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Skin and Soft Tissue Infections: Current Advancement in Epidemiology, Pathogenesis and Management
Abstract
Skin and soft tissue infections are brought on by invasion of microbes on the skin and underlying soft
tissues (SSTIs). They appear in a series of shapes, causes the high level of severeness. Differentiating
between SSTI situations that require prompt attention and surgical or medical intervention from those
that don't is difficult. SSTIs are most prevalent in emergency rooms and affect 7% to 10% of hospitalised
patients. SSTIs are characterised by inflammatory components as well as other symptoms including
fever, quickly growing lesions, and bullae. The creation of a severity categorization approach to specify
suitable empirical treatment would improve the management of SSTIs. Based on the patient's status
knowledge of potential infections, an antibiotic medicine is chosen. Oral antibiotics are sufficient for
simple mild-to-moderate infections; however, intravenous antibiotics are required for complicated
severe infections
... The primary mechanisms leading to antibiotic resistance in bacteria predominantly involve modifications to target genes or the achievement of resistance genes through plasmids [8]. One of the most important steps in treating bacterial infections is the use of antibiotics that specifically target the etiologic agents [9]. Since they are used in modern medicine, antibacterial drugs have been in use for 80 years. ...
Background
Due to increasing antibiotic resistance, researchers are investigating the medicinal potential of nanoparticles, particularly their antibacterial and antiviral properties. Among other things, this concern mandates the journey for novel and more potent antibacterial drugs. The crucial role of nanoparticles in the treatment of various microbial diseases has been demonstrated in several research studies.
Aim & Objective
This study focuses on the role of Selenium nanoparticles (SeNPs) against infectious diseases, with an emphasis on exploring their probable mechanisms of action.
Methodology
Nanoparticles have been exploited as delivery mechanisms and broad-spectrum inhibitors in viral and microbial studies. Their significant therapeutic potential stems from their high surface area to volume ratio, which enables diverse applications. Various materials have been employed in the synthesis of nanoparticles, each tailored to meet specific therapeutic requirements. The unique combination of biological relevance, environmental friendliness, and versatile applications makes SeNPs a promising alternative to other nanoparticles in various fields.
Results
The therapeutic potential of nanoparticles, especially Selenium nanoparticles (SeNPs), is significant and warrants further exploration. They have shown promise as delivery agents and potent materials for combating infectious diseases, making them a valuable asset in the fight against antibiotic resistance.
Conclusion
Selenium nanoparticles (SeNPs) are potential biological prospects because of their biocompatibility, bioavailability, and low toxicity. Size, shape, and synthesis affect SeNP uses in biological systems. SeNPs are chemopreventive, anti-inflammatory, and antioxidant medicines that may cure fungal, bacterial, and parasite infections, cancer, and diabetes. They have better absorption, bioavailability, and antibacterial action than micron-size particles. Their large surface area facilitates biological contact and bioactive chemical functionalization. Functionalized SeNPs are less cytotoxic than other seleniums. They prevent DNA oxidation, detoxify heavy metals, and inhibit hydroxyl radicals. In conclusion, selenium nanoparticles have considerable promise for medication delivery, antimicrobials, and cancer and diabetes treatment. They are attractive nanomedicine prospects due to their low toxicity, biocompatibility, and high bioavailability.
... Initial processing included Gram staining, followed by inoculation on 5% sheep blood agar, procedures are a significant concern for patients, causing substantial physical and financial 138 burden on individuals and the healthcare system worldwide [7]. Any skin or skin structure injury 139 can lead to inflammation, creating an environment conducive to the growth and multiplication of 140 pathogenic microorganisms, resulting in pyogenic infections [8]. In this setting, bacteria adapt 141 and survive by producing toxins, virulence factors, and biofilms. ...
Skin and skin structure infections are one of the leading causes of difficult to treat infections. Knowledge about antimicrobial susceptibility and resistance patterns of the isolates yielded from pus specimens will help in efficient and effective management of patients. The aim of our study was to determine the aerobic bacteriological profile from various types of skin and skin structure infections and the susceptibility pattern of difficult-to-treat resistant Gram negative bacteria isolated from pus specimens. This was a retrospective study conducted in Pak Emirates Military Hospital department of microbiology, Army Medical College (National University of Medical Sciences) Rawalpindi. Data of 1,250 pus specimens from January 2023 to December 2023 was retrieved from hospital management system. Pus was processed according to standard microbiological procedure and antimicrobial susceptibility was determined following Clinical and Laboratory Standards Institute 2023.Data was analyzed using statistical package for social sciences version 26 and p value was calculated. Descriptive factors (frequencies, percentage) were calculated for the socio demographic characteristics and antibiotic susceptibility was determined. P value of less than or equal to 0.05 was taken as significant. A total of 1,250 pus specimens were received during one year. Out of these 416 (33.2%) were Gram negative rods and 356 (28.4%) were Gram positive cocci. The most frequently isolated organism was Escherichia coli 156(30.3%) followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Acinetobacter baumannii emerged as the most resistant pathogen. It was resistant to all antimicrobials except colistin and tigecycline. This study has enabled us to determine various types of Gram negative rods present in pus specimens, as well as their sensitivity for different antibiotics. This information will be used to create our institutional antibiogram, which will guide clinicians in making valuable treatment decisions. Additionally, this study highlights the importance of effective infection control and prevention practices in a large hospital setting, which can help prevent antimicrobial resistance and promote optimal patient care.
... Skin and soft tissue infections (SSTIs) are common conditions involving a wide range of physiological structures with varying severity and prognosis [1,2]. Among them, diabetes-related foot infection (DFI) represents a diagnostic and therapeutic challenge [3]. ...
Skin and soft tissue infections (SSTIs), and particularly diabetic-related foot infections (DFI), present diagnostic and therapeutic complexities, often leading to severe complications. This study aims to evaluate the in vitro efficacy of cefditoren and amoxicillin/clavulanic acid against typical DFI pathogens. Clinical samples from 40 patients with mild SSTIs were analyzed, revealing a predominance of Staphylococcus spp. and Streptococcus spp. species. Cefditoren exhibited activity against 90% of isolates, with superior potency over amoxicillin/clavulanic acid. These findings underscore the utility of cefditoren in empirical treatment of DFI, although a larger sample size would be desirable for further validation.
... Nowadays, many lethal and serious infectious diseases are caused due to pathogenic microorganisms especially multidrug-resistant strains, viz. vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus, which have become a serious growing problem in healthcare despite advancements in antimicrobial therapy [27][28][29]. As invasive microbial species become resistant to currently used antibiotics, this prompts medicinal chemists to develop alternative drug therapies having antimicrobial activity [30,31]. ...
Background: A new series of 3,5-disubstituted thiazolidin-2,4-dione molecules were derived and characterized using various spectral techniques ( ¹ H NMR, IR, carbon, hydrogen, nitrogen, etc.) and physicochemical parameters. Materials & methods: The molecules were derived using Knoevenagel condensation followed by Mannich reaction and further synthesized analogues were screened for their antioxidant and antimicrobial potential using 2,2-diphenyl-1-picrylhydrazyl free radical scavenging method and serial tube dilution method, respectively, along with in silico studies (docking and absorption, distribution, metabolism and excretion parameters) to explore the drug–receptor interaction and druglikeness. Results & conclusion: In antimicrobial screening, the analogs MP2, MM6, MM7 and MM8 displayed promising activity while molecule MM4 exhibited better antioxidant potential in the series. In molecular docking analysis, the best-fitted analogs, namely, MM6 and MM7, showed good interactions.
Objective: To determine the clinical microbial synergy in skin and soft tissue infections (SSTIs) based on bacterial groups and explore the likelihood ratios of clinical parameters. Study Design: Descriptive cross-sectional study. Place and Duration of the Study: The study was conducted at the Methodology: A total of 304 pus samples from clinically diagnosed cases of SSTIs were included in the study and were processed for microbiological work-up. Isolates were cultured on blood and MacCokney's agar media. Staphylococcal species were identified via the Rapid-ID staph plus system. Continuous data was represented as mean and standard deviation and categorical data were expressed as frequencies (percentages) and were further analysed by using the Chi-square test and multinomial regression model. Results: The study revealed substantial associations between bacterial types and factors such as clinical unit, ethnicity, skin-barrier disruptions, infection site, and wound classification (p-value <0.05) in SSTIs. Metabolic and endocrine disorders increased the odds ratio of gram-negative rod infections (OR = 3.25). Accidents and trauma were associated with higher odds ratio of gram-positive cocci infections (OR = 3.288). Bacterial types varied across wound classes, with gram-positive cocci more common in classes I, II, and III (OR = 3.29, 2.00). Conclusion: This study identifies key predictors of bacterial aetiology in skin SSTIs, revealing increased associations between gram-negative rods and metabolic and endocrine disorders, gram-positive cocci and trauma-related SSTIs, and gram-negative rods in surgical site infections.
