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Sample records for acrodermatitis

  1. Acrodermatitis

    Science.gov (United States)

    ... in the United States. Epstein-Barr virus (EBV, mononucleosis ) is the virus most often associated with acrodermatitis. ... Images Gianotti-Crosti syndrome on the leg Infectious mononucleosis References Dickey BZ, Chiu YE. Diseases of the ...

  2. Acrodermatitis Enteropathica

    Science.gov (United States)

    Nistor, Nicolai; Ciontu, Lavinia; Frasinariu, Otilia-Elena; Lupu, Vasile Valeriu; Ignat, Ancuta; Streanga, Violeta

    2016-01-01

    Abstract Acrodermatitis enteropathica is a rare genetic autosomal recessive disorder, characterized by periorificial dermatitis, alopecia, and diarrhea. It is caused by mutations in the gene that encodes a membrane protein that binds zinc. We report a 14-month-old boy, admitted for erythematous, scaly and pustular lesions, initially located in the inguinal and perianal regions and on thighs, and very few erythematous lesions on the face. Due to the numerous bacterial skin superinfections with Staphylococcus aureus, including abscesses that required surgical incision, the clinical picture was modified, leading to a delayed establishment of the diagnosis. Later, the symptoms became suggestive for this disease, the diagnostic having been confirmed by low plasma zinc values. Under zinc therapy, skin lesions improved significantly in a few days, with favorable outcome. Two months later, the skin lesions almost disappeared. Abscesses due to bacterial skin superinfections may lead to initially misdiagnosed acrodermatitis enteropathica. PMID:27196457

  3. Acrodermatitis enteropática

    Directory of Open Access Journals (Sweden)

    María Elena Martínez-Bustamante

    2017-07-01

    Conclusiones: El diagnóstico diferencial de acrodermatitis enteropática es amplio e incluye infecciones cutáneas, por lo que el reconocimiento temprano de las características de las lesiones favorece la sospecha, el diagnóstico y el tratamiento adecuado.

  4. Acrodermatitis Enteropathica: A Case Report.

    Science.gov (United States)

    Nistor, Nicolai; Ciontu, Lavinia; Frasinariu, Otilia-Elena; Lupu, Vasile Valeriu; Ignat, Ancuta; Streanga, Violeta

    2016-05-01

    Acrodermatitis enteropathica is a rare genetic autosomal recessive disorder, characterized by periorificial dermatitis, alopecia, and diarrhea. It is caused by mutations in the gene that encodes a membrane protein that binds zinc. We report a 14-month-old boy, admitted for erythematous, scaly and pustular lesions, initially located in the inguinal and perianal regions and on thighs, and very few erythematous lesions on the face. Due to the numerous bacterial skin superinfections with Staphylococcus aureus, including abscesses that required surgical incision, the clinical picture was modified, leading to a delayed establishment of the diagnosis. Later, the symptoms became suggestive for this disease, the diagnostic having been confirmed by low plasma zinc values. Under zinc therapy, skin lesions improved significantly in a few days, with favorable outcome. Two months later, the skin lesions almost disappeared.Abscesses due to bacterial skin superinfections may lead to initially misdiagnosed acrodermatitis enteropathica.

  5. Acrodermatitis Enteropathica Type-II in Libya

    Directory of Open Access Journals (Sweden)

    Abdalla Ibraham EI-Sherif

    1987-01-01

    Full Text Available A 6 mouth old Libyan girl was seen with well - defined erythematous scaly, exudative and crusted lesions around the mouth, neck, back perineum, thighs and legs suggestive of acrodermatitis enteropathica. Two of the 3 other siblings had also suffered from similar lesions for a month or so at the age of 5-7 months. All of them were on breast feeding and improved on weaning. This is believed to be type II acrodermatitis enteropathica caused by deficient secretion of zinc in the mother′s milk.

