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4.
J Am Acad Dermatol ; 81(2): 342-347, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30890340

RESUMO

BACKGROUND: Epidermal necrolysis (EN) involving ≥10% of the body surface area (BSA) is often complicated by bacterial infections. OBJECTIVE: We sought to describe the epidemiology of bloodstream infections (BSIs) in EN involving a BSA ≥10% and the diagnostic performances of skin cultures for predicting the pathogen(s) isolated from BSIs. METHODS: This retrospective single-center observational study was conducted between 2009 and 2017. All patients referred at the acute phase for EN involving a BSA ≥10% were included. All clinical and bacteriologically relevant data were collected (blood and skin cultures results, number, and severity and time of BSI). Sensitivity, specificity, and predictive values of skin cultures and impact of the bacterial inoculum were investigated. RESULTS: Of 98 patients, 46 (46.9%) had ≥1 BSI episode during the hospital stay (BSIs were caused by Staphylococcus aureus [n = 17, 36.9%] and Pseudomonas aeruginosa [n = 17, 36.9%]). Skin cultures were concordant with blood cultures in 32 cases (71.1%). The positive and negative predictive values were 57.7% and 89.4% for S aureus and 50.0% and 80.9% for P aeruginosa, respectively. BSI increased with cutaneous inoculum of S aureus. LIMITATIONS: This was a retrospective single-center design with a low total number of BSIs. CONCLUSION: Skin cultures for S aureus and P aeruginosa may help predict the pathogens involved in BSIs.


Assuntos
Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Infecções por Pseudomonas/complicações , Pele/microbiologia , Infecções Estafilocócicas/complicações , Síndrome de Stevens-Johnson/complicações , Adulto , Idoso , Hemocultura , Superfície Corporal , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Pseudomonas aeruginosa/isolamento & purificação , Estudos Retrospectivos , Staphylococcus aureus/isolamento & purificação
5.
Orphanet J Rare Dis ; 13(1): 56, 2018 04 10.
Artigo em Inglês | MEDLINE | ID: mdl-29636107

RESUMO

Epidermal necrolysis (EN) encompasses Stevens-Johnson syndrome (SJS, < 10% of the skin affected), Lyell syndrome (toxic epidermal necrolysis, TEN, with ≥30% of the skin affected) and an overlap syndrome (10 to 29% of the skin affected). These rare diseases are caused, in 85% of cases, by pharmacological treatments, with symptoms occurring 4 to 28 days after treatment initiation. Mortality is 20 to 25% during the acute phase, and almost all patients display disabling sequelae (mostly ocular impairment and psychological distress).The objective of this French national diagnosis and care protocol (protocole national de diagnostic et de soins; PNDS), based on a critical literature review and on a multidisciplinary expert consensus, is to provide health professionals with an explanation of the optimal management and care of patients with EN. This PNDS, written by the French National Reference Center for Toxic Bullous Dermatoses was updated in 2017 ( https://www.has-sante.fr/portail/jcms/c_1012735/fr/necrolyse-epidermique-syndromes-de-stevens-johnson-et-de-lyell ). The cornerstone of the management of these patients during the acute phase is an immediate withdrawal of the responsible drug, patient management in a dermatology department, intensive care or burn units used to dealing with this disease, supportive care and close monitoring, the prevention and treatment of infections, and a multidisciplinary approach to sequelae. Based on published data, it is not currently possible to recommend any specific immunomodulatory treatment. Only the culprit drug and chemically similar molecules must be lifelong contraindicated.


Assuntos
Síndrome de Stevens-Johnson/diagnóstico , Cuidados Críticos , França , Humanos , Pele/patologia , Síndrome de Stevens-Johnson/patologia
6.
J Invest Dermatol ; 138(6): 1293-1300, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29369774

RESUMO

Cyclosporine has shown promising results for mortality in patients with Stevens-Johnson syndrome/toxic epidermal necrolysis. However, available studies included only a small number of patients and did not include a validated and homogenous control group. We present the results from a retrospective monocentric study including 174 patients with Stevens-Johnson syndrome/toxic epidermal necrolysis during 2005-2016. Among them, 95 received cyclosporine (3 mg/kg/day) plus supportive care, and 79 received supportive care only. Both a traditional exposed/unexposed method and a propensity score-matching method were used to compare the progression of skin detachment between day 0 and day 5, the proportion of patients with cutaneous re-epithelialization starting on day 5 or mucosal re-epithelialization on day 10, the duration of progression, and the number of deaths between the two groups. None of these outcomes significantly favored cyclosporine, either by the exposed/unexposed method or the propensity score method. Acute renal failure affected more patients receiving cyclosporine (P = 0.05). Overall, the results of this epidemiological study did not show a beneficial effect of cyclosporine in patients with Stevens-Johnson syndrome/toxic epidermal necrolysis. They are discordant with those previously published. The large number of patients and the use of a propensity score method provide valuable insights. The main limitation of the study is the lack of randomization.