The novel Coronavirus has brought global mortality, disruption, and a significant loss of life. A compromised immune system is a known risk factor for all viral influenza infections. Due to the perceived “immune-boosting” properties of nutraceutical products, sales of dietary supplements have grown globally. In recent years, consumers have increasingly demanded nutraceutical products rather than curative synthetic medicines for preventive therapies for the coronavirus disease outbreak of 2019 (COVID-19). Healthy foods and nutraceuticals have become daily diet plans for consumers. Although there has been an increase in demand, there is no such regulation and harmonized process, which stands as a barrier to the approval of these products. Therefore, many misbranded and spurious products are entering the market, which may harm consumers. This article focuses on the role of functional foods and nutraceutical in the management of COVID-19 also focuses on the different nutraceutical regulations in each country and compare the similarities and differences of the following countries: India, the USA (United States of America), the EU (European Union), and China. The comparative study of nutraceutical regulations in India, the USA, Europe, and China shows that there is a difference regarding the nutraceutical regulations; however, despite the differences, it is observed that it has the same underlying objective, i.e., ensuring the safety of the consumers by maintaining the product quality.
The global upsurge in antibiotic resistant bacteria (ARB) is putting immense pressure on healthcare. The spreading of antimicrobial resistance is facilitated by mobile genetic elements, most especially plasmids. The widespread use of antibiotics in clinical and veterinary environments creates selective pressure that drives the evolution of ARB. Plasmids contribute to the propagation of AR in different types of clinical infections. The role plasmids play in this evolution necessitates their utilization in molecular surveillance to detect the emergence of ARB and track the spread of AR plasmids. Recent technologies like replicon typing and whole genome sequencing (WGS) have become the gold standard for molecular epidemiology of plasmids for the detection and control of epidemics in clinical settings. Unfortunately, access to such technologies is limited in low- and middle-income countries (LMICs). The major aim of this review is to examine the specific contributions of plasmids to the upsurge of AR in clinical settings and elucidate the various replicon types that have been attributed to specific antibiotic-resistant infections in healthcare settings. Healthcare in LMICs should be supported to build capacity in WGS and molecular surveillance to effectively prevent and control AR bacterial infections.
Pityrosporum folliculitis (PF) is a fungal acneiform disease of the hair follicles that often presents with pruritic papules and pustules on the upper body and face. This condition is commonly mistaken for acne vulgaris and can be distinguished from bacterial acne by the presence of fungal spores in the follicular lumen. Although studies have been performed to describe PF in cohorts, little work has been done to aggregate these data. Thus, the goal of this review is to describe the clinical characteristics and treatment outcomes of PF in immunocompetent patients. PubMed, Web of Science, and Embase were searched using the terms “Pityrosporum folliculitis” or “Malassezia folliculitis.” All cohorts reporting PF characteristics in patients classified as immunocompetent were reviewed. A total of 15 studies were included. Majority of patients were male (64%) with the average age of presentation of 24.26 years. The most common locations of lesions were the chest (70%) and back/shoulders (69.2%). Pruritus was reported by the majority of patients (71.7%). Additionally, 40.5% of patients reported a history of unsuccessful treatment regimens. Treatment was most successful with an oral antifungal (92%), followed by a topical antifungal (81.6%). In conclusion, majority of patients with PF were younger males. Many patients were primarily treated incorrectly, suggesting the importance of proper diagnosis. PF may be distinguishable from acne vulgaris by the presence of pruritus or suggested when a new acneiform eruption develops following antibiotic therapy or immunosuppression. When properly diagnosed, majority of cases of PF achieve complete response with oral or topical antifungals.
Background
Skin carbuncle is a suppurative infection of adjacent multiple hair follicles and their surrounding tissues, mostly caused by Staphylococcus aureus. Skin carbuncle often occurs in the neck, the back, and other skin thicker parts. It can also spread to the subcutaneous tissue and cause extensive subcutaneous infection. It is especially common in people with low immunity such as diabetes, nephritis, and malnutrition.
Patients and Methods
We reported four cases of carbuncle of the neck, three of which were treated with traditional Chinese medicine therapy based on fire needles combined with topical drugs, and the other one was treated by surgical incision and drainage, debridement, and dressing change.
Results
All four cases achieved good therapeutic effects. The results showed that in the treatment of early carbuncle, compared with surgical treatment, fire needle therapy had less trauma, smaller prognosis scar, less cost, and faster recovery. However, when the carbuncle significantly expands or the deep tissue of the late carbuncle shows erosion necrosis, surgical debridement is necessary.
Conclusion
The traditional Chinese medicine therapy based on the fire needle for the early treatment of carbuncle has important clinical significance, which is worthy of further study.
Annually, more than 10 million in-patients (or more than a quarter of all hospital stays) undergo surgical treatments. Cesarean sections, orthopedic surgeries, neurosurgery treatments, and intra-abdominal operations are some common surgical procedures. Ambulatory surgical centers (facilities specifically designed for certain types of surgery after which the patient can be discharged directly home) are also seeing an increase in patients. The Centers for Disease Control and Prevention defines a surgical site infection (SSI) as an infection at or near the site of a surgical incision that develops within 30 days after surgery or within 90 days if prosthetic material is inserted during surgery.
From July 2022, cases of imported diphtheria with toxigenic Corynebacterium diphtheriae remarkably increased among migrants arriving in Germany. Up to 30 September 2022, 44 cases have been reported to the national public health institute, all laboratory-confirmed, male, and mainly coming from Syria (n = 21) and Afghanistan (n = 17). Phylogeny and available journey information indicate that most cases (n = 19) were infected along the Balkan route. Active case finding, increased laboratory preparedness and epicentre localisation in countries along this route are important.
Only three Corynebacterium species are known to produce a lethal exotoxin called diphtheria toxin. These are C. diphtheriae, C. ulcerans and C. pseudotuberculosis. The diphtheria toxin gene (tox) is carried in a family of closely related corynebacteriophages and therefore the toxin can be produced only through lysogenisation, in which the corynephage encoding tox is stably inserted into the chromosome. However, ‘nontoxigenic tox gene-bearing’ (NTTB) strains, which are genotypically tox-positive but do not express the protein, have been described. The emergence of NTTB strains was first observed during the 1990s diphtheria epidemic in Eastern Europe and nowadays such isolates have been detected in many countries in the world. Recently, novel species of Corynebacterium genus have been described which might have the potential of producing the diphtheria toxin due to the possession of the diphtheria toxin gene but it has not produced toxin in laboratory tests. The circulation of NTTB strains could be related to the increased risk for diphtheria disease arising from the risk of re-emerging toxin expression. The article presents the mechanism of diphtheria toxin expression and action, recently described novel species of NTTB corynebacteria as well as the taxonomic changes within the C. diphtheriae group.
The increase in prevalence of staphylococcal antimicrobial resistance has been also associated with pyoderma in dogs, and prolonged antibiotic treatment, as often needed in severe cases of pyoderma, has been related to influencing possible development of multidrug resistance (MDR). Fluorescent light energy (FLE) has been indicated to improve pyoderma lesions as adjunct therapy to systemic antibiotics. In the present study, we evaluated the effect of FLE on clinical signs of MDR canine deep pyoderma (CDP) and interdigital furunculosis (CIF) when administered as solely management. Sixteen client-owned dogs affected by CIF (five dogs) and CDP (eleven dogs) were scored using a dedicated scoring system and received a single FLE applications twice weekly, until clinical resolution was achieved. Mean time to achieve complete resolution was 5.20 ± 3.56 weeks (median 3 weeks) for CIF cases and 4.18 ± 1.47 weeks (median 4 weeks) for CDP ones. FLE shows promise as an aid to managing clinical signs while reducing reliance on antibiotics for MDR CDP and CIF. In this study, FLE was responsible for the decrease in lesion scores and resolution of MDR pyoderma infection without any adjunct therapy, having a potential useful role to play in antibiotic stewardship programs, efficiently promoting complete clinical resolution of MDR lesions while optimizing the use of antibiotics.
Background:
Urticaria is a common condition presenting both as acute and chronic disease within primary care. To those without specialist training it is poorly understood from the points of view of diagnosis and management. It causes a considerable disease burden to sufferers with marked impact on quality of life.
