[Epidemiology of dermatomycoses in Slovakia]. / Epidemiologická situácia výskytu dermatomykóz v Slovenskej republike.

The authors analyze the incidence of dermatomycoses in the Slovak Republic in 1994-1999. They found an increase of these infections in particular epidermophytoses, trichophytoses and candidoses. From 25,762 examined subjects with suspicion of dermatomycosis they isolated in 1990 till 1999 8,237 cultures of dermatophytes. The most frequent causal agent was Trichophyton rubrum (81.61%). In the conclusion the authors draw attention to the inevitability of introduction of effective preventive measures.

The effect of nickel sulphate, potassium dichromate, cobalt nitrate and cadmium sulphate on the proteins of cellular contacts and actin skeleton of cultivated human keratinocytes.

UNLABELLED: The authors tested the effects of known allergens, namely nickel sulphate, potassium dichromate, cobalt nitrate and cytotoxic cadmium sulphate on the proteins of cellular contacts (vinculin, talin, E-cadherin, desmoplaktin) and actin cytoskeleton (actin filaments) of cultivated human keratinocytes. The localisation of proteins of cellular contacts was detected by means of direct immunofluorescence. The authors have detected a decrease in, and destruction of cellular contact proteins and actin cytoskeleton after testing the effect of all allergens, while the most significant changes were detected in E-cadherin, vunkulin and actin filaments. Desmoplaktin and talin were less damaged. Potassium dichromate caused damage already in concentration of 1 microg/ml. A similar effect of the other two tested haptanes was brought about in concentration being 100-fold higher. CONCLUSION: the gained results indicate that the investigation of cellular contact proteins and actin cytoskeleton of cultivated human keratinocytes can possibly become a part of the testing of allergy-triggering potential of chemical substances. (Tab. 1, Fig. 4, Ref. 18.)

[Skin manifestations of Lyme borreliosis in patients at the 1st Dermato-venereologic Clinic of Comenius University Medical School in Bratislava 1996-1998]. / Kozné prejavy lymskej boreliózy u pacientov 1. dermatovenerologickej kliniky LF UK v Bratislave v rokoch 1996-1998.

60-70% of Lyme borreliosis is formed by early manifestations, in particular erythema migrans (EM). All vegetative forms of the tick Ixodes ricinus (e.g. full grown tick, nymphae and larvae) transmit the causal organism, the spirochete Borrelia burgdorferi sensu stricto and Borrelia burgdorferi sensu lato (B. garinii, B. afzelii). The objective of the work was to evaluate clinical and epidemiological parameters and to contribute by testing and investigating in greater detail criteria to the early and exact diagnosis of the disease. In a group of 50 patients the time of development of EM was evaluated, the mode of transmission, the incubation period, localization, symptoms of dissemination of B. burgdorferi, the period of treatment and the antibiotic used. The dynamics of the antibody titre against B. burgdorferi (IFA test) were assessed in 21 patients with EM for a period of 1 to 22 months and in 5 patients with acrodermatitis chronic atrophicans (ACA) for 3 to 55 months. In 50% EM developed during the summer months. 66% reported as the vector a tick, 14% insects and 20% did not know. An incubation of 1 and 2 weeks was reported in 34%, the lower extremities were affected in 52%. Manifestations of dissemination were found in 6 patients, in 2 patients EM relapsed. Antibodies (Ab) against B. burgdorferi were present in 38 patients. In 21 patients the dynamics of the antibody titre were followed up for 1 to 22 months and no substantial changes were found. Serum positivity in patients with ACA persisted without change of the titre for several years. In the treatment of EM most frequently doxycycline was administered for two weeks. EM as the early stage of LB is a seasonal disease with a natural focus. If treatment is started in the early stage of infection, antibodies against B. burgdorferi need not develop. There is no correlation between clinical complaints and serological results and the type of treatment. The prognosis of the disease is favourable in the majority of patients. Vaccination offers new possibilities in active protection against Borrelia infection, in particular in endemic areas. For European countries at present a recombined vaccine is being prepared from the surface lipoprotein A (OspA) made from prevalent strains of B. afzelii and B. garinii.

[Borrelia burgdorferi antibodies in scleroderma circumscripta, lichen sclerosus et atrophicus, erythema nodosum, granuloma annulare, erythema annulare and chronic urticaria]. / Protilátky proti Borrelia burgdorferi pri sclerodermia circumscripta, lichen sclerosus et atrophicus, erythema nodosum, granuloma anulare, erythema anulare a urticaria chronica.

