Murat Durdu

Clinical features, epidemiology, and efficacy and safety of intralesional antimony treatment of cutaneous leishmaniasis: Recent experience in Turkey

A total of 1,030 patients, 40.2% men and 59.8% women, identified during the period of October 1998 to November 2002 as having cutaneous leishmaniasis (CL), were studied; 1,431 lesions were identified in the 1,030 patients. One lesion was present in 80.7% of the patients. The size of the lesions (longest axis) was 13.6 mm (standard, 12.1 mm; range 3–150 mm). Most of the lesions were of the papular type (51.2%), although several atypical clinical presentations of CL were observed. The duration of the disease ranged between 1 and 72 mo (mean duration, 10.8 mo). The clinical suspicion of CL was confirmed by the observation of amastigotes on lesion tissue samples stained by Giemsa. The test was positive in 851 of 1,030 patients (82.6%). Intralesional meglumine antimonate solution (85 mg Sb/ml, 0.2–1 ml, depending on the size of the lesion) weekly until complete cure or up to 20 wk was used for first-line therapy of 890 patients (86.4%). We found that this regimen of intralesional Sb has an efficacy of 97.2% with a low relapse rate of 3.9% and no serious adverse side effects.

The value of Tzanck smear test in diagnosis of erosive, vesicular, bullous, and pustular skin lesions

BACKGROUND Tzanck smear is generally used for the diagnosis of the pemphigus group of autoimmune bullous diseases and mucocutaneous herpesvirus infections. There are only a few studies in the literature investigating its diagnostic value. OBJECTIVES We aimed to investigate Tzanck smear findings and to determine the diagnostic value of this test in moist (erosive, vesicular, bullous, and pustular) skin lesions. We also aimed to develop an algorithmic approach for the diagnosis of these types of skin lesions according to the Tzanck smear findings. METHODS Samples were stained with May-Grünwald-Giemsa and evaluated by the same dermatologist. In some patients, methylene blue and Gram staining or direct immunofluorescence examinations were additionally performed. In all of the study cases, after the evaluation of clinical and laboratory findings (including, when appropriate, potassium hydroxide examination; viral serology; bacterial and fungal cultures; histopathology; direct and indirect immunofluorescence; patch testing), the definite diagnosis was established. We also determined the sensitivity and the specificity of certain Tzanck smear findings. RESULTS Tzanck smear was performed in a total of 400 patients with moist skin lesions. The sensitivities of multinucleated giant cells and acantholytic cells in herpetic infections, dyskeratotic acantholytic cells and cocci in bullous impetigo, pseudohyphae in candidiasis, acantholytic cells in pemphigus and more than 10 tadpole cells (magnification x100) in spongiotic dermatitis were 84.7%, 92%, 100%, 100%, and 81.5%, respectively. LIMITATIONS Because Tzanck smears were evaluated by the same dermatologist, no comment could be made regarding the interobserver reliability of this test and how the level of experience with this technique might affect the results. Also, the sensitivity and the specificity of Tzanck smear test findings for certain diseases could not be calculated because of an insufficient number of patients. CONCLUSION The Tzanck smear test is an inexpensive, useful, and an easy diagnostic tool for certain skin diseases.

Tinea pedis: The etiology and global epidemiology of a common fungal infection

Abstract Tinea pedis, which is a dermatophytic infection of the feet, can involve the interdigital web spaces or the sides of the feet and may be a chronic or recurring condition. The most common etiological agents are anthropophiles, including Trichophyton rubrum sensu stricto, which is the most common, followed by Trichophyton interdigitale and Epidermophyton floccosum. There has been a change in this research arena, necessitating a re-evaluation of our knowledge on the topic from a multidisciplinary perspective. Thus, this review aimed to provide a solid overview of the current status and changing patterns of tinea pedis. The second half of the twentieth century witnessed a global increase in tinea pedis and a clonal spread of one major etiologic agent, T. rubrum. This phenomenon is likely due to increases in urbanization and the use of sports and fitness facilities, the growing prevalence of obesity and the aging population. For optimal patient care and management, the diagnosis of tinea pedis should be verified by microbiological analysis. In this review, we discuss the epidemiology, clinical forms, complications and mycological characteristics of tinea pedis and we highlight the pathogenesis, prevention and control parameters of this infection.