Purpose of this review:
The recent publication of the EAACI/GA²LEN/EuroGuiDerm/APAAACI Guideline for the Definition, Classification, Diagnosis and Management of Urticaria guideline prompted us to take this excellent resource and re-configure its findings and recommendations to a non-specialist audience with particular reference to the needs of the primary care team.
Urticaria is a common skin rash, which can be acute or chronic. It can be idiopathic or associated with various disorders and infections, but rarely human immunodeficiency virus (HIV). We report a case of an adult male presenting with a new onset of chronic urticaria. Its workup revealed newly diagnosed HIV. The frequency and severity of urticaria wheals improved significantly with HIV treatment.
Background:
Diphtheria is rare in Australia, but an increasing number of cases have been notified in recent years. Alongside notifications from 1999 to 2019, we analysed other relevant national data sources to evaluate trends over the past two decades.
Methods:
Diphtheria notifications (National Notifiable Diseases Surveillance System [NNDSS]), hospitalisations (National Hospital Morbidity Database [NHMD]) and deaths (Australian Bureau of Statistics and the Australian Coordinating Registry) were separately analysed by site of infection, age group, sex, state/territory, Aboriginal and Torres Strait Islander status, and vaccination status.
Results:
During the study period, eight (0.002 per 100,000 population per year) cases of respiratory diphtheria and 38 (0.008 per 100,000 population per year) cases of cutaneous diphtheria were recorded in the NNDSS, with 45/46 reported in the nine years since 2011. Corynebacterium diphtheriae accounted for 87% of notified cases, who had a median age of 31.5 years (respiratory diphtheria) and 52.5 years (cutaneous diphtheria); no respiratory diphtheria was notified in those under 15 years of age. A majority of the cutaneous diphtheria cases (27/38; 71%) were acquired overseas, as were 3/8 (38%) of the respiratory diphtheria cases. Rates of both presentation types were higher in Aboriginal and Torres Strait Islander people (respiratory: 0.007 per 100,000 population per year; cutaneous: 0.021 per 100,000 population per year) than were rates in the overall population. Queensland had the highest rate of notified respiratory cases (0.007 per 100,000 population per year), and the Northern Territory the highest rate of cutaneous notifications (0.043 per 100,000 population per year). There were 29 hospitalisations with a principal-diagnosis diphtheria code in the NHMD between 2002 and 2018, of which eight were designated as respiratory (0.002 per 100,000 population per year), eight as cutaneous (0.002 per 100,000 population per year), and 13 with an unknown site of infection. Among notified cases, two deaths were reported in unvaccinated people in Queensland.
Conclusions:
Although diphtheria remains rare in Australia, 45 cases were notified in the years 2011-2019, compared with one case between 1999 and 2010. Robust surveillance remains important to detect all cases. High immunity will need to be maintained across all age groups to prevent outbreaks, and travel and adult booster doses should be encouraged.
Toxigenic Corynebacterium ulcerans is as an emerging zoonotic agent of diphtheria. We describe the zoonotic transmission of diphtheria caused by toxigenic C. ulcerans from domestic animals in Spain, confirmed by core-genome multilocus sequence typing. Alongside an increasing number of recent publications, our findings highlight the public health threat posed by diphtheria reemergence.
Objective
The present narrative review provides a comprehensive update of the current knowledge on urticaria, both in adult and pediatric populations, and on the safety and efficacy of fexofenadine hydrochloride (HCl) as a treatment option.
Data source
A literature search was conducted on Embase and Medline.
Study selection
Clinical studies published in English and published between 1999 and 2020 were selected.
Results
Although the exact pathogenesis of urticaria is not fully understood, multiple pathways of mast cell activation are discussed to explain the existence of phenotypically different clinical manifestations of urticaria. An overview of the worldwide prevalence of chronic urticaria, including disease burden and patient’s quality of life is provided. The impact of urticaria on patient’s life differs on the basis of whether its form is acute or chronic, but pharmacological approaches are most often needed to control the disabling symptoms. A summary of the current management of urticaria recommended by different guidelines across countries (Global; European; American; Australian; Asian; Japanese) is presented. Non-sedating, second-generation H 1 -antihistamines are the preferred choice of treatment across several guidelines worldwide. Herein, the efficacy and safety of fexofenadine HCl, a representative second-generation H 1 -antihistamine approved for the treatment of urticaria, is discussed. The occurrence of urticaria manifestations in COVID-19 patients is also briefly presented.
Conclusion
The burden of acute and chronic urticaria is high for patients. Second generation anti-histamines such as fexofenadine HCl can help managing the symptoms.
Staphylococcus aureus (S. aureus) is a Gram-positive bacterium that may cause life-threatening diseases and some minor infections in living organisms. However, it shows notorious effects when it becomes resistant to antibiotics. Strain variants of bacteria, viruses, fungi, and parasites that have become resistant to existing multiple antimicrobials are termed as superbugs. Methicillin is a semisynthetic antibiotic drug that was used to inhibit staphylococci pathogens. The S. aureus resistant to methicillin is known as methicillin-resistant Staphylococcus aureus (MRSA), which became a superbug due to its defiant activity against the antibiotics and medications most commonly used to treat major and minor infections. Successful MRSA infection management involves rapid identification of the infected site, culture and susceptibility tests, evidence-based treatment, and appropriate preventive protocols. This review describes the clinical management of MRSA pathogenesis, recent developments in rapid diagnosis, and antimicrobial treatment choices for MRSA.
Electrospinning (ES) has become a straightforward and customizable drug delivery technique for fabricating drug-loaded nanofibers (NFs) using various biodegradable and non-biodegradable polymers. One of NF’s pros is to provide a controlled drug release through managing the NF structure by changing the spinneret type and nature of the used polymer. Electrospun NFs are employed as implants in several applications including, cancer therapy, microbial infections, and regenerative medicine. These implants facilitate a unique local delivery of chemotherapy because of their high loading capability, wide surface area, and cost-effectiveness. Multi-drug combination, magnetic, thermal, and gene therapies are promising strategies for improving chemotherapeutic efficiency. In addition, implants are recognized as an effective antimicrobial drug delivery system overriding drawbacks of traditional antibiotic administration routes such as their bioavailability and dosage levels. Recently, a sophisticated strategy has emerged for wound healing by producing biomimetic nanofibrous materials with clinically relevant properties and desirable loading capability with regenerative agents. Electrospun NFs have proposed unique solutions, including pelvic organ prolapse treatment, viable alternatives to surgical operations, and dental tissue regeneration. Conventional ES setups include difficult-assembled mega-sized equipment producing bulky matrices with inadequate stability and storage. Lately, there has become an increasing need for portable ES devices using completely available off-shelf materials to yield highly-efficient NFs for dressing wounds and rapid hemostasis. This review covers recent updates on electrospun NFs in nanomedicine applications. ES of biopolymers and drugs is discussed regarding their current scope and future outlook.
Anthrax is an acute disease caused by the bacterium Bacillus anthracis, and is a potential biowarfare/bioterrorist agent. Its pulmonary form, caused by inhalation of the spores, is highly lethal and is mainly related to injury caused by the toxins secretion. Antibodies neutralizing the toxins of B. anthracis are regarded as promising therapeutic drugs, and two are already approved by the Federal Drug Administration. We developed a recombinant human-like humanized antibody, 35PA83 6.20, that binds the protective antigen and that neutralized anthrax toxins in-vivo in White New Zealand rabbits infected with the lethal 9602 strain by intranasal route. Considering these promising results, the preclinical and clinical phase one development was funded and a program was started. Unfortunately, after 5 years, the preclinical development was cancelled due to industrial and scientific issues. This shutdown underlined the difficulty particularly, but not only, for an academic laboratory to proceed to clinical development, despite the drug candidate being promising. Here, we review our strategy and some preliminary results, and we discuss the issues that led to the no-go decision of the pre-clinical development of 35PA83 6.20 mAb. Our review provides general information to the laboratories planning a (pre-)clinical development.
