Pascal Del Giudice

Primary Skin Abscesses Are Mainly Caused by Panton-Valentine Leukocidin-Positive Staphylococcus aureus Strains

Background: The role of Panton-Valentine leukocidin (PVL) in skin and soft-tissue infections is not clear. Objective: Our purpose was to determine the prevalence of PVL gene carriage among Staphylococcus aureus strains isolated from primary and secondary skin abscesses. Methods: A prospective study was conducted. From July 2003 to June 2008, S. aureus isolates from skin abscesses were screened for the PVL genes. The abscesses were considered primary if they occurred on previously healthy skin and secondary in all other cases. Results: Fifty-seven patients presenting with S. aureus skin abscesses were included in the study. The PVL genes were detected in 40 (70%) of the 57 S. aureus isolates. Thirty-eight (92.7%) of the 41 primary skin abscesses were due to PVL-positive strains, compared to only 2 (12.5%) of the 16 secondary skin abscesses (p < 0.001). Conclusions: Primary skin abscesses are mainly caused by PVL-positive S. aureus strains.

Different patterns of skin manifestations associated with parvovirus B19 primary infection in adults

BACKGROUNDnSkin involvement is reported during primary parvovirus B19 infection in adults.nnnOBJECTIVESnWe sought to describe the cutaneous presentations associated with parvovirus B19 primary infection in adults.nnnMETHODSnWe conducted a descriptive, retrospective, multicenter study. The patients included (>18 years old) had well-established primary infections with parvovirus B19.nnnRESULTSnTwenty-nine patients were identified between 1992 and 2013 (17 women, 12 men). The elementary dermatologic lesions were mostly erythematous (86%) and often purpuric (69%). Pruritus was reported in 48% of cases. The rash predominated on the legs (93%), trunk (55%), and arms (45%), with a lower frequency of facial involvement (20%). Four different but sometimes overlapping patterns were identified (45%): exanthema, which was reticulated and annular in some cases (80%); the gloves-and-socks pattern (24%); the periflexural pattern (28%); and palpable purpura (24%).nnnLIMITATIONSnThe limitations of this study were its retrospective design and possible recruitment bias in tertiary care centers.nnnCONCLUSIONnOur findings suggest that primary parvovirus B19 infection is associated with polymorphous skin manifestations with 4 predominant, sometimes overlapping, patterns. The acral or periflexural distribution of the rash and the presence of purpuric or annular/reticulate lesions are highly suggestive of parvovirus B19 infection.

Panton-Valentine Leukocidin-Positive Staphylococcus aureus Strains Are Associated with Follicular Skin Infections

Background/Aims: Panton-Valentine leukocidin (PVL)-positive Staphylococcus aureus have been associated with suppurative infections; however, their precise role in skin infections has not been elucidated. We studied the rate of PVL-positive S. aureus in the different types of skin infections and compared follicular to nonfollicular skin infections. Methods: In our institution, patients with a skin infection caused by S. aureus were enrolled in a prospective, observational cohort study (from July 1, 2003 to June 30, 2010). We studied the rate of PVL-positive S. aureus in the different clinical types of skin infections and compared the rate of PVL-positive S. aureus in follicular infections to that in nonfollicular infections. Results: A total 229 skin infections were included: 97 (42.5%) were caused by PVL-positive strains. Thirty-nine of the 53 (74%) follicular infections [8 of the 17 (47%) with folliculitis, 30 of the 35 (85.5%) with furuncles and 1 with a carbuncle (100%)] were caused by PVL-positive S. aureus, compared to 16 of the 131 (12%) nonfollicular infections (p < 0.001). Conclusion: PVL-positive S. aureus strains are mainly associated with follicular skin infections.

Clinical Aspects of Syphilis Reinfection in HIV-Infected Patients

Background: The incidence of HIV-syphilis co-infection has risen since 2000, especially among men having sex with men (MSM). Syphilis reinfection can occur, but the clinical features of such events remain poorly characterized. Objective: To compare the cutaneous lesions seen with syphilis reinfections with those of first episodes in HIV-infected patients. Methods: In a cohort of HIV-infected patients, syphilis reinfection was established both clinically and biologically by evaluating changes in Venereal Disease Research Laboratory titers. Photographs and medical records were studied in order to determine the type of skin lesions and their quantification. Results: Among 533 HIV-infected patients, 42 (8%) experienced a first syphilis infection. Thirteen episodes of reinfection occurred in 12/42 (28%) patients, all MSM. In 78% of cases, reinfections were less symptomatic than first episodes. All patients presented classical syphilis lesions. Conclusions: We observed a high rate of reinfection, but with less severe skin manifestations during reinfection episodes.

Two Cases of Cellulitis in the Course of African Tick Bite Fever: A Fortuitous Association?

In African tick bite fever (ATBF), inoculation eschar – resulting from disruption of the cutaneous barrier – may be a risk factor for cellulitis. We report 2 cases of ATBF associated with cellulitis. A 77-year-old woman was referred for severe leg cellulitis upon returning from sub-Saharan Africa. She developed erythematous macules. Rickettsia africae was detected by PCR assay from a skin biopsy specimen, and ATBF diagnosis was confirmed. A 75-year-old man was hospitalized after his return from Zimbabwe for a maculopapular exanthema and erysipelas-like rash of the leg. The diagnosis of cellulitis associated with ATBF was confirmed by PCR and serological methods. Both patients were treated for ATBF and cellulitis by a combination of doxycycline and β-lactam antibiotics, and both had a good recovery. Inoculation eschar may be a risk factor for cellulitis; thus, we hypothesize a non-fortuitous association between ATBF and cellulitis.

Contents Vol. 230, 2015

G. Argenziano, Reggio Emilia M. Augustin, Hamburg W.H. Boehncke, Geneva L. Borradori, Bern R.P. Braun, Zurich R. Cerio, London L. Cerroni, Graz O. Chosidow, Créteil A. Dupuy, Rennes J.W. Fluhr, Berlin L. French, Zurich F. Furukawa, Wakayama M. Gilliet, Lausanne A.K. Gupta, London, Ont. R. Happle, Freiburg R.J. Hay, London P. Itin, Basel G. Kaya, Geneva R.G.B. Langley, Halifax, N.S. J.M. Mascaro, Jr., Barcelona K. Matsunaga, Nagoya L. Naldi, Bergamo F. Nestle, London C. Paul, Toulouse T. Shiohara, Tokyo T. Simonart, Brussels H.P. Soyer, Brisbane, Qld. L. Thomas, Lyon R.M. Trüeb, Wallisellen T.J. Yoon, Jinju C.C. Zouboulis, Dessau International Advisory Board