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ABSTRACT: Background The increasing prevalence of antimicrobial resistance in Propionibacterium acnes poses a significant challenge to successful treatment outcomes in acne patients. Although P. acnes resistance has been demonstrated throughout the world, no previous data regarding the antimicrobial susceptibility of P. acnes in Colombia are available. Objectives The aim of this study was to determine the antimicrobial susceptibility of P. acnes to common antibiotics used in the treatment of acne in a Colombian population. Methods Samples were collected from facial acne lesions of 100 dermatology patients. All?samples were cultured in anaerobic conditions, and final identification of isolates was performed. Isolates of P. acnes were then subjected to antimicrobial susceptibility tests using erythromycin, clindamycin, tetracycline, doxycycline, and minocycline. Results Propionibacterium acnes isolates resistant to erythromycin (35%), clindamycin (15%), doxycycline (9%), tetracycline (8%), and minocycline (1%) were observed. Isolates with cross-resistance were also observed (to erythromycin and clindamycin [12%] and to doxycycline and tetracycline [6%]). Overall, 46% of isolates taken from patients with a history of antibiotic use demonstrated resistance, whereas 29% of isolates taken from patients who had never used antibiotics demonstrated resistance. Conclusions Antimicrobial resistance in P. acnes in this Colombian population has a lower prevalence than those reported in Europe and follows a similar pattern to findings elsewhere in Latin America. Resistance is demonstrated even in isolates from patients with no previous history of antibiotic use. Resistance to erythromycin is most commonly observed. Minocycline emerges as the most effective antibiotic.
International journal of dermatology 03/2013; · 1.18 Impact Factor
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ABSTRACT: Importance: Approximately 10% to 25% of patients treated with BRAF inhibitors develop cutaneous squa-mous cell carcinoma (SCC), but the mechanism re-sponsible has not yet been determined. We report what we believe to be the first case in which Merkel cell poly-omavirus (MCPyV) and human papillomavirus subtype 17 (HPV-17) were associated with cutaneous SCC that developed during treatment with the BRAF inhibitor dabrafenib. Observations: A 62-year-old woman with V600E BRAF-mutant metastatic melanoma enrolled in a phase 1 trial of dabrafenib, a selective inhibitor of V600-mu-tant BRAF kinase. During the first 6 weeks of treatment, the patient developed multiple skin lesions, including a 6-mm crusted papule on the left eyebrow, which was resected and, on pathology examination, revealed SCC. The DNA extracted from paraffin-embedded tissue was amplified by polymerase chain reaction for detection of MCPyV and epidermodysplasia verruciformis HPV (EV-HPV) types. Analysis of the cloned and sequenced polymerase chain reaction products revealed the pres-ence of MCPyV and HPV-17 DNA. Other EV-HPV sub-types were not detected.
Archives of Dermatology 03/2013; 149(3):322-326. · 3.89 Impact Factor
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ABSTRACT: IMPORTANCE Approximately 10% to 25% of patients treated with BRAF inhibitors develop cutaneous squamous cell carcinoma (SCC), but the mechanism responsible has not yet been determined. We report what we believe to be the first case in which Merkel cell polyomavirus (MCPyV) and human papillomavirus subtype 17 (HPV-17) were associated with cutaneous SCC that developed during treatment with the BRAF inhibitor dabrafenib. OBSERVATIONS A 62-year-old woman with V600E BRAF -mutant metastatic melanoma enrolled in a phase 1 trial of dabrafenib, a selective inhibitor of V600-mutant BRAF kinase. During the first 6 weeks of treatment, the patient developed multiple skin lesions, including a 6-mm crusted papule on the left eyebrow, which was resected and, on pathology examination, revealed SCC. The DNA extracted from paraffin-embedded tissue was amplified by polymerase chain reaction for detection of MCPyV and epidermodysplasia verruciformis HPV (EV-HPV) types. Analysis of the cloned and sequenced polymerase chain reaction products revealed the presence of MCPyV and HPV-17 DNA. Other EV-HPV subtypes were not detected. CONCLUSIONS AND RELEVANCE To our knowledge, this is the first report demonstrating the coexistence of MCPyV and HPV-17 in cutaneous SCC. Because both viruses have oncogenic potential, their role in the development of BRAF inhibitor-related SCC merits further investigation.
JAMA dermatology (Chicago, Ill.). 03/2013; 149(3):322-6.
