Identification and molecular characterization of Orfvirus infection in occupationally exposed women inSouth America

Abstract Contagious Ecthyma (CE) is a severe exanthematous dermatitis caused by the Orf virus (ORFV) that mainly affects domestic small ruminants such as sheep and goats. It is a worldwide-distributed occupational zoonosis, particularly infecting those in close contact with animals or animal products such as shepherds, farmers and veterinarians, among others. In the present work, we report the first human CE case confirmed in Argentina. A phylogenetic analysis based on four gene sequences of the isolated strain responsible for the disease showed that this isolate grouped with other ORFV sequences that caused reported CE cases in sheep from the same Argentine province. We also sequenced a sample from a Chilean human case reported in 2017, whose phylogenetic analysis showed that it groups together with other Argentine isolates from locations close to the border with Chile. Keywords: Contagious Ecthyma; Dermatitis; Human Orf; Zoonosis; Molecular characterization.

Resumen El ectima contagioso (EC) es una dermatitis exantemática grave causada por el virus Orf (ORFV), que afecta mayormente a pequeños rumiantes domésticos, como ovinos y caprinos. Es una zoonosis ocupacional con distribución mundial, infecta a humanos en estrecho contacto con animales o sus productos, como granjeros, esquiladores y veterinarios, entre otros. En este trabajo se informa el primer caso humano de EC confirmado en Argentina. Un análisis filogenético basado en cuatro genes de la cepa responsable de este caso mostró que el aislamiento agrupa con otras secuencias de ORFV que causaron casos en ovinos en la misma provincia argentina. También se secuenció una muestra del caso de ectima humano reportado en Chile en 2017 y el análisis filogenético mostró que dicho aislamiento forma un grupo con otros aislamientos argentinos de localidades cercanas a la frontera con Chile. Palabras clave: Ectima contagioso; Dermatitis; Orf en humanos; Zoonosis; Caracterización molecular.

Ectima gangrenoso en el paciente inmunocomprometido: debut leucemia aguda

El Ectima gangrenoso es un trastorno infeccioso infrecuente, clásicamente relacionado a bacteriemia, descrito principalmente en poblaciones inmunodeprimidas. Se asocia con la sepsis y bacteriemia por P. aeruginosa en pacientes inmunodeprimidos, incluidos aquellos con neutropenia o inmunodeficiencias, también se han descrito casos por hongos filamentosos y levaduras. Se ha observado en aproximadamente un 1,3-3 % de los casos de bacteriemia por P. Aeruginosa1. Se ha descrito ectima en pacientes con déficit en su inmunidad2, como en el caso que se describe a continuación. El Ectima puede presentarse como lesión única o múltiple, caracterizadas por máculas eritematosas que progresan a vesículas, bullas o pústula, evolucionando hasta la necrosis central con halo eritematoso. Se presenta el caso de un paciente con Ectima Gangrenoso, refractario inicialmente a tratamiento, que evolucionó con empeoramiento progresivo, presentándose en el hemograma hiperleucocitosis asociado a anemia y trombopenia, con diagnóstico ulterior de Leucemia Mieloide Aguda.

Ecthyma gangrenosum is an uncommon infectious disorder classically associated with bacteremia and found mainly in immunocompromised populations. It is associated with sepsis and Pseudomonas aeruginosa bacteremia in immunocompromised patients, including those with neutropenia or immune deficiencies. There have also been cases caused by filamentous fungi and yeasts. It has been seen in approximately 1.3 ­ 3% of Pseudomonas aeruginosa bacteremias. Ecthyma has been reported in immune-deficient patients, as in the case described below. Ecthyma can present with a single or multiple lesions with erythematous macules progressing to vesicles, bullas or pustules, which develop central necrosis with an erythematous halo. We present the case of a patient, later diagnosed with Acute Myeloid Leukemia, with ecthyma gangrenosum, initially refractory to treatment, which worsened progressively, presenting hyperleukocytosis associated with anemia and thrombocytopenia in the whole blood count.