OBJECTIVES: The role of B. burgdorferi in the etiology of sclerodermia circumscripta (SC) and lichen sclerosus et atrophicus (LSA) are is reported in numerous, however controversial studies. The objective of our study is to approximate the solution of the given problem and to widen these consideration by other diagnoses with multifactorial and unclear etiology such as erythema nodosum (EN), granuloma anulare (GA), erythema anulare (EA) and urticaria chronica. MATERIAL AND METHODS: 124 probands were divided into groups according the diagnoses presented above and compared with the negative control group of 131 probands with dermatologic diagnoses, in which the etiologic agent of B. burgdorferi was not assumed and positive group of 55 probands with lyme boreliosis. Indirect immunofluorescent test was used to find out the tieter of antibodies against B. burgdorferi in all groups by using the endemic strains as antigens, which has caused a higher value of the so-called cut-off. RESULTS: The negative control had a positive titer in 44 cases (n = 131, i.e. in 33.6%). The positive titer was found in 11 probands from the SC group (34.4% =, n = 32), 5 probands in LSA (71.4%, n = 7), 9 probands in the EN group (64.3%, n = 14), 6 probands in the EA and GA groups (42.3%, n = 14) and 19 probands in the group of urticaria chronica (33.3%, n = 57). CONCLUSION: We assume that in the probands with high titers of antibodies, B. burgdorferi could play a role in the etiology of the given diseases titers of antibodies against B. burgdorferi. The draft problem could be solved by modern method including PCR with the use of several primers focused on different antigens regarding the certain epidemiologic regions. (Fig. 7, Ref. 17.)

[Skin manifestations of Lyme borreliosis--occurrence, diagnosis, therapy]. / Kozné prejavy lymskej boreliózy--výskyt, diagnostika, terapia.

Eight genotypes of Borrelia burgdorferi are known currently. In Slovakia (Carpathian Euroregion) the most frequent genotypes are B. garini, B. afzelii, as well as B. valaisiana and B. lusitaniae. Infestation of the vector Ixodes ricinus is 3-30%. The most frequent early skin manifestation is erythema migrans (60-70%). Borrelia burgdorferi is suggested to be the causative agent in sclerodermia circumscripta, lichen sclerosus et atrophicus, maybe also in urticaria chronica, granuloma anulare, erythema anulare, erythema nodosum. It can be the causative agent also in neurological diagnoses as e.g. chronic oligosymptomatic encephalopathy, "sclerosis multiplex-like" syndrome and fatigue syndrome, arthralgia, myalgia, seronegative indifferentiated oligoarthritis and fibromyalgies. The serological diagnosis has to be coincide with clinical findings. Used serological examinations are ELISA, Immunoblot, indirect immunofluorescence examination. PCR is an important contribution in examination of synovial fluid (85% detection) and cerebrospinal liquor (24-100%). The importance of PCR is stressed in cases with mixed infections by several borrrelia genotypes. The first line treatment includes doxyciclin, amoxicilin, and erythromycin. The second line includes macrolides, cephalosporines. New perspectives are ascribed to active immunisation with recombined antigen OsA (LYMErix, ImuLyme).

[Etiopathogenesis and therapy of dermatophytosis of the nails]. / Etiopatogenéza a terapia dermatofytóz nechtov.

The importance of mycotic infections of the skin and its adnexa has a rising trend. The causal agents are not only dermatophytes and candidae but to an increasing extent opportune fungal microorganisms. Most frequently these diseases develop during intense immunosuppressive treatment, e.g. in oncological, oncohaematological diseases and in developed AIDS syndrome. In addition to the reduced defence capacities of the organism favourable conditions are created e.g. by antibiotic treatment, treatment with female hormones, unsuitable clothing, obesity, a certain part is played also by occupational predisposition. Treatment of onychomycoses is complicated and difficult. Before griseofulvin was available there was only surgical ablation and treatment with keratolytics. At present a number of substances with marked fungistatic effects is available. The author mentions: griseofulvin, ketoconazole, fluconazole, itraconazole (azole derivatives), allylamines (terbinafine-Lamisil). He discusses the mode of administration, dosage and undesirable effects. The recent antimycotics are ciclopiroxolamines (Batrafen) and amorolfin (Loceryl) in the form of lac.

Omega-3 fatty acid-based lipid infusion in patients with chronic plaque psoriasis: results of a double-blind, randomized, placebo-controlled, multicenter trial.

