Progressão infantil de tinea capitis, kerion celsi e infecção secundária bacteriana cutânea com hemocultura positiva para s. Aureus ­ relato de caso / Infant progression of tinea capitis, kerion celsi and secondary bacterial skin infection with positive blood culture s. Aureus - case report

Introdução: A Tinea Capitis (TC) é uma dermatofitose que tem como evolução grave a forma Kerion Celsi (KC). Clinicamente, é caracterizada por manifestações tonsurantes e inflamatórias; diagnosticada por achados clínicos e laboratoriais, como micológico direto com KOH, tricoscopia e cultura fúngica. É utilizado no tratamento de TC antifúngicos sistêmicos por seis a oito semanas. Nesse caso houve associação de infecção secundária por Staphylococcus aureus, caracterizando um quadro atípico, raro. Objetivo: Relatar o caso, pouco descrito na literatura, de criança com Tinea Capitis (TC) com Kerion Celsi (KC) e bacteremia por contaminação secundária local e sistêmica de Staphylococcus aureus. Relato do caso: Paciente feminino, 5 anos, com manchas hiperemiadas, descamativas e pruriginosas de crescimento centrífugo em face, com surgimento de lesões circulares e pelos tonsurados em couro cabeludo que, após uso de antifúngico oral, houve inflamação aguda e saída de secreção. Apesar do tratamento independente domiciliar, com Betametasona e Cetoconazol creme e Cetoconazol 2% xampu, houve involução da lesão de face e ampliação da área de alopecia. Com a procura médica, iniciou tratamento sistêmico com Griseofulvina, seguido de antibioticoterapia oral por quadro bacteriano secundário em couro cabeludo. Houve linfonodomegalia cervical e intensificação do prurido e secreção. Foi internada para análise clínica e laboratorial, com antibioticoterapia endovenosa de amplo espectro: Ceftriaxona e Clindamicina. Colhida cultura da lesão e hemocultura, definiu-se, em ambas, S. aureus. Devido à resistência bacteriana, ocorreu troca para Cefazolina endovenosa. Na alta, a paciente seguiu com apoio dermatológico semanal e Griseofulvina, havendo a troca do antifúngico por Terbinafina. Conclusão: Quadro atípico e raro com progressão para bacteremia. O alerta para o diagnóstico precoce possibilita tratamento oral adequado e menor impacto da doença na qualidade de vida, evitando-se a contaminação secundária bacteriana

Introduction: Tinea Capitis (TC) is a dermatophytosis that has as severe evolution the form Kerion Celsi (KC). Clinically, it is characterized by tonsuring and inflammatory manifestations; diagnosed by clinical and laboratory findings, such as direct mycological with KOH, trichoscopy and fungal culture. It is used in the treatment of systemic antifungal CT for six to eight weeks. In this case there was an association of secondary infection by Staphylococcus aureus, characterizing an atypical, rare condition. Objective: To report the case, little described in the literature, of a child with Tinea Capitis (TC) with Kerion Celsi (KC) and bacteremia due to local and systemic secondary contamination of Staphylococcus aureus. Case report: Female patient, 5 years old, with hyperaemic, scaling and pruritic spots of centrifugal growth on the face, with the appearance of circular lesions and tonsure on the scalp that, after use of oral antifungal, there was acute inflammation and discharge of secretion. Despite the independent home treatment, with Betamethasone and Ketoconazole cream and Ketoconazole 2% shampoo, there was involution of the face injury and enlargement of the area of alopecia. With medical demand, he started systemic treatment with Griseofulvin, followed by oral antibiotic therapy for secondary bacterial condition in the scalp. There was cervical lymph node enlargement and intensification of pruritus and secretion. She was hospitalized for clinical and laboratory analysis, with broad spectrum intravenous antibiotic therapy: Ceftriaxone and Clindamycin. Culture of the lesion and blood culture, was defined in both S. aureus. Due to bacterial resistance, there was exchange for intravenous Cefazolin. At discharge, the patient followed with weekly dermatological support and Griseofulvin, with the exchange of antifungal by Terbinafine. Conclusion: Atypical and rare condition with progression to bacteremia. Early diagnosis provides adequate oral treatment and less impact of the disease on quality of life, avoiding secondary bacterial contamination

