Swimming pool deck as environmental reservoir of Fusarium

While investigations on fungal contamination of swimming pools usually focus on dermatophytes, data on other potentially pathogenic molds are scarce. Here, we report the investigation of fungal colonization of the deck surrounding a hospital physical therapy swimming pool. Five series of samples from 8 sites were collected over one year from the pool surroundings. Concomitantly, 58 patients using the swimming pool were examined and samples obtained from those with suspected onychomycosis. All surface samples were positive for fungi, with Fusarium the most frequently recovered from 22 of 27 samples of sites surrounding the pool. Among the outpatients evaluated, two presented with a mixed onychomycosis from which Fusarium and Trichophyton rubrum were isolated. The questions of possible acquisition from the swimming pool area must be considered in both cases as the ungual lesions had developed within the previous three months. This warrants further studies to better understand the epidemiology of potentially pathogenic molds in areas surrounding pools in order to adopt appropriate measures to avoid contamination. This is of particular importance within medical institutions, considering the potential role of Fusarium onychomycosis as a starting point for disseminated infections in immunocompromised patient

Tuberculous Cutaneous Ulcers Associated with Miliary Tuberculosis in an Elderly Woman

Skin localizations in disseminated tuberculosis may present a clinical resistant evolution. An 81-year-old woman, treated by long-term steroids and methotrexate for rheumatoid polyarthritis, developed a disseminated tuberculosis in chest, bones and skin. While pulmonary symptoms quickly improved under conventional tuberculostatic drugs, skin ulcers showed positive cultures for 5 months and healed after 12 months of treatment

Long-term HIV infection and antiretroviral therapy are associated with bone microstructure alterations in premenopausal women

Summary: We evaluated the influence of long-term HIV infection and its treatment on distal tibia and radius microstructure. Premenopausal eumenorrheic HIV-positive women displayed trabecular and cortical microstructure alterations, which could contribute to increased bone fragility in those patients. Introduction: Bone fragility is an emerging issue in HIV-infected patients. Dual-energy X-ray absorptiometry (DXA) quantified areal bone mineral density (BMD) predicts fracture risk, but a significant proportion of fracture risk results from microstructural alterations. Methods: We studied the influence of long-term HIV infection on bone microstructure as evaluated by high-resolution peripheral quantitative computed tomography (HR-pQCT) in 22 HIV-positive (+ve) premenopausal eumenorrheic women and 44 age- and body mass index (BMI)-matched HIV-negative (−ve) controls. All subjects completed questionnaires regarding calcium/protein intakes and physical activity, and underwent DXA and HR-pQCT examinations for BMD and peripheral skeleton microstructure, respectively. A risk factor analysis of tibia trabecular density using linear mixed models was conducted. Results: In HIV+ve women on successful antiretroviral therapy (undetectable HIV-RNA, median CD4 cell count, 626), infection duration was 16.5 ± 3.5 (mean ± SD) years; median BMI was 22 (IQR, 21-26) kg/m2. More HIV+ve women were smokers (82 versus 50%, p = 0.013). Compared to controls, HIV+ve women had lower lumbar spine (spine T-score −0.70 vs −0.03, p = 0.014), but similar proximal femur BMD. At distal tibia, HIV+ve women had a 14.1% lower trabecular density and a 13.2% reduction in trabecular number compared to HIV−ve women (p = 0.013 and 0.029, respectively). HR-pQCT differences in distal radius were significant for cortical density (−3.0%; p = 0.029). Conclusions: Compared with HIV−ve subjects, premenopausal HIV+ve treated women had trabecular and cortical bone alterations. Adjusted analysis revealed that HIV status was the only determinant of between group tibia trabecular density differences. The latter could contribute to increased bone fragility in HIV+ve patient

Use of Treponema pallidum PCR in Testing of Ulcers for Diagnosis of Primary Syphilis(1.).

