Human infections by Microsporon Gypseum in Romania

Summary Over a period of 10 years (1955–1965), 21 cases of human infections byM. gypseum have been observed in Romania. The patients were from 4 to 74 years of age, 8 females and 13 males. Most of the lesions affected the glabrous skin, the herpetiform type being the main aspect. The dysidrotic type of tinea manum et pedis were observed in 2 patients. Scalp involvement byM. gypseum was seen in 7 cases (five of them resembling Kerion). One case of tinea barbae was also found. Various types of hair invasion were detected, either endothrix (like in favus), or ectothrix (microsporia or Kerion-like), but fluorescence failed. The soil was the source of infection in 11 cases; an animal origin was suspected in 2 patients (M. gypseum was isolated from all the soil specimens, which was incriminated as probable source of the patients' infection).     

Tinea capitis due to Microsporum canis in infants

Three cases of scalp involvement by M. canis in infants are briefly reported. The first was a 2-month-old female with a few erythematous spots on the scalp, the second an 8-month-old male with lesions resembling seborrhoeic dermatitis and the third an 11-month-old male having areas of folliculitis of a kerion type. The father of the second case was found to have a tinea barbae infection due to the same fungus. Stray kittens were the most probable source of infection in all these cases.     

Antinuclear antibody-keratinocyte interactions in photosensitive cutaneous lupus erythematosus

Autoimmune diseases are characterized by various circulating autoantibodies, especially antinuclear antibodies (ANA). It has been a long-standing issue as to whether and/or how ANA interact with epidermal cells to produce skin lesions. Of these ANA, the anti-SS-A/Ro antibody is the most closely associated with photosensitivity in patients with systemic lupus erythematosus (SLE) and its subgroups, including subacute cutaneous lupus erythematosus (SCLE) and neonatal lupus erythematosus (NLE). SS-A/Ro antigens are present in the nucleus and cytoplasm, and interestingly, ultraviolet B (UVB) light translocates these antigens to the surface of the cultured keratinocytes. Thus, anti-SS-A/Ro antibodies in the sera can bind to the relevant antigens expressed on the UVB-irradiated keratinocyte surface, and have been speculated to be an important inducer of antibody-dependent keratinocyte damage. This interaction between the anti-SS-A/Ro antibodies and UVB-irradiated keratinocytes may induce the skin lesions through a cytotoxic mechanism. This review will focus on the involvement of antibody-dependent cellular cytotoxicity in the pathogenesis of the skin lesions observed in photosensitive cutaneous lupus erythematosus.     

Some data on the occurrence of trichophyton tonsurans in Romania

Summary During the last 12 years,T. tonsurans has been isolated from 250 cases of various mycotic infections, 80% in the adults, the rest in children. The age of infected patients varied from 1 to 66 years, the female being represented by 10%.Most of the cases (93%) involved the hair follicles, 45 of them affecting the bearded area, in which 4 clinical types could be distinguished: the superficial form, the kerion type (in 11% of the cases) and 2 intermediate forms.In 16% of cases,T. tonsurans attacked the scalp, simulating various nonmycotic dermatoses as impetigo, seborrheic dermatitis, tinea amiantacea etc. 5 cases of the scalp infection were found in the adults (3 of black-dot type, the other 2 of superficial tinea capitis). The same variety of clinical manifestations was observed in the glabrous skin, which this species affected in 7% of the cases. It also involved the nails in 2 cases only. T. tonsurans is in continuous decrease in Romania for the last ten years (4% of all the dermatophytes). This dermatophyte remained, till now, the main agent of tinea barbae in Romania. Community epidemics as those caused byM. audouinii andM. ferrugineum have not yet occurred in this country.     

The incidence of skin manifestations by dermatophytes in patients with psoriasis

Thirty-four psoriatic patients (23 males, 11 females) were found to have skin manifestations of dermatophyte infection. Tinea pedis was observed in 20 cases, tinea cruris in 6 and tinea mannum in 2. T. rubrum was the causative agent in all of these with the exception of 2 cases caused by E. floccosum. Lesions of tinea corporis were found intermingled with psoriatic plaques in various areas of the body skin in 6 patients (4 males, 2 females); T. rubrum was isolated from 5 of these and M. canis from one. Twenty-one of these psoriatic patients also had lesions caused by C. albicans in the toe-webs and interdigital aspects of the fingers, the latter being associated with paronychia in 9 cases. These findings indicate that we should remain aware of the possibility of fungus manifestations in patients with psoriasis, which would not appear to be an exceptional occurrence.     