Introducción: La Tinea Capitis (TC) es una dermatofitosis cuya evolución severa es la forma Kerion Celsi (KC). Clínicamente se caracteriza por manifestaciones amigdalizantes e inflamatorias; se diagnostica por hallazgos clínicos y de laboratorio, como micología directa con KOH, tricoscopia y cultivo fúngico. Se utiliza en el tratamiento de la TC antifúngica sistémica durante seis a ocho semanas. En este caso se asoció infección secundaria por Staphylococcus aureus, caracterizando una condición atípica y rara. Objetivo: Reportar el caso, poco descrito en la literatura, de un niño con Tinea Capitis (TC) con Kerion Celsi (KC) y bacteriemia por contaminación secundaria local y sistémica de Staphylococcus aureus. Caso clínico: Paciente femenino, de 5 años de edad, con placas hiperémicas, descamativas y pruriginosas de crecimiento centrífugo en la cara, con aparición de lesiones circulares y pelo tonsurado en el cuero cabelludo que, luego de utilizar un antifúngico oral, presentó inflamación aguda y salida de secreciones. A pesar del tratamiento independiente domiciliario, con crema de Betametasona y Ketoconazol y shampoo de Ketoconazol al 2%, se presentó involución de la lesión facial y agrandamiento del área de alopecia. Con la búsqueda médica se inició tratamiento sistémico con Griseofulvina, seguido de antibioticoterapia oral por una afección bacteriana secundaria en el cuero cabelludo. Había agrandamiento de los ganglios linfáticos cervicales y aumento del prurito y la secreción. Ingresa para análisis clínicos y de laboratorio, con antibioticoterapia endovenosa de amplio espectro: Ceftriaxona y Clindamicina. Tras la recogida de cultivo de la lesión y hemocultivo, se definió S. aureus en ambos. Debido a la resistencia bacteriana, hubo un cambio a cefazolina intravenosa. Al alta, la paciente continuó con soporte dermatológico semanal y Griseofulvina, reemplazándose el antifúngico por Terbinafina. Conclusión: Condición atípica y rara con progresión a bacteriemia. La alerta para el diagnóstico precoz permite un adecuado tratamiento oral y menor impacto de la enfermedad en la calidad de vida, evitando contaminaciones bacterianas secundarias

Does a Positive Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screen Predict the Risk for MRSA Skin and Soft Tissue Infection?

BACKGROUND: Skin and soft tissue infections (SSTIs) are often caused by gram-positive bacteria that colonize the skin. Given the overuse of antibiotics, SSTIs are increasingly caused by resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA). Guidance on the utility of MRSA nasal screening for MRSA SSTI is limited. OBJECTIVE: To determine whether MRSA nasal screening predicts the risk of MRSA SSTIs. METHODS: This was a single-center, retrospective cohort study of adult patients with an SSTI diagnosis that had MRSA nasal screening and wound cultures obtained within 48 hours of starting antibiotics. Sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratios were calculated using VassarStats. Pretest and posttest probabilities were estimated with Microsoft Excel. RESULTS: A total of 884 patient encounters were reviewed between December 1, 2018, and October 31, 2021, and 300 patient encounters were included. The prevalence of MRSA SSTI was 18.3%. The MRSA nasal colonization had a sensitivity of 63.6%, specificity of 93.9%, positive predictive value of 70.0% (95% CI = 55.2%-81.7%), negative predictive value of 92.0% (95% CI = 87.7%-94.9%), positive likelihood ratio of 10.39 (95% CI = 6.12-17.65), negative likelihood ratio of 0.39 (95% CI = 0.27-0.55), positive posttest probability of 70.0%, and negative posttest probability of 8.0%. CONCLUSIONS: Given the high positive likelihood ratio, a positive MRSA nasal screen was associated with a large increase in the probability of MRSA SSTI at our institution, and a negative MRSA nasal screen was associated with a small but potentially significant decrease in the probability of MRSA SSTI.

Impact of MRSA polymerase chain reaction (PCR) wound swabs on antibiotic de-escalation in skin and soft tissue infections.