In the present study, chitosan/polyvinyl alcohol (PVA)-based honey hydrogel films were developed for potential wound healing application. The hydrogel films were developed by a solvent-casting method and were evaluated in terms of thickness, weight variation, folding endurance, moisture content and moisture uptake. The water vapor transmission rate was found to range between 1650.50 ± 35.86 and 2698.65 ± 76.29 g/m²/day. The tensile strength and elongation at break were found to range between 4.74 ± 0.83 and 38.36 ± 5.39 N, and 30.58 ± 3.64 and 33.51 ± 2.47 mm, respectively, indicating significant mechanical properties of the films. SEM images indicated smooth surface morphology of the films. FTIR, DSC and in silico analysis were performed, which highlighted the docking energies of the protein–ligand complex and binding interactions such as hydrogen bonding, Pi–Pi bonding, and Pi–H bonding between the selected compounds and target proteins; hence, we concluded, with the three best molecules (lumichrome, galagin and chitosan), that there was wound healing potential. In vitro studies pointed toward a sustained release of honey from the films. The antimicrobial performance of the films was investigated against Staphylococcus aureus. Overall, the results signaled the potential application of chitosan/PVA based hydrogel films as wound dressings. Furthermore, in vivo experiments may be required to evaluate the clinical efficacy of honey-loaded chitosan/PVA hydrogel films in wound healing.
Bacterial impetigo is one of the most common skin infection in childhood. Uncertainty exists about its management. This article offers practical suggestions, given the existing evidence and experts’ opinions, for correctly managing pediatric impetigo in both hospital and ambulatory settings. Italian physicians with an expertise on pediatric impetigo appointed a working group. A preliminary literature search using Pubmed/MEDLINE and Cochrane Library databases has been performed. The most common controversial issues about pediatric impetigo have been identified and then discussed from multidisciplinary perspectives, according to the ‘structured controversy’ methodology, a technique discovered and designed to get engaged in a controversy and then guide participants to seek consensus. The expert panels identified 10 main controversies about pediatric impetigo. All of them have been discussed from dermatological, pediatric, pharmacological and microbiological points of view reaching consensus. Each controversy has been revised thus giving practical issues for an easy use in clinical practice. Based on clinical experts’ opinion, local epidemiology and literature review this article offers practical suggestions for the management of pediatric impetigo trying to reduce uncertainty in this setting of care.
Importance
In most countries, the diphtheria-tetanus–acellular pertussis (DTaP) vaccine is administered as a 3-dose infant series followed by additional booster doses in the first 5 years of life. Short-term immunity from the DTaP vaccine can depend on the number, timing, and interval between doses. Not receiving doses in a timely manner might be associated with a higher pertussis risk.
Objective
To examine the association between number and timeliness of vaccine doses and age-specific pertussis risk.
Design, Setting, and Participants
This population-based, retrospective cohort study used Washington State Immunization Information System data and pertussis surveillance data from Public Health Seattle and King County, Washington. Included participants were children aged 3 months to 9 years born or living in King County, Washington, between January 1, 2008, and December 31, 2017. Data were analyzed from June 30 to December 1, 2019.
Exposures
Being undervaccinated (receiving fewer than recommended doses at a given age) or delayed vaccination (not receiving doses within time frames recommended by Centers for Disease Control and Prevention).
Main Outcomes and Measures
Suspected, probable, and confirmed pertussis diagnosis.
Results
A total of 316 404 children (median age, 65.2 months [interquartile range, 35.3-94.1 months]; 162 025 boys [51.2%]) as of December 31, 2017, with 17.4 million person-months of follow-up were included in the analysis. A total of 19 943 children (6.3%) had no vaccines recorded in the Immunization Information System, 116 193 (36.7%) received a vaccine with a delay, and 180 268 (56.9%) were fully vaccinated with no delay. Delayed vaccination and undervaccination rates were higher for older children (17.6% delayed or undervaccinated at age 2 months for dose 1 at 3 months vs 41.6% at age 5 years for dose 5) but improved for successive birth cohorts (52.2% for 2008 birth cohort vs 32.3% for 2017 birth cohort). Undervaccination was significantly associated with higher risk of pertussis for the 3-dose primary series (adjusted relative risk [aRR], 4.8; 95% CI, 3.1-7.6), the first booster (aRR, 3.2; 95% CI, 2.3-4.5), and the second booster (aRR, 4.6; 95% CI, 2.6-8.2). However, delay in vaccination among children who received the recommended number of vaccine doses was not associated with pertussis risk.
Conclusions and Relevance
The results of this cohort study suggest that undervaccination is associated with higher pertussis risk. Short delays in vaccine receipt may be less important if the age-appropriate number of doses is administered, but delaying doses is not recommended. Ensuring that children receive all doses of pertussis vaccine, even if there is some delay, is important.
Purpose
Impetigo affects approximately 162 million children worldwide at any given time. Lack of consensus on the most effective treatment strategy for impetigo and increasing antibiotic resistance continue to drive research into newer and alternative treatment options. We conducted a systematic review to assess the effectiveness of new treatments for impetigo in endemic and nonendemic settings.
Methods
We searched PubMed, MEDLINE, CINAHL, Web of Science, and Embase via Scopus for studies that explored treatments for bullous, nonbullous, primary, and secondary impetigo published between August 1, 2011, and February 29, 2020. We also searched online trial registries and hand-searched the reference lists of the included studies. We used the revised Cochrane risk of bias (version 2.0) tool for randomized trials and the National Heart, Lung, and Blood Institute for nonrandomized uncontrolled studies to assess the risk of bias.
Findings
We included 10 studies that involved 6651 participants and reported on 9 treatments in the final analysis. Most clinical trials targeted nonbullous impetigo or did not specify this. The risk of bias varied among the studies. In nonendemic settings, ozenoxacin 1% cream appeared to have the strongest evidence base compared with retapamulin and a new minocycline formulation. In endemic settings, oral co-trimoxazole and benzathine benzylpenicillin G injection were equally effective in the treatment of severe impetigo. Mass drug administration intervention emerged as a promising public health strategy to reduce the prevalence of impetigo in endemic settings.
Implications
This review highlights the limited research into new drugs used for the treatment of impetigo in endemic and nonendemic settings. Limited recent evidence supports the use of topical ozenoxacin or retapamulin for impetigo treatment in nonendemic settings, whereas systemic antibiotics and the mass drug administration strategy have evidence for use in endemic settings. Given the troubling increase in resistance to existing treatments, there is a clear need to ensure the judicious use of antibiotics and to develop new treatments and alternative strategies; this is particularly important in endemic settings. PROSPERO identifier: CRD42020173042.
Diphtheria is a respiratory disease caused by the bacterium Corynebacterium diphtheriae . Although the development of a toxin-based vaccine in the 1930s has allowed a high level of control over the disease, cases have increased in recent years. Here, we describe the genomic variation of 502 C. diphtheriae isolates across 16 countries and territories over 122 years. We generate a core gene phylogeny and determine the presence of antimicrobial resistance genes and variation within the tox gene of 291 tox ⁺ isolates. Numerous, highly diverse clusters of C. diphtheriae are observed across the phylogeny, each containing isolates from multiple countries, regions and time of isolation. The number of antimicrobial resistance genes, as well as the breadth of antibiotic resistance, is substantially greater in the last decade than ever before. We identified and analysed 18 tox gene variants, with mutations estimated to be of medium to high structural impact.
The skin is the largest, and arguably, the most vulnerable organ in the human body. Scratches and scrapes, bites and puncture wounds, impetigo and erysipelas—all these disruptions can lead to pain, swelling, and/or systemic symptoms. In this article, which is based on the Infectious Diseases Society of America’s 2014 guidelines and the World Society of Emergency Surgery and Surgical Infection Society of Europe’s 2018 consensus statement, a structured approach to skin and soft tissue infections (SSTIs) is reviewed, comparing treatment for suppurative and non-suppurative infections, and then discussing specific conditions commonly seen in Primary Care and Urgent Care facilities.
Impetigo (school sores) is a common superficial bacterial skin infection affecting around 162 million children worldwide, with the highest burden in Australian Aboriginal children. While impetigo itself is treatable, if left untreated, it can lead to life-threatening conditions, such as chronic heart and kidney diseases. Topical antibiotics are often considered the treatment of choice for impetigo, but the clinical efficacy of these treatments is declining at an alarming rate due to the rapid emergence and spread of resistant bacteria. In remote settings in Australia, topical antibiotics are no longer used for impetigo due to the troubling rise of antimicrobial resistance, demanding the use of oral and injectable antibiotic therapies. However, widespread use of these agents not only contributes to existing resistance, but also associated with adverse consequences for individuals and communities. These underscore the urgent need to reinvigorate the antibiotic discovery and alternative impetigo therapies in these settings. This review discusses the current impetigo treatment challenges in endemic settings in Australia and explores potential alternative antimicrobial therapies. The goals are to promote intensified research programs to facilitate effective use of currently available treatments, as well as developing new alternatives for impetigo.