A study of dermatophytosis in South West of Iran (Ahwaz)

Two hundred and seventy nine patients suspected of having fungal lesions were examined. Skin scrapping, hair samples and nail clippings were collected from patients. Direct and culture examinations were performed for all samples. About 115 cases of examined subjects had dermatophytosis. Dermatophytosis occurred mainly in adults males (20–29 years). Tinea cruris (24.3%) was the most common type of dermatophytosis followed by tinea pedis (16.5%), tinea corporis (14.8%), tinea ungium (13%), tinea capitis (11.3%), tinea faciei (11.3%), tinea manuum (7%) and tinea barbae (1.7%). Trichophyton mentagrophytes was the most prevalent species followed by Epidermophyton floccosum.     

Tinea capitis by Microsporon gypseum

Summary Scalp involvement byM. gypseum was found in 22 children (15 boys and 7 girls), ranging from 1 till 12 years of age, most cases coming from urban areas. Kerion-like manifestation was observed in 9 cases, the rest presenting the superficial form of tinea capitis infection. The main type of hair invasion was ecto-endothrix, but endothrix type was also observed in 4 cases with favus-like aspect. The parasitised hair exhibited no fluorescence. The soil was proved to be the source of contamination in 40 % of the cases, where a trauma had favoured the transmission of the causative agent.     

EXPERIENCES WITH ACTH AND CORTISONE IN SELECTED DERMATOSES

Fifty patients with various kinds of skin diseases who were not adequately relieved by conventional therapy were treated with ACTH or cortisone given systemically.Almost all patients with disseminated neurodermatitis had dramatic initial response, but in only about half the cases was improvement maintained when use of the drugs was discontinued.It appeared that in other skin diseases, such as lupus erythematosus, scleroderma, psoriasis, dermatomyositis and pemphigus, while improvement may be noted for a time, relapse to the original state occurs after the treatment is stopped.In four cases of chronic discoid lupus erythematosus, although some improvement was observed when steroid therapy was given, the histologic pattern of biopsy material taken from the lesions after treatment still was characteristic of the disease.     

Tinea Infection with Scutula-like Lesions Caused by Microsporum Gypseum in a SLE Patient: Case Report and Literature Review

Scutula are characteristic lesions of tinea favosa or favus; the most frequently identified causative organism is Trichophyton schoenleinii. Although scutula-like lesions were described in Microsporum gypseum infection, their presence on glabrous skin in a patient with SLE has not been reported previously. We report a case of tinea infection with scutula-like lesions caused by Microsporum gypseum in a SLE patient, who was treated with topical terbinafine cream, and the lesions resolved completely. In addition, we reviewed the reported cases about this rare clinical manifestation caused by Microsporum gypseum in the medical literature.     

Atypical cases of Microsporum canis infection in the adult

Eleven adult patients (7 males, 4 females) were found to be infected with Microsporum canis. There was involvement of the scalp in three patients: in one male and one female there were kerion-like lesions and in one male the lesions resembled seborrheic dermatitis. There were three cases of tinea barbae, males aged 28, 65 and 82 years, in the first resembling an infected single lesion of granuloma annulare, the second with a kerion-like lesion and the third with an abscess-like tumor. There were five patients with lesions in glabrous areas: one male with a lesion of the palm resembling erythema multiforme and one with an infection of the auricular lobe resembling a seborrheic dermatitis or otitis externa; of three females with tinea faciei one had a lesion simulating granuloma faciale, one simulating lymphocytic infiltration and one simulating discoid lupus erythematosus. A cat was the source of infection in three cases; in the remainder it could not be determined with certainty. It is of note that a continuous increase in infection with M. canis has been observed in Israel during the past five years.