Methicillin-resistant strains of S. aureus (MRSA) polymerase chain reaction (PCR) testing is a laboratory test that allows for rapid detection of MRSA and is available to use in skin infections via wound swab. There are limited data demonstrating the utility of MRSA PCR wound swabs on clinical outcomes in skin and soft tissue infections. This retrospective, single-center study included 652 patients to determine if the use of a MRSA PCR wound swab in skin infections results in a more rapid de-escalation in antibiotics. Patients with a MRSA PCR negative wound swab demonstrated a 1.0 (-1.5 to -0.53) day reduction of anti-MRSA antibiotic usage compared to those in the control group who did not have a MRSA PCR available (wound culture data only) (P < 0.001, unadjusted). The results of this study demonstrate that MRSA PCR wound swab assays have the potential to play a significant role in antibiotic de-escalation in the setting of skin and soft tissue infections.

Acute myeloid leukaemia presenting with ecthyma gangrenosum as the first manifestation: A case report.

RATIONALE: Ecthyma gangrenosum (EG) is an uncommon cutaneous infection usually associated with Pseudomonas aeruginosa bacteremia in immunocompromised patients, particularly those with underlying malignant diseases. Despite its rarity, especially in immunocompetent or nondiagnosed immunodeficiency patients, EG can present as the first manifestation of an underlying immunosuppression. PATIENT CONCERNS: A 42-year-old Japanese man was admitted to our hospital with a 3-day history of a painless red macule on his right forearm and fever. DIAGNOSES: Blood culture on admission revealed the presence of Pseudomonas aeruginosa, whereas pus culture of the skin lesion showed Pseudomonas aeruginosa and methicillin-susceptible Staphylococcus aureus positivity. INTERVENTIONS: Additional bone marrow aspirate examination and immunophenotyping were performed to confirm the diagnosis of acute promyelocytic leukaemia with PML-retinoic acid alpha receptor. OUTCOMES: The patient was successfully treated with a 14-day course of antibiotics, and no evidence of relapse was noted. The patient achieved complete remission after treatment for acute promyelocytic leukaemia. LESSONS: It should be kept in mind that EG is an important cutaneous infection that is typically associated with P aeruginosa bacteremia and the presence of underlying immunodeficiency, such as acute leukaemia.

Accurate and sensitive analysis of Staphylococcus aureus through CRISPR-Cas12a based recycling signal amplification cascades for early diagnosis of skin and soft tissue infections.

Early-diagnosis and treatments of skin and soft tissue infections remain a huge challenge due to the difficulties in the detection of trace amounts of bacteria. We develop here a novel method through CRISPR-Cas12a based recycling signal amplification cascades and demonstrated its feasibility of Staphylococcus aureus detection in a sensitive and accurate way. The highlights of the proposed method are calculated as: i) the designed allosteric probe is responsible for accurate identification of SA through PBP2a-specific aptamer; ii) high sensitivity from three processes, including DNA polymerase-based target SA release, Nb.BbvCI enzyme induced ssDNA generation and attached CRISPR-Cas12a. As a result, the proposed method exhibited a detection range from 106 to 102 CFU/ml. Eventually, we believe that the proposed method could be expanded for the construction of diverse sensing platforms for detecting different trace bacteria.

Staphylococcal Skin and Soft Tissue Infections.

Staphylococcus aureus is the most common bacteria causing purulent skin and soft tissue infections. Many disease-causing S aureus strains are methicillin resistant; thus, empiric therapy should be given to cover methicillin-resistant S aureus. Bacterial wound cultures are important for characterizing local susceptibility patterns. Definitive antibiotic therapy is warranted, although there are no compelling data demonstrating superiority of any one antibiotic over another. Antibiotic choice is predicated by the infection severity, local susceptibility patterns, and drug-related safety, tolerability, and cost. Response to therapy is expected within the first days; 5 to 7 days of therapy is typically adequate to achieve cure.

Comorbid Diabetes in Inflammatory Bowel Disease Predicts Adverse Disease-Related Outcomes and Infectious Complications.

