Severe Gram-Negative Intertrigo of the Feet

Introduction: Intertrigo is a common disease of the skin usually caused by fungi and/or bacteria, often involving major or minor skin folds. Here, we report a case of severe, ulcerative intertrigo of all interdigital folds of both feet caused by Pseudomonas aeruginosa in a patient with type II diabetes who acquired the infection during a trip to Senegal. Case Presentation: Lesions involved all toe-web spaces and the back of the toes and the soles. Ulcers with a purulent-necrotic bed, with some of them covered by brownish-black eschars associated with a greenish, odiferous discharge were recorded. The patient was treated with piperacillin/tazobactam IM for 14 days, achieving complete remission of the infection. In this article, we underline the importance of an early diagnosis and appropriate treatment to achieve healing of bacterial intertrigo without complications. Topical therapy with antiseptics (potassium permanganate, gentian violet solution, hydrogen peroxide) or antibiotics (gentamicin, amikacin) is effective only in early stages of the infection. Systemic antibiotics must be considered in all extensive and severe cases. The choice of antibiotic should be based on the culture and antibiogram results. When this is not possible, wide-spectrum antibiotics that act on both gram-positive and gram-negative bacteria (such as third-generation cephalosporin or quinolone) should be prescribed. Conclusion: The length of treatment should not be less than ten days. In addiction, all patients should be trained to avoid predisposing conditions and adopt preventive measures to reduce the risk of infection

An Erythematous-squamous Lesion of the Foot: A Quiz

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Leishmaniasis of the eyelid mimicking an infundibular cyst and review of the literature on ocular leishmaniasis

Abstract Cutaneous leishmaniasis is an infection caused by protozoa belonging to the genus Leishmania . The disease is transmitted by sandflies. Reservoirs are represented by dogs, mice, rats, and wild rodents. Cutaneous leishmaniasis is usually characterized by a single, polymorphous lesion located in an uncovered area. We report a case of cutaneous leishmaniasis localized on the left upper eyelid in a 36-year-old woman. The disease was characterized by a single, asymptomatic nodule, which was clinically diagnosed as an inflammatory infundibular cyst. The lesion was excised surgically. Histopathological examination showed an inflammatory infiltrate consisting of lymphocytes, histiocytes, and plasma cells. Several Leishmania spp amastigotes were observed in the cytoplasm of macrophages. Culture examination on Novy–MacNeal–Nicolle medium was positive for Leishmania spp . PCR was positive for Leishmania infantum . No relapses were observed during follow-up (17 months). The purpose of this report is to emphasize the changeability of clinical presentation in cutaneous leishmaniasis

Haemophilus influenzae periorbital cellulitis in a 95-year-old patient

Periorbital cellulitis (POC) is an acute bacterial infection of the eyelids. In the past, before the introduction of Haemophilus influenzae type B vaccination, POC was usually caused by this bacterium. Vaccination was introduced in 1985 and extended in 1990. Since then, most cases are caused by Staphylococcus aureus or Group A β-hemolytic Streptococcus. We present a case of POC caused by H. influenzae in a 95-year-old woman: to our knowledge, this is the oldest patient with POC reported in the literature

Comedone switch and reverse in acne pathogenesis and treatment. A role for silimarin

Recent developments in the understanding of pathophysiology of acne are creating new opportunities in the treatment of this disease. In this brief review, we illustrate the role of local inflammation, and LRIG1+ cells in the development of comedone switch, and the potential of silimarin to counteract this process and favour comedone reverse. Preliminary data using Silybum marianum in different studies have shown promising results. Further data from ongoing studies will clarify its role in the long-term treatment of patients with acne