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Résumé Onze malades adultes ont été infectés par Microsporum canis. L'invasion du cuir chevelu a été observée chez 3 malades; un homme et une femme présentaient des lésions à l'aspect de Kérion; chez le troisième (homme aussi) les lésions simulaient un pytiriasis stéatoïde. Il y avait encore 3 cas de teigne de la barbe, à l'âge de 28, 65 et 82 ans, ressemblant, pour le premier, un granulome annulaire, le second présentant le type de Kérion et le troisième un abscès. Chez le groupe de 5 malades avec des lésions sur la peau glabre, il y avait un homme avec une éruption palmaire ressemblant un érythème multiforme et un autre avec une infection du lobe de l'oreille très sembleble à une dermatite séborrhéique ou à une otite externe. Chez les 3 femmes à teigne glabreuse les lésions siégeaient le visage en simulant un granulome faciale, un lupus érythémateux discoïde et une infiltration lymphocitaire. La source d'infection a été le chat dans 3 cas, dans le reste elle ne pouvant être déterminée avec précision. Il est à noter que l'infection par M. canis en Israel s'est très rapidement dévelopée dans les dernières années.

     

Is disturbed clearance of apoptotic keratinocytes responsible for UVB-induced inflammatory skin lesions in systemic lupus erythematosus?

Apoptotic cells are thought to play an essential role in the pathogenesis of systemic lupus erythematosus (SLE). We hypothesise that delayed or altered clearance of apoptotic cells after UV irradiation will lead to inflammation in the skin of SLE patients. Fifteen SLE patients and 13 controls were irradiated with two minimal erythemal doses (MEDs) of ultraviolet B light (UVB). Subsequently, skin biopsies were analysed (immuno)histologically, over 10 days, for numbers of apoptotic cells, T cells, macrophages, and deposition of immunoglobulin and complement. Additionally, to compare results with cutaneous lesions of SLE patients, 20 biopsies of lupus erythematosus (LE) skin lesions were analysed morphologically for apoptotic cells and infiltrate. Clearance rate of apoptotic cells after irradiation did not differ between patients and controls. Influx of macrophages in dermal and epidermal layers was significantly increased in patients compared with controls. Five out of 15 patients developed a dermal infiltrate that was associated with increased epidermal influx of T cells and macrophages but not with numbers of apoptotic cells or epidermal deposition of immunoglobulins. Macrophages were ingesting multiple apoptotic bodies. Inflammatory lesions in these patients were localised near accumulations of apoptotic keratinocytes similar as was seen in the majority of LE skin lesions. In vivo clearance rate of apoptotic cells is comparable between SLE patients and controls. However, the presence of inflammatory lesions in the vicinity of apoptotic cells, as observed both in UVB-induced and in LE skin lesions in SLE patients, suggests that these lesions result from an inflammatory clearance of apoptotic cells.     

Analysis of Dermatomycoses in Lanzhou District of Northwestern China

The skin mycoses, perticularly dermatophytoses, in Lanzhou district, Northwestern China, was investigated during July 2002–June 2003. The specimens from patients suspected of having dermatomycoses were examined microscopically in KOH preparations and cultured on Sabouraud dextrose agar (SDA). Among 1443 suspected cases, 594 were KOH positive and 221 cultures of fungi were isolated. The most frequently isolated fungi were Trichophyton rubrum (43.9%) Trichophyton mentagrophytes (29.4%) and Candida species (14.0%). The frequency of tinea pedis, onychomycosis and tinea manuum were 38.7, 27.8 and 13.5%, respectively. In Lanzhou district, tinea pedis is the most commonly seen dermatophytoses, and T. rubrum is the most frequent etiologic agent.     