BACKGROUND: Diabetes mellitus (DM) and inflammatory bowel diseases (IBD) are chronic systemic illnesses associated with chronic inflammation, dysbiosis, impaired immune function, and infection risk. The impact of DM in modifying disease activity in patients with IBD remains largely unknown. AIM: To investigate the impact of DM on IBD-related disease outcomes, mortality, and infections in patients with IBD. METHODS: We performed a longitudinal cohort analysis. Using a large institutional database, patients with concurrent IBD and DM (IBD-DM), and IBD without DM (IBD cohort), were identified and followed longitudinally to evaluate for primary (IBD-related) and secondary (mortality and infections) outcomes. Cox proportional hazards models were used to determine the independent effect of DM on each outcome, adjusting for confounding effects of covariates. RESULTS: A total of 901 and 1584 patients were included in the IBD-DM and DM cohorts. Compared with IBD, IBD-DM had significantly higher risk of IBD-related hospitalization [adjusted hazard ratio (HR) 1.97, 95% confidence interval (1.71-2.28)], disease flare [HR 2.05 (1.75-2.39)], and complication [HR 1.54 (1.29-1.85)]. No significant difference was observed in the incidence of IBD-related surgery. All-cause mortality, sepsis, Clostridioides difficile infection (CDI), pneumonia, urinary tract infection, and skin infection were also more frequent in the IBD-DM than the IBD cohort (all p ≤ 0.05). Subgroup analysis of Crohn's disease (CD) and ulcerative colitis patients showed similar associations, except with an additional risk of surgery and no association with CDI in the CD-DM cohort. CONCLUSION: Comorbid diabetes in patients with IBD is a predictor of poor disease-related and infectious outcomes.

Skin Infections Caused by Staphylococcus aureus.

Staphylococcus aureus is the most common pathogen involved in skin infections worldwide, regardless of the patient's age, the climate or geographical area. The main skin clinical manifestations can be linked to a few toxins produced by the bacteria, which give rise to a rich and varied clinical spectrum. Panton Valentine leucocidin, exfoliatins, enterotoxins and toxin shock syndrome toxin 1 are the main toxins involved in most dermatological manifestations associated with S. aureus. Other less frequent cutaneous manifestations can occur in endocarditis, bacteraemia. Currently, the most important event is worldwide emergence of community-acquired S. aureus resistant to methicillin (CA-MRSA), mainly causing skin infections.

Recurrent mucocutaneous infections caused by PVL-positive Staphylococcus aureus strains: a challenge in clinical practice.

BACKGROUND: Recurrent mucocutaneous infections caused by PVL-positive Staphylococcus (S.) aureus strains represent an increasing problem in Germany. Although there have been several outbreaks at day care centers and in urban communities in recent years, there are currently no diagnostic algorithms or treatment recommendations for these particular infections in Germany. METHODS: We performed a literature search in the PubMed/MEDLINE database with the goal of developing an algorithm for diagnosis and treatment of these infections. National and international recommendations were also considered. RESULTS: Panton-Valentine leukocidin (PVL) is a pore-forming protein produced by certain S. aureus strains. Both methicillin-susceptible (MSSA) and methicillin-resistant S. aureus (MRSA) strains may carry the lukS-lukF gene responsible for PVL production. The clinical presentation of infections caused by PVL-positive S. aureus ranges from isolated recurrent abscesses to extensive furunculosis. Despite adequate treatment of primary infections, approximately 40 % of patients develop recurrent disease. The choice of treatment regimen is guided by the clinical presentation of the infection. In addition, some scientific literature recommends bacteriological screening of patients and their contacts, followed by decolonization of affected individuals. CONCLUSIONS: The present article focuses on the pathogenesis and risk factors of recurrent mucocutaneous infections caused by PVL-positive S. aureus strains and proposes a diagnostic and therapeutic algorithm for optimal patient care.

Preclinical Models and Methodologies for Monitoring Staphylococcus aureus Infections Using Noninvasive Optical Imaging.