Ectima gangrenoso, manifestación cutánea infrecuente de una infección por diversos agentes / Ecthyma gangrenosum, a rare cutaneous manifestation of infection by various agents

El ectima gangrenoso es un trastorno infeccioso infrecuente clásicamente relacionado a bacteriemia, descrito principalmente en poblaciones inmunodeprimidas. El agente más comúnmente relacionado es Pseudomonas aeruginosa, sin embargo, se han descrito otras etiologías bacterianas, hongos filamentosos y levaduras. Su patogénesis está dada por la invasión de la pared de los vasos sanguíneos, causando trombosis arterial y venosa, desencadenando necrosis de epidermis y tejidos subdérmicos. Clínicamente, se manifiesta como máculas, vesículas o pústulas hemorrágicas que evolucionan a úlceras de superficie necrótica rodeadas por un halo eritematoso característico, habitualmente en un contexto clínico de sepsis. El diagnóstico de este cuadro es clínico, sin embargo, el estudio microbiológico es clave en la identificación del agente etiológico y un posterior tratamiento dirigido. En su manejo es esencial una alta sospecha clínica y el inicio de tratamiento antibiótico en forma precoz. La duración del tratamiento es variable y en algunos casos debe asociarse a debridación quirúrgica. El pronóstico es variable dependiendo de múltiples factores: estado inmunológico, agente etiológico, presencia de sepsis y el tiempo de inicio de tratamiento.(AU)

Ecthyma gangrenosum is an infrequent infectious disorder classically related to bacteremia, described mainly in immunosuppressed populations. The most related agent is Pseudomonas aeruginosa, however other bacterial etiologies, filamentous fungi and yeasts have been described. Its pathogenesis is given by the invasion of the blood vessel wall, causing arterial and venous thrombosis, triggering necrosis of epidermis and subdermal tissues. Clinically, it manifests as hemorrhagic macules, vesicles or pustules that evolve into ulcers with a necrotic surface surrounded by a characteristic erythematous halo, usually in a clinical setting of sepsis. The diagnosis of this condition is clinical, however the microbiological study is key in the identification of the etiological agent and a subsequent directed treatment. In its management, a high clinical suspicion and an early start of antibiotic treatment are essential. The duration of treatment is variable and in some cases it must be associated with surgical debridement. The prognosis is variable depending on multiple factors: immunological status, etiological agent, presence of sepsis and time of initiation of treatment.(AU)

Severe bacterial skin infections

Abstract The severe bacterial diseases discussed herein are those that present dermatological lesions as their initial manifestations, for which the dermatologist is often called upon to give an opinion or is even the first to examine the patient. This review focuses on those that evolve with skin necrosis during their natural history, that is, necrotizing fasciitis, Fournier gangrene, and ecthyma gangrenosum. Notice that the more descriptive terminology was adopted; each disease was individualized, rather than being referred by the generic term "necrotizing soft tissue infections". Due to their relevance and increasing frequency, infections by methicillin-resistant Staphylococcus aureus (MRSA) were also included, more specifically abscesses, furuncle, and carbuncle, and their potential etiologies by MRSA. This article focuses on the epidemiology, clinical dermatological manifestations, methods of diagnosis, and treatment of each of the diseases mentioned.

Microorganismos más frecuentes en infecciones cutáneas en el Hospital Provincial General Ambato / Most frequent microorganisms in skin infections at the General Provincial Hospital "Ambato"

Las infecciones cutáneas producidas por microorganismos afectan directamente a la piel, partes blandas y tejidos, donde proliferan y ocasionan graves alteraciones. Estas infecciones constituyen un problema de salud pública, ya que muchos microorganismos muestran resistencia a antimicrobianos comunes y no comunes, lo cual incide directamente en la aplicación del tratamiento adecuado al paciente. El objetivo de este estudio fue identificar los microorganismos más frecuentes en infecciones cutáneas, su sensibilidad y resistencia a los antibióticos en los pacientes con infección que acudieron al Hospital Provincial General "Ambato" en el período mayo 2017 ­ junio 2018. La metodología empleada en esta investigación se basa en un estudio descriptivo, de corte transversal y enfoque cuali-cuantitativo, empleando la técnica documental y el reporte de resultados como instrumento. La información se tabuló y analizó mediante el paquete operativo Microsoft 2010. Se encontró que en el 29% de las muestras procesadas se aisló Staphylococcus aureus como el más frecuente en este tipo de infecciones, con mayor sensibilidad a Clindamicina, Doxacilina y Linezolid (100%) y resistencia a Penicilinas y Oxacilina (47,82%). Es importante destacar que el 47,83 % de las cepas de S. aureus aisladas expresaron fenotípicamente el gen mecA. La entidad clínica más frecuente asociada a este tipo de infección fue el ectima con un 55%. En conclusión, se comprobó la resistencia de cepas a diversos antibióticos presentando las más relevantes como meticilino resistentes, vancomicina resistentes y Klebsiella pneumoniae carbapenemasas