疑似红斑狼疮的面部难辨认癣1例

报告1例面部难辨认癣 患者为21岁女性,农民,由于长期外用糖皮质激素软膏而使局部皮损不典型,当地医师怀疑为红斑狼疮建议到我院做全面检查。病损标本真菌镜检发现菌丝,培养分离出须癣毛癣菌。免疫学检查排除红斑狼疮。病理检查在角质层及毛囊周围发现真菌菌丝。内服特比萘芬3周治愈。     

New data on the epidemiology of Tinea cruris in Israel

Among 250 patients with tinea cruris (160 males, 90 females) lesions of both tinea pedis and tinea unguium were found in 221 and lesions of only tinea pedis in another 25. The four children were free of associated dermatophytic lesions. The predominant causative agent was T. rubrum, which was also found to be responsible for the hairy area invasion of the beard and pubis in 12 patients and for the widespread lesions of tinea corporis in 10 patients with lymphoma. None of these patients had noticed the discrete nail and foot involvement. It is therefore recommended that all patients with tinea cruris be subjected to careful examination of all possible mycotic foci, particularly the feet and nails.     

A critical survey of 1000 cases of dermatophytosis in the tel aviv area during 1970–1975

Clinical and mycological data on 1000 cases of dermatophytosis seen from 1970 to 1975 are reported. Tinea pedis was present in 44%, T. rubrum being the main causative agent; nail involvement was present in 41% of these cases. Tineainguinalis was present in 13%, 38% of them females, withT. rubrum isolated in 87% and the swimming-pool incriminated as the main source of contamination. There were various manifestations of tinea corporis in 128 patients, withT. rubrum responsible in 91%. Among the 21 cases of tinea capitis, there was one adult female with a kerion-type due toT. violaceum, 4 cases due toM. gypseum and 2 toM. canis. Tinea favosa was seen in 6 patients, all of them females and one with a spreading fungus on the soles and palms. Amonh the 10 cases with tinea barbae,T. rubrum was found in 4,T. tonsurans in 3,T. mentagrophytes in 2 andM. gypseum in one. There were widespread lesions ofT. rubrum located on large areas of the body and including the legs, arms, groins and nails, in 11 patients with other disorders, including diabetes, Cushing's syndrome and lymphoma.It was apparent that the dermatophytic flora of Israel comprises 10 dermatophytes,T. rubrum being the predominant agent of infection (in more than 80%), with a gradually increasing incidence evident. The other agents found in our survey wereT. mentagrophytes, T. violaceum, T. schoenleinii, T. tonsurans (found sporadically),E. floccosum andMicrosporum spp.M. canis andM. gypseum, the latter being reported for the first time in this country.T. verruccosum andT. megnini, mentioned in former publications, were not found in this survey.     

Trichophyton violaceum is the dominant cause of tinea capitis in children in Tripoli,Libya: Results of a two year survey

The causative agents of tinea capitis in Libyan nationals attending the out patient Dermatology Clinic of the Tripoli Medical Centre over the period December 1997 to December 1999 were investigated. Samples (hair and scalp scrapings) were taken from 940 patients who presented with suspected tinea capitis. The etiological agents were identified in 584 cases. Trichophyton violaceum was found to be the most prevalent organism isolated being responsible for 64.4% (376/584) of culture positive cases, followed by Microsporum canis at 24.7% (144/584) and T. mentagrophytes at 5.5% (32/584). The majority of infections (380/584) occurred in females and in children with ages less than 12 years (554/584). This revised version was published online in June 2006 with corrections to the Cover Date.     

The role of cytokines in the pathogenesis of cutaneous lupus erythematosus

Cutaneous lupus erythematosus (CLE) is an inflammatory disease with a broad range of cutaneous manifestations that may be accompanied by systemic symptoms. The pathogenesis of CLE is complex, multifactorial and incompletely defined. Below we review the current understanding of the cytokines involved in these processes. Ultraviolet (UV) light plays a central role in the pathogenesis of CLE, triggering keratinocyte apoptosis, transport of nucleoprotein autoantigens to the keratinocyte cell surface and the release of inflammatory cytokines (including interferons (IFNs), tumor necrosis factor (TNF)-α, interleukin (IL)-1, IL-6, IL-8, IL-10 and IL-17). Increased IFN, particularly type I IFN, is central to the development of CLE lesions. In CLE, type I IFN is produced in response to nuclear antigens, immune complexes and UV light. Type I IFN increases leukocyte recruitment to the skin via inflammatory cytokines, chemokines, and adhesion molecules, thereby inducing a cycle of cutaneous inflammation. Increased TNFα in CLE may also cause inflammation. However, decreasing TNFα with an anti-TNFα agent can induce CLE-like lesions. TNFα regulates B cells, increases the production of inflammatory molecules and inhibits the production of IFN-α. An increase in the inflammatory cytokines IL-1, IL-6, IL-10, IL-17 and IL-18 and a decrease in the anti-inflammatory cytokine IL-12 also act to amplify inflammation in CLE. Specific gene mutations may increase the levels of these inflammatory cytokines in some CLE patients. New drugs targeting various aspects of these cytokine pathways are being developed to treat CLE and systemic lupus erythematosus (SLE).     