  6. Acrodermatitis enteropathica during adequate enteral nutrition.

    Science.gov (United States)

    Changela, Avani; Javaiya, Hemangkumar; Changela, Kinesh; Davanos, Evangelia; Rickenbach, Kiersten

    2012-03-01

    Acrodermatitis enteropathica is a rare skin disorder of zinc deficiency. This case report describes a 91-year-old female nursing home resident who presented with a skin eruption resembling acrodermatitis enteropathica while receiving adequate enteral nutrition (EN) via a percutaneous gastrostomy tube. A low zinc level of 36 mcg/dL confirmed zinc deficiency, and treatment with oral zinc sulfate 220 mg 3 times a day resulted in rapid resolution of the skin lesions. This case supports the notion of close monitoring of patients on long-term EN for clinical manifestations of zinc deficiency, especially in the presence of an unexplained skin rash. Although micronutrient deficiencies are more prevalent in underdeveloped countries and with patients receiving parenteral nutrition, these deficiencies should be kept in mind for patients in developed countries as well as patients receiving EN.

  7. A Methylmalonic Acidemia Case Presenting with Acrodermatitis Enteropathica

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    hesaneh izadyar

    2014-08-01

    Full Text Available We encountered a patient with methylmalonic aciduria associated with skin lesions resembling acrodermatitis enteropathica. This child was being fed with a low-protein diet when the skin disorder developed. A deficiency in plasma levels isoleucine, was confirmed. Supplementation of a high-caloric, protein-rich diet led to a prompt improvement of skin lesions. We assume that in our patient the skin lesions were the result of malnutrition, rather than being primarily associated with the underlying metabolic disease. To our knowledge, few reports are so far available concerning methylmalonic aciduria complicated by skin eruptions.

  8. Zinc Deficiency with Acrodermatitis Enteropathica-like Eruption After Pancreaticoduodenectomy

    Directory of Open Access Journals (Sweden)

    Hsin-Hsien Yu

    2007-10-01

    Full Text Available Pancreaticoduodenectomy (PD is the standard operation for periampullary lesions. Most reports have focused on the clinical outcome, complications and tumor recurrence after PD. Few studies have focused on the nutritional sequelae that result from the extended resection of the upper gastrointestinal tract and disruption of the normal physiologic process of digestion. Zinc is absorbed mainly in the duodenum and proximal jejunum, which are removed during PD. Herein, we report two patients who experienced zinc deficiency with acrodermatitis enteropathica-like eruption, alopecia, glossitis and nail dystrophy after PD. The lesions improved dramatically after supplementation with zinc sulfate, pancreatic enzyme and diet instructions. No symptoms related to zinc deficiency were noted on follow-up after nutritional instructions had been given to the patients.

  9. Gray hair and acrodermatitis enteropathica-like dermatitis: an unexpected presentation of cystic fibrosis.

    Science.gov (United States)

    Dalgic, Buket; Egritas, Odul

    2011-10-01

    Presentation of cystic fibrosis (CF) with an acrodermatitis enteropathica-like skin rash, anemia, and hypoproteinemia without pulmonary disease is rarely reported before. We describe an 11-month-old boy with rash and edema as the presenting signs of cystic fibrosis. The interesting additional finding in our patient was the graying hair after 3 months of age. A reversal of the gray hair was observed by pancreatic enzyme replacement therapy. In conclusion, acrodermatitis-like eruption and hypoproteinemia can be a presenting sign of CF. Graying hair has not been noticed so far as a sign of CF in these patients.

  10. Zinc-deficiency acrodermatitis in a patient with chronic alcoholism and gastric bypass: a case report

    Directory of Open Access Journals (Sweden)

    Dariush Shahsavari

    2014-07-01

    Full Text Available Acquired adult-onset zinc deficiency is occasionally reported in patients with malnutrition states, such as alcoholism, or malabsorptive states, such as post-bariatric surgery. The defining symptoms of hypozincemia include a classic triad of necrolytic dermatitis, diffuse alopecia, and diarrhea. We report a case of zinc deficiency in a 39-year-old man with history of gastric bypass surgery and alcoholism. For this patient, severe hypozincemia confirmed acrodermatitis, and zinc supplementation was met with gradual improvement.

