成功治疗暴发性紫癜1例

患者。女，12岁，因面部、四肢突然发生对称性淤斑，肿胀，伴疼痛2天，于2004年7月15日入我院就诊。7月13日上午，不明原因情况下患儿突然感觉双手背剧痒、发麻，面部、足背相继出现同样症状。2h后上述部位肿胀、疼痛，进而出现紫红色斑片。第2天，在当地治疗后无好转，且病情逐渐加重。入院时，患儿精神差，病重外观，但神志清楚。双眼睑高度水肿，不能睁眼。面颊部、双手背、手指、前臂、上臂及双足背对称性大片状淤斑，中心部及指趾呈紫黑色，     

成人暴发性紫癜一例

患者女,45岁,公务员。因头面、四肢大面积暗红色瘀斑8 d由感染科转入我科。患者发病前1 d同家人晚餐进食熟河豚和海鲜,同时饮少量葡萄酒,患者于次日晨起两面颊、耳廓和四肢出现红色瘀斑,自觉微痒,红色瘀斑迅速扩大,瘙痒加重,并出现灼痛。起病当日曾在本市某医院就诊,拟诊“网状青斑”、“变应性血管炎”等,予口服药（具体不详）和青鹏软膏等治疗。瘀斑仍继续增多扩大,疼痛难忍,致行动不便,故来我院诊治,拟诊“中毒性红斑”收住感染科……     

暴发性紫癜1例

暴发性紫癜又名坏死性紫癜,是一种少见但病情凶险的血栓性出血性疾病,病死率高达40％－92％01多发生于儿童,近10年的文献报道此病发生于成人仅5例,现将我科诊治的1例报道如下。     

暴发性紫癜并指趾坏疽1例

暴发性紫癜（Purpura Fulminans PF）又称坏疽性紫癜（purpura gangrenosa）和出血性紫癜（purpura hemorhagica），最多见于儿童，是一种少见的急性严重皮肤出血性栓塞和坏死。     

暴发性紫癜一例

患者女，27岁，因双下肢红斑，水疱伴痒痛2周于2002年4月26日入院。患者于2周前因发热而用氨苄西琳，当晚双侧小腿出现红斑，稍痒，数小时后红斑上起水疱，伴痒痛，次日皮疹扩大增多，波及至大腿外侧及屈侧，部分融合成大片，水疱疱液转为血性，红斑颜色为暗红色，大部分变黑，双下肢肿胀疼痛，行走困难。当地医院给予抗炎及对症治疗，     

脉络宁注射液治疗暴发性紫癜2例

例1　女,6个月。发烧2天后,头面部及全身突然出现紫色网斑,患儿状态极差,急送当地医院抢救。诊为“流行性乙型脑炎”,用先锋霉素、皮质激素、6542等治疗。紫色渐限于手足,且指趾变黑。1周后,黑斑加重,足底又出现血疱,于发病第9天来我院。体检:系统检查无异常。鼻尖有豆粒大小紫红斑。左手无名指、小指紫黑色,末节黑色。右手5指均紫黑色,末节黑色。双足踝以下均紫黑色。足底外侧皮肤索条状黑色,表面少许豆粒大小血疱,足趾黑色,表面紧张发亮。皮温低。实验室检查:ＷＢＣ4.04×109/Ｌ、Ｓｔ0.02、Ｓ0.8、Ｌ0.14、Ｍｏｎ0.04、ＰＬＴ520×109/Ｌ…     

金黄色葡萄球菌烫伤样皮肤综合征并发败血症1例

赖某,女,９５１２岁,因发烧全身皮疹半月全身发红水肿一周入院。患儿半月前受凉发烧咳嗽,次日躯干部出现针头至米粒大小淡红斑,经中药口服未见好转,皮疹增多,仍烧,Ｔ３９５℃。全身弥漫针头大小红斑丘疹,未融合成片,诊断“麻疹”,“上呼吸道感染”。给以病毒...     

化脓性链球菌败血症致成人暴发性紫癜一例

暴发性紫癜是一种进展迅速的以皮肤出血性坏死、广泛疼痛性水疱为表现的疾病.好发于儿童,成人少见.多发生于各种感染后.我们报道1例由化脓性链球菌败血症引起的老年男性病例,患者病程进展迅猛、发病72 h内死亡(入院后48 h内).     