Majocchi ' s granuloma: a symptom complex caused by fungal pathogens

Majocchis granuloma (MG) is a well-recognized but uncommon infection of dermal and subcutaneous tissues that is caused by mold fungi. Although primarily caused by keratinophilic dermatophytes such as anthropophilic Trichophyton rubrum, species from the Aspergillus and Phoma genera have been occasionally detected as etiologic agents of MG. In both healthy individuals and immunocompromised hosts, MG often presents as nodules, plaques, and papules on areas that are prone to trauma. Although MG generally appears on the upper and lower extremities (forearms, hands, legs, or ankles), it occasionally appears on the scalp and face. The clinical, mycologic, and/or cytologic diagnosis should be confirmed by the demonstration of perifollicular granulomatous inflammation by histologic examination. This review focuses on the clinical presentation, pathogenesis, laboratory diagnostic methods (including the Tzanck smear test), etiologic agents, histopathologic characteristics, and therapeutic approaches to the treatment of MG.

Cutaneous id reactions: A comprehensive review of clinical manifestations, epidemiology, etiology, and management

Id reactions are a type of secondary inflammatory reaction that develops from a remote localized immunological insult. To date, id reactions caused by various fungal, bacterial, viral, and parasitic infections have been reported. Superficial fungal infections, especially tinea pedis, are the most common cause of id reactions. Id reactions exhibit multiple clinical presentations, including localized or widespread vesicular lesions, maculopapular or scarlatiniform eruptions, erythema nodosum, erythema multiforme, erythema annulare centrifugum, Sweet’s syndrome, guttate psoriasis, and autoimmune bullous disease. The mechanisms underlying id reactions vary depending on the type of clinical presentation. The most important aspect of therapy involves the identification and adequate treatment of the underlying infection or dermatitis. This review comprehensively discusses the current state of the field concerning cutaneous id reactions, including diagnostic criteria, clinical presentations, underlying infectious conditions, etiologic agents, immunologic characteristics, histopathologic findings, and management strategies.

More experiences with the Tzanck smear test: cytologic findings in cutaneous granulomatous disorders.

BACKGROUND Granulomatous dermatitis is a distinctive histopathologic cutaneous reaction pattern against various infectious and noninfectious agents. Cytologically, granulomatous dermatitis shows granulomas and multinucleated giant cells. Various etiologic agents of granulomatous diseases can also be identified. OBJECTIVE We aimed to investigate Tzanck smear findings in granulomatous skin diseases. METHODS Patients who had granulomas and/or multinucleated giant cells of Langhans, foreign body- and/or Touton type in Tzanck smear tests were included in the study. In these patients, Tzanck preparations were then further evaluated for additional cytologic findings. Samples stained with May-Grünwald-Giemsa stain were evaluated by the same dermatologist throughout the study. In some patients, methylene blue, Gram and/or Erlich-Ziehl-Nielsen stains were also performed. In all of the study cases, the final diagnosis was established after the evaluation of clinical and laboratory findings (including, when appropriate, potassium hydroxide examination; bacterial, leishmanial, and fungal cultures; histopathology; tuberculosis and leishmania polymerase chain reaction). We also calculated the sensitivity and specificity of the Leishman-Donovan body for cutaneous leishmaniasis. RESULTS Over a 2-year period, 94 of 950 patients (9.9%) in whom Tzanck smear tests were performed had cytologic findings consistent with a granulomatous reaction. In 74 (78.7%) and 20 (21.3%) patients, the granulomatous reaction was due to infectious and noninfectious causes, respectively. Infectious causes included cutaneous leishmaniasis in 65 patients (87.8%), candidal granuloma in two patients, botyromycosis in two patients, and aspergillosis, blastomycosis, mucormycosis, leprosy, and cutaneous tuberculosis in one patient each. In 58 of 74 patients (78.4%) with infectious granulomatous dermatitis, the causes of the granulomas were identified. Noninfectious granulomatous reactions were due to granuloma annulare in 7 patients, sarcoidosis in 5 patients, a foreign body in 4 patients, necrobiosis lipoidica in 2 patients, and juvenile xanthogranuloma in 2 patients. In 17 of 20 patients (85%) with noninfectious granulomatous reactions, the cytologic findings were characteristic of the final diagnoses. The sensitivity and specificity of Leishman-Donovan bodies for cutaneous leishmaniasis were 76.9% and 100%, respectively. LIMITATIONS All of the samples were evaluated by the same dermatologist throughout the study; therefore no comment could be made regarding the reliability of the Tzanck smear test. In addition, the sensitivity and specificity of Tzanck smear test findings for diseases other than cutaneous leishmaniasis could not be calculated because of an insufficient number of patients. CONCLUSION The Tzanck smear test may be a useful diagnostic tool for certain granulomatous skin diseases.