  11. Acrodermatitis chronica atrophicans kan være vanskelig at diagnosticere

    DEFF Research Database (Denmark)

    Rosenlund, Signe; Bækgaard, Niels; Menné, Torkil

    2011-01-01

    A healthy 29 year-old man developed over four years a slowly increasing swelling and violet discolouring of the third toe on his left foot. He was examined by several specialists and an amputation was recommended since the condition was unknown and aggravating. On suspicion of Borrelia infection...... the patient was prescribed penicillin treatment for 28 days with convincing effect. Serologic tests showed increased Borrelia titer. Biopsy showed chronic inflammation without any suspicion of malignity. Denmark is endemic for borreliosis and per year approximately 50 cases develop acrodermatitis chronic...

  12. Acrodermatitis due to zinc deficiency after combined vertical gastroplasty with jejunoileal bypass: case report

    Directory of Open Access Journals (Sweden)

    Selma Freire de Carvalho Cunha

    Full Text Available CONTEXT: Nutritional complications may occur after bariatric surgery, due to restriction of food intake and impaired digestion or absorption of nutrients. CASE REPORT: After undergoing vertical gastroplasty and jejunoileal bypass, a female patient presented marked weight loss and protein deficiency. Seven months after the bariatric surgery, she presented dermatological features compatible with acrodermatitis enteropathica, as seen from the plasma zinc levels, which were below the reference values (34.4 mg%. The skin lesions improved significantly after 1,000 mg/day of zinc sulfate supplementation for one week. CONCLUSIONS: The patient's evolution shows that the multidisciplinary team involved in surgical treatment of obesity should take nutritional deficiencies into consideration in the differential diagnosis of skin diseases, in order to institute early treatment.

  13. Phrynoderma and acquired acrodermatitis enteropathica in breastfeeding women after bariatric surgery.

    Science.gov (United States)

    Monshi, Babak; Stockinger, Theresa; Vigl, Kornelia; Richter, Leo; Weihsengruber, Felix; Rappersberger, Klemens

    2015-11-01

    Women who have undergone bariatric surgery are susceptible to nutritional deficiencies in subsequent pregnancies. We highlight the importance of dermatologists in the early recognition of cutaneous signs of malnutrition occurring in this specific clinical setting. We compare clinical characteristics of two young women with dermatological signs of combined post-gestational nutritional deficiencies following Roux-en-Y gastric bypass surgery. Patient 1 exhibited follicular papules on the extremities, perianal eczema, perlèche, alopecia, and depigmentation of hair. Patient 2 showed erythematous plaques in genitoanal and acral areas, perlèche, diffuse alopecia, and depigmentation of hair. Based on clinical and histopathological findings, decreased vitamin A (patient 1) and zinc levels (patient 2), we diagnosed phrynoderma and acquired acrodermatitis enteropathica, respectively. Comparison of the two patients revealed that both (i) were lacking follow-up after gastric bypass surgery, (ii) developed skin lesions as primary symptoms with (iii) mixed clinical manifestations due to combined deficiencies, and (iv) experienced initial symptoms during lactation suggesting a causal relationship. Our observations highlight the potentially increased risk of women to develop post-gestational dermatological manifestations of malnutrition following bariatric surgery. The awareness of dermatologists with respect to this emerging, susceptible patient group may help avert damage to mother and child. © 2015 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.

  14. A mouse model of acrodermatitis enteropathica: loss of intestine zinc transporter ZIP4 (Slc39a4 disrupts the stem cell niche and intestine integrity.