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ABSTRACT: Rocky Mountain Spotted Fever (RMSF) is a tick-bourne illness, which can be fatal if unrecognized. We discuss the case of a patient treated with an anti-TNF-alpha inhibitor for rheumatoid arthritis who later developed a generalized erythematous macular eruption accompanied by fever. The clinical findings were suggestive of RMSF, which was later confirmed with serology. Prompt treatment with doxyclycine is recommended for all patients with clinical suspicion of RMSF.
Dermatology online journal 01/2013; 19(3):7.
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Journal of the American Academy of Dermatology 11/2012; 67(5):1074-5. · 3.99 Impact Factor
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Population Health Management 10/2012; · 1.02 Impact Factor
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ABSTRACT: Members of arthropod classes Chilopoda (centipedes), Diplopoda (millipedes), and Arachnida (spiders and scorpions) cause tissue injury via bites, stings, and/or a release of toxins. A few members of the Acari subclass of Arachnida (mites and ticks) can transmit a variety of infectious diseases, but this review will cover the noninfectious manifestations of these vectors. Dermatologists should be familiar with the injuries caused by these arthropods in order to initiate proper treatment and recommend effective preventative measures.
Journal of the American Academy of Dermatology 09/2012; 67(3):347.e1-9; quiz 355. · 3.99 Impact Factor
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ABSTRACT: Although many tropical insects carry infectious diseases, cutaneous injury can occur by other mechanisms, for example erucism (envenomation by caterpillars) or lepidopterism (dermatitis from moths). Pararama is a unique form of erucism seen in workers in contact with rubber trees in the Amazon, and it is caused by Premolis larvae, resulting in progressive periarticular fibrosis, ankylosis, and the loss of articulation. Ants and aquatic insects of the Belostomatidae family can cause painful bites and stings. Anaphylactic shock and death can result from the venom of bees and wasps. Beetles can cause vesicular dermatitis via cantharidin or paederin. Myiasis results from fly larvae (maggots) feeding on live or necrotic tissue of humans or other hosts, while New World screwworm fly larvae feed only on living tissue and burrow (ie, screw) more deeply when attempts are made to remove them. Tungiasis is characterized by very pruritic and painful papules and ulcers resulting from a Tunga flea penetrating the host's skin. Dermatologists should be able to diagnose and treat the cutaneous manifestations of these tropical insects and educate their patients on prevention.
Journal of the American Academy of Dermatology 09/2012; 67(3):331.e1-14; quiz 345. · 3.99 Impact Factor
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International journal of dermatology 06/2012; 51(6):713-5. · 1.18 Impact Factor
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International journal of dermatology 04/2012; 51(4):442-4. · 1.18 Impact Factor
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ABSTRACT: Trichodysplasia spinulosa (TS) is a rare, disfiguring skin condition that affects immunosuppressed patients, universally involving the central face. New data point to the recently discovered TS-associated polyomavirus (TSPyV) as the causative agent.
We report a case of TS in a 48-year-old African American man after renal transplant; via polymerase chain reaction and sequencing, confirm the detection of TSPyV in lesional skin; and report the novel detection of TSPyV DNA in renal allograft tissue. Results of polymerase chain reaction analysis were negative for Merkel cell polyomavirus in lesional skin. Fifteen months later, urine cytologic findings showed morphologic evidence of a urinary tract polyomavirus infection. Results of SV40 immunohistochemical analysis were negative in lesional skin, renal allograft, and urine specimens.
To our knowledge, this is the first reported case in which TSPyV DNA has been detected in extracutaneous tissues and the third with combined ultrastructural and molecular confirmation of the presence of TSPyV in lesional skin. Lack of detection of other pathogenic human polyomaviruses in this patient's skin supports the specific role of this polyomavirus in the genesis of TS. Further basic science studies are needed to determine the exact pathomechanisms of this polyomavirus and to explore possible tumorigenic roles in other skin diseases.
Archives of dermatology 02/2012; 148(6):726-33. · 4.76 Impact Factor
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ABSTRACT: Herpes zoster (HZ) vaccine was recently approved for adults ≥ 50 years of age and has been shown to reduce the incidence of zoster, postherpetic neuralgia (PHN), and associated healthcare costs. However, currently HZ immunization is sub-optimal. We examined awareness of HZ and of the HZ vaccine. Information was gathered via a one-page survey given to patients ≥ 50 years of age presenting at the dermatology clinic. From the surveyed population of 1000 individuals, the HZ vaccination rate was 11.9 percent. Vaccination coverage was highest for the ≥ 70 age group (18.3%), followed by age groups 60-69 (8.9%) and 50-59 (1.4%). Individuals with female gender, older age (≥ 70 years), higher level of education (college and beyond), retired employment status, memory of chickenpox, knowledge of shingles, and history of shingles and influenza vaccination in the past year all were more likely to have heard of and have received the HZ vaccine (except female gender, education level, and awareness of shingles). Our study suggests lack of awareness to be a significant factor in non-immunization with zoster vaccine. Targeting adults in younger age groups and minorities would be beneficial towards increasing zoster vaccine awareness and thus preventing herpes zoster and its many complications.