The zoonotic disease anthrax is endemic to most continents. It is a disease of herbivores that incidentally infects humans through contact with animals that are ill or have died from anthrax or through contact with Bacillus anthracis-contaminated byproducts. In the United States, human risk is primarily associated with handling carcasses of hoofstock that have died of anthrax; the primary risk for herbivores is ingestion of B. anthracis spores, which can persist in suitable alkaline soils in a corridor from Texas through Montana. The last known naturally occurring human case of cutaneous anthrax associated with livestock exposure in the United States was reported from South Dakota in 2002. Texas experienced an increase of animal cases in 2019 and consequently higher than usual human risk. We describe the animal outbreak that occurred in southwest Texas beginning in June 2019 and an associated human case. Primary prevention in humans is achieved through control of animal anthrax.
Bacillus anthracis has been identified as a potential military and bioterror agent as it is relatively simple to produce, with spores that are highly resilient to degradation in the environment and easily dispersed. These characteristics are important in describing how anthrax could be used as a weapon, but they are also important in understanding and determining appropriate prevention and treatment of anthrax disease. Today, anthrax disease is primarily enzootic and found mostly in the developing world, where it is still associated with considerable mortality and morbidity in humans and livestock. This review article describes the spectrum of disease caused by anthrax and the various prevention and treatment options. Specifically we discuss the following; (1) clinical manifestations of anthrax disease (cutaneous, gastrointestinal, inhalational and intravenous-associated); (2) immunology of the disease; (3) an overview of animal models used in research; (4) the current World Health Organization and U.S. Government guidelines for investigation, management, and prophylaxis; (5) unique regulatory approaches to licensure and approval of anthrax medical countermeasures; (6) the history of vaccination and pre-exposure prophylaxis; (7) post-exposure prophylaxis and disease management; (8) treatment of symptomatic disease through the use of antibiotics and hyperimmune or monoclonal antibody-based antitoxin therapies; and (9) the current landscape of next-generation product candidates under development.
A suspected human cutaneous anthrax epidemic caused by butchering sick cattle occurred in Zhijin County of Guizhou Province, Southwest of China, in 2016. Epidemiological investigation and etiological analysis were performed to provide a scientific basis for the source tracking of the epidemic. The epidemic was epidemiologically investigated, and skin blister samples collected from patients and soil samples collected from the butchering spots were used for Bacillus anthracis isolation. The suspicious B. anthracis isolates were identified using conventional methods and PCR, followed by genotyping using multiple-locus variable-number tandem repeats (VNTRs) analysis (MLVA-15) and canonical single-nucleotide polymorphism (canSNP). The genetic relationship of epidemic strains and isolates collected from other regions was analyzed. Epidemiological investigation results showed that the patients may be infected by B. anthracis during butchering sick cattle. Two suspected B. anthracis strains were isolated from blood samples and blister fluids, respectively. Conventional methods identified the two suspected isolates as B. anthracis, while PCR results showed that anti-protective antigen (PA) and capsule (CAP) gene were positive in the two isolates. MLVA-15 showed that the MLVA profiles of the two isolates were 9-20-12-53-16-2-8-8-8-4-4-4-4-10-4, which is different from the MLVA profiles of representative strains from other regions. CanSNP analysis showed that the two strains belonged to cluster A.Br.001/002. Clustering analysis and minimum spanning tree (MST) demonstrated that the two isolates were clustered with strains previously isolated from Guizhou Province. The results indicated that B. anthracis was the pathogen for this epidemic, and the patients were infected during butchering the sick. The genetic characteristics and the relationship of the B. anthracis isolates to strains from other regions indicated that the epidemic was a local occurrence.
Background
Diphtheria is a potentially fatal disease caused by toxigenic strains of Corynebacterium diphtheriae, C. ulcerans or C. pseudotuberculosis.AimOur objective was to review the epidemiology of diphtheria in the United Kingdom (UK) and the impact of recent changes in public health management and surveillance.Methods
Putative human toxigenic diphtheria isolates in the UK are sent for species confirmation and toxigenicity testing to the National Reference Laboratory. Clinical, epidemiological and microbiological information for toxigenic cases between 2009 and 2017 are described in this population-based prospective surveillance study.ResultsThere were 33 toxigenic cases of diphtheria aged 4 to 82 years. Causative species were C. diphtheriae (n = 18) and C. ulcerans (n = 15). Most C. diphtheriae cases were cutaneous (14/18) while more than half of C. ulcerans cases had respiratory presentations (8/15). Two thirds (23/33) of cases were inadequately immunised. Two cases with C. ulcerans infections died, both inadequately immunised. The major risk factor for C. diphtheriae aquisition was travel to an endemic area and for C. ulcerans, contact with a companion animal. Most confirmed C. diphtheriae or C. ulcerans isolates (441/507; 87%) submitted for toxigenicity testing were non-toxigenic, however, toxin positivity rates were higher (15/23) for C. ulcerans than C. diphtheriae (18/469). Ten non-toxigenic toxin gene-bearing (NTTB) C. diphtheriae were also detected.Conclusion
Diphtheria is a rare disease in the UK. In the last decade, milder cutaneous C. diphtheriae cases have become more frequent. Incomplete vaccination status was strongly associated with the risk of hospitalisation and death.
Background:
Acne is an inflammatory disorder of the pilosebaceous gland, and the most common dermatosis in adolescents globally. Infectious dermatoses are common in the tropics, but due to the paucity of epidemiologic surveys, not much is known about the prevalence and common types found in different sub-populations including adolescents. It is however presumed that the prevalence will be high and the pattern diverse. We therefore conducted a school-based survey to ascertain the prevalence and pattern of infectious dermatoses, infestations, and papular urticaria (insect bite reactions) in teenage adolescents in Calabar, Nigeria.
Methods:
A cross sectional observational survey of adolescents aged 13-19 years attending randomly selected secondary schools in Calabar, Nigeria. It involved the use of questionnaires and subsequent whole body examination.
Results:
A total of 1447 senior secondary school students were examined. Infectious dermatoses, infestations, and papular urticaria (IDIP) were observed in 505 (34.9%) persons, among whom were 269 (53.3%) males, and 236 (46.7%) females (X2=34.87, p=<0.001). Fungal dermatoses constituted more than 90% of the diseases, the bulk of which was contributed by pityriasis versicolor [430 (79.6%)]. The six most common dermatoses in descending order of frequencies were Pityriasis versicolor, tinea, papular urticaria, candidiasis, furuncles, and viral warts.
Conclusion:
A high prevalence of cutaneous infections exists among teenage adolescents in Calabar, Nigeria. Males have a higher predisposition to fungal dermatoses. Control of the predominant cause of cutaneous infections - pityriasis versicolor, will significantly affect the prevalence of infectious dermatoses, and invariably, the burden of skin disorders in adolescents in Calabar, Nigeria.
Funding:
Self sponsored.
Blastocystis is one of the most common intestinal protozoan parasites worldwide, which is linked to cutaneous lesions and urticaria. In a setting of systematic review, the data on the association of Blastocystis infection with cutaneous lesions were searched in order to summarize the main clinical symptoms, diagnostic methods, treatment, and outcome of the patients. The search identified 28 eligible articles, including 12 cross-sectional studies and 16 case reports/case series (including 23 cases). A diverse spectrum of skin symptoms, mainly urticaria, rash, and itching, was reported from the studies. Of the 23 infected cases with the skin symptoms, gastrointestinal symptoms were reported from the 16 cases, whereas 7 cases with urticaria had asymptomatic infection. The most frequent subtypes were ST1, ST2, and ST3, respectively. Metronidazole, paromomycin, and tinidazole were the most prescribed drugs in patients with single Blastocystis infection. Notably, urticaria and other cutaneous symptoms of all treated patients were resolved after treatment. In conclusion, this study indicates that Blastocystis infection can be a neglected cause of urticaria and skin disorders. Since the treatment of Blastocystis infection is simple, screening and treatment of this infection should be considered in patients with urticaria and other skin disorders.
