phenylephrine-hydrochloride and Skin-Diseases--Bacterial

Infections of the skin or subcutis of the naso-ocular region develop through two mechanisms. Cases with lesions but without concomitant signs of nasal disease probably result from cat scratch injuries. Under certain circumstances, such lacerations result in the introduction of saprophytic microorganisms in such large numbers that host defence mechanisms are overwhelmed. This results in localised, variably invasive, disease in an otherwise immunocompetent host. An unpredictable range of organisms can give rise to such infections including a variety of fungal and bacterial genera. Causal organisms will likely vary from one geography to another as a result of differences in soil type and related environmental factors. Accordingly, procurement of appropriate tissue specimens for culture and susceptibility testing is essential to guide therapy, as these cases require medical and sometimes surgical intervention in order to effect a favourable outcome. In contrast, patients with naso-ocular lesions and concurrent signs of nasal disease have a different pathogenesis. Primary infection of the sinonasal region likely results from the inhalation of infectious propagules, with the infection subsequently penetrating overlying bones to invade the subcutaneous space. These lesions are typically the result of cryptococcosis or aspergillosis and must be distinguished from invasive nasal malignancies. An approach to the investigation and treatment of these patients is presented together with photographs of representative cases.

Topics: Animals; Cat Diseases; Cats; Eye; Nose; Risk Factors; Skin Diseases, Bacterial

Skin colonization by antibiotic-resistant propionibacteria is commonplace among acne patients globally. Increasing attention is now being paid to how resistance rates might be reduced to preserve the future efficacy of antibiotics, especially erythromycin and clindamycin in acne therapy.. To assess the efficacy of oral isotretinoin in the control of antibiotic-resistant propionibacteria.. Acne patients (72 in the U.K., 62 in the U.S.A.) colonized with high numbers of antibiotic-resistant propionibacteria were sampled before, during and 12 weeks after oral isotretinoin therapy. Propionibacterial samples were collected from five acne-prone skin surface sites using a detergent scrub method and from the anterior nares using moistened swabs. Total and antibiotic-resistant propionibacteria were enumerated by viable counting on media with and without selective antibiotics.. After 16 weeks of oral isotretinoin therapy, mean population densities of viable propionibacteria and variants resistant to erythromycin, clindamycin or tetracycline had fallen by more than 90% at all skin sites and in the nares. The sole exception was a smaller reduction in tetracycline-resistant strains on the lower back. In general, greater reductions were observed on skin than in the nares. By the end of the treatment period only three patients (all in Philadelphia) yielded no antibiotic-resistant strains from any site. Post-treatment, propionibacterial counts remained well below pretreatment levels but had begun to recover on the face and in the nares. The recovering propionibacterial population included both susceptible and resistant strains. Changes during and post-treatment at the two centres were similar but not identical.. Oral isotretinoin effectively reduced skin and nasal colonization by antibiotic-resistant propionibacteria. However, viable populations of resistant isolates persisted post-treatment at multiple sites. Novel methods are required to eradicate antibiotic-resistant propionibacteria completely, especially from the nasal reservoir.

Topics: Acne Vulgaris; Administration, Oral; Adolescent; Adult; Anti-Bacterial Agents; Drug Resistance, Bacterial; Female; Gram-Positive Bacterial Infections; Humans; Isotretinoin; Male; Microbial Sensitivity Tests; Middle Aged; Nose; Propionibacterium; Skin Diseases, Bacterial; Treatment Outcome

Topics: Cryptococcosis; Humans; Immunocompromised Host; Male; Middle Aged; Multiple Myeloma; Nose; Nose Diseases; Skin Diseases, Bacterial

In the present study four methicillin-resistant Staphylococcus pseudintermedius (MRSP) strains isolated from a dog (n=3) and the anterior nares of the dog owner (n=1) were investigated by conventional and molecular methods. The species identity of the four S. pseudintermedius strains was confirmed by conventional methods, by PCR mediated amplification of S. intermedius/S. pseudintermedius specific segments of thermonuclease encoding gene nuc and by restriction fragment length polymorphism analysis of phosphoacetyltransferase encoding gene pta. Investigation of the four S. pseudintermedius for toxinogenic potential revealed that all four strains were positive for the exfoliative toxin encoding gene siet and the leukotoxin encoding genes lukS, lukF. The oxacillin and penicillin resistance of the four S. pseudintermedius strains could be determined by cultivation of the strains on oxacillin resistant screening agar base, ChromID MRSA Agar and Brilliance MRSA Agar and by multiplex PCR detecting the resistance genes mecA and blaZ. The genetic relatedness of the strains was studied by macrorestriction analysis of their chromosomal DNA using pulsed field gel electrophoresis (PFGE). According to PFGE all four S. pseudintermedius strains represent an identical bacterial clone indicating a cross transmission between the dog and the dog owner.

Topics: Animals; Dog Diseases; Dogs; Humans; Male; Methicillin Resistance; Nose; Ownership; Skin Diseases, Bacterial; Staphylococcus

Nasal augmentation rhinoplasty is a common cosmetic procedure. Alloplastic or synthetic materials are frequently used with Silastic, the most commonly used type worldwide. In the Orient, this common procedure has a low complication rate. However, infection and extrusion of the implant through the skin may occur and patients may be reluctant to report the augmentation procedure to the dermatologist. Therefore, the dermatologist needs to be highly suspicious and include this complication in the differential of ulcerated nasal tip nodules.

Topics: Anti-Bacterial Agents; Combined Modality Therapy; Device Removal; Follow-Up Studies; Humans; Male; Middle Aged; Nose; Prostheses and Implants; Prosthesis-Related Infections; Reoperation; Rhinoplasty; Skin Diseases, Bacterial; Skin Ulcer; Staphylococcal Infections; Staphylococcus aureus; Transplantation, Homologous

A group of patients (n=86) suffering from superficial abscesses was recruited in the Khartoum Teaching Hospital, Sudan. Detailed clinical and socio-economic data were collected. It appeared that 83% of all patients were younger than 40. Labourers were most prevalent (28%), followed by students (23%) and housewives (16%). The head and neck were most often affected (22%), with hands being second (19%). In 92% of all pus cultures a microbial agents was identified, the large majority being Staphylococcus aureus (69%). Among patients, 47% were nasal carriers of S. aureus, similar to the carriage rate measured among controls, suggesting that nasal carriage is no risk factor for abscess development. Multivariate logistic regression analysis revealed that a history of abscess, recent traditional medical treatment, poor hygiene and low socio-economic status were significantly and independently associated with the occurrence of superficial abscesses.

Topics: Abscess; Adolescent; Adult; Age Factors; Aged; Child; Child, Preschool; DNA Fingerprinting; Female; Genotype; Humans; Hygiene; Infant; Male; Medicine, African Traditional; Middle Aged; Nose; Risk Factors; Skin Diseases, Bacterial; Socioeconomic Factors; Staphylococcal Infections; Staphylococcus aureus; Sudan

Topics: Facial Dermatoses; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Nose; Propionibacterium acnes; Skin Diseases, Bacterial