Dermatology online journal 01/2012; 18(8):2.
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ABSTRACT: Ceftaroline is an advanced-generation cephalosporin antibiotic recently approved by the US Food and Drug Administration for the treatment of complicated skin and skin-structure infections (cSSSIs). This intravenous broad-spectrum antibiotic exerts potent bactericidal activity by inhibiting bacterial cell wall synthesis. A high affinity for the penicillin-binding protein 2a (PBP2a) of methicillin-resistant Staphylococcus aureus (MRSA) makes the drug especially beneficial to patients with MRSA cSSSIs. Ceftaroline has proved in multiple well-conducted clinical trials to have an excellent safety and efficacy profile. In adjusted doses it is also recommended for patients with renal or hepatic impairment. Furthermore, the clinical effectiveness and high cure rate demonstrated by ceftaroline in cSSSIs, including those caused by MRSA and other multidrug-resistant strains, warrants its consideration as a first-line treatment option for cSSSIs. This article reviews ceftaroline and its pharmacology, efficacy, and safety data to further elucidate its role in the treatment of cSSSIs.
Infection and Drug Resistance 01/2012; 5:23-35.
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ABSTRACT: Scedosporium apiospermum is a ubiquitous soil fungus with a worldwide distribution. It can cause a wide range of clinical disease, from cutaneous and subcutaneous infections, to pneumonia, brain abscess, and life threatening systemic illness. The diagnosis of cutaneous disease is with biopsy and culture. We discuss the case of an elderly immunocompromised woman who presented with a persistent erythematous plaque on the elbow after minor trauma. A biopsy revealed Scedosporium apiospermum. Treatment usually requires surgical resection in conjunction with antifungal therapy.
Dermatology online journal 01/2012; 18(4):2.
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ABSTRACT: Live attenuated vaccines exist for varicella and herpes zoster. Varicella vaccine is largely administered in the immunocompetent population despite substantial evidence indicating its safety and effectiveness in immunocompromised groups.
Varicella vaccine has been around for decades and its safety and efficacy in healthy children is well documented in the literature. The vaccine is contraindicated in the immunodeficient population. Recent studies have examined the immune response of varicella vaccine in children suffering from hematological malignancies, inflammatory bowel disease, human immunodeficiency virus with a CD4 T-cell count of at least 200 cell/μl, atopic dermatitis, and juvenile rheumatic diseases and found that the vaccine was immunogenic in most cases. In addition, the herpes zoster vaccine, which is the newest addition to the varicella vaccine family, has proven to be well tolerated and effective in healthy adults; however, the vaccination rate has been dismal.
Studies suggest that varicella vaccine is well tolerated and immunogenic in moderately immunocompromised children and could be beneficial in reducing the burden of viral infection. Similar studies in immunodeficient adults should be undertaken for herpes zoster vaccine, which has been shown to lower the incidence of herpes zoster and postherpetic neuralgia.
Current Opinion in Infectious Diseases 11/2011; 25(2):135-40. · 4.93 Impact Factor
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ABSTRACT: Recently, a study of patients with rheumatoid arthritis who developed herpes zoster while taking a tumor necrosis factor (TNF)-α inhibitor reported a decreased incidence of postherpetic neuralgia. The objective of this study was to investigate whether patients on TNF-α inhibitors who developed herpes zoster have a lower incidence of subsequent development of postherpetic neuralgia. A retrospective review of herpes zoster patients on TNF-α inhibitors (infliximab, etanercept, or adalimumab) was conducted in 12 dermatology clinics. Medical records of such patients were reviewed thoroughly to confirm herpes zoster and TNF-α inhibitors and any subsequent development of postherpetic neuralgia (pain score ≥ 3 out of 10 after 90 days of shingles onset) was noted. A total of 206 cases were reviewed, of which only 2 cases (<1%) developed postherpetic neuralgia, a considerably lower incidence rate than noted in the literature. Increasing age is a known risk factor in the development of postherpetic neuralgia. However, of the 58 (28.1%) cases ≥ 70 years of age, only 1 patient (1.7%) developed neuralgia compared to approximately 50% of patients who develop postherpetic neuralgia in this age group as reported in the literature. Treatment with TNF-α inhibitors may be associated with a lower incidence of postherpetic neuralgia but further prospective large-scale studies are needed to confirm this data.