Clinical significance of circulating dendritic cells in patients with systemic lupus erythematosus

Dendritic cells are a complex group of mainly bone-marrow-derived leukocytes that play a role in autoimmune diseases. The total number of circulating dendritic cells (tDC), and their plasmacytoid dendritic cell (pDC) and myeloid dendritic cell (mDC1 and mDC2) subpopulations were assessed using flow cytometry. The number of tDC and their subsets were significantly lower in systemic lupus erythematosus patients than in the control group. The count of tDC and their subsets correlated with the number of T cells. The number of tDC and pDC subpopulation were lower in the patients with lymphopenia and leukopenia than in the patients without these symptoms. Our data suggest that fluctuations in blood dendritic cell count in systemic lupus erythematosus patients are much more significant in pDC than in mDC, what may be caused by their migration to the sites of inflammation including skin lesions. Positive correlation between dendritic cell number and TCD4+, TCD8+ and CD19+ B cells, testify of their interactions and influence on SLE pathogenesis. The association between dendritic cell number and clinical features seems to be less clear.     

Is disturbed clearance of apoptotic keratinocytes responsible for UVB-induced inflammatory skin lesions in systemic lupus erythematosus?

Apoptotic cells are thought to play an essential role in the pathogenesis of systemic lupus erythematosus (SLE). We hypothesise that delayed or altered clearance of apoptotic cells after UV irradiation will lead to inflammation in the skin of SLE patients. Fifteen SLE patients and 13 controls were irradiated with two minimal erythemal doses (MEDs) of ultraviolet B light (UVB). Subsequently, skin biopsies were analysed (immuno)histologically, over 10 days, for numbers of apoptotic cells, T cells, macrophages, and deposition of immunoglobulin and complement. Additionally, to compare results with cutaneous lesions of SLE patients, 20 biopsies of lupus erythematosus (LE) skin lesions were analysed morphologically for apoptotic cells and infiltrate. Clearance rate of apoptotic cells after irradiation did not differ between patients and controls. Influx of macrophages in dermal and epidermal layers was significantly increased in patients compared with controls. Five out of 15 patients developed a dermal infiltrate that was associated with increased epidermal influx of T cells and macrophages but not with numbers of apoptotic cells or epidermal deposition of immunoglobulins. Macrophages were ingesting multiple apoptotic bodies. Inflammatory lesions in these patients were localised near accumulations of apoptotic keratinocytes similar as was seen in the majority of LE skin lesions. In vivo clearance rate of apoptotic cells is comparable between SLE patients and controls. However, the presence of inflammatory lesions in the vicinity of apoptotic cells, as observed both in UVB-induced and in LE skin lesions in SLE patients, suggests that these lesions result from an inflammatory clearance of apoptotic cells.     

PSYCHOSIS AND SYSTEMIC LUPUS ERYTHEMATOSUS—A Review of the Literature and Case Reports

In a review of the literature of the last 60 years concerning the association between psychosis and systemic lupus erythematosus, reports of 227 cases of this association were found. The average incidence of psychosis in the various series of systemic lupus erythematosus that were reviewed was 22 per cent. In only 25 per cent of the cases in which the information was given was the psychosis associated with steroid therapy.The psychiatric manifestations are variable and may be associated with a neurological disorder. Psychosis may antedate by many years other features of lupus. The psychosis due to lupus may respond to steroid therapy. Since systemic lupus erythematosus sometimes may be an important differential diagnosis of functional psychosis, appropriate diagnostic studies should be carried out in psychotic patients who have an accelerated sedimentation rate or positive serological test for syphilis without apparent reason.