DNA identification of species of the Anopheles maculipennis complex and first record of An. daciae in Belgium.

The present study aimed at identifying the members of the Anopheles maculipennis complex (Diptera: Culicidae) occurring in Belgium. Therefore, the second internal transcribed spacer of nuclear ribosomal DNA (ITS2) and the mitochondrial cytochrome oxidase subunit I (COI) loci were sequenced in 175 and 111 specimens, respectively, collected between 2007 and 2019. In parallel, the suitability of two species-diagnostic PCR-RFLP assays was tested. The identified specimens included: An. maculipennis s.s. (N = 105), An. daciae (N = 62), An. atroparvus (N = 6) and An. messeae (N = 2). Each species was characterized by unique ITS2 haplotypes, whereas COI only supported the monophyly of An. atroparvus, a historical malaria vector in Belgium. Species identification results were further supported by unique PCR-RFLP banding patterns. We report for the first time An. daciae in Belgium, where it was found to co-occur with An. maculipennis s.s. The latter was the most prevalent in the collection studied (60%) and appears to have the widest distribution in Belgium. As in other studies, An. daciae and An. messeae appeared the most closely related species, up to the point that their species status remains debatable, while their ecological differences, including vector competences, need further study.

Netherton's syndrome: a severe neonatal disease. A case report.

A male infant was born with generalized erythroderma and scaling; the newborn demonstrated poor neonatal development and developed several complications such as hypernatremic dehydration, septicemia, gastroenteritis and seizures. In the neonatal period, the erythema faded, but exfoliation persisted. The parents are healthy but related. One older brother, who died at the age of 3 months, had shown the same clinical picture in the neonatal period and was diagnosed with congenital psoriasis. All clinical investigations, including serum immunoglobulins, complement levels and lymphocyte counts, were normal. Only raised total IgE and multiple positive specific IgE reactions were noted. Skin biopsy revealed an image of ichthyosis. Polarization microscopy of scalp hair showed trichorrhexis nodosa and discrete focal twisting of the hair shaft. This clinical picture and all histological findings are compatible with the indications of Netherton's syndrome. The purpose of this report is to call attention to this severe presentation of congenital ichthyosis in the neonatal period and to the difficulty of a correct diagnosis when confronted with congenital erythroderma.

A particular subtype of ichthyosis congenita type III. Clinical, light, and electron microscopic features.

We report the case of a second patient with the extraordinary ultrastructural findings of vacuolated structures intermingled with membranes in the perinuclear part of the upper epidermal cells. Clinical, light microscopic, and electron microscopic features of this particular presentation of ichthyosis congenita type III have already been presented by K. M. Niemi and L. Kanerva in 1989. Although our patient has more or less the same light and electron microscopic findings, the clinical picture is more severe. The patient was born as a collodion baby. Later, he showed signs of generalized severe involvement with large scales, erythrodermia, and itching. Successful therapy with retinoids resulted in complete removal of the hyperkeratosis but left the striking reticulate skin pattern. Noting the heterogeneous clinical presentation, the specific electron microscopic findings are diagnostic. No biochemical data on this disease are known.

Dermatologic and systemic manifestations of syphilis.

The incidence of syphilis is increasing, predominantly among urban heterosexuals. Early recognition is important in preventing progression of the disease and transmission of Treponema pallidum to the fetus. Untreated primary syphilis is characterized by intervals of active disease punctuated by periods of latency. Not all patients progress through each phase, and the physician must be alert to varying presentations. Cutaneous lesions are the hallmark of syphilis. However, diagnosis can be difficult, because the lesions can be asymptomatic or transient. The course of syphilis is accelerated in patients infected with the human immunodeficiency virus, and these patients frequently exhibit atypical lesions. The incidence of congenital syphilis is increasing, and efforts to control fetal morbidity depend on prompt recognition and treatment of infection during pregnancy. The definitive diagnosis of any stage of syphilis is based on historical and clinical findings supported by serologic testing.

Mucocutaneous manifestations of chancroid, lymphogranuloma venereum and granuloma inguinale.

The sexually transmitted diseases chancroid, lymphogranuloma venereum and granuloma inguinale should be familiar to physicians who care for patients at risk. The mucocutaneous manifestations of these three diseases must be distinguished from the lesions of other venereal diseases, such as primary syphilis and genital herpes simplex. Human immunodeficiency virus (HIV) infection should always be considered in patients with any venereal disease, since sexually transmitted diseases often occur together. Furthermore, the genital erosions that occur in patients with these three disorders may predispose them to HIV infection.