    Directory of Open Access Journals (Sweden)

    Jim Geiser

    Full Text Available Mutations in the human Zip4 gene cause acrodermatitis enteropathica, a rare, pseudo-dominant, lethal genetic disorder. We created a tamoxifen-inducible, enterocyte-specific knockout of this gene in mice which mimics this human disorder. We found that the enterocyte Zip4 gene in mice is essential throughout life, and loss-of-function of this gene rapidly leads to wasting and death unless mice are nursed or provided excess dietary zinc. An initial effect of the knockout was the reprogramming of Paneth cells, which contribute to the intestinal stem cell niche in the crypts. Labile zinc in Paneth cells was lost, followed by diminished Sox9 (sex determining region Y-box 9 and lysozyme expression, and accumulation of mucin, which is normally found in goblet cells. This was accompanied by dysplasia of the intestinal crypts and significantly diminished small intestine cell division, and attenuated mTOR1 activity in villus enterocytes, indicative of increased catabolic metabolism, and diminished protein synthesis. This was followed by disorganization of the absorptive epithelium. Elemental analyses of small intestine, liver, and pancreas from Zip4-intestine knockout mice revealed that total zinc was dramatically and rapidly decreased in these organs whereas iron, manganese, and copper slowly accumulated to high levels in the liver as the disease progressed. These studies strongly suggest that wasting and lethality in acrodermatitis enteropathica patients reflects the loss-of-function of the intestine zinc transporter ZIP4, which leads to abnormal Paneth cell gene expression, disruption of the intestinal stem cell niche, and diminished function of the intestinal mucosa. These changes, in turn, cause a switch from anabolic to catabolic metabolism and altered homeostasis of several essential metals, which, if untreated by excess dietary zinc, leads to dramatic weight loss and death.

  15. Lesões de pele do tipo acrodermatite enteropática em duas crianças com doença da urina de xarope do bordo Acrodermatitis enteropathica-like eruption in two children with maple syrup urine disease

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    Erasmo Barbante Casella

    2007-04-01

    Full Text Available Lesões cutâneas semelhantes à acrodermatite enteropática têm sido descritas em pacientes com algumas doenças metabólicas tratadas com dietas hipoprotéicas. Esses pacientes geralmente apresentam baixos níveis séricos de alguns aminoácidos, especialmente da isoleucina. Descrevemos dois pacientes que evoluíram com lesões semelhantes às da acrodermatite enteropática durante o tratamento da doença da urina do xarope de bordo , sem deficiência do zinco. A suplementação da isoleucina determinou rápida melhora das lesões dermatológicas.Acrodermatitis enteropathica-like cutaneous lesions have been reported in patients with some metabolic disorders that are treated with a low-protein diet. These patients usually have low blood levels of some amino acids, especially isoleucine. We describe two patients who evolved with eruptions resembling acrodermatitis enteropathica while undergoing treatment for maple syrup urine disease, without zinc deficiency. Isoleucine supplementation led to a prompt improvement of the skin disorder.

  16. A Souvenir From France: Acrodermatitis Chronica Atrophicans Presenting in the United States.

    Science.gov (United States)

    Correa-Selm, Lilia M; Bronsnick, Tara; Rao, Babar K; Kirkorian, A Yasmine; Marcus, Alan; Cha, Jisun

    2016-01-01

    A 70-year-old man was referred by his rheumatologist to our dermatology clinic for evaluation of dermatitis on his right arm that appeared 3 months earlier. The skin lesion was asymptomatic and the patient denied current systemic symptoms, including fever, chills, and joint pain; however, 10 months prior to this presentation he experienced arthritis in the left knee. At that time, Borrelia serology revealed positive IgG (6.07; <0.8 negative, 0.8 to 0.99 borderline, ≥1 positive) and negative IgM titers. The patient had not received treatment for Lyme disease in the past. He was referred to rheumatology for evaluation of possible Lyme disease but did not follow up until 10 months later. The arthritis has since resolved. He travels frequently to France and recalls multiple tick bites during these trips.