Journal of Medical Virology 11/2011; 83(11):2051-5. · 2.82 Impact Factor
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ABSTRACT: Herpes zoster is a common mucocutaneous infection caused by reactivation of latent varicella zoster virus previously introduced during a varicella infection. The epidemiology of the disease has changed since the approval of Zostavax(®) and the risk factors have been studied in depth.
To further assess the possibility of family history as a risk factor for herpes zoster, determine the age of herpes zoster onset and the rate of recurrence.
A case-control study involved 1103 acute herpes zoster patients and 523 controls.
Case patients were more likely to report blood relatives with a history of herpes zoster than controls (43.5% vs. 10.5%; P<0.001) (odds ratio for first-degree relatives, 4.44; 95% confidence interval 3.11-6.35). A dose-dependent effect was documented; risk was increased with multiple blood relatives (odds ratio, 17.15; 95% confidence interval, 7.50-39.18) compared with single blood relatives (odds ratio, 5.24; 95% confidence interval, 3.79-7.23). The mean age of herpes zoster onset was 51.7 (SD 19.0) years and the recurrence rate was 9.3%.
The results indicate a stronger association between herpes zoster and family history of herpes zoster than previously reported in the literature and suggest a genetic predisposition to herpes zoster may be more frequently inherited along maternal lines. A lower mean age of herpes zoster onset than previously documented in the literature is reported, which has implications for vaccine timing.
Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 09/2011; 52(4):344-8. · 3.12 Impact Factor
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Maria A Nagel,
Alexander Choe,
Randall J Cohrs,
Igor Traktinskiy,
Kyle Sorensen,
Satish K Mehta,
Duane L Pierson, Stephen K Tyring,
Kassie Haitz,
Catherine Digiorgio,
Whitney Lapolla,
Don Gilden
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ABSTRACT: Analysis of saliva samples from individuals aged ≥ 60 years who had a history of zoster (group 1), zoster and postherpetic neuralgia (PHN; group 2), or no history of zoster (group 3) revealed varicella zoster virus (VZV) DNA in saliva samples from 11 of 17 individuals in group 1, 10 of 15 individuals in group 2, and 2 of 17 individuals in group 3. The frequency of VZV DNA detection was significantly higher (P = .001) in saliva of subjects with a history of zoster, with or without PHN (21 [67%] of 32 subjects in groups 1 and 2), than in saliva of age-matched subjects with no zoster history (2 [12%] of 17 subjects in group 3). Thus, persistence of VZV DNA in saliva is the outcome of zoster, independent of PHN. Because VZV infection can produce neurological and ocular disease without zoster rash, future studies are needed to establish whether VZV DNA can be detected in the saliva of such patients.
The Journal of Infectious Diseases 09/2011; 204(6):820-4. · 6.41 Impact Factor
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ABSTRACT: Analysis of 36 individuals over age 60 years who were immunized with Zostavax revealed varicella zoster virus (VZV) DNA in swabs of skin inoculation sites obtained immediately after immunization in 18 (50%) of 36 subjects (copy number per nanogram of total DNA, 28 to 2.1 × 10(6)) and in saliva collected over 28 days in 21 (58%) of 36 subjects (copy number, 20 to 248). Genotypic analysis of DNA extracted from 9 random saliva samples identified vaccine virus in all instances. In some immunized individuals over age 60, vaccine virus DNA is shed in saliva up to 4 weeks.
The Journal of Infectious Diseases 06/2011; 203(11):1542-5. · 6.41 Impact Factor
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ABSTRACT: Generalized verrucosis has been described in the past as synonymous with epidermodysplasia verruciformis. It has been shown, however, that epidermodysplasia verruciformis and other genetic or immunodeficiency diseases are just a subset of diffuse infections with human papillomavirus termed "generalized verrucosis." This article defines generalized verrucosis and distinct diseases associated with generalized warts. The indications for histopathologic testing, human papillomavirus typing, and other laboratory analyses and potential treatment options are discussed.
Journal of the American Academy of Dermatology 05/2011; 66(2):292-311. · 3.99 Impact Factor
