Inverse salt sensitivity: an independent risk factor for cardiovascular damage in essential hypertension.

OBJECTIVE: Salt sensitivity is a powerful risk factor for cardiovascular (CV) disease and mortality in both normotensive and hypertensive patients. We investigated the predictive value of the salt sensitivity phenotype in the development of CV events and hypertensive target organ damage (TOD) among essential hypertensive patients. METHODS: Eight hundred forty-four naive hypertensive patients were recruited and underwent an acute saline test during which blood pressure (BP) displayed either no substantial variation (salt-resistant, SR individuals), an increase (salt-sensitive, SS), or a paradoxical decrease (inverse salt-sensitive, ISS). Sixty-one patients with the longest monitored follow-up (median 16 years) for blood pressure and organ damage were selected for the present study. A clinical score for TOD development based on the severity and the age of onset was set up by considering hypertensive heart disease, cerebrovascular damage, microalbuminuria, and vascular events. RESULTS: CV events were significantly higher among SS and ISS than in SR patients. The relative risk of developing CV events was 12.67 times higher in SS than SR and 5.94 times higher in ISS than SR patients. The development of moderate to severe TOD was 10-fold higher in SS and over 15-fold higher in ISS than in SR patients. Among the three phenotypes, changes in plasma endogenous ouabain were linked with the blood pressure effects of saline. CONCLUSIONS: Salt sensitivity and inverse salt sensitivity appear to be equivalent risk factors for CV events. The response to an acute saline test is predictive of CV damage for newly identified ISS individuals.

Bullous cutaneous larva migrans: case series and review of atypical clinical presentations.

Hookworm-related cutaneous larva migrans (HRCLM) is caused by the penetration and migration in the epidermis of larvae of Ancylostoma braziliense and Ancylostoma caninum. It is characterized by slightly raised and erythematous tracks, located especially on the feet. These tracks may be single or multiple, serpiginous or linear, ramified and intertwined, accompanied by pruritus. Atypical clinical presentations of HRCLM are currently more frequent than in the past. We present six patients with bullous HRCLM and discuss the possible pathogenetic factors. Furthermore, we present a review of atypical clinical presentations of HRCLM. From 1998 to 2013 we observed approximately 180 patients with HRCLM. In all patients race, nationality, sex, age, country of infestation, location of the disease, clinical picture, laboratory and instrumental examinations and therapy were collected. In six patients (4 males and 2 females), we made a diagnosis, based on the history and clinical picture, of bullous HRCLM. The infestation was characterized by single or multiple blisters, round or oval in shape, of different size, with a clear serous fluid. Some tracks were also visible. All patients complained of pruritus. General physical examination and laboratory and instrumental examinations were normal or negative. Cytological examinations of the blisters showed the presence of lymphocytes and neutrophils, with numerous eosinophils. All patients were successfully treated with oral albendazole. Blisters appear because of the release by the larvae of lytic enzymes (metalloproteases and hyaluronidases). Furthermore, blisters might be the final clinical result of a delayed hypersensitivity reaction due to the release by larvae of unknown antigens. Finally, only in some patients, bullous HRCLM might represent an acute irritant/allergic contact dermatitis caused by topical drugs applied on the lesions. This hypothesis has been excluded in our patients because no topical treatment was made before our observation.

Treatment of sporotrichoid fish tank granuloma with pulsed clarithromycin.

BACKGROUND: There is no established therapy of choice for Mycobacterium marinum skin infections; clarithromycin monotherapy was used in some anecdotical cases at changeable daily doses and length. OBJECTIVE: To evaluate the efficacy and safety of pulsed clarithromycin monotherapy. METHODS: 29 patients with a clinical diagnosis of sporotrichoid fish tank granuloma were admitted from 2002 to 2013. In 14 patients, the clinical diagnosis was confirmed by history, histopathology and bacteriological examinations. All patients were treated with clarithromycin (500 mg/day for 10 consecutive days/month for 5 months). RESULTS: In 12 out of 14 patients (85.7%) complete clinical remission was recorded. Two patients showed partial remission after 3 months of therapy, but they were lost to follow-up and were therefore not considered evaluable. CONCLUSION: Our study suggests that pulsed clarithromycin monotherapy is effective and safe in sporotrichoid M. marinum skin infections.

Scolopendra bites: a report of two cases and review of the literature.

BACKGROUND: Centipedes are arthropods belonging to the class Chilopoda. Approximately 3000 species have been described. Centipedes are found more commonly in tropical and subtropical countries. Centipedes possess venomous fangs. The Scolopendra represent the best-known genus of centipede. METHODS: We describe two cases of severe skin reactions caused by Scolopendra subspinipes bites. RESULTS: Both patients were bitten on the hand. The clinical picture was characterized by severe erythematous edema. In addition, one patient presented with a blister. Both patients complained of severe pain. Laboratory examinations showed leukocytosis and an increase in erythrocyte sedimentation rate (ESR). Complete remission was achieved within two weeks by means of paracetamol and oral prednisone. CONCLUSIONS: Western dermatologists should be aware of the possibility of severe skin reactions caused by centipede bites.

Anthrax of the lower lip.

Anthrax of the oral cavity and oropharynx is well known, whereas anthrax of the lips is very rare. We present a case of anthrax of the lower lip in a 57-year-old man. The infection was characterized by a wide, black eschar, surrounded by vesicles, crusts, and erythematous-edematous halo, with submandibular and laterocervical lymphadenopathy. The oral cavity, oropharynx, and tonsils were normal. Laboratory examinations revealed leukocytosis and increased inflammatory markers. Otolaryngologic, gastrointestinal, lung, and neurologic examinations were negative. The patient was successfully treated with oral ciprofloxacin. Although rare, anthrax should be considered in the differential clinical diagnosis in patients returning from areas where this disease is endemic.

Paederus fuscipes dermatitis: a report of nine cases observed in Italy and review of the literature.

Paederus sp. is a beetle belonging to Staphylinidae family and Coleoptera order. Its distribution is worldwide, especially in hot climates. Over 600 species of Paederus are known, approximately 50 are able to cause an irritant contact dermatitis. When the beetle is accidentally crushed on the skin, it releases pederin, a potent toxin with vesicating action. In Europe, only anecdotical cases of Paederus sp. dermatitis have been reported. Since 1993, we have observed approximately 25 patients with suspected Paederus sp. dermatitis. In 9 the clinical diagnosis was confirmed because Paederus fuscipes were found. The case list includes 6 males and 3 females, ages ranging from 6 to 53 years (mean age: 26.3 years). Six patients presented with one lesion and 3 with 2 lesions. Eyelids (3 patients), shoulders (3), neck (2), cheek (1), breast (1), back (1) and calf (1) were involved. All patients showed erythema, 2 oedema, 2 blisters, 1 vesicles, 1 pustules and 1 crusts. In the patient with pustules, bacteriological examinations were negative. A biopsy was carried out in 4 patients. In the early stages, spongiosis with exocytosis of neutrophils was observed. Vesicles with neutrophils and necrosis of the epidermis were typical of the advanced stage. Oedema of the dermis and a mixed infiltrate, with eosinophils, neutrophils and lymphocytes, in the papillary and upper reticular dermis, were also observed. Direct immunofluorescence was negative in all patients. Paederus sp. should also be considered in temperate climates as a possible aetiological agent in cases of acute dermatitis.