THERAPY OF TINEA CAPITIS—The Value of X-Ray Epilation

Roentgen ray epilation, which is at present the most important single weapon against M. audouini infection of the scalp, should not be withheld except in special circumstances, from a child who has the disease. It can quickly cure the disease and halt spread from one child to another. Harmful sequelae and medicolegal complications can be averted by competent use of the method and simple precautions.The Keinbock-Adamson technique of epilation can be recommended without hesitancy, provided it is carried out meticulously in every detail, and administered by an operator of suitable training and experience in roentgen therapy of the skin.     

Therapy of tinea capitis; the value of x-ray epilation

Roentgen ray epilation, which is at present the most important single weapon against M. audouini infection of the scalp, should not be withheld except in special circumstances, from a child who has the disease. It can quickly cure the disease and halt spread from one child to another. Harmful sequelae and medicolegal complications can be averted by competent use of the method and simple precautions. The Keinbock-Adamson technique of epilation can be recommended without hesitancy, provided it is carried out meticulously in every detail, and administered by an operator of suitable training and experience in roentgen therapy of the skin.     

RADIATION THERAPY OF RINGWORM OF THE SCALP

A recent epidemic of tinea capitis in children has revived a considerable interest in the methods of treatment of this disease.The most efficacious form of therapy for M. audouini infections is roentgen epilation.The various methods of x-ray treatment are briefly presented and compared. A modification of the four-point technique is shown to offer a simple yet safe method of curing ringworm of the scalp. Results with this method compare favorably with the best of those reported by the use of other methods.Cure was effected by this method in all of a group of 125 cases.     

TRICHOPHYTON TONSURANS (CRATERIFORME) INFECTION OF THE SCALP

Of 484 cases of ringworm of the scalp observed in a period of two and a half years at a clinic in Los Angeles, 57 (11.78 per cent) were caused by Trichophyton tonsurans, an organism previously considered an infrequent cause of tinea capitis in the United States. The hairs at the site of infection with this organism are distinctively fluorescent when viewed under a Wood light—glowing white rather than green as do hairs infected with microsporum. Endothrix spore formation may be noted in microscopic examination of infected hairs. Material planted on Sabouraud''s media grows as a typical crateriform colony. Occasionally variant growths on cultures are obtained.Trichophyton tonsurans may cause either dry, scaly lesions or inflammatory reaction. In the present series the incidence of cure was higher and the period of treatment shorter for patients with the inflammatory variety. Various antifungal preparations were employed for topical application and although the results were extremely variable, it was felt that some benefit was derived from their use. For lesions of the dry, non-inflammatory type, roentgen ray epilation appeared to be the treatment of choice.     

Surgery versus epilation for the treatment of minor trichiasis in Ethiopia: a randomised controlled noninferiority trial

Background

Trachomatous trichiasis can cause corneal damage and visual impairment. WHO recommends surgery for all cases. However, in many regions surgical provision is inadequate and patients frequently decline. Self-epilation is common and was associated with comparable outcomes to surgery in nonrandomised studies for minor trichiasis (Methods and Findings1,300 individuals with minor trichiasis from Amhara Regional State, Ethiopia were recruited and randomly assigned (1∶1) to receive trichiasis surgery or epilation. The epilation group were given new forceps and epilation training. The surgical group received trichiasis surgery. Participants were examined every 6 months for 2 years by clinicians masked to allocation, with 93.5% follow-up at 24 months. The primary outcome measure (“failure”) was ≥five lashes touching the eye or receiving trichiasis surgery during 24 months of follow-up, and was assessed for noninferiority with a 10% prespecified noninferiority margin. Secondary outcomes included number of lashes touching, time to failure, and changes in visual acuity and corneal opacity.Cumulative risk of failure over 24 months was 13.2% in the epilation group and 2.2% in the surgical group (risk difference = 11%). The 95% confidence interval (8.1%–13.9%) includes the 10% noninferiority margin. Mean number of lashes touching the eye was greater in the epilation group than the surgery group (at 24 months 0.95 versus 0.09, respectively; p<0.001); there was no difference in change in visual acuity or corneal opacity between the two groups.