  17. [Cutaneous manifestations of cystic fibrosis in an infant: acrodermatitis enteropathica and gray hair].

    Science.gov (United States)

    Yarmuch, G Paula; Chaparro, R Ximena; Fischer, S Cecilia

    2015-01-01

    Cutaneous manifestations at the time of CF diagnosis are rare. To describe the case of an infant with an unusual cutaneous presentation of cystic fibrosis. The case is presented of an infant with delayed physical growth at two months, and at the age of four months, presented with a skin rash and gray hair. Tests revealed the presence of hypoproteinemia and anemia, with the diagnosis of Cystic Fibrosis being confirmed by genetic testing. The rash was completely resolved after pancreatic enzyme replacement therapy. This is the second gray hair case reported in children with this disease. Metabolic diseases such as cystic fibrosis should be suspected in malnourished children who develop skin disorders. Copyright © 2015. Publicado por Elsevier España, S.L.U.

  18. [Lyme disease acrodermitis chronica atrophicans: misleading vascular signs].

    Science.gov (United States)

    Blaise, S; Fiandrino, G; Satger, B; Carpentier, P-H

    2014-05-01

    Lyme disease acrodermatitis chronica atrophicans is a tertiary form of Lyme borrelliosis. It occurs at least six months, but also up to several years, after a tick bite. This rare condition is probably underestimated because of the difficult diagnosis. Clinical presentations of acrodermatitis chronic atrophicans are quite variable depending upon the duration of the disease. Complimentary explorations are difficult to interpret and rarely specific. Only rare configurations allow formal diagnosis of Borrelia burgdoferi infection. We present a patient who exhibited an atypical clinical presentation of Lyme disease acrodermatitis chronic atrophicans. The clinical outcome was quite favorable with treatment, confirming the diagnosis. Such treatments, which are well tolerated and highly effective, are essential since an untreated disease can lead to potentially severe neurological involvement. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

  19. Disease: H00353 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H00353 Borreliosis, including: Lyme disease; Neuroborreliosis; Acrodermatitis chron...ica atrophicans Borreliosis is the multisystem infectious disease caused by the tick-borne spirochetes Borre...disorders (Lyme neuroborreliosis) can occur as well. Infectious disease Borrelia burgdorferi (Lyme disease) ...Lancet 379:461-73 (2012) PMID:12872317 (description, env_factor, drug) Halperin JJ Lyme disea

  20. Digit loss due to Demodex spp. infestation in a dog: clinical and pathological features

    Science.gov (United States)

    Grandi, F.; Pasternak, A.; Beserra, H.E.O.

    2013-01-01

    Here we describe a rare clinical manifestation of canine pododemodicosis. A dog was presented with pedal erythema, scaling, crusting, severe edema and digit loss. The following diseases were taken into account for the differential diagnosis: pododemodicosis, lethal acrodermatitis, zinc responsive dermatosis and pemphigus foliaceus. Results from skin biopsies revealed the presence of Demodex spp. of mites in the follicular infundibula and a severe inflammatory process (pododemodicosis). Upon the acaricidal treatment, the patient exhibited favorable signs of clinical improvement. PMID:26623312

  1. Diagnósticos diferenciales de la histiocitosis a células de Langerhans The differential diagnostics of Langerhans cell histiocytosis

    OpenAIRE

    C. N. Chirino; R. J. Scwartz; O. L. Musitani

    2007-01-01

    La histiocitosis a células de Langerhans (HCL) debe diferenciarse de las siguientes entidades: eritema tóxico neonatorum (ETN), dermatitis seborreica (DS), foliculitis pustulosa eosinofílica (FPE), incontinencia pigmenti (IP), mastocitosis/urticaria pigmentosa (M/UP), acrodermatitis enteropática (ADE), síndrome de Wiskott-Aldrich (WAS), acropustulosis infantil (API). Además se deben considerar la enfermedad de Rosai- Dorfman (ERD), xantomas diseminados, melanosis pustulosa neonatal (MPN), can...