The skin infections caused by microorganisms directly alter the skin, soft tissues and tissues cause serious damage and the proliferation of them, which is a problem for health centers and hospitals, since these microorganisms are often resistant to antibacterial which are not very common is a problem for the treatment of the patient. The objective of this study was to identify the most frequent microorganisms in cutaneous infections, their sensitivity and resistance to antibiotics in the patients with infection who when to the General Provincial Hospital "Ambato", in the period May 2017 - June 2018 the methodology used in this investigation is based on a descriptive cutting study cross-section and qualitative-quantitative approach, using the documentary technique and the report of results as an instrument. The information was tabulated and analyzed using the Microsoft 2010 operating package. It was found that 29% of the samples processed were isolated Staphylococcus aureus as the most frequent in this type of infections, with greater sensitivity to Clindamycin, Doxacillin and Linezolid (100%) and resistance to Penicillins and Oxacillin (47,82%). It is important to note that 47,82% of strains of S. aureus were expressly phenotypically expressed in the mecA gene. The most frequent clinical entity associated with this type of infection was efficacy with 55%. In conclusion, the resistance of strains in several antibiotics was proved, presenting the most relevant ones as methicillin resistant, vancomycin resistant and Klebsiella pneumoniae carbapenemasas.

Ecthyma gangrenosum and agranulocytosis in a previously healthy 12-month-old girl: Report of 1 case with a literature review

Ecthyma gangrenosum (EG) is a rare skin manifestation which starts with a maculopapular eruption and followed by a necrotic ulcer covered with black eschar. EG usually occurs in immunosuppressed patients with Pseudomonas aeruginosa sepsis. We present a previously healthy 12-month-old girl with EG by P. aeruginosa and agranulocytosis due to influenza A and then rhinovirus infection, without bacteremia. It is important for allergists to culture wound and differentiate EG from other skin disorders including Tsutsugamushi disease and initiate appropriate empiric antipseudomonal antibiotic treatment, and to evaluate for possible immunodeficiency, even in a healthy child.

Orf virus ORF047 gene eukaryotic expression and cell localization / 中国人兽共患病学报

The object of study was to clone the gene of ORFV ORF047 and study the eukaryotic expression and cell localization,making the theoretical basis for the subsequest screening of protein that interact with ORF047.ORF047 gene was amplificated by the specifical primer from the DNA of ORFV using PCR,the length was 735 bp,compared with L1 published in NC-005336.1,the homologies of the nucleotide acid sequence and amino acid sequence were 98.8％ and 98.8％.In order to defined the expression and location of the ORF047 gene in cell,the recombinant plasmid pEGFP-ORF047 was constructed and transfected into 293T cell,after 36 h,the green fluorescence could be observed under fluorescence microscope,and 54 kD protein was detected by western bloting.The plasmid of pHcRed1-Nuc,pHcRed1-Mito and pHcRed1-ER with the recombinant plasmid of pEGFP-ORF047 was cotransfected to veroE6 cell respectively,that fusion protein of ORF047 was mainly located in the cytoplasm,a small amount in the mitochondriabyconfocal microscopy analysis.

