Efficacy and safety of silver textile in the treatment of atopic dermatitis (AD)

BACKGROUND: Patients with atopic dermatitis (AD) have an increased tendency to develop bacterial skin infections. Colonization with Staphylococcus aureus is known to be a major trigger and might also play a pathophysiological role. Because of their antiseptic action, silver-coated textiles suppress S. aureus colonization and toxin formation, thus damping the inflammatory reaction. OBJECTIVES: To evaluate the clinical effectiveness and safety of a special silver textile in the treatment of patients suffering from acute AD. METHODS: In a randomized phase II monocenter parallel-group comparative study 30 patients were recruited (average age 25.5 years, min. 4 years, max. 70 years) who were affected by AD in an acute phase. During the first study phase from Day 1 to Day 14, 10 patients received a silver textile (Group 1), 10 a silver-free textile (Group 2), and 10 prednicarbate ointment (Group 3). In the second phase from Day 15 to Day 28 all patients wore the silver textile, and during the follow-up period from Day 28 to Day 56 no textiles were used. Prednicarbate ointment was allowed as emergency medication, but ointment consumption was measured. The overall severity of the disease was evaluated using the SCORAD index as the primary efficacy parameter. Secondary parameters included severity of pruritus and the patients' assessment of their disease control (uncontrolled, limited, good or complete). Safety tests included hematology, blood chemistry, urinalysis for silver, and physical examination for silver deposits in the skin and mucous membranes.RESULTS: The initial SCORAD was 61.6 (IQR 26.6, min. 30.6, max. 99.9). At the end of the Study Phase 1 the SCORAD had improved significantly in the patients of Groups 1 (74.6-29.9, p = 0.005) and 3 (57.8-24.0, p = 0.009). During Study Phase 2 healing of eczema continued in Group 1 (SCORAD 29.9-18.1, p = 0.037), was observed in Group 2 (48.2-24.1, p = 0.015), and remained at an improved level in Group 3 (SCORAD 24-23.5). Consumption of prednicarbate ointment (Phase 1, Phase 2, follow-up period, medians are given): Group 1: 135 g, 10 g, 45 g; Group 2: 13 g, 0 g, 0 g; Group 3: 145 g, 30 g, 90 g. Silver textiles reduced the severity of the pruritus (p = 0.031); silver-free textiles (n.s.) and prednicarbate (n.s.) were less effective. No undesired events were observed. CONCLUSION: The elastic silver textile worn directly against the skin led to an impressive improvement of AD and a reduction in the use of prednicarbate ointment.     

A large outbreak of multiresistant Pseudomonas aeruginosa strains in north-eastern Germany

Multiply-resistant Pseudomonas aeruginosa were first detected in north-eastern Germany at the end of 1996; since then they have been isolated predominantly from patients in intensive care units. Colonization/infection, especially of the respiratory tract, has been demonstrated in 80 patients, with strains resistant to beta-lactams, carbapenems, aminoglycosides and quinolones. Amikacin showed in-vitro synergy with cefepime, ceftazidime or piperacillin/tazobactam. Horizontal transfer of strains was followed by PFGE and identical strains were detected in the environment, but the source of infection was not established. Rigorous infection control and restricted clinical use of carbapenems limited further dissemination of this outbreak.     

Ts mutations in the genome of cold-adapted variants of human influenza virus A/Krasnodar/101/59 (H2N2) at different passage levels and their reproduction in lungs of hamsters

Human influenza virus A/Krasnodar/101/59 (H2N2) was passaged in chick fibroblast cultures in the presence of trypsin at suboptimal temperature. The virus which underwent 16 passages at 28 degrees C possessed cold-adapted (ca) and temperature sensitive (ts) phenotypes and formed larger plaques at the optimal temperature (33 degrees C). Its reproduction in the lungs of hamsters was decreased as evidenced by approximately 2.5 log10 lower titres; only one of 9 virus isolates from the lungs of hamsters acquired the ts +/- phenotype, although it had retained a ca phenotype. Recombination of this variant with ts mutants of fowl plague virus (FPV) revealed a ts mutation only in gene 4 of this variant coding for haemagglutinin (HA). The virus which had had 25 passages at 28 degrees C possessed the same properties as the previous variant, but all eight virus isolates from the lungs of hamsters retained the ts phenotype; the genome of this variant contained ts mutations in genes 1, 3, 4, 5 and 6. The mutation found in gene 8 was not a ts mutation. The virus, which underwent 25 passages at 28 degrees C and additional 15 passages at 27 degrees C, formed large plaques and alike to the previous variants it possessed the ca and ts phenotypes; however, its reproduction in the lungs of hamsters was decreased by 4.0 log10 and occurred in the lungs only of 4 out 16 infected animals. This variant contained ts mutations in genes 1, 3, 4, 5, 6 and 7 and a non-ts mutation in gene 8.     

<Emphasis Type="Italic">Ureaplasma urealyticum</Emphasis>–harmless commensal or underestimated enemy of human reproduction? A review

This article reviews the role, diagnosis and treatment of Ureaplasma infections in human reproduction.     

egc-Encoded superantigens from Staphylococcus aureus are neutralized by human sera much less efficiently than are classical staphylococcal enterotoxins or toxic shock syndrome toxin

PCR was employed to determine the presence of all known superantigen genes (sea, seq, and tst) and of the exotoxin-like gene cluster (set) in 40 Staphylococcus aureus isolates from blood cultures and throat swabs; 28 isolates harbored superantigen genes, five on average, and this strictly correlated with their ability to stimulate T-cell proliferation. In contrast, the set gene cluster was detected in every S. aureus strain, suggesting a nonredundant function for these genes which is different from T-cell activation. No more than 10% of normal human serum samples inhibited the T-cell stimulation elicited by egc-encoded enterotoxins (staphylococcal enterotoxins G, I, M, N, and O), whereas between 32 and 86% neutralized the classical superantigens. Similarly, intravenous human immunoglobulin G preparations inhibited egc-encoded superantigens with 10- to 100-fold-reduced potency compared with the classical enterotoxins. Thus, there are surprisingly large gaps in the capacity of human serum samples to neutralize S. aureus superantigens.     

Transmission of a multiresistant Pseudomonas aeruginosa strain at a German University Hospital

Over 15 months, 60 patients at a German University Hospital became infected or colonized by a multiresistant Pseudomonas aeruginosa strain, which was isolated from tracheal secretions, blood, urine, venous catheters, ascites and several wounds. Most patients had undergone invasive treatment (surgery, cancer therapy).The genetic relationship of the isolates was investigated by pulsed field gel electrophoresis. The isolates were resistant to beta-lactam antibiotics, including carbapenems and aztreonam, to aminoglycosides and quinolones. The only in vitro susceptibility was to polymyxin B.Extensive sampling was carried out to identify contaminated medical devices, surfaces or media (water, food). Samples were taken from doctors and nursing staff and various treatment procedures were observed for several weeks. The handling of respirators, resuscitation tubes, urine bottles, and bedpans resulted in the contamination of the patients' environment, although most devices were cleaned and disinfected with automatic washer/disinfectors. Several wash basins on the intensive care unit were contaminated, but none of the drinking water samples showed any growth of P. aeruginosa.We recommend the strict use of gloves and strict application of alcoholic hand disinfectants immediately after discarding the gloves. The chain of infection ceased after strict cohort isolation and the subsequent introduction of the specific hygiene regime.