Treponema pallidum PCR (Tp-PCR) has been noted as a valid method for diagnosing syphilis. We compared Tp-PCR to a combination of darkfield microscopy (DFM), the reference method, and serologic testing in a cohort of 273 patients from France and Switzerland and found the diagnostic accuracy of Tp-PCR was higher than that for DFM

Rubor, calor, dolor, tumor : infections de la peau et des tissus mous [Rubor, calor, dolor, tumor : skin and soft tissue infections]

Skin infections are a frequent cause of consultation, yet the diagnosis can be challenging for physicians. Microbiological documentation is rare, and empiric antibiotic regimens should cover the most commonly identified bacteria, i.e. streptococci Staphylococcus aureus. Other pathogens should be considered in case of immunosuppression or certain exposures. Necrotizing fasciitis (NF) is a severe but rare infection. Early surgical management in parallel with antibiotics is the cornerstone of treatment. Despite the high incidence of these infections, little progress has been made in their management and some areas of uncertainty exist, especially regarding the optimal duration of treatment, the prevention of recurrences and the use of polyclonal immunoglobulins for NF. This article reviews the main aspects of diagnosis and treatment of these infections

Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management

Osteoarthritis (OA) is a highly prevalent condition and the hand is the most commonly affected site. Patients with hand OA frequently report symptoms of pain, functional limitations, and frustration in undertaking everyday activities. The condition presents clinically with changes to the bone, ligaments, cartilage and synovial tissue, which can be observed using radiography, ultrasonography or MRI. Hand OA is a heterogeneous disorder and is considered to be multifactorial in aetiology. This review provides an overview of the epidemiology, presentation and burden of hand OA, including an update on hand OA imaging (including the development of novel techniques), disease mechanisms and management. In particular, areas for which new evidence has substantially changed the way we understand, consider and treat hand OA are highlighted. For example, genetic studies, clinical trials and careful prospective imaging studies from the past 5 years are beginning to provide insights into the pathogenesis of hand OA that might uncover new therapeutic targets in disease

Swimming pool deck as environmental reservoir of Fusarium

While investigations on fungal contamination of swimming pools usually focus on dermatophytes, data on other potentially pathogenic molds are scarce. Here, we report the investigation of fungal colonization of the deck surrounding a hospital physical therapy swimming pool. Five series of samples from 8 sites were collected over one year from the pool surroundings. Concomitantly, 58 patients using the swimming pool were examined and samples obtained from those with suspected onychomycosis. All surface samples were positive for fungi, with Fusarium the most frequently recovered from 22 of 27 samples of sites surrounding the pool. Among the outpatients evaluated, two presented with a mixed onychomycosis from which Fusarium and Trichophyton rubrum were isolated. The questions of possible acquisition from the swimming pool area must be considered in both cases as the ungual lesions had developed within the previous three months. This warrants further studies to better understand the epidemiology of potentially pathogenic molds in areas surrounding pools in order to adopt appropriate measures to avoid contamination. This is of particular importance within medical institutions, considering the potential role of Fusarium onychomycosis as a starting point for disseminated infections in immunocompromised patients

Strongyloïdiase: corticothérapie et dermite linéaire prurigineuse

L’infection à Strongyloides stercoralis est une helminthiase endémique des pays tropicaux et subtropicaux. Des cas de transmission sporadique surviennent également dans certaines régions du bassin méditerranéen. Une fois acquise, cette parasitose peut persister durant plusieurs décennies en phase latente de façon a- ou pauci-symptomatique. En cas d’immuno-suppression, un syndrome d’hyperinfestation (HS) ou une strongyloïdiase disséminée (DS) peuvent se développer et engendrer des complications sévères, parfois fatales. Le dermatologue doit être attentif aux manifestations cutanées provo-quées par ce nématode. Aussi, afin d’éviter le risque de HS/DS, chaque patient ayant séjourné en zone d’endémie devrait bénéficier d’un dépis-tage avant toute prescription de corticothérapie systémique ou autre trai-tement immunosuppresseur. Pour illustrer les lésions cutanées caractéris-tiques de cette pathologie, nous présentons deux cas de strongyloïdiase chez des patients traités par corticothérapie