Erythroderma can occur in cutaneous T-cell lymphoma (CTCL). Staphylococcus aureus (S. aureus) prevalence is increased in CTCL patients and contributes to CTCL disease flares. Our primary aim was to describe S. aureus infections, including resistance patterns and the antibiotic treatment regimens used, in erythrodermic CTCL patients. This was a retrospective chart review of erythrodermic CTCL patients who had S. aureus infection or colonization and were treated at the UT MD Anderson Cancer Center’s Melanoma Skin Center between 2012 and 2016. Twenty-six erythrodermic CTCL patients had 50 documented S. aureus colonization or infection events. Patients had an improvement in body surface area (BSA) or modified Severity Weighted Assessment Tool (mSWAT) in 53% events treated for S. aureus. Seventeen of the 50 (34%) events were due to methicillin-resistant S. aureus (MRSA). One-third (33%) of MRSA events were initially treated with dicloxacillin. The MRSA isolates were sensitive to trimethoprim–sulfamethoxazole (92%) and doxycycline (88%). Patients treated in the outpatient setting (OR 0.073; 95% CI 0.008–0.627; p = 0.017) and patients with a previous history of topical anti-S. aureus decolonization treatments before S. aureus event as stand-alone (OR 0.125; 95% CI 0.018–0.887; p = 0.038) or in combination treatment with systemic antibiotics (OR 0.094; 95% CI 0.009–0.944; p = 0.045) were less likely to see improvement in BSA or mSWAT from S. aureus treatment. Treatment of S. aureus improved CTCL skin score in a high number of erythrodermic patients. The MRSA prevalence was high in erythrodermic CTCL patients. Clinicians should consider using empiric MRSA antibiotic coverage for these patients.
Pyoderma gangrenosum is a neutrophilic dermatosis characterized by chronic ulcers due to an abnormal immune response. Despite the existence of diagnostic criteria, there is no gold standard for diagnosis or treatment. In Latin America, recognizing and treating pyoderma gangrenosum is even more challenging since skin and soft tissue bacterial and non-bacterial infections are common mimickers. Therefore, this review aims to characterize reported cases of pyoderma gangrenosum in this region in order to assist in the assessment and management of this condition. Brazil, Mexico, Argentina, and Chile are the countries in Latin America that have reported the largest cohort of patients with this disease. The most frequent clinical presentation is the ulcerative form and the most frequently associated conditions are inflammatory bowel diseases, inflammatory arthropaties, and hematologic malignancies. The most common treatment modalities include systemic corticosteroids and cyclosporine. Other reported treatments are methotrexate, dapsone, and cyclophosphamide. Finally, the use of biological therapy is still limited in this region.
Corynebacterium diphtheriae (C. diphtheriae) is a relatively rare pathogen in most Western countries. While toxin producing strains can cause pharyngeal diphtheria with potentially fatal outcomes, the more common presentation is wound infections. The diphtheria toxin is encoded on a prophage and can also be carried by Corynebacterium ulcerans and Corynebacterium pseudotuberculosis. Currently, across Europe, infections are mainly diagnosed in travelers and refugees from regions where diphtheria is more endemic, patients from urban areas with poor hygiene, and intravenous drug users. About half of the cases are non-toxin producing isolates. Rapid identification of the bacterial pathogen and toxin production is a critical element of patient and outbreak management. Beside the immediate clinical management of the patient, public health agencies should be informed of toxigenic C. diphtheriae diagnoses as soon as possible. The collection of case-related epidemiological data from the patient is often challenging due to language barriers and social circumstances. However, information on patient contacts, vaccine status and travel/refugee route, where appropriate, is critical, and should be documented. In addition, isolates should be characterized using high resolution typing, in order to identify transmissions and outbreaks. In recent years, whole genome sequencing (WGS) has become the gold standard of high-resolution typing methods, allowing detailed investigations of pathogen transmissions. De-centralized sequencing strategies with redundancy in sequencing capacities, followed by data exchange may be a valuable future option, especially since WGS becomes more available and portable. In this context, the sharing of sequence data, using public available platforms, is essential. A close interaction between microbiology laboratories, treating physicians, refugee centers, social workers, and public health officials is a key element in successful management of suspected outbreaks. Analyzing bacterial isolates at reference centers may further help to provide more specialized microbiological techniques and to standardize information, but this is also more time consuming during an outbreak. Centralized communication strategies between public health agencies and laboratories helps considerably in establishing and coordinating effective surveillance and infection control. We review the current literature on high-resolution typing of C. diphtheriae and share our own experience with the coordination of a Swiss-German outbreak.
Background:
Bacillus anthracis, the causative agent for anthrax, poses a potential bioterrorism threat and is capable of causing mass morbidity and mortality. Antimicrobials are the mainstay of postexposure prophylaxis (PEP) and treatment of anthrax. We conducted this safety review of 24 select antimicrobials to identify any new or emerging serious or severe adverse events (AEs) to help inform their risk-benefit evaluation for anthrax.
Methods:
Twenty-four antimicrobials were included in this review. Tertiary data sources (e.g. Lactmed, Micromedex, REPROTOX) were reviewed for safety information and summarized to evaluate the known risks of these antimicrobials. PubMed was also searched for published safety information on serious or severe AEs with these antimicrobials; AEs that met inclusion criteria were abstracted and reviewed.
Results:
A total of 1316 articles were reviewed. No consistent observations or patterns were observed among the abstracted AEs for a given antimicrobial; therefore, the literature review did not reveal evidence of new or emerging AEs that would add to the risk-benefit profiles already known from tertiary data sources.
Conclusions:
The reviewed antimicrobials have known and/or potential serious or severe risks that may influence selection when recommending an antimicrobial for PEP or treatment of anthrax. Given the high fatality rate of anthrax, the risk-benefit evaluation favors use of these antimicrobials for anthrax. The potential risks of antimicrobials should not preclude these reviewed antimicrobials from clinical consideration for anthrax but rather guide appropriate antimicrobial selection and prioritization across different patient populations with risk mitigation measures as warranted.
Urticaria is an inflammatory skin disorder that affects up to 20% of the world population at some point during their life. It presents with wheals, angioedema or both due to activation and degranulation of skin mast cells and the release of histamine and other mediators. Most cases of urticaria are acute urticaria, which lasts ≤6 weeks and can be associated with infections or intake of drugs or foods. Chronic urticaria (CU) is either spontaneous or inducible, lasts >6 weeks and persists for >1 year in most patients. CU greatly affects patient quality of life, and is linked to psychiatric comorbidities and high healthcare costs. In contrast to chronic spontaneous urticaria (CSU), chronic inducible urticaria (CIndU) has definite and subtype-specific triggers that induce signs and symptoms. The pathogenesis of CSU consists of several interlinked events involving autoantibodies, complement and coagulation. The diagnosis of urticaria is clinical, but several tests can be performed to exclude differential diagnoses and identify underlying causes in CSU or triggers in CIndU. Current urticaria treatment aims at complete response, with a stepwise approach using second-generation H1 antihistamines, omalizumab and cyclosporine. Novel treatment approaches centre on targeting mediators, signalling pathways and receptors of mast cells and other immune cells. Further research should focus on defining disease endotypes and their biomarkers, identifying new treatment targets and developing improved therapies. Full text link: https://rdcu.be/cVCVy
Skin is the largest protecting organ of body and is the first line of defense against various pathogens and bacteria. Skin integrity plays an important role in maintenance of physiological homeostasis of the human body. Skin also protects internal tissues from varying temperature and ultraviolet radiations, thus it becomes susceptible to injury. A wound is an injury which involves physical disruption of the skin membrane due to trauma [3,4]. Based on the duration and nature of their healing processes, wounds are categorized into two types, acute and chronic wounds. Chronic wounds do not heal via normal healing process and may take a long time to heal. Examples of such wounds are ulcer, diabetic wound and burn. Whereas acute wound are caused by accidents or surgeries. Acute wounds heal within the expected range of time, depending on the extent of injuries.
Skin is the largest non – parenchymal organ of the human body. It constitutes a natural barrier against pathogens and harmful environmental exposures and contributes to the human body's homeostasis. Conditions affecting the skin range from infections and injury to autoimmune diseases and cancer. Herbs have been used in the treatment of dermatological conditions for a long time. Traditional approaches to delivering herbs to the skin include ointments, gels, creams, and lotions. However, poor lipophilicity or hydrophilicity in most herbal preparations results in limited bioavailability and poor penetration, restricting their effectiveness. Nanotechnology-based approaches have a major potential to this end, showing promising results in enhancing transdermal penetration compared to traditional approaches. This review article summarizes such advances and sheds light on future directions on the use of nanotechnology-based strategies.
Although there is a big heap of treatment options available for the wound and burns dressings, improvements in technology are still required. Bacterial cellulose is a polymer derived from the microbiological world and has shown some promising properties that recommend it as a wound healing therapeutic. Moreover, bacterial cellulose can be nanosized to form Bacterial Nanocellulose (BNC), enhancing its properties. Most importantly, in addition to its inherent antibacterial properties, BNC can be used to deliver drugs. This article presents a birds-eye view of the preparation method and applications of BNC based wound dressings.
