Primary cutaneous aspergillosis at the site of cyanoacrylate skin adhesive in a neonate

Primary cutaneous aspergillosis is a rare but potentially life‐threatening disease. We present the case of a premature infant who developed primary cutaneous aspergillosis with Aspergillus niger at the site of a skin abrasion that had been treated with a purple‐colored cyanoacrylate product. The infection was treated successfully with gentle debridement of the cyanoacrylate product, followed by intravenous voriconazole and topical fluconazole. To our knowledge, this is the first reported case of primary cutaneous aspergillosis occurring at the site of cyanoacrylate‐based skin adhesive.     

小儿反复呼吸道感染危险因素分析

目的:探讨小儿反复呼吸道感染(RRTI)的危险因素,为降低儿童RRTI患病率制定相应的预防措施。方法:采用成组设计的病例对照研究方法,对RRTI病例及健康小儿各101例进行问卷调查,采用原子吸收法检测血微量元素(血锌、铜、铁、钙、镁)及血铅水平,采用免疫透射比浊法测定IgM、IgA、IgG、补体C3、补体C4的含量。应用Logistic回归模型控制混杂因素干扰。结果:儿童期不偏食、血锌为保护性因素。血铅含量偏高、主要看护人不是自己父母、户外活动时间短、既往佝偻病史为RRTI的可能危险因素。结论:运用科学的营养方式,杜绝偏食,坚持体育锻炼及户外活动,父母多看护儿女,定期检测微量元素,必要时补充锌或驱铅治疗,提高机体抵抗力,将会减少RRTI发生率。     

Clinical and microbiological properties of Staphylococcus lugdunensis skin infections

Staphylococcus lugdunensis is an emerging pathogen in skin and soft tissue infections that was previously considered a commensal. The aim of this study was to elucidate the characteristics of skin infections by S. lugdunensis and its appropriate management, in a tertiary referral medical center. The clinical files, bacterial cultures and histopathology reports of all S. lugdunensis isolates from skin infections over a period of 8 years (September 2009–September 2017) were reviewed. S. lugdunensis was isolated from 29 patients with skin infections, aged 7–89 years (mean 33.3 years). A state of immune suppression (drug‐induced, malignancy or diabetes) was present in five patients (17%). Folliculitis and cutaneous pustulosis were the most common presentations (16 cases, 55%), followed by secondary infection of hidradenitis suppurativa (five cases, 17%). Other sources of isolation were infected molluscum contagiosum (two cases), folliculitis decalvans (one case), dissecting cellulitis (one case), abscess (one case), cyst (one case), impetigo (one case) and granuloma after trauma (one case). The in vitro antibiotic sensitivity tests showed susceptibility to most tested antibiotics, although a few isolates were resistant to gentamycin, penicillin and oxacillin. In 19 of 20 patients for whom follow ups were available, cutaneous manifestations improved or resolved with proper local and/or oral antibiotic therapy. S. lugdunensis may play a role as a primary or secondary pathogen in various skin infections, most commonly folliculitis and pustulosis. Proper antibiotic therapy may lead to improvement or resolution.     

Genetic analysis of human rhinovirus species A to C detected in patients with acute respiratory infection in Kumamoto prefecture,Japan 2011–2012

We performed detailed genetic analysis of the VP4/VP2 coding region in human rhinovirus species A to C (HRV-ABC) strains detected in patients with a variety of acute respiratory infections in Kumamoto, Japan in the period 2011–12. The phylogenetic tree and evolutionary timescale were obtained by the Bayesian Markov chain Monte Carlo method. Phylogenetic analyses showed that the present HRV-A, -B, and -C strains belonged to 25, 4, and 18 genotypes, respectively. Some new genotypes were confirmed as prevalent strains of HRV-C. An ancestor of the present HRV-ABCs could be dated back to about 20,000 years ago. The present HRV-A and -C strains have wide genetic divergence (pairwise distance >0.2) with rapid evolutionary rates (around 7 × 10⁻⁴ to 4 × 10⁻³ substitutions/site/year). Over 100 sites were found to be under negative selection, while no positively selected sites were found in the analyzed region. No evidence of recombination events was found in this region of the present strains. Our results indicate that the present HRV strains have rapidly evolved and subsequently diverged over a long period into multiple genotypes.     

