Immunohistochemical and ultrastructural characterization of tonofilament and hemidesmosome abnormalities in a case of epidermolysis bullosa herpetiformis (Dowling-Meara).

BACKGROUND: A neonate with epidermolysis bullosa herpetiformis (EBH) (Dowling-Meara) had an undescribed ultrastructural and immunohistochemical abnormality. OBJECTIVE: The objective was to clarify the ultrastructural and immunohistochemical abnormalities in EBH to gain further insight into the pathogenesis of this disorder. METHODS: Tissue from the patient was studied with routine histochemistry, electron microscopy, and immunohistochemistry. RESULTS: Excessive clumping of tonofilaments on electron microscopic examination, anomalous hemidesmosomes, and immunohistochemical evidence of aberrant keratin expression by basal epidermal cells was found. CONCLUSION: This case of EBH provides further evidence for primary abnormalities involving cytoskeletal-membrane attachment plaque formation in this rare disorder.

Indigenous multiresistant bacteria from flowers in hospital and nonhospital environments.

The microbial flora of 60 vase water samples from cut flowers obtained from several environments, including a hospital, were examined in this study. Forty-one different bacterial species were identified, including 12 species of Pseudomonas. The mean total aerobic bacterial count per 500 ml of vase water was 4.5 x 10(8) organisms, and high levels of antibiotic resistance were found. To ascertain the origin of the bacteria found on the flowers as well as their growth patterns, natural cut flowers were compared with sterilized cut flowers in tap water over time. Although the density of organisms was similar, the flora in vase water of sterilized flowers consisted almost entirely of aerobic spore formers while mixed flora of gram-negative bacteria, staphylococci, aerobic spore formers, and fungi were isolated from natural flowers. Our results indicate that the multiply-resistant microbial flora found in vase water is indigenous to flowers, rather than originating from the environment in which they are placed, and that such water is a reservoir of large numbers of multiresistant organisms.

Microbial ecology of interdigital infections of toe web spaces.

The microbial flora of normal and macerated interdigital toe web spaces was qualitatively and quantitatively identified in 77 patients. Dermatophyte fungi were recovered from 11% of normal patients compared with a 31% recovery from patients with macerated interspaces. Macerated interspaces were characterized by a greater recovery of organisms with pathogenic potential, with Staphylococcus aureus recovered from 36% of patients, Micrococcus sedentarius in 37%, Brevibacterium epidermidis in 54%, Corynebacterium minutissimum in 69%, and Pseudomonas species in 26%. The bacterial flora of macerated interspaces showed a significantly higher incidence of resistance to multiple antibiotics, and the recovery of antibiotic-resistant bacteria correlated with the recovery of dermatophytes that produce penicillin-like substances. The results of this study support the hypothesis that overgrowth of the resident bacterial population determines the severity of interdigital toe-web infections.

The antibacterial efficacy of econazole nitrate in interdigital toe web infections.

Twenty-four patients with severe interdigital toe web infections and no evidence of dermatophyte colonization received randomized treatment with either econazole nitrate (Spectazole) or its vehicle. Of the patients treated with econazole nitrate, 88% had good to excellent responses, whereas no patient treated with the vehicle showed improvement. The total aerobic flora in the econazole group decreased 93%, with decreases in the large-colony diphtheroids, lipophilic diphtheroids, and gram-negative bacteria. The results of this study demonstrate that the antibacterial activity of econazole nitrate makes it an effective agent for the treatment of severe interdigital bacterial infections uncomplicated by dermatophyte colonization.

Subungual bacteria of the hand: contribution to the glove juice test; efficacy of antimicrobial detergents.

Methodologies for evaluating the efficacy of antimicrobial agents in the bacterial flora of the hand involve variations of the "glove juice" or "sterile bag" procedures. In this study we demonstrate that the subungual flora contribute significantly to the recovery of bacteria in these procedures. Culturing hands that had the subungual spaces sealed with acrylic polish demonstrated a decay type of curve for the number of bacteria recovered in successive samplings with 10(6) colony forming units (CFU) bacteria recovered in the first sampling and 10(3) in the sixth while the opposite hand on which the subungual spaces were not sealed demonstrated a continuous recovery of 10(6) CFU. Serial scrubbings of three minutes with plain detergent, 10% povidone-iodine or 4% chlorhexidine demonstrated a three logarithm reduction for povidone-iodine and four logarithm reduction compared to plain detergent alone for chlorhexidine in hands that had subungual spaces sealed, while the opposite hand showed only a 0.5 to 1.0 logarithm reduction. Povidone-iodine produced a 0.6 logarithm reduction and 4% chlorhexidine or 1.4 logarithm reduction in the density of subungual bacteria.