ABSTRACT
BACKGROUND: Colonization of the skin of patients with atopic dermatitis (AD) by Staphylococcus aureus (SA) is associated with more severe disease. AIM: To determine the association of SA colonization patterns and densities in lesional and nonlesional skin in patients with varying severities of AD, and to determine the antibiotic sensitivity patterns of SA isolates from Sri Lanka. METHODS: Skin and nasal swabs collected from 100 patients with AD and 120 controls were used to investigate the presence of SA. Severity of AD was graded using the Nottingham Eczema Severity Score. Colony counts were obtained for skin samples, and antibiotic sensitivity testing was performed in cases positive for SA. RESULTS: Skin colonization was seen in 57 patients (57%) but in only 10 controls (8%). Lesional skin of most patients (52/57; 91%) had SA densities of > 300 colony-forming units/cm(2) . Colonization rates with SA significantly increased with increasing age (Spearman correlation coefficient R = 0.9, P < 0.05) and increasing duration of lesions in patients with AD (Spearman R = 0.87, P < 0.05). Isolates from eight patients (13.5%) were found to be methicillin-resistant S. aureus (MRSA). Only 6 isolates (10%) were susceptible to penicillin and 22 (37%) to erythromycin, while 28 (47%) isolates had erythromycin-induced resistance to clindamycin. CONCLUSIONS: SA colonization rates were significantly associated with increasing age and severity of AD, and particularly with duration of lesions. Patients with severe disease were also more likely to be colonized with SA strains resistant to conventional antibiotics.
Subject(s)
Dermatitis, Atopic/microbiology , Staphylococcal Infections/microbiology , Staphylococcus aureus/isolation & purification , Adolescent , Adult , Age Distribution , Case-Control Studies , Child , Child, Preschool , Drug Resistance, Bacterial , Female , Humans , Infant , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Microbial Sensitivity Tests , Middle Aged , Nasal Cavity/microbiology , Severity of Illness Index , Skin/microbiology , Staphylococcus aureus/drug effects , Young AdultSubject(s)
Genital Diseases, Male/diagnosis , Hypereosinophilic Syndrome/diagnosis , Oral Ulcer/diagnosis , Penis/pathology , Scrotum/pathology , Adult , Genital Diseases, Male/etiology , Humans , Hypereosinophilic Syndrome/complications , Male , Oral Ulcer/etiology , Penile Diseases/diagnosis , Penile Diseases/etiologyABSTRACT
BACKGROUND: In Sri Lanka, varicella zoster virus (VZV) is typically acquired during adulthood with significant associated disease morbidity and mortality. T cells are believed to be important in the control of VZV replication and in the prevention of reactivation. The relationship between viral load, disease severity and cellular immune responses in primary VZV infection has not been well studied. METHODOLOGY: We used IFNgamma ELISpot assays and MHC class II tetramers based on VZV gE and IE63 epitopes, together with quantitative real time PCR assays to compare the frequency and phenotype of specific T cells with virological and clinical outcomes in 34 adult Sri Lankan individuals with primary VZV infection. PRINCIPAL FINDINGS: Viral loads were found to be significantly higher in patients with moderate to severe infection compared to those with mild infection (p<0.001) and were significantly higher in those over 25 years of age (P<0.01). A significant inverse correlation was seen between the viral loads and the ex vivo IFNgamma ELISpot responses of patients (P<0.001, r = -0.85). VZV-specific CD4+ T cells expressed markers of intermediate differentiation and activation. CONCLUSIONS: Overall, these data show that increased clinical severity in Sri Lankan adults with primary VZV infection associates with higher viral load and reduced viral specific T cell responses.
Subject(s)
Chickenpox/immunology , Chickenpox/virology , Herpesvirus 3, Human/immunology , Adult , Age Factors , Aged , Base Sequence , DNA Primers/genetics , DNA, Viral/blood , DNA, Viral/genetics , HLA-DR Antigens/immunology , HLA-DRB1 Chains , Herpesvirus 3, Human/genetics , Herpesvirus 3, Human/isolation & purification , Humans , Immunity, Cellular , Middle Aged , Sri Lanka , T-Lymphocytes/immunology , Viral Load , Young AdultABSTRACT
BACKGROUND: In a modern hospital built recently in Sri Lanka the staff members on night shifts and some patients in the open wards were known to be affected by an acute vesicating dermatitis. The study was carried out to identify the cause of the dermatitis and recommend preventive measures. METHODS: Members of the hospital staff and patients who developed an acute vesicating dermatitis over a period of 2 years were studied using a questionnaire. The clinical features, relationship to night shifts and the month of occurrence were noted. Insects were caught at night on several occasions and identified. Lesions were reproduced in volunteers. RESULTS: Out of a total of 124 patients studied, 108 were members of the hospital staff and it was noted that they had all been on night shifts within 2 days prior to the onset of the lesions. The insect caught belongs to class Coleoptera, family Staphylinidae, genus Paederus, and species fuscipes. The incidence was seasonal with clustering of cases seen to occur twice a year. CONCLUSIONS: This is an outbreak of dermatitis due to Paederus fuscipes. Awareness of the condition and its clinical features will prevent misdiagnosis and the simple preventive measures suggested are based on the behavioral pattern of this nocturnal beetle.