  2. Microelements and inherited metabolic diseases.

    Science.gov (United States)

    Marklová, Eliska

    2002-01-01

    In addition to the main groups of inherited metabolic diseases, including mitochondrial, peroxisomal and lysosomal defects, organic acidurias, porphyrias, defects of amino acids, saccharides and fatty acids metabolism, disorders of transport and utilisation of microelements have also been recognized. Recent findings concerning hereditary hemochromatosis (iron), Wilson and Menkes diseases (copper), molybdenum cofactor deficiency (molybdenum), defects of cobalamine synthesis (cobalt) and acrodermatitis enteropathica (zinc) are reviewed.

  3. Brote de onicomadesis posvírica en Valladolid

    National Research Council Canada - National Science Library

    Redondo Granado, M.J; Torres Hinojal, M.C; Izquierdo López, B

    2009-01-01

    ... los procesos febriles, las enfermedades inflamatorias graves, como el síndrome de Stevens-Johnson o la enfermedad de Kawasaki, las toxicodermias, la quimioterapia, la acrodermatitis enteropática y las infecciones, como sífilis y escarlatina 1,2 . En el recién nacido se pueden observar debido al estrés del parto 1 . Por otra parte, la enfermedad...

  4. Parakeratosis pustulosa - a distinct but less familiar disease

    Directory of Open Access Journals (Sweden)

    Pandhi Deepika

    2003-01-01

    Full Text Available Parakeratosis pustulosa (PP is a distinct but less commonly known skin disease, which is frequently seen, in young girls. We describe the clinical and histological features of PP in a 7 month old female baby. Further, it is stressed that unless carefully looked for, this entity may be easily misdiagnosed as chronic paronychia, acrodermatitis of Hallopeau, pustular psoriasis, atopic dermatitis, tinea pedis or dry fissured eczematoid dermatitis and mistreated subsequently.

  5. Digit loss due to Demodex spp. infestation in a dog: clinical and pathological features

    Directory of Open Access Journals (Sweden)

    F. Grandi

    2013-05-01

    Full Text Available Here we describe a rare clinical manifestation of canine pododemodicosis. A dog was presented with pedal erythema, scaling, crusting, severe edema and digit loss. The following diseases were taken into account for the differential diagnosis: pododemodicosis, lethal acrodermatitis, zinc responsive dermatosis and pemphigus foliaceus. Results from skin biopsies revealed the presence of Demodex spp. of mites in the follicular infundibula and a severe inflammatory process (pododemodicosis. Upon the acaricidal treatment, the patient exhibited favorable signs of clinical improvement.

  6. Persistent bacterial infections : identification of immunogenic structures of Borrelia burgdorferi sensu lato and Chlamydophila pneumoniae by phage surface display

    OpenAIRE

    Müller, Markus

    2004-01-01

    In dieser Arbeit wurden die immunogenen (Antikörper induzierenden) Eigenschaften von Borrelia burgdorferi s.l. und Chlamydophila pneumoniae, beides Pathogene, die in Menschen über Jahre persistieren können, wurden untersucht.B. burgdorferi s.l. ist der Verursacher der Lyme Borreliose (LB) und Persistenz kann in Menschen zu Spätmanifestationen wie Acrodermatitis chronica atropicans, Arthritis und Neuroborreliose führen.C. pneumoniae stellt ein weit verbreiteter Atemwegserreger dar, der zu Lung...

  7. [Serum IgE in skin diseases of children (author's transl)].

    Science.gov (United States)

    Urbanek, R; Karitzky, D; Künzer, W

    1978-03-24

    Using the paper-radioimmunosorbens test (PRIST) normal values were obtained from 200 non-allergic children. The IgE level was aged-dependent, in part with significant differences between various age groups. These normal values were compared with those in children with seborrhoeic dermitis, constitutional neurodermatitis, parasitoses, urticaria, Quincke oedema, Schönlein-Henoch purpura, pityriasis rosea, multiform exudative erythema, erythema nodosum and infantile papular acrodermatitis. Half-life of IgE in neonates was 16.2 hours.