Virus orf en humanos, confirmación molecular de un caso clínico en Chile / Orf virus in human, confirmation in case report from Chile

Resumen La infección por el virus orf, también conocida como ectima contagioso, es reconocida una zoonosis ocupacional. Se diagnostica por lesiones cutáneas que evolu cionan rápidamente desde máculas a pápulas, vesículas y pústulas. Se presenta el caso clínico de una estudiante de medicina veterinaria que había tenido contacto con caprinos, clínicamente sanos y sin lesiones aparentes, hacía 19 días. Presentó dos lesiones vesiculares que coalescieron hasta formar una lesión de mayor tamaño rodeada por un halo eritematoso. Las lesiones fueron compatibles con la presentación clásica de las producidas por el virus orf en humanos. Se confirmó la presencia del virus orf mediante una RPC anidada del tejido de biopsia. Es uno de los primeros casos confirmados mediante técnicas moleculares en seres humanos en Chile.

Infection with the orf virus, also known as contagious ecthyma, is recognized as an occupational zoonosis worldwide. It is diagnosed by cutaneous lesions that progress rapidly from macules to papules, vesicles and pustules. The clinical case of a student of veterinary medicine who had had contact with goats, clinically healthy and without apparent lesions, which occured 19 days ago, is reported. She presented two vesicular lesions that coalesced to form a larger lesion surrounded by an erythematous halo. The lesions were compatible with the classical presentation of those produced by the orf virus in humans. The presence of the orf virus was confirmed by a nested PCR from biopsy tissue. It is one of the first cases confirmed by molecular techniques in humans in Chile.

Ecthyma gangrenosum: a report of eight cases

Abstract: Ecthyma gangrenosum is a rare skin infection classically associated with Pseudomonas aeruginosa. We performed a retrospective study of all cases diagnosed with ecthyma gangrenosum from 2004-2010 in a university hospital in Mexico (8 cases, 5 female patients and 3 male patients, ages between 4 months and 2 years). The most common risk factor for ecthyma gangrenosum is neutropenia in immunocompromised patients. In previously healthy patients, immunological evaluation is important to rule out underlying immunodeficiency. Ecthyma gangrenosum in healthy patients has a high mortality rate and early diagnosis and aggressive antibiotic treatment is imperative as it can improve patients' prognosis.

Ecthyma Gangrenosum in a Previously Healthy Adolescent / 대한피부과학회지

No abstract available.

¿Cuál es el mejor tratamiento farmacológico para el ectima gangrenoso? / What is the best pharmacological treatment for ecthyma gangrenosum?

Se efectúa una breve revisión del tratamiento del ectima gangrenoso. El ceftazimide demostró menor morbi-mortalidad, mientras que los amino glucósidos y el imipemen, mayor mortalidad y resistencia respectivamente.

A brief review about the best treatment of the echthyma gangrenosum are reported. Ceftazidime showed less morbi-mortality while aminoglycosides and imipenem higher mortality and resistance.

Ectima gangrenoso secundario a Staphylococcus aureus / Ecthyma gangrenosum caused by Staphylococcus aureus

El ectima gangrenoso es una vasculitis necrosante poco frecuente, en la mayoría de los casos secundaria a sepsis por Pseudomonas aeruginosa en pacientes inmunocomprometidos. Sin embargo, existen reportes de ectima gangrenoso secundarios a otras etiologías infecciosas. Presentamos un caso de ectima gangrenoso asociado a una infección por Staphylococcus aureus resistente a meticilina en una paciente sin los factores de riesgo clásicos de inmunosupresión que se describen en la literatura médica.

Ecthyma gangrenosum is an uncommon necrotizing vasculitis, in most cases secondary to sepsis by Pseudo-mona aeruginosa in immunocompromised patients. However, there have been several reports of ecthyma gangre-nosum caused by other infectious etiologies. We report an unusual case of ecthyma gangrenosum associated with methicillin-resistant Staphylococcus aureus infection in a patient without the classic immunological risk factors described in the literature.