Conclusions

This trial was inconclusive regarding inferiority of epilation to surgery for the treatment of minor trichiasis, relative to the prespecified margin. Epilation had a comparable effect to surgery on visual acuity and corneal outcomes. We suggest that surgery be performed whenever possible but epilation be used for treatment of minor trichiasis patients without access to or declining surgery.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT00522912","term_id":"NCT00522912"}}NCT00522912 Please see later in the article for the Editors'' Summary     

WORKMEN'S COMPENSATION ACT—Some Aspects of Interest to California Physicians

This article was prepared by Mr. William M. Whelan, Director of Special Services, California Medical Association, under the supervision of Dr. Francis J. Cox, Chairman of the Medical Services Commission of the Association, and Mr. Howard Hassard, the Association''s Legal Counsel. It is intended as a brief synopsis of the California Workmen''s Compensation Law as it applies to the physician in private practice. It is not an exhaustive treatment of the subject. A physician who desires to acquaint himself in detail with California industrial practice should consult the article entitled “The Physician''s Role in Workmen''s Compensation,” California Medicine, 82:352-362, April, 1955. Inquiries regarding industrial medicine should be addressed to Mr. William M. Whelan, California Medical Association, 450 Sutter St., San Francisco 8.     

Mycobacterium ulcerans Fails to Infect through Skin Abrasions in a Guinea Pig Infection Model: Implications for Transmission

Transmission of M. ulcerans, the etiological agent of Buruli ulcer, from the environment to humans remains an enigma despite decades of research. Major transmission hypotheses propose 1) that M. ulcerans is acquired through an insect bite or 2) that bacteria enter an existing wound through exposure to a contaminated environment. In studies reported here, a guinea pig infection model was developed to determine whether Buruli ulcer could be produced through passive inoculation of M. ulcerans onto a superficial abrasion. The choice of an abrasion model was based on the fact that most bacterial pathogens infecting the skin are able to infect an open lesion, and that abrasions are extremely common in children. Our studies show that after a 90d infection period, an ulcer was present at intra-dermal injection sites of all seven animals infected, whereas topical application of M. ulcerans failed to establish an infection. Mycobacterium ulcerans was cultured from all injection sites whereas infected abrasion sites healed and were culture negative. A 14d experiment was conducted to determine how long organisms persisted after inoculation. Mycobacterium ulcerans was isolated from abrasions at one hour and 24 hours post infection, but cultures from later time points were negative. Abrasion sites were qPCR positive up to seven days post infection, but negative at later timepoints. In contrast, M. ulcerans DNA was detected at intra-dermal injection sites throughout the study. M. ulcerans was cultured from injection sites at each time point. These results suggest that injection of M. ulcerans into the skin greatly facilitates infection and lends support for the role of an invertebrate vector or other route of entry such as a puncture wound or deep laceration where bacteria would be contained within the lesion. Infection through passive inoculation into an existing abrasion appears a less likely route of entry.     

Dissecting cellulitis of the scalp

Dissecting cellulitis of the scalp or perifolliculitis capitis abscedens et suffodiens is a rare, chronic, progressive, suppurative disease of the scalp of unknown etiology. It is characterized by painful nodules, purulent drainage, burrowing interconnecting abscesses, and cicatricial alopecia. The pathogenesis is unknown, although it is probably related to follicular occlusion, secondary infection, and deep inflammation. Black men in their second to fourth decade are predominantly affected. Treatment varies from systemic antibiotics to incision and drainage, x-ray epilation of the affected areas, systemic steroid administration, and surgical excision. Our experience with four patients with extensive scalp disease is presented. Wide excision of the affected areas and splitthickness skin graft are favored as our treatment of choice.     