  8. Enzootic origins for clinical manifestations of Lyme borreliosis.

    Science.gov (United States)

    Jahfari, Setareh; Krawczyk, Aleksandra; Coipan, E Claudia; Fonville, Manoj; Hovius, Joppe W; Sprong, Hein; Takumi, Katsuhisa

    2017-04-01

    Both early localized and late disseminated forms of Lyme borreliosis are caused by Borrelia burgdorferi senso lato. Differentiating between the spirochetes that only cause localized skin infection from those that cause disseminated infection, and tracing the group of medically-important spirochetes to a specific vertebrate host species, are two critical issues in disease risk assessment and management. Borrelia burgdorferi senso lato isolates from Lyme borreliosis cases with distinct clinical manifestations (erythema migrans, neuroborreliosis, acrodermatitis chronica atrophicans, and Lyme arthritis) and isolates from Ixodes ricinus ticks feeding on rodents, birds and hedgehogs were typed to the genospecies level by sequencing part of the intergenic spacer region. In-depth molecular typing was performed by sequencing eight additional loci with different characteristics (plasmid-bound, regulatory, and housekeeping genes). The most abundant genospecies and genotypes in the clinical isolates were identified by using odds ratio as a measure of dominance. Borrelia afzelii was the most common genospecies in acrodermatitis patients and engorged ticks from rodents. Borrelia burgdorferi senso stricto was widespread in erythema migrans patients. Borrelia bavariensis was widespread in neuroborreliosis patients and in ticks from hedgehogs, but rare in erythema migrans patients. Borrelia garinii was the dominant genospecies in ticks feeding on birds. Spirochetes in ticks feeding on hedgehogs were overrepresented in genotypes of the plasmid gene ospC from spirochetes in erythema migrans patients. Spirochetes in ticks feeding on hedgehogs were overrepresented in genotypes of ospA from spirochetes in acrodermatitis patients. Spirochetes from ticks feeding on birds were overrepresented in genotypes of the plasmid and regulatory genes dbpA, rpoN and rpoS from spirochetes in neuroborreliosis patients. Overall, the analyses of our datasets support the existence of at least three

  9. Clinical Aspects of Trace Elements: Zinc in Human Nutrition – Zinc Deficiency and Toxicity

    Directory of Open Access Journals (Sweden)

    Michelle M Pluhator

    1996-01-01

    Full Text Available Available evidence suggests that trace elements, such as zinc, once thought to have no nutritional relevance, are possibly deficient in large sections of the human population. Conditioned deficiencies have been reported to result from malabsorption syndromes, acrodermatitis enteropathica, alcoholism, gastrointestinal disease, thermal injury, chronic diseases (eg, diabetes, sickle cell anemia, and in total parenteral nutrition therapy. Awareness that patients with these problems are at risk has led health professionals to focus increasingly on the importance of zinc therapy in the prevention and treatment of deficiency. More recently zinc toxicity and its role in human nutrition and well-being have come under investigation. Reports have focused on the role of zinc toxicity in causes of copper deficiency, changes in the immune system and alterations in blood lipids. As the numerous challenges presented by the study of zinc in human nutrition are met, more appropriate recommendations for dietary and therapeutic zinc intake are being made.

  10. [Late manifestations of Lyme borreliosis].

    Science.gov (United States)

    Rossi, M

    2005-11-01

    Month to years after an early local or an early disseminated infection some patients develop late manifestations of lyme borreliosis. Most frequently involved organs are the skin (acrodermatitis chronica atrophicans), joints (Lyme arthritis) and the nervous system. A history of exposure and the clinical picture may suggest Lyme borreliosis, however, confirmation by serological and other tests is needed. Antibiotic treatment during early stages normally prevents development of late manifestations. Late stages persist if not treated. By adequate antimicrobial therapy they are treatable and usually show a good prognosis. Recovery may be delayed, some patients suffer from residual difficulties. Currently there is no accepted case definition for a "post lyme syndrome". The term "chronic Lyme disease" suggests (a never proven) persistent infection by viable bacteria. Repeated and prolonged antibiotic treatments are not indicated.