BACKGROUND: Profound changes in the metabolism of eicosanoids with increased concentrations of free arachidonic acid (AA) and its proinflammatory metabolites have been observed in psoriatic lesions. Free eicosapentaenoic acid (EPA) may compete with liberated AA and result in an antiinflammatory effect. OBJECTIVE: Our purpose was to assess the efficacy and safety of intravenously administered fish-oil-derived lipid emulsion on chronic plaque-type psoriasis. METHODS: A double-blind, randomized, parallel group study was performed in eight European centers. Eighty-three patients hospitalized for chronic plaque-type psoriasis with a severity score of at least 15 according to the Psoriasis Area and Severity Index (PASI) participated in a 14-day trial. They were randomly allocated to receive daily infusions with either a omega-3 fatty acid-based lipid emulsion (Omegavenous; 200 ml/day with 4.2 gm of both EPA and docosahexaenoic acid (DHA); 43 patients) or a conventional omega-6-lipid emulsion (Lipovenous; EPA+DHA < 0.1 gm/100 ml; 40 patients). The groups were well matched with respect to demographic data and psoriasis-specific medical history. Efficacy of therapy was evaluated by changes in PASI, in an overall assessment of psoriasis by the investigator, and a self-assessment by the patient. In one center neutrophil 4- versus 5-series leukotriene (LT) generation and platelet 2- versus 3- thromboxane generation were investigated and plasma-free fatty acids were determined. RESULTS: The total PASI score decreased by 11.2 +/- 9.8 in the omega-3 group and by 7.5 +/- 8.8 in the omega-6 group (p = 0.048). In addition, the omega-3 group was superior to the omega-6 group with respect to change in severity of psoriasis per body area, change in overall erythema, overall scaling and overall infiltration, as well as change in overall assessment by the investigator and self-assessment by the patient. Response (defined as decrease in total PASI of at least 50% between admission and last value) was seen in 16 of 43 patients (37%) receiving the omega-3 emulsion and 9 of 40 patients (23%) receiving omega-6 fatty acid-based lipid emulsion. No serious side effects were observed. Within the first few days of omega-3 lipid administration, but not in the omega-6 supplemented patients, a manifold increase in plasma-free EPA concentration, neutrophil leukotriene B5 and platelet thromboxane B3 generation occurred. CONCLUSION: Intravenous omega-3-fatty acid administration is effective in the treatment of chronic plaque-type psoriasis. This effect may be related to changes in inflammatory eicosanoid generation.

[Lyme borreliosis--diagnosis, clinical aspects and therapy of the cutaneous form]. / Lymská borelióza--diagnostika, klinika a terapia kozných foriem.

Occurrence of Lyme borreliosis and namely its skin forms have a rising tendency. Thick population of ticks and their relatively high contamination with borrelia (app. 9% in Slovakia), increased presence of man in nature and frequent professional exposition create good conditions for the spreading of the disease. During the period of 20 months in 1993-1994 19 cases of borreliosis were recorded among 2,187 patients hospitalized at the Bratislava Dermatologic Clinic--17 cases of erythema chronicum migrans and two cases of acrodermatitis chronica atrophicans. All patients stated that they came into contact with ticks 24 hours--12 months prior to the origin of dermatologic alterations. 14 cases of erythema chronicum migrans being IFT examined by means of B. burgdorferi antigen included 10 patients who yielded the titre of antibodies higher than 1:256; 6 patients being examined by means of ELISA test included 2 positive findings. The IFT values varied also in cases of classical clinical picture of erythema chronicum migrans and a discrepancy was observed between IFT and ELISA results. Two cases of acrodermatitis chronica atrophica had positive serologic test. The serologic tests were performed also in 4 cases of scleroderma with positive results. Into their analysis the authors included also other studies on the basis of which they present schemes of diagnostic examination and therapeutic interventions in Lyme borreliosis. (Tab. 2, Ref. 4.)

The occurrence of dermatophytes in Slovakia.

We have compared the epidemiology of dermatophytoses in Slovakia during the periods 1956-85 and 1986-92. Infections caused by Trichophyton rubrum gradually increased while infections due to Trichophyton verrucosum and Microsporum canis decreased.

Relationship between antifungal activity and hydrophobicity of kojic acid derivatives.

Twenty three kojic acid derivatives were tested in the agar diffusion test against twenty five dermatophytic fungi. The inhibitory effects at equal doses (10 mg/L) were correlated with the 1-octanol-water partition coefficients of the compounds. An improvement in antifungal activity can be achieved by increasing the hydrophobicity of the compounds.

[Microsporum canis infection in rabbits and its transmission to humans]. / Microsporum canis-Infektion beim Kaninchen mit Ubertragung auf den Menschen.

The infection of the capillitium of an 8-year old child due to Microsporum canis is described. The child occasionally visited its mother working at an animal farm. The focus of the infection was found in farm rabbits infected by M. canis. A contamination of the environment (cages and floors) by the above mentioned dermatophyte could also be demonstrated. The infection was transferred to an animal feeder as well. The infection focus was eliminated by strict disinfection and sanitary measures. The importance of the mycological examination of animals with focal loss of hair is stressed.

An evaluation of topical mupirocin in moderately severe primary and secondary skin infections.

Five days' treatment with topical mupirocin, applied twice daily, in 36 patients with moderately severe primary and secondary skin infections, resulted in resolution/much improvement of skin lesions in 75.0% of patients and bacterial eradication in 83.9% of cases. Penicillin-resistant and penicillin-sensitive staphylococci were most commonly implicated. No adverse effects were reported in any of the patients treated. Physicians' assessment of cure/improvement was recorded in 91.7% of patients.