In vivo whole-animal optical (bioluminescence and fluorescence) imaging of Staphylococcus aureus infections has provided the opportunity to noninvasively and longitudinally monitor the dynamics of the bacterial burden and ensuing host immune responses in live anesthetized animals. Herein, we describe several different mouse models of S. aureus skin infection, skin inflammation, incisional/excisional wound infections, as well as mouse and rabbit models of orthopedic implant infection, which utilized this imaging technology. These animal models and imaging methodologies provide insights into the pathogenesis of these infections and innate and adaptive immune responses, as well as the preclinical evaluation of diagnostic and treatment modalities. Noninvasive approaches to investigate host-pathogen interactions are extremely important as virulent community-acquired methicillin-resistant S. aureus strains (CA-MRSA) are spreading through the normal human population, becoming more antibiotic resistant and creating a serious threat to public health.

Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen in erythrodermic cutaneous T-cell lymphoma (CTCL) patients.

Erythroderma can occur in cutaneous T-cell lymphoma (CTCL). Staphylococcus aureus (S. aureus) prevalence is increased in CTCL patients and contributes to CTCL disease flares. Our primary aim was to describe S. aureus infections, including resistance patterns and the antibiotic treatment regimens used, in erythrodermic CTCL patients. This was a retrospective chart review of erythrodermic CTCL patients who had S. aureus infection or colonization and were treated at the UT MD Anderson Cancer Center's Melanoma Skin Center between 2012 and 2016. Twenty-six erythrodermic CTCL patients had 50 documented S. aureus colonization or infection events. Patients had an improvement in body surface area (BSA) or modified Severity Weighted Assessment Tool (mSWAT) in 53% events treated for S. aureus. Seventeen of the 50 (34%) events were due to methicillin-resistant S. aureus (MRSA). One-third (33%) of MRSA events were initially treated with dicloxacillin. The MRSA isolates were sensitive to trimethoprim-sulfamethoxazole (92%) and doxycycline (88%). Patients treated in the outpatient setting (OR 0.073; 95% CI 0.008-0.627; p = 0.017) and patients with a previous history of topical anti-S. aureus decolonization treatments before S. aureus event as stand-alone (OR 0.125; 95% CI 0.018-0.887; p = 0.038) or in combination treatment with systemic antibiotics (OR 0.094; 95% CI 0.009-0.944; p = 0.045) were less likely to see improvement in BSA or mSWAT from S. aureus treatment. Treatment of S. aureus improved CTCL skin score in a high number of erythrodermic patients. The MRSA prevalence was high in erythrodermic CTCL patients. Clinicians should consider using empiric MRSA antibiotic coverage for these patients.

The role of bacterial skin infections in atopic dermatitis: expert statement and review from the International Eczema Council Skin Infection Group.

Patients with atopic dermatitis (AD) have an increased risk of bacterial skin infections, which cause significant morbidity and, if untreated, may become systemic. Staphylococcus aureus colonizes the skin of most patients with AD and is the most common organism to cause infections. Overt bacterial infection is easily recognized by the appearance of weeping lesions, honey-coloured crusts and pustules. However, the wide variability in clinical presentation of bacterial infection in AD and the inherent features of AD - cutaneous erythema and warmth, oozing associated with oedema, and regional lymphadenopathy - overlap with those of infection, making clinical diagnosis challenging. Furthermore, some features may be masked because of anatomical site- and skin-type-specific features, and the high frequency of S. aureus colonization in AD makes positive skin swab culture of suspected infection unreliable as a diagnostic tool. The host mechanisms and microbial virulence factors that underlie S. aureus colonization and infection in AD are incompletely understood. The aim of this article is to present the latest evidence from animal and human studies, including recent microbiome research, to define the clinical features of bacterial infections in AD, and to summarize our current understanding of the host and bacterial factors that influence microbial colonization and virulence.

Molecular Epidemiology of Staphylococcus aureus in Skin and Soft Tissue Infections and Bone and Joint Infections in Korean Children.