Pesticidal activity of Solanum elaeagnifolium Cav. Leaves against nematodes and perennial weeds

Sliver nightshade (Solanum elaeagnifolium Cav.) an invasive weed species in cultivated lands of Egypt threatens native and crop species. The allelopathic potential of this weed was assessed against nematode and weeds. The aqueous extracts of Sliver nightshade leaves and seeds exhibited strong impacts in root knot nematode Meloidogyne incognita galls, egg-masses, female's numbers and juveniles' number. The incorporate dried leaves of S. elaeagnifolium with soil positively affected M. incognita infection and enhanced Eggplant Solanum melongena cv. white Balady growth traits under the greenhouse proportional to concentration. The allelopathy of aqueous extracts negatively influenced Convolvulus arvensis, Polypogon monspeliensis, Phalaris minor and Triticum aestivum germination and growth. Bioassay and spectroscopic instruments guided to four active flavonoids; hydroxyl −3-methoxyflavone, quercetin, kaempferol 3β-D-(6”-O-cis-cinnamoyl glucoside) and chlorogenic acid on Convolvulus arvensis and Arabidopsis thaliana weeds total biomass. These findings proved the importance of invasive weeds allelochemicals to be considered as a source of natural pesticides into agricultural systems.     

The mediator of cellular immunity. IV. Cooperation between lymphocytes and mononuclear phagocytes

Acquired resistance to an intravenous infection with Listeria monocytogenes involves the interaction of two cell types: specifically committed lymphocytes and monocyte-derived macrophages. This interaction was revealed in experiments using the polyfunctional alkylating agent, cyclophosphamide. Cyclophosphamide is toxic for both lymphocytes and blood monocyte antecedents. Rats treated with cyclophosphamide were immunized adoptively with cells obtained from the thoracic duct lymph of Listeria-immune donors. But such animals benefited from a lymphocyte injection only while they could assemble monocyte-derived macrophages in an inflammatory exudate. The results imply that blood monocytes provide an essential element to the host's defense mechanism against intracellular bacterial parasites, and that monocyte-derived macrophages are the instruments through which cellular resistance to infection is expressed.     

Interactions with M Cells and Macrophages as Key Steps in the Pathogenesis of Enterohemorragic Escherichia coli Infections

Enterohemorrhagic Escherichia coli (EHEC) are food-borne pathogens that can cause serious infections ranging from diarrhea to hemorrhagic colitis (HC) and hemolytic-uremic syndrome (HUS). Translocation of Shiga-toxins (Stx) from the gut lumen to underlying tissues is a decisive step in the development of the infection, but the mechanisms involved remain unclear. Many bacterial pathogens target the follicle-associated epithelium, which overlies Peyer''s patches (PPs), cross the intestinal barrier through M cells and are captured by mucosal macrophages. Here, translocation across M cells, as well as survival and proliferation of EHEC strains within THP-1 macrophages were investigated using EHEC O157:H7 reference strains, isogenic mutants, and 15 EHEC strains isolated from HC/HUS patients. We showed for the first time that E. coli O157:H7 strains are able to interact in vivo with murine PPs, to translocate ex vivo through murine ileal mucosa with PPs and across an in vitro human M cell model. EHEC strains are also able to survive and to produce Stx in macrophages, which induce cell apoptosis and Stx release. In conclusion, our results suggest that the uptake of EHEC by M cells and underlying macrophages in the PP may be a critical step in Stx translocation and release in vivo. A new model for EHEC infection in humans is proposed that could help in a fuller understanding of EHEC-associated diseases.     

Epidemiology and Antifungal Susceptibilities of Yeasts Causing Vulvovaginitis in a Teaching Hospital