Otitis externa maligna con ectima gangrenoso en un paciente con infección por VIH / Malignant otitis externa with ecthyma gangrenosum in an hiv-positive patient

La otitis externa maligna es considerada una infección invasiva del conducto auditivo externo, infrecuente y sumamente agresiva, que llega, en ocasiones, a comprometer la base del cráneo. Se presenta habitualmente en inmunocomprometidos, incluidos aquellos con infección por VIH. El ectima gangrenoso es una infección cutánea localizada, inusual, causada, en la mayoría de los casos por Pseudomonas aeruginosa, con compromiso multisistémico y evolución tórpida. La asociación entre ambas entidades es aún más rara. A continuación, presentamos el caso de una mujer de 37 años, con el antecedente principal de infección por VIH desde hace 10 años, adherente al tratamiento antirretroviral y, a pesar de mantener una adecuada respuesta inmunológica y virológica, se presenta a la urgencia de nuestro hospital en shock séptico por otitis externa maligna, con ectima gangrenoso y posible síndrome hemofagocítico como complicación, aislándose Pseudomonas aeruginosa como agente causal.

Malignant otitis externa is an aggressive, infrequent and invasive infection of the external auditory canal. In some cases it leads to skull base compromise, particularly in immunocompromised individuals, including HIV-positive patients. Ecthyma gangrenosum is an unusual, localized cutaneous infection, caused mostly by Pseudomonas aeruginosa, with systemic compromise and a torpid evolution. An association between these 2 entities is even more rare. We present the case of a 37-year old woman with a history of 10 years’ HIV infection and good adherence to antiretroviral therapy. Although she had an adequate immunological and virological response, she presented at our emergency department in septic shock due to malignant otitis externa with ecthyma gangrenosum and possible haemophagocytic syndrome as a complication, with Pseudomonas aeruginosa determined to be the causative agent.

Nonpseudomonal ecthyma gangrenosum of the upper lid treated with lid reconstruction.

Ecthyma gangrenosum (EG) is a cutaneous infection which usually occurs in immunocompromised patients. We report a case of EG of the eyelid treated with escharotomy and skin grafting, highlighting the importance of surgical management. A 2‑year‑old Asian Indian female presented to us with right upper lid edema with a large necrotic area. The child received intravenous cefotaxime for a week and the necrotic area turned to a well‑defined eschar. Escharotomy with wound debridement and skin grafting was done. The present case highlights the importance of surgical intervention to prevent the sequelae of scarring of upper lid.

Clinical Observation of Ecthyma Treatment under Blue and Red Light Phototherapy Combined with TCM External Treatment / 中国药房

OBJECTIVE:To observe clinical efficacy and ADR of blue and red light phototherapy combined with TCM exter-nal treatment in the treatment of ecthyma. METHODS:64 ecthyma patients were randomly divided into experimental group and control group by number with 32 cases in each group. Both groups were provided with intravenous drip of Erigeron injection and Shenxiong glucose injection to improve limb microcirculation. The experimental group was also provided with blue and red light phototherapy (blue light 20 min+ red light 20 min) combined with TCM external treatment once a day;while control group was provided with only TCM external treatment once a day. After 1 month treatment,clinical efficacy and healing time of 2 groups were observed and compared,and ADR monitoring was conducted. RESULTS:The cure rate of experimental group was 78.13%, and the total effective rate was 96.88%,which were higher than those of control group(40.63% and 81.25%),there was statisti-cally significant difference (P<0.05). The average healing time of experimental group was (18.75 ± 5.97) d,and that of control group was(27.12 ± 6.67)d;there was statistically significant difference between 2 groups (P<0.05). No ADR was found in 2 groups during treatment. CONCLUSIONS:Blue and red light phototherapy combined with TCM external treatment in the treatment of ecthyma has the remarkable curative effect and good safety,and shorten the healing time.

Ectima gangrenoso en pediatría / Ecthyma gangrenosum in pediatrics

Resumen El ectima gangrenoso es una infección poco frecuente de la piel, conocida con una característica lesión causada principalmente por la Pseudomoma aeruginosa, pero que también se puede presentar por otro tipo de bacterias del tipo Staphylococcus aureus o el Streptococcus beta hemolítico del grupo A ( S. beta hemolítico del grupo A), entre otros. Esta entidad se asocia frecuentemente con inmunodeficiencias primarias y secundarias. Las lesiones, clínicamente, se presentan como máculas eritematovioláceas, descamativas que rápidamente evolucionan a papulovesículas, ampollas hemorrágicas y costrosas que dejan unas úlceras profundas en sacabocado con fondo necrótico. La mortalidad es alta, entre 40 y 75% de los individuos inmunológicamente comprometidos. Se describe el caso de una niña de 5 años que inicialmente presentó varicela y luego una sobreinfección por S. aureus ocasionando un cuadro clínico de un ectima gangrenoso; al diagnóstico se llega por la clínica, cultivos y biopsias de piel. Se realizó manejo con aciclovir, clindamicina y cefepime endovenoso, con buena y rápida respuesta de la paciente.