Epidemiology of pityriasis versicolor in Adana, Turkey

Pityriasis versicolor is a common superficial mycoses of the skin. It is now recognized that the causative organisms of this infection are different species of Malassezia. The aim of this study was to determine the distribution of Malassezia species in patients with pityriasis versicolor in Adana, Turkey. In total, 97 patients positive for Malassezia elements, namely, yeast cells and short hyphae in microscopic examination, were included in the study. All samples were inoculated in plates containing modified Dixons medium. However, only 44 of the patients (45.4%) showed Malassezia spp. in culture. Malassezia globosa (47.7%) was the most commonly isolated species followed by Malassezia furfur (36.4%) and Malassezia slooffiae (15.9%). Mixed Malassezia species were not isolated. In conclusion, M. globosa was found to be the predominant PV isolate in Adana, Turkey.

Gianotti–Crosti syndrome in a child following hepatitis B virus vaccination

Gianotti–Crosti syndrome is self‐limited, characterized by papular eruption with a symmetrical distribution on the limbs and face of children, and a dermatosis of unknown etiology. However, there are many suggested factors such as a number of diseases (viral or bacterial) and vaccination. We report a case of Gianotti‐Crosti syndrome that had developed 3 weeks after the hepatitis B virus vaccination.

Annular lichenoid dermatitis of youth.

indentations in the nail plate of variable depth and obliquity. The obliquity of the indentation reflects the rate of onset and its severity. Beau lines of maximum obliquity are likely to occur in a relatively severe upset (4). In the most benign extreme, simple indentation without any obliquity is observed. In the most severe involvement, potential or actual shedding of the nail occurs [Onychomadesis: medesis (Greek) = to shed or pluck]. Clinically Beau lines may be seen in all 20 nails. They may be most prominent in fingernails; sometimes the toenails escape involvement. Within a limb, the thumb and great toe-nail have themost prominent signs. Personal variability in the manifestation is great. After an extensive literature search, only one report of a newborn having Beau lines was found (5). However, in view of the patho-mechanism of development of Beau lines and the frequency of intrauterine insult, it does not seem that it is very uncommon. The rarity may be due to individual variations in manifestations of the nail changesor itmaybe socommonthat researchers arenotmuch interested in reporting it, which is a less likely hypothesis. In one study involving 100 children including infants through 17 years of age, only one had Beau lines (6). The clinical significance of Beau lines in our patient lies in the fact that it is indicative of some severe intrauterine insult in the formof congenital pneumonia, as the lines were evident at the time of birth. The exact time of the insult is difficult to ascertain because of the extreme variability in the rate of nail growth.

Clinical and cytologic features of antibiotic-resistant acute paronychia.

BACKGROUND Acute paronychia usually is treated as a bacterial infection, but antibiotic-resistant acute paronychia may be caused by other infectious and noninfectious problems. OBJECTIVE We sought to describe the clinical, etiologic, cytologic, and therapeutic features of antibiotic-resistant acute paronychia. METHODS A retrospective review of medical records and cytology was performed in 58 patients (age, 1 month-91 years; 36 children and adolescents [62%] and 22 adults [38%]) who had antibiotic-resistant acute paronychias. RESULTS Causes of paronychia included bacteria (25 patients [43%]), viruses (21 patients [36%]), fungi (5 patients [9%]), drugs (3 patients [5%]), pemphigus vulgaris (3 patients [5%]), and trauma (1 patient [2%]). Diagnostic cytologic findings were noted in 54 patients (93%); no diagnostic cytologic findings were present with drug-induced (3 patients) or traumatic (1 patient) paronychia. The most common predisposing factors were the habits of finger- or thumb-sucking (14 patients [24%]) and nail-biting (11 patients [19%]). Complications included id reaction with erythema multiforme in 3 patients (5%). LIMITATIONS Limitations include retrospective study design from 1 treatment center. CONCLUSION Antibiotic-resistant acute paronychia may be infectious or noninfectious. Cytologic examination with Tzanck smear may be useful diagnostically and may prevent unnecessary use of antibiotics and surgical drainage.