Objective
One of the vital signaling pathways in cancer development and metastasis is mitogen-activated protein kinases (MAPKs). Bacillus anthracis Lethal Toxin (LT) is a potent MAPK signaling inhibitor. This toxin is comprised of two distinct domains, Lethal Factor (LF), MAPK inhibitor, and Protective Antigen (PA). To enter various cell lines, LF must be associated with the protective antigen (PA), which facilitates LF delivery. In the current study, to block MAPK signaling, LF was loaded into anti-CD19 immunoliposomes nanoparticle to deliver the cargo to Raji B cells.
Methods
The liposome nanoparticle was prepared using classical lipid film formation, then conjugated to anti-CD19 VHH. The binding efficiency was measured through flow cytometry. The targeted cytotoxicity of LF immunoliposome was confirmed by BrdU lymphoproliferation assay. This was followed by Real-Time PCR to assess the effect of formulation on pro-apoptotic genes. The inhibitory effect of LF on MAPK signaling was confirmed by western blot.
Results
Liposome nano-formulation was optimized to reach the maximum LF encapsulation and targeted delivery. Next, phosphorylation of MAPK pathway mediators like MEK1/2, P38 and JNK were inhibited following the treatment of Raji cells with LF-immunoliposome. The treatment also upregulated caspase genes, clearly illustrating cell death induced by LF through pyroptosis and caspase-dependent apoptosis.
Conclusions
In conclusion, anti-CD19 VHH immunoliposome was loaded with LF, a potent MAPK inhibitor targeting B cells, which curbs proliferation and ushers B cells toward apoptosis. Thus, immunoliposome presents as a versatile nanoparticle for delivery of LF to block aberrant MAPK activation. To use LF as a therapy, it would be necessary to materialize LF without PA. In the current study, PA was substituted with anti-CD19 immunoliposome to make it targeted to CD19⁺ while keeping the normal cells intact.
Wound healing is the complex and a never-ending process that involves numerous mediators, enzymatic cascades that are directly or indirectly involved in the mechanism. So, it becomes necessary to closely examine critical factors such as gaseous exchange, a moist environment, anti-microbial activity, and exudation liquids' absorption while designing wound dressings. There is a heap of wound dressings available for human use, but they all are way apart from the ideal dressing. Use of biopolymers may be a solution to tackle the difficulties such as combining with growth factors and cells that can trigger the wound healing. This article reviews such therapies for wound healing application.
Background:
Impetigo is a contagious bacterial infection that affects the superficial skin layers. Increasing worldwide antimicrobial resistance (AMR) to existing topical agents commonly prescribed to treat impetigo is central to treatment failure. The Worldwide Health Organization developed a global action plan on AMR, but omitted information about AMR stewardship programs for topical antibiotics.
Objectives:
The review aims to provide information to clinicians and stakeholders regarding AMR and antimicrobial stewardship on topical antimicrobial drugs for impetigo treatment.
Methods:
The literature searches reviewed the status of AMR to current topical antibiotics in impetigo, current therapeutic behavior, and concordance with antimicrobial stewardship principles. Two international panels convened to discuss the output of the searches, and the results of the panel discussions were used in the development of the manuscript.
Results:
The literature search included clinical trials, research studies, clinical guidelines, consensus papers, and reviews (if they provided original data), published between January 2008 and May 2019. The articles were selected based on clinical relevancy of impetigo management, clinical efficacy, and safety of the treatment and antimicrobial resistance. The searches resulted in one-hundred and ninety-eight articles. After applying the eligibility criteria, nineteen articles met inclusion criteria and were considered in the present review.
Conclusions:
While published antimicrobial stewardship guidelines have focused on systemic antibiotics, few studies have attempted to evaluate topical antibiotic prescribing practices for impetigo treatment. Many of the topical impetigo treatments currently in use have developed resistance. The appropriate use of topical ozenoxacin can help eradicate impetigo while minimizing AMR.J Drugs Dermatol. 20(4):366-372. doi:10.36849/JDD.5795.
Introduction:
Impetigo is a superficial bacterial skin infection largely affecting the pediatric population. The objective of this review was to provide a comparison of mechanism of action, efficacy and safety of the available topical antibiotics for impetigo.
Areas covered:
Randomized clinical trials that evaluated the use of topical antibiotics for treatment of impetigo were included. 2,089 studies were initially identified, and 5 randomized clinical trials met the criteria for further analysis.
Expert opinion:
Topical antibiotics had greater resolution of impetigo in comparison to vehicle in the pivotal clinical trials in which these medications were evaluated. Adverse events were minimal, with the most common adverse event being pruritus at the application site. Cost or insurance coverage may be a limiting factor in choosing the best therapeutic agent, with mupirocin ointment having the lowest cost. Mupirocin has shown clinical efficacy against MRSA but a bacterial culture is recommended to rule out resistance. Ozenoxacin and retapmulin are effective alternatives but may entail higher cost. Retapamulin is indicated for lesions of impetigo that are colonized by MSSA and streptococcus S. pyogenes but not MRSA based on clinical efficacy of phase III trials. Fusidic acid, available in other countries is a non-FDA approved medication although rising resistance rates represent a growing concern.
Background:
Bacterial folliculitis and boils are globally prevalent bacterial infections involving inflammation of the hair follicle and the perifollicular tissue. Some folliculitis may resolve spontaneously, but others may progress to boils without treatment. Boils, also known as furuncles, involve adjacent tissue and may progress to cellulitis or lymphadenitis. A systematic review of the best evidence on the available treatments was needed.
Objectives:
To assess the effects of interventions (such as topical antibiotics, topical antiseptic agents, systemic antibiotics, phototherapy, and incision and drainage) for people with bacterial folliculitis and boils.
Search methods:
We searched the following databases up to June 2020: the Cochrane Skin Specialised Register, CENTRAL, MEDLINE, and Embase. We also searched five trials registers up to June 2020. We checked the reference lists of included studies and relevant reviews for further relevant trials. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that assessed systemic antibiotics; topical antibiotics; topical antiseptics, such as topical benzoyl peroxide; phototherapy; and surgical interventions in participants with bacterial folliculitis or boils. Eligible comparators were active intervention, placebo, or no treatment.
Data collection and analysis:
We used standard methodological procedures expected by Cochrane. Our primary outcomes were 'clinical cure' and 'severe adverse events leading to withdrawal of treatment'; secondary outcomes were 'quality of life', 'recurrence of folliculitis or boil following completion of treatment', and 'minor adverse events not leading to withdrawal of treatment'. We used GRADE to assess the certainty of the evidence.
Main results:
We included 18 RCTs (1300 participants). The studies included more males (332) than females (221), although not all studies reported these data. Seventeen trials were conducted in hospitals, and one was conducted in clinics. The participants included both children and adults (0 to 99 years). The studies did not describe severity in detail; of the 232 participants with folliculitis, 36% were chronic. At least 61% of participants had furuncles or boils, of which at least 47% were incised. Duration of oral and topical treatments ranged from 3 days to 6 weeks, with duration of follow-up ranging from 3 days to 6 months. The study sites included Asia, Europe, and America. Only three trials reported funding, with two funded by industry. Ten studies were at high risk of 'performance bias', five at high risk of 'reporting bias', and three at high risk of 'detection bias'. We did not identify any RCTs comparing topical antibiotics against topical antiseptics, topical antibiotics against systemic antibiotics, or phototherapy against sham light. Eleven trials compared different oral antibiotics. We are uncertain as to whether cefadroxil compared to flucloxacillin (17/21 versus 18/20, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.70 to 1.16; 41 participants; 1 study; 10 days of treatment) or azithromycin compared to cefaclor (8/15 versus 10/16, RR 1.01, 95% CI 0.72 to 1.40; 31 participants; 2 studies; 7 days of treatment) differed in clinical cure (both very low-certainty evidence). There may be little to no difference in clinical cure rate between cefdinir and cefalexin after 17 to 24 days (25/32 versus 32/42, RR 1.00, 95% CI 0.73 to 1.38; 74 participants; 1 study; low-certainty evidence), and there probably is little to no difference in clinical cure rate between cefditoren pivoxil and cefaclor after 7 days (24/46 versus 21/47, RR 1.17, 95% CI 0.77 to 1.78; 93 participants; 1 study; moderate-certainty evidence). For risk of severe adverse events leading to treatment withdrawal, there may be little to no difference between cefdinir versus cefalexin after 17 to 24 days (1/191 versus 1/200, RR 1.05, 95% CI 0.07 to 16.62; 391 participants; 1 study; low-certainty evidence). There may be an increased risk with cefadroxil compared with flucloxacillin after 10 days (6/327 versus 2/324, RR 2.97, 95% CI 0.60 to 14.62; 651 participants; 1 study; low-certainty evidence) and cefditoren pivoxil compared with cefaclor after 7 days (2/77 versus 0/73, RR 4.74, 95% CI 0.23 to 97.17; 150 participants; 1 study; low-certainty evidence). However, for these three comparisons the 95% CI is very wide and includes the possibility of both increased and reduced risk of events. We are uncertain whether azithromycin affects the risk of severe adverse events leading to withdrawal of treatment compared to cefaclor (274 participants; 2 studies; very low-certainty evidence) as no events occurred in either group after seven days. For risk of minor adverse events, there is probably little to no difference between the following comparisons: cefadroxil versus flucloxacillin after 10 days (91/327 versus 116/324, RR 0.78, 95% CI 0.62 to 0.98; 651 participants; 1 study; moderate-certainty evidence) or cefditoren pivoxil versus cefaclor after 7 days (8/77 versus 5/73, RR 1.52, 95% CI 0.52 to 4.42; 150 participants; 1 study; moderate-certainty evidence). We are uncertain of the effect of azithromycin versus cefaclor after seven days due to very low-certainty evidence (7/148 versus 4/126, RR 1.26, 95% CI 0.38 to 4.17; 274 participants; 2 studies). The study comparing cefdinir versus cefalexin did not report data for total minor adverse events, but both groups experienced diarrhoea, nausea, and vaginal mycosis during 17 to 24 days of treatment. Additional adverse events reported in the other included studies were vomiting, rashes, and gastrointestinal symptoms such as stomach ache, with some events leading to study withdrawal. Three included studies assessed recurrence following completion of treatment, none of which evaluated our key comparisons, and no studies assessed quality of life.