Nodular secondary syphilis with associated granulomatous inflammation: case report and literature review

A 62‐year‐old male presented with a 10‐day history of a diffuse, erythematous papular rash sparing the palms and soles. Histopathologic examination of a skin lesion showed loose non‐caseating granulomas in a lymphoplasmacytic background. Scattered spirochetes were identified by Treponema pallidum immunohistochemistry, in keeping with a diagnosis of secondary syphilis. Granulomatous inflammation in secondary syphilis is uncommon. A review of the literature reveals that the majority of prior reported cases of granulomatous secondary syphilis share similar characteristics to this case; namely, a papular or nodular clinical presentation, sparing of the palms and soles, and collections of epithelioid histiocytes with associated lymphocytes and variable numbers of plasma cells.     

广东梅州地区性病门诊3824例支原体检测及药敏分析

目的 了解梅州地区性病门诊就诊患者支原体引起泌尿生殖道感染的状况及支原体感染的药敏情况.方法 2008年8月至2011年3月对性病门诊拟诊为尿道炎、阴道炎或宫颈炎的3 824例就诊者,采用珠海迪尔生物工程公司支原体培养、药敏一体化试剂盒进行支原体培养,并对阳性患者进行12种抗生素的药敏试验.结果 共培养出1 103例支原体感染者(阳性率28.24%),解脲支原体(Uu)743株(67.36%),人型支原体(Mh)24株(2.18%),两种支原体混合感染336株(30.46%).对Uu药敏感率最高的药物为交沙霉素,其次为多西环素和美满霉素;对Mh及Uu/Mh两种支原体混合感染药物敏感也呈同样趋势.对Uu耐药最高的是环丙沙星,其次是红霉素和氧氟沙星;对Mh耐药最高的红霉素,其次是阿奇霉素和克拉霉素,对Uu/Mh两种支原体混合感染耐药最高的是红霉素,其次是氧氟沙星和罗红霉素.结论 临床用药应该考虑该地区耐药株的流行情况,最好按照药敏试验结果合理用药.     

Monitoring of human cytomegalovirus DNAemia during primary infection in transmitter and non-transmitter mothers

Background and objectivesIt has been reported that maternal DNAemia is detectable in three quarters of pregnant women with acute/recent primary HCMV infections, with a higher median number of HCMV DNA copies/ml blood in transmitter as compared with non-transmitter mothers.Study designThe kinetics of HCMV DNA in blood of transmitter vs non-transmitter pregnant women with primary HCMV infection was retrospectively analyzed from their first blood sampling at referral up to amniocentesis strictly performed at 19–21 weeks’ gestation. Monthly monitoring of maternal HCMV DNAemia was performed up to prenatal diagnosis.ResultsHCMV DNAemia was determined in 154 pregnant women. At amniocentesis, HCMV DNA in blood was positive in 42/50 (84.0%) amniotic fluid (AF) −positive and 21/104 (20.2%) AF-negative mothers (p < 0.0001). The number of HCMV DNA copies/ml blood was not significantly different in AF-positive as compared with AF-negative mothers in the interval 0–30 days post-infection (p = 0.14). On the contrary, HCMV DNA load at 30–60 days (p = 0.03) and at 60–90 days (p < 0.001) after onset of infection was significantly different, as observed at amniocentesis (p < 0.001). Three patterns (clearance, delayed decrease, and increasing) in both transmitter and non-transmitter mothers were observed. However, 79.8% AF- negative mothers cleared HCMV DNA in blood, while in AF-positive mothers increasing (44.0%) or persisting (40.0%) levels of DNAemia were observed.ConclusionsThe presence of viral DNA in maternal blood at amniocentesis is statistically associated with fetal HCMV infection. Increasing or persisting levels of maternal DNAemia during primary HCMV infection in pregnancy correlate with HCMV transmission to the fetus.     

123株阴沟肠杆菌的临床分布和耐药性分析

目的 了解医院2010年1月-2011年6月阴沟肠杆菌的临床分布及耐药性分析,为临床合理用药提供依据.方法 从近年来感染标本中分离出阴沟肠杆菌,采用法国生物梅里埃公司VITEK-2 Compact全自动细菌分析仪对所分离的菌株进行鉴定和药敏试验,采用WHONET5.4软件进行统计分析.结果 分离的123株阴沟肠杆菌主要来自于肝胆外科、ICU等科室,标本主要来源于痰液、胆汁及尿液中；阴沟肠杆菌对亚胺培南、美罗培南、厄他培南、阿米卡星等有较好的抗菌活性,敏感率依次为99.19％、99.19％、94.31％、94.31％;而对头孢西丁、头孢唑林、氨苄西林/舒巴坦、头孢替坦、氨苄西林的敏感性较差,敏感率依次为1.63％、1.63％、4.88％、4.88％和4.07％.结论 临床分离的阴沟肠杆菌耐药现象比较严重,应加强耐药性监测,以指导临床合理用药,控制医院感染.