罕见暴发性痤疮并发混合型过敏性紫癜患者1例护理

 对1例暴发性痤疮并发混合型过敏性紫癜患者颜面部脓疱、皮肤紫癜情况采取针对性护理,通过皮损护理、饮食管理、心理护理和健康指导进行前瞻性护理干预。经治疗及护理,患者面部痤疮控制、糜烂面愈合,皮肤紫癜消退,住院16 d,病情好转出院。     

艾滋病合并暴发性紫癜1例

<正>人免疫缺陷病毒(HIV)是一种能攻击人体免疫系统的病毒,可降低感染者免疫力,致感染者发生各种机会性感染,暴发性紫癜是一种非血小板减少性紫癜,临床以突然发生的对称性、广泛性、触痛性瘀斑为特征,此病常发生于败血症患者,多见于儿童,成人少见[1]。笔者诊治1例成人艾滋病合并暴发性紫癜,现报告如下。     

Vibrio vulnificus septicemia presenting as purpura fulminans

We present a case of Vibrio vulnificus septicemia presenting as purpura fulminans, which can often result in a catastrophic course. This case had a fortunate outcome due to immediate and intensive empirical antibiotic treatment and the relatively healthy condition of the patient. We focused on the prognostic factors for the relatively good outcome in this patient.     

Case of purpura fulminans due to septicemia after artificial abortion

We describe a case of purpura fulminans due to septicemia after artificial abortion. Our patient suffered purpuric progressive skin necrosis on the back, extremities and buttock. Rhabdomyolysis involvement was confirmed by high level of creatinine phosphokinase and appearance of much brownish discharge from necrotic gluteal muscle and latissimus dorsi muscle. Amputation of both feet and second, third, fourth and fifth fingers of the right hand was performed. The buttock lesion was reconstructed with the posterolateral thigh V-Y flap after debridement. Other lesions were covered with split-thickness skin grafts.     

Necrotizing fasciitis caused by Staphylococcus epidermidis in a neonate with extremely low birthweight

Necrotizing fasciitis (NF) is a severe life‐threatening soft tissue infection characterized by rapidly spreading necrosis of the fascia and the subcutaneous tissue. The initial skin presentation ranges from minimal rash to cellulites. The lesions subsequently spread rapidly. Even with appropriate medical and surgical therapy, the mortality rate in NF is more than 50%. In cases of neonates, mortality rate is higher than that ratio. High index of suspicion, prompt aggressive surgery, appropriate antibiotics and supportive care are the mainstays of management in the newborn infant with NF. Herein, we report a case of invasive and mortal NF caused by Staphylococcus epidermidis in an infant with extremely low birthweight.     

氨基酮戊酸光动力疗法对浮游表皮葡萄球菌抑制作用的体外研究

目的 观察氨基酮戊酸光动力疗法(ALA-PDT)对浮游表皮葡萄球菌的影响,探讨ALA最适浓度和最佳孵育时间.方法 实验分3组,第1组,50 mmol/L ALA与细菌37℃避光孵育3、5、8、12、16、18、20、24h;第2组,不同浓度ALA(10、20、30、40、50 mmol/L)与细菌37℃避光孵育16h;第3组,单纯胰蛋白陈大豆肉汤培养基(TSB)(不加ALA)与细菌37℃避光孵育24h.3个组均通过激光共聚焦显微镜( CLSM)检测不同时间点原卟啉Ⅸ(PpⅨ)的荧光强度并做定量分析.同时对第1组进行不同剂量(30、50、70、90、100 J/cm2)红光照射,第2组用100 J/cm2红光照射,第3组不照光,同时设不同剂量红光照射对照组.采用菌落计数法分析ALA-PDT对浮游表皮葡萄球菌的影响.结果 第1组,CLSM下均观察到砖红色荧光,荧光强度随着孵育时间的延长而逐渐增强,孵育16、18、20、24h的荧光强度明显高于3、5、8、12 h(P＜ 0.05);第2组,荧光强度随着ALA浓度的增加而增强,50 mmol/L ALA组荧光强度明显高于10、20、30、40 mmol/L ALA组(P＜0.05);第3组,未见砖红色荧光.前两组经红光照射后发现,随着ALA浓度和光剂量的增加,存活的细菌数逐渐减少,当ALA为50 mmol/L、光剂量为100 J/cm2时,细菌生长受到抑制.结论 ALA-PDT对浮游表皮葡萄球菌有明显抑制作用,最适治疗参数为50 mmol/L ALA、孵育16 h,光照剂量100 J/cm2.     

氨基酮戊酸光动力对表皮葡萄球菌生物膜作用

目的 探讨氨基酮戊酸光动力（ALA-PDT）对表皮葡萄球菌生物膜的作用。方法 盖玻片上培养并形成表皮葡萄球菌生物膜,激光共聚焦显微镜（CLSM）观察其结构;将实验分为不同光剂量（100 ~ 300 J/cm2）的ALA-PDT组和阴性对照组及单纯红光照射组。采用活菌计数法评估ALA-PDT对生物膜细菌的杀菌作用,CLSM观察ALA-PDT对生物膜细菌活力的影响,扫描电镜检测ALA-PDT对生物膜结构的影响。结果 ＡＬＡ－ＰＤＴ组分别给予100、200、300 J/cm2红光照射后,存活的细菌数分别为（210 ± 7.55） × 105、（91 ± 1.53） × 105、（16 ± 1.52） × 105,经统计学分析,各组和阴性对照组及单纯红光照射组之间,差异均有统计学意义（P < 0.01）;死菌/活菌比例分别为1.254 ± 0.096、1.301 ± 0.160、3.410 ± 1.140,各组与阴性对照组及单纯红光照射组之间差异有统计学意义（P < 0.01）。扫描电镜结果显示,生物膜结构疏松、模糊,当光剂量达300 J/cm2时,生物膜结构消失,细菌呈单菌落分布。结论 ALA-PDT对生物膜有一定的抗菌作用,不仅能降低生物膜的活力,还能破坏生物膜的结构。     

