a disease that should be kept in mind in cutaneous infections even in isolated lesions, especially in endemic areas.