Assuntos
Injúria Renal Aguda/epidemiologia , Ciclosporina/uso terapêutico , Imunossupressores/uso terapêutico , Cuidados Paliativos , Reepitelização/efeitos dos fármacos , Síndrome de Stevens-Johnson/terapia , Injúria Renal Aguda/etiologia , Adulto , Ciclosporina/farmacologia , Progressão da Doença , Feminino , Humanos , Imunossupressores/farmacologia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Reepitelização/imunologia , Estudos Retrospectivos , Pele/efeitos dos fármacos , Pele/imunologia , Pele/patologia , Síndrome de Stevens-Johnson/complicações , Síndrome de Stevens-Johnson/imunologia , Síndrome de Stevens-Johnson/mortalidade , Análise de Sobrevida , Falha de Tratamento
7.
Dermatology ; 232(2): 220-3, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26866828

RESUMO

Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse drug reaction leading to extensive sloughing of the skin. Late cutaneous complications such as pigmentation disorders are frequently reported. In this report, we present particular facial cutaneous sequelae with histological analysis after TEN. Two young patients who had survived TEN presented permanent multiple hypopigmented papules on the face affecting their quality of life. Histological analysis revealed areas of scarring, dystrophic microcalcifications and sebaceous hyperplasia. Late cutaneous sequelae are well documented; however, the physiopathological mechanisms leading to different clinical presentations remain unknown. We suggest that the destruction of the hair follicle by necrolysis leads to secondary dermal microcalcifications, scarring and sebaceous hyperplasia. Further studies are needed for a better understanding of these findings.


Assuntos
Cicatriz Hipertrófica/patologia , Dermatoses Faciais/patologia , Folículo Piloso/patologia , Glândulas Sebáceas/patologia , Pele/patologia , Síndrome de Stevens-Johnson/complicações , Adolescente , Adulto , Calcinose/patologia , Cicatriz Hipertrófica/etiologia , Dermatoses Faciais/etiologia , Feminino , Fibrose , Humanos , Masculino
8.
J Exp Zool B Mol Dev Evol ; 316(4): 263-75, 2011 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-21271675

RESUMO

Owing to its phylogenetic position at the base of the chordates, the cephalochordate amphioxus is an emerging model system carrying immense significance for understanding the evolution of vertebrate development. One important shortcoming of amphioxus as a model organism has been the unavailability of animal husbandry protocols to maintain amphioxus adults away from the field. Here, we present the first report of successful maintenance and spawning of Branchiostoma lanceolatum adults in a facility run on artificial seawater. B. lanceolatum has been chosen for this study because it is the only amphioxus species that can be induced to spawn. We provide a step-by-step guide for the assembly of such a facility and discuss the day-to-day operations required for successful animal husbandry of B. lanceolatum adults. This work also includes a detailed description of the B. lanceolatum spawning behavior in captivity. Our analysis shows that the induced spawning efficiency is not sex biased, but increases as the natural spawning season progresses. We find that a minor fraction of the animals undergo phases of spontaneous spawning in the tanks and that this behavior is not affected by the treatment used to induce spawning. Moreover, the induced spawning efficiency is not discernibly correlated with spontaneous spawning in the facility. Last, we describe a protocol for long-term cryopreservation of B. lanceolatum sperm. Taken together, this work represents an important step toward further establishing amphioxus as a laboratory animal making it more amenable to experimental research, and hence assists the coming of age of this emerging model.


Assuntos
Criação de Animais Domésticos/métodos , Cordados não Vertebrados/fisiologia , Ambiente Controlado , Ciência dos Animais de Laboratório/métodos , Comportamento Sexual Animal/fisiologia , Espermatozoides/citologia , Animais , Criopreservação/métodos , Abrigo para Animais , Masculino , Água do Mar
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