Acne fulminans (acute febrile ulcerative conglobate acne) treated with isotretinoin: a case report

A 16-year-old boy was treated for acne fulminans (AF) with isotretinoin when the acute inflammatory stage had been suppressed with oral corticosteroids. From our experience of this case and from our review of the literature, we recommend that isotretinoin should be withheld during the acute, inflammatory phase of AF in order to prevent exacerbation of the condition.     

The treatment of acne fulminans: a review of 25 cases

The treatment of acne fulminans has been difficult. It is difficult to perform a controlled treatment trial due to the rarity of the complication. However, it is possible to compare four different therapeutic regimens which have evolved with time in the management of 25 patients over a period of 25 years. Oral antibiotics produced a slow response in the resolution of acne and systemic symptoms. The addition of a systemic steroid produced a quick resolution of systemic features, but the time until resolution of the acne was longer than when it was used in combination with oral isotretinoin. The protocols which used a combination of prednisolone and isotretinoin led to faster control of systemic features as well as clearance of acne when compared with other protocols. This was particularly so if the oral steroid was used sooner rather than later. We conclude that the preferred treatment of acne fulminans is oral prednisolone 0.5-1 mg/kg daily for 4-6 weeks (thereafter slowly reduced to zero) with oral isotretinoin being added to the regimen at the fourth week, initially at 0.5 mg/kg daily and gradually increased to achieve complete clearance.     

Effect of leave-on cosmetic antimicrobial preservatives on healthy skin resident Staphylococcus epidermidis

Background

The effect of high doses preservatives in the leave-on cosmetic products to the skin microbiota is not clear. Studies have shown that the preservatives might alter the balance of the skin microbiota.

Aim

In this study, we aimed to evaluate antimicrobial effect of nine cosmetic chemical preservatives.

Material & Method

A total of 77 Staphylococcus epidermidis isolates from 46 healthy zygomatic skin samples were characterized by multilocus sequence typing (MLST). Nine preservatives used in leave-on cosmetics were analyzed by testing the minimal inhibitory concentrations (MICs) against S. epidermidis isolates. We also determined the mutant prevention concentration (MPC) and bactericidal kinetics on selected isolates.

Results

More than 17 sequence types were recognized among 77 S. epidermidis isolates. Our data demonstrated that the maximum permitted doses of 2-bromo-2-nitro-1,3-propanediol, ethyl 4-hydroxybenzoate, hexadecyltrimethylammonium bromide, and imidazolidinyl urea were significantly higher than both their MICs and MPCs. We showed that, at the maximum permitted doses, two preservatives could completely kill 10⁷ CFU/mL S. epidermidis in less than 1 h in MH broth.

Conclusion

Our data demonstrated that certain preservatives of the leave-on cosmetics might inhibit or kill S. epidermidis cells and perturb the skin microbiota balance. The determination of the maximum permitted doses of the preservatives should not only be based on the toxicological data, but also antimicrobial susceptibility analysis. This comprehensive evaluation would ensure a balanced and healthy skin microbiota.     

The Antibiotic Susceptibility of Propionibacterium acnes and Staphylococcus epidermidis Isolated from Acne

We studied the susceptibility of antimicrobial agents to Propionibacterium acnes (P. acnes) and Staphylococcus epidermidis (S. epidermidis) isolated from acne patients. We measured the minimum inhibitory concentrations (MICs) of the following five drugs: roxithromycin (RXM), erythromycin (EM), clindamycin (CLDM), minocycline (MINO) and ofloxacin (OFLX), which are frequently Used to treat acne and skin infections. We found many resistant strains of S. epidermidis and some resistant strains of P. acnes. There was a correlation between the resistance of S. epidermidis and the former therapy for acne, but no distinct correlation between the resistance of P. acnes and the former therapy for acne.     

高球蛋白血症性紫癜并发原发性干燥综合征一例

患者，女，47岁。双下肢反复出现瘀点、瘀斑4个月，劳累、不良情绪刺激后加重。实验室检查球蛋白增高、血沉增快、类风湿因子强阳性、轻度贫血、血小板正常；抗SSA、SSB抗体2+，Schirmer试验+，唾液腺ECT：唾液腺自主排泌功能降低。唇腺病理活检符合干燥综合征。结合患者临床表现，诊断为高球蛋白血症性紫癜合并原发性干燥综合征。使用糖皮质激素联合羟氯喹、乙酰半胱氨酸、白芍总苷等口服并规律减量， 随访2年病情稳定无复发。