Vulvovaginal candidiasis is one of the most common mycosis. However, the information about antifungal susceptibilities of the yeasts causing this infection is scant. We studied 121 yeasts isolated from 118 patients with vulvovaginal candidiasis. The isolates were identified by phenotypic and molecular methods, including four phenotypic methods described to differentiate Candida albicans from C. dubliniensis. Antifungal susceptibility testing was performed according to CLSI documents M27A3 and M27S4 using the drugs available as treatment option in the hospital. Diabetes, any antibacterial and amoxicillin treatment were statistically linked with vulvovaginal candidiasis, while oral contraceptives were not considered a risk factor. Previous azole-based over-the-counter antifungal treatment was statistically associated with non-C.albicans yeasts infections. The most common isolated yeast species was C. albicans (85.2 %) followed by C. glabrata (5 %), Saccharomyces cerevisiae (3.3 %), and C. dubliniensis (2.5 %). Fluconazole- and itraconazole-reduced susceptibility was observed in ten and in only one C. albicans strains, respectively. All the C. glabrata isolates showed low fluconazole MICs. Clotrimazole showed excellent potency against all but seven isolates (three C. glabrata, two S. cerevisiae, one C. albicans and one Picchia anomala). Any of the strains showed nystatin reduced susceptibility. On the other hand, terbinafine was the less potent drug. Antifungal resistance is still a rare phenomenon supporting the use of azole antifungals as empirical treatment of vulvovaginal candidiasis.     

The comparison of hair from gastric cancer patients and from healthy persons studied by infrared microspectroscopy and imaging using synchrotron radiation

Objective: The objective is to apply synchrotron-based FTIR microspectroscopy and imaging to human hair tissue and investigate the possibility of the method in gastric cancer research and diagnosis. Methods: Human hair from gastric cancer patients’ scalp and normal persons’ scalp were studied by synchrotron-based FTIR microspectroscopy and imaging. Results: The micro-spectra and imaging show the difference between the normal and malignant hair tissues. Obvious peak shift of symmetric phosphate band is observed in micro-spectra of medulla region for the hair tissue of gastric cancer patients. Chemical imaging shows the distributions of lipid and amide II/v_sPO₂^? have changed in the gastric cancer cases. Conclusions: The study indicates that the hair tissue's infrared microspectroscopy and imaging using synchrotron will be a potentially useful method for rapid early gastric cancer diagnosis.     

Risk of Buruli ulcer and detection of Mycobacterium ulcerans in mosquitoes in southeastern Australia

Background

Buruli ulcer (BU) is a destructive skin condition caused by infection with the environmental bacterium, Mycobacterium ulcerans. The mode of transmission of M. ulcerans is not completely understood, but several studies have explored the role of biting insects. In this study, we tested for an association between the detection of M. ulcerans in mosquitoes and the risk of BU disease in humans in an endemic area of southeastern Australia.

Methodology/Principal Findings

Adult mosquitoes were trapped in seven towns on the Bellarine Peninsula in Victoria, Australia, from December 2004 to December 2009 and screened for M. ulcerans by real-time PCR. The number of laboratory-confirmed cases of BU in permanent residents of these towns diagnosed during the same period was tallied to determine the average cumulative incidence of BU in each location. Pearson''s correlation coefficient (r) was calculated for the proportion of M. ulcerans-positive mosquitoes per town correlated with the incidence of BU per town. We found a strong dose-response relationship between the detection of M. ulcerans in mosquitoes and the risk of human disease (r, 0.99; 95% CI, 0.92–0.99; p<0.001).

Conclusions/Significance

The results of this study strengthen the hypothesis that mosquitoes are involved in the transmission of M. ulcerans in southeastern Australia. This has implications for the development of intervention strategies to control and prevent BU.     

Cloxacillin and Sodium Fusidate in Management of Shunt Infections

The effectiveness of two oral antibiotics, cloxacillin and sodium fusidate, has been evaluated in the treatment of shunt infections among 37 patients allocated at random to two treatment groups. Both proved to be safe bactericidal agents giving adequate serum M.I.C. when taken by mouth. Treatment should always be started on the basis of the clinical presentation without waiting for the bacteriologist''s report. The commonest infecting organism is Staphylococcus aureus. Nine shunts were lost in this study, eight through Staphylococcus aureus infection. The nasal carrier state is of considerable importance in perpetuating these shunt infections.     