Authors' conclusions:
We found no RCTs regarding the efficacy and safety of topical antibiotics versus antiseptics, topical versus systemic antibiotics, or phototherapy versus sham light for treating bacterial folliculitis or boils. Comparative trials have not identified important differences in efficacy or safety outcomes between different oral antibiotics for treating bacterial folliculitis or boils. Most of the included studies assessed participants with skin and soft tissue infection which included many disease types, whilst others focused specifically on folliculitis or boils. Antibiotic sensitivity data for causative organisms were often not reported. Future trials should incorporate culture and sensitivity information and consider comparing topical antibiotic with antiseptic, and topical versus systemic antibiotics or phototherapy.
The tissue engineering is governed by use of cells and polymers. The cells may be accounted for type of tissue to be targeted, while polymers may vary from natural to synthetic. The natural polymers have advantages such as non immunogenic and complex structures that helps in formation of bonds in comparison to the synthetic ones. Various targeted drug delivery systems have been prepared using polymers and cells such as nanoparticles, hydrogels, nanofibers and micro-spheres. The design of scaffolds depends on the negative impact of material used on the human body and they have been prepared either using surface modification technique or neo material synthesis. The dermal substitutes are a distinctive array that aims at replacement of skin part either through grafting or some other means. This review focuses on biomaterials, for their use in tissue engineering. This article shall provide the bird eye view about the scaffolds and dermal substitutes, which are naturally derived.
Anthrax is an infection caused by bacterium Bacillus anthracis (B. anthracis), and is an old disease that poses a new threat to humans as a biological weapon. Gram-staining and polymerase chain reaction (PCR)-based assays of specimens are standard diagnostic tools for anthrax, but it is time-consuming and limited for the on-site application. In this study, we disclose a porous silicon-based nanoprobe for the detection of dipicolinic acid (DPA), which is a crucial biomarker of the anthrax spore, and its practical sensing applications. The surface of the porous silicon nanoparticles (pSiNPs) was functionalized with multiple amine arms, via a ring-opening click amination and was grafted with terbium ion (Tb³⁺). A double antenna effect from DPA and pSiNPs to Tb³⁺ was appeared dramatically and was accompanied by a significant fluorescence enhancement that had high selectivity, sensitivity, and fast response time. The resulting pSiNPs-Tb formulation was used to detect DPA in real water samples and the stimulated Bacillus subtilis (B. subtilis) spores. Besides, the DPA sensing application on the cellulose-based paper was successfully demonstrated as a real-time on-site sensing kit. We believe the demonstrations in this study could encourage further applications throughout a wide variety of fields.
Introduction
Diphtheria due to Corynebacterium diphtheriae (C. diphtheriae) has become rare in developed countries. In France only 10 cases of toxigenic diphtheria have been reported since 1989, in all cases causing pharyngitis and all emanating from endemic countries with exception of one contact case. We report herein 13 cases with cutaneous diphtheria, in 5 of which diphtheria toxin was produced, and all imported into France between 2015 and 2018.
Observations
Thirteen patients aged 4 to 77 years presented painful and rapidly progressive round ulcerations of the legs, that were superficial and in some cases purulent, with an erythematous-purple border covered with greyish membrane. Bacteriological sampling of ulcers revealed the presence of C. diphtheriae. Only 6 patients had been properly immunized over the preceding 5 years.
Discussion
These cases underline the resurgence of cutaneous diphtheria and the circulation of toxigenic strains in France following importation from Indian Ocean countries. This may constitute an important reservoir for ongoing transmission of the disease. Re-emergence of this pathogen stems from the current migratory flow and decreased adult booster coverage.
Conclusion
Cutaneous diphtheria should be considered in cases of rapidly developing painful skin ulcers with greyish membrane, especially among patients returning from endemic areas, regardless of their vaccination status. The clinician should order specific screening for C. diphtheriae from the bacteriologist, since with routine swabbing Corynebacteriaceae may be reported simply as normal skin flora. Vaccination protects against toxigenic manifestations but not against actual bacterial infection. Early recognition and treatment of cutaneous diphtheria and up-to-date vaccination are mandatory to avoid further transmission and spread of both cutaneous and pharyngeal diphtheria.
Pyoderma gangrenosum (PG) is a rare, ulcerating, inflammatory disease that is often misdiagnosed as a skin and soft tissue infection. If PG is identified, it is treated with topical or systemic immunosuppressants to reduce inflammation and induce remission. However, the use of immunosuppressants has been linked to a higher risk of superimposed infections. The authors report the case of a 24-year-old female patient with bilateral lower extremity PG with a superimposed infection of Pseudomonas aeruginosa and Bacteroides fragilis after intralesional corticosteroid therapy.
Bioprinting is an additive mechanism–based technology where the living cells are impregnated and the media used for bioprinting is known as bioink. The nature of the material determines the output as well as the process or mechanism to be followed. The science behind the printing needs to be decoded to gain insight into the basic mechanism behind three-dimensional printing. The printing process is controlled via computers so that the minute detailing of the whole process could be controlled. In this chapter, a detailed review about the technologies available for bioprinting of artificial extracellular matrices, along with the bioinks employed for their printing is provided. A detailed review of the bioink materials such as hydrogels, cell aggregates, microcarriers, and decellularized matrix components has been undertaken.
Background
Pyoderma gangrenosum (PG) is a chronic, ulcerative neutrophilic dermatosis. PG presents a diagnostic challenge, largely due to the many mimicking diseases, the lack of confirmatory laboratory or biological markers, and the absence of widely accepted diagnostic criteria. In particular, PG is often mistaken for necrotizing soft tissue infections (NSTI).
Methods
We reviewed four major textbooks each in general surgery, plastic surgery, trauma surgery, vascular surgery, emergency medicine, and dermatology. We also performed a search of review articles addressing NSTI and necrotizing fasciitis (NF).
Results
Ten out of the 20 non-dermatology textbooks did not list PG anywhere, and only two listed a differential diagnosis for PG. None of the non-dermatology textbooks indicated PG in the NSTI differential diagnosis, while three of the dermatology textbooks included PG in the NSTI differential diagnosis. PG was listed in all of the dermatology textbooks. Only one of the NSTI and NF articles mentioned PG in the differential diagnosis.
Conclusions
There is an underrepresentation in major textbooks of surgery and emergency medicine and in NSTI and NF review articles when it comes to diagnosing PG. This might be leading to trainees and advanced providers in these fields being uninstructed on PG, and likely contributes to PG misdiagnosis and mismanagement. We recommend PG be included in the differential diagnosis of chronic ulcers and NSTI in non-dermatology textbooks. We also suggest adding identification and diagnosis of inflammatory mimickers of NSTI (e.g. PG) in teaching modules in surgical and emergency specialties to address this knowledge gap.