Abstract Ecthyma gangrenosum (EG) is a rare infection of the skin, known as a characteristic lesion caused by Pseudomoma aeruginosa , but also can occur from other types of bacteria like Staphylococcus aureus or beta hemolytic group, among others. This condition is often associated with primary and secondary immunodeficiencies. The lesions present clinically as scaly, erythematous violacious macules that rapidly evolve into papule-vesicles, bleeding and crusty blisters leaving a deep punch ulcer with a necrotic base. Mortality is high, between 40% and 75% of immunologically compromised individuals. We describe the case of a girl of 5 years of age who initially presented chickenpox and then superinfection with Staphylococcus aureus, causing a clinical picture of EG. The diagnosis was reached based on symptoms, cultures and skin biopsies. Management was achieved with acyclovir, intravenous clindamycin and cefepime, with a good and quick response by the patient.

Ectima gangrenoso y osteoartritis por pseudomonas aeruginosa en un paciente previamente sano / Ecthyma gangrenosum and osteoarthritis by pseudomonas aeruginosa in a previously healthy patient

Las infecciones por pseudomonas aeruginosa se presentan habitualmente en individuos con factores predisponentes, siendo excepcional su ocurrencia en los previamente sanos. Se describe el caso de un lactante de 2 meses sin antecedentes patológicos a destacar que presentó una infección grave por pseudomonas aeruginosa, presentando al momentode la consulta en emergencia lesiones en piel características de ectima gangrenoso. El reconocimiento de estas lesiones permite adecuar el tratamiento antibiótico empírico a la susceptibilidad antimicrobiana de este germen. La presencia de una infección por esta bacteria obliga al clínico a la búsqueda de inmunodeficiencias no diagnosticadas previamente...

Multiple Ecthyma Gangrenosum in a Hemophagocytic Lymphohistiocytosis Patient / 대한피부과학회지

No abstract available.

Ecthyma Gangrenosum Caused by Klebsiella Pneumoniae in Immunocompromised Patient Associated with Severe Aplastic Anemia / 임상소아혈액종양

Ecthyma gangrenosum (EG) is a skin infection that is classically associated with Pseudomonas aeruginosa septicemia in immunocompromised patients with severe neutropenia. Other bacterial, viral, and fungal pathogens also have been implicated in EG. EG is rare condition with characteristic clinical appearance of red macule that progresses to a central area presenting a necrotic black or gray-black eschar with surrounding erythema. The skin lesions usually occur in the gluteal and perineal regions or extremities and widespread over the body. Although the usual outcome is poor, early recognition and appropriate systemic antibiotic treatment can lead to successful outcome. Therefore, we describe a case of EG associated with Klebsiella pneimoniae in a 15-year-old patient with severe aplastic anemia and review the literature.

Ecthyma Gangrenosum Caused by Klebsiella Pneumoniae in Immunocompromised Patient Associated with Severe Aplastic Anemia / 임상소아혈액종양

Ecthyma gangrenosum (EG) is a skin infection that is classically associated with Pseudomonas aeruginosa septicemia in immunocompromised patients with severe neutropenia. Other bacterial, viral, and fungal pathogens also have been implicated in EG. EG is rare condition with characteristic clinical appearance of red macule that progresses to a central area presenting a necrotic black or gray-black eschar with surrounding erythema. The skin lesions usually occur in the gluteal and perineal regions or extremities and widespread over the body. Although the usual outcome is poor, early recognition and appropriate systemic antibiotic treatment can lead to successful outcome. Therefore, we describe a case of EG associated with Klebsiella pneimoniae in a 15-year-old patient with severe aplastic anemia and review the literature.