Epidemia de tiña por Trichophyton tonsurans en un área sanitaria de la Comunidad de Madrid (España)

BackgroundTrichophyton tonsurans is a dermatophyte fungus that can cause ringworm outbreaks. In our health area in September 2013, two cases of T. tonsurans ringworm were diagnosed in children who lived in a Children's Centre.AimsTo determine the origin and extent of the outbreak.MethodsMycological cultures of scalp and skin samples from the contacts of the diagnosed cases were performed, as well as environmental samples from the Children's Centre. The patients started with a treatment for their ringworm, and an environmental disinfection of the centre was performed.ResultsTwelve cases of ringworm were detected, along with three asymptomatic scalp carriers of T. tonsurans among 20 children in the Centre. The index case was a resident in whose family, that had just returned from their country of origin, Nigeria, three cases of ringworm were diagnosed. From November 2013 to February 2014 another five cases of ringworm were diagnosed among schoolmates of three cases from the Children's Centre.ConclusionsThe antifungal treatment of the children resulted in the mycological and clinical resolution, and from February to November 2014 no other cases of ringworm by T. tonsurans in the same health area were diagnosed.     

Interactions between Meloidogyne incognita,M. hapla,and Pratylenchus brachyurus in Tobacco

In a greenhouse pot experiment on the pathogenicity and interactions of Meloidogyne incognita, M. hapla and Pratylenchus brachyurus on four cultivars o f tobacco the cultivars ''Hicks'' and ''NC 2326'' were susceptible to each nematode and "NC 95'' and ''NC 2512'' resistant only to M. incognita.Mean heights of susceptible plants were depressed but fresh weight of tops did not differ significantly. Meloidogyne spp. increased fresh weight of susceptible (but not the resistant) roots.Reproduction of M. incognita was decreased in the presence of P. brachyurus in one case. M. hapla reproduction was less with either of the other nematodes in five out of eight cases. In 12 combinations involving P. brachyurus, reproduction of this species was depressed in seven, not affected in four and increased in one.Mechanisms involved in associative interactions were not identified but appeared to be indirect and to involve individual host-nematode responses.     

RNA silencing of the anionic peroxidase gene impairs potato plant resistance to Phytophthora infestans (Mont.) de Bary

Potato Solanum tuberosum L. plants expressing an antisense M21334 fragment were obtained by agrobacterial transformation. A manifold decrease in activity of anionic isoperoxidase with pI ～ 3.5 in the transformed plants demonstrated that the enzyme is encoded by M21334. The transformed plants showed a decrease in lignin accumulation and a dramatically lower resistance to the late blight agent Phytophthora infestans, implicating the enzyme in the response to P. infestans infection.     

In vivo study of human Plasmodium knowlesi inMacaca fascicularis

Plasmodium knowlesi is a malaria parasite of Old World monkeys and is infectious to humans. In this study Macaca fascicularis was used as a model to understand the host response to P. knowlesi using parasitological and haematological parameters. Three M. fascicularis of either sex were experimentally infected with P. knowlesi erythrocytic parasites from humans. The pre-patent period for P. knowlesi infection in M. fascicularis ranged from seven to 14 days. The parasitemia observed was 13,686-24,202 parasites per μL of blood for asexual stage and 88-264 parasites per μL of blood for sexual stage. Periodicity analysis adopted from microfilaria periodicity technique of asexual stage showed that the parasitemia peak at 17:39 h while the sexual stage peaked at 02:36 h. Mathematical analysis of the data indicates that P. knowlesi gametocytes tend to display periodicity with a peak (24:00-06:00) that coincides with the peak biting activity (19:00-06:00) of the local vector, Anopheles latens. The morphology of P. knowlesi resembled P. falciparum in early trophozoite and P. malariae in late trophozoite. However, it may be distinguishable by observing the appliqué appearance of the cytoplasm and the chromatin lying inside the ring. Haematological analysis on macaques with knowlesi malaria showed clinical manifestations of hypoglycaemia, anaemia and hyperbilirubinemia. Gross examination of spleen and liver showed malaria pigments deposition in both organs.