RESUMO
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.
Assuntos
Dermatite Atópica/microbiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/isolamento & purificação , Adolescente , Adulto , Distribuição por Idade , Estudos de Casos e Controles , Criança , Pré-Escolar , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Masculino , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Cavidade Nasal/microbiologia , Índice de Gravidade de Doença , Pele/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Adulto JovemRESUMO
Cutaneous leishmaniasis in a Sri Lankan, who had not left the country, is reported. The diagnosis was confirmed by detecting the parasite in smears under microscopic examination. This is the first case report of locally acquired leishmaniasis in Sri Lanka.
Assuntos
Reservatórios de Doenças , Leishmaniose Cutânea/transmissão , Zoonoses , Adulto , Animais , Humanos , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Sri LankaRESUMO
Three case reports of falciparum malaria not responding to standard chloroquine therapy and necessitating the use of alternative antimalarial drugs for clinical improvement, are documented. In vitro drug sensitivity tests and chloroquine assays were not carried out to conclusively exclude drug failure. However, the clinical course and the persistence of parasitaemia on thick blood film monitoring were suggestive of high grade chloroquine resistance. Such patients require clinical vigilance and the timely use of alternative antimalarials. When rapid clearance of parasitaemia is required quinine is the drug of choice. In malarial chemotherapy it is mandatory that strict therapeutic criteria be followed, to safeguard the efficacy of chloroquine as well as to prevent abuse of alternative drugs. In this context, the availability of thick blood films and in vitro drug sensitivity testing facilities in hospitals would be useful to clinicians.