BACKGROUND: Community acquired-methicillin resistant Staphylococcus aureus (MRSA) clones, including ST1, ST8, and ST30 are reported worldwide. However, data among Korean children are limited. Thus, we investigated the molecular characteristics of S. aureus among children in Korea. METHODS: S. aureus isolated from Korean children diagnosed with skin and soft tissue infection (SSTI) or bone and joint infection due to S. aureus infection at Seoul National University Bundang Hospital, from August 2010 to November 2016, were analyzed for multilocus sequence type (ST) and SCCmec typing. Polymerase chain reaction of Panton-Valentine leukocidin (PVL), qac A/B, smr and mupA genes were also performed. Electronic medical records were reviewed for clinical data and antibiotic susceptibility results. Cases were classified into three groups: health care-associated community-onset (HACO) infections, hospital-onset (HO) infections, and community-acquired (CA) infections. RESULTS: A total of 67 strains from children with SSTI (41/67, 61.2%) and bone and joint infection (26/67, 38.8%) were included. Among all isolates, 29.9% (20/67) were MRSA, and 70% (14/20) were classified as CA, 20% (4/20) as HACO and 10% (2/20) as HO infections. MRSA rate according to disease was 34.1% (14/41) for SSTI and 23.1% (6/26) for bone and joint infection. MRSA strains included ST72-SCCmec IV (14/20, 70.0%), ST5-SCCmec II (3/20, 15.0%) and ST1-SCCmec IV (2/20, 10.0%). ST30 was the most common cause of SSTI and bone and joint infections and 96.6% (28/29) were methicillin-susceptible Staphylococcus aureus (MSSA). PVL genes were detected in 3 strains (3.8%, ST30-SCCmec IV n = 1, MSSA ST30 n = 2), qac A/B in 3 (MRSA = 3), smr in 3 (MSSA = 1, MRSA = 2) and mupA in 7 (MRSA = 5, MSSA = 2). CONCLUSION: Molecular epidemiology of S. aureus in Korean children with SSTI and bone and joint infection showed that ST30 was predominant and mostly MSSA. Among MRSA, ST72-SCCmec type IV was the most common strain.

Characterisation of community-acquired Staphylococcus aureus causing skin and soft tissue infections in a children's hospital in Shanghai, China.

Community-acquired Staphylococcus aureus is a major pathogen responsible for skin and soft tissue infections (SSTIs). This study aimed to investigate the prevalence and molecular characteristics of community-acquired S. aureus isolates recovered from paediatric patients with SSTIs in Shanghai, China. Between January 2015 and January 2018, 91 community-acquired S. aureus isolates were characterised by antibiotic susceptibility, multilocus sequence typing (ST), staphylococcal protein A gene (spa) type and virulence genes. Methicillin-resistant S. aureus (MRSA) strains were also characterised by staphylococcal cassette chromosome mec (SCCmec) type. Forty-one (45.1%) S. aureus isolates were MRSA. ST59 (33.0%, 30/91) was the most common sequence type, and t437 (18.7%, 17/91) was the most common spa type. SCCmec IV and V accounted for 61.0% and 34.1% of all MRSA isolates, respectively. Each isolate carried at least six virulence genes. The positive rates of Panton-Valentine leukocidin genes among all S. aureus, MRSA and methicillin-susceptible S. aureus isolates were 30.8% (28/91), 39.0% (16/41) and 24% (12/50), respectively. The prevalence of community-associated MRSA was surprisingly high among children with community-acquired SSTIs in Shanghai. ST59-t437 was the most prevalent community-acquired S. aureus clone causing SSTIs.

[Spider bite or infection caused by Panton Valentine leucocidin-producing Staphylococcusaureus?] / Morsure d'araignée ou infection à Staphylococcusaureus producteur de toxine de Panton Valentine ?

INTRODUCTION: Spiders, especially those of the genus Loxoceles such as L. rufescens, endemic in Mediterranean regions, are frequently reported as causes of venom poisoning in humans in the south of France. The most common signs consist of cutaneous necrosis presenting initially as inflammatory cellulitis and progressing towards the emergence of a necrotic centre. PATIENTS AND METHODS: We report 4 cases, initially considered as spider bites due to their sudden occurrence and pain. Rigorous clinical examination coupled with collection of samples for laboratory analysis ultimately enabled the diagnosis to be corrected to one of suppurative skin infection caused by Staphylococcusaureus producing the cytotoxin Panton Valentine leucocidin. DISCUSSION: These observations highlight the potential for confusion between spider bites and infections with PVL-producing S. aureus.