Chronic hookworm-related cutaneous larva migrans

Summary Objectives The purpose of this study is to present the 'chronic' or 'persistent' form of hookworm-related cutaneous larva migrans. Methods From 1998 to 2011, 13 patients were seen in our department with clinically typical hookworm-related cutaneous larva migrans that had been present for more than 5 months and that, because of the absence of pruritus, had never been treated. Results The duration of hookworm-related cutaneous larva migrans ranged from 5 to 14 months (mean 7.8 months) in these 13 patients (10 males and three females, aged 23–55 years). The infestation was acquired in Brazil (three patients), Jamaica (three patients), Mexico (two patients), Tanzania (two patients), Thailand (two patients), and Martinique (one patient). The infestation was located on the feet in 10 patients; one of these patients also presented tracks on the back and another presented tracks on a knee. The chest (two patients) and thigh (two patients) were also involved. All patients presented with clinically typical hookworm-related cutaneous larva migrans: seven patients had one track and six patients had two tracks. Laboratory and instrumental examinations were within the normal range or negative. Histopathological examination revealed edema in the papillary and upper dermis, and a perivascular and perifollicular infiltrate in the upper dermis, consisting mainly of lymphocytes and eosinophils. No larvae were detected. Conclusions This can be considered the 'chronic' or 'persistent' form of hookworm-related cutaneous larva migrans. Some pathogenetic hypotheses are suggested

Onychomycosis caused by Trichosporon mucoides

A case of onychomycosis caused by Trichosporon mucoides in a man with diabetes is presented. The infection was characterized by a brown–black pigmentation of the nail plates and subungual hyperkeratosis of the first three toes of both feet. Onychogryphosis was also visible on the third left toe. Direct microscopic examinations revealed wide and septate hyphae and spores. Three cultures on Sabouraud–gentamicin–chloramphenicol 2 agar and chromID Candida agar produced white, creamy, and smooth colonies that were judged to be morphologically typical of T. mucoides. Microscopic examinations of the colonies showed arthroconidia and blastoconidia. The urease test was positive. A sugar assimilation test on yeast nitrogen base agar showed assimilation of galactitol, sorbitol, and arabinitol. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) confirmed the diagnosis of T. mucoides infection. The patient was treated with topical urea and oral itraconazole. Three months later, a mild improvement was observed. The patient was subsequently lost to follow-up

leishmaniasis of the lip

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Scabies and nocturnal pruritus: Preliminary observations in a group of African migrants

Introduction: Pruritus of scabies is due to a type IV T cell-mediated reaction to the mite's saliva, eggs, excrements and other products released by the mite during its life cycle. Movements of the mite also induce pruritus. According to the literature, scabies pruritus has higher frequency and intensity at night. Methodology: In this short communication we present the results of a survey on nocturnal pruritus in a group of African migrants with scabies. A questionnaire was given to 36 patients: "Is your pruritus more severe at night?" and "Do you wake up from the sleep because of pruritus?". Results: The answer to the first question was "yes" in 13/18 patients (72.2%) visited from October 2018 to February 2019, and in 6/18 patients (33.3%) visited from May to September 2019. The answer to the second question was "yes" in 11/18 patients (61.1%) of the first group and in 5/18 patients (27.7%) of the second group. Conclusions: It is possible that nocturnal pruritus in scabies is due to the temperature of the skin surface: when it is high, because of the use of pajamas, heavy sheets and blankets (from October to February), pruritus increases; when the skin's temperature is low, as in the summertime, when people usually sleeps without blankets, with light sheets and pajamas or not having a stitch on, pruritus is less frequent and severe. These conclusions must be confirmed by studies based on larger groups of patients

Endolimax nana and urticaria.

Endolimax nana is a commensal protozoan of the colon. We report a case of chronic urticaria associated with E. nana in a 34-year-old Italian woman. The patient suffered from abdominal pain, diarrhoea and weight loss. The disease appeared after a trip to Vietnam. Laboratory examinations showed mild blood eosinophilia. Three coproparasitological examinations were positive for cysts of E. nana. The patient was successfully treated with two courses of metronidazole (2 g/day for 10 days each). No antihistamines were used. Three coproparasitological examinations, carried out at the end of the therapy, were negative. Follow up (six months) was negative. E. nana can be responsible for very rare cases of abdominal pain, diarrhoea, polyarthritis and urticaria