  11. Pustular psoriasis: pathophysiology and current treatment perspectives

    Directory of Open Access Journals (Sweden)

    Benjegerdes KE

    2016-09-01

    Full Text Available Katie E Benjegerdes,1 Kimberly Hyde,2 Dario Kivelevitch,3 Bobbak Mansouri1,4 1Texas A&M Health Science Center College of Medicine, Temple, 2Texas A&M Health Science Center College of Medicine, Round Rock, 3Division of Dermatology, Baylor University Medical Center, Dallas, 4Department of Dermatology, Scott and White Hospital, Texas A&M Health Science Center College of Medicine, Temple, TX, USA Abstract: Psoriasis vulgaris is a chronic inflammatory disease that classically affects skin and joints and is associated with numerous comorbidities. There are several clinical subtypes of psoriasis including the uncommon pustular variants, which are subdivided into generalized and localized forms. Generalized forms of pustular psoriasis include acute generalized pustular psoriasis, pustular psoriasis of pregnancy, and infantile and juvenile pustular psoriasis. Localized forms include acrodermatitis continua of Hallopeau and palmoplantar pustular psoriasis. These subtypes vary in their presentations, but all have similar histopathologic characteristics. The immunopathogenesis of each entity remains to be fully elucidated and some debate exists as to whether these inflammatory pustular dermatoses should be classified as entities distinct from psoriasis vulgaris. Due to the rarity of these conditions and the questionable link to the common, plaque-type psoriasis, numerous therapies have shown variable results and most entities remain difficult to treat. With increasing knowledge of the pathogenesis of these variants of pustular psoriasis, the development and use of biologic and other immunomodulatory therapies holds promise for the future of successfully treating pustular variants of psoriasis. Keywords: psoriasis, pustular psoriasis, generalized pustular psoriasis, von Zumbusch, impetigo herpetiformis, acrodermatitis continua of Hallopeau, palmoplantar pustulosis, biologic

  12. Diagnósticos diferenciales de la histiocitosis a células de Langerhans The differential diagnostics of Langerhans cell histiocytosis

    Directory of Open Access Journals (Sweden)

    C. N. Chirino

    2007-06-01

    Full Text Available La histiocitosis a células de Langerhans (HCL debe diferenciarse de las siguientes entidades: eritema tóxico neonatorum (ETN, dermatitis seborreica (DS, foliculitis pustulosa eosinofílica (FPE, incontinencia pigmenti (IP, mastocitosis/urticaria pigmentosa (M/UP, acrodermatitis enteropática (ADE, síndrome de Wiskott-Aldrich (WAS, acropustulosis infantil (API. Además se deben considerar la enfermedad de Rosai- Dorfman (ERD, xantomas diseminados, melanosis pustulosa neonatal (MPN, candidiasis congénita, listeriosis neonatal, herpes simple perinatal y la varicela neonatal. Debido a que los métodos auxiliares de laboratorio no siempre están disponibles o los resultados laboratoriales algunas veces son extemporáneos, y puesto que el médico práctico a menudo necesita tomar decisiones precozmente, es que la epidemiología resulta útil, pues brinda el marco adecuado para ordenar y jerarquizar las sospechas diagnósticas frente a un caso concreto, con un paciente determinado, en un momento específico.The differential diagnostics of Langerhans cell histiocytosis should include the following disorders: erythema toxicum neonatorum, seborrheic dermatitis, eosinophilic pustular folliculitis, incontinentia pigmenti, mastocytosis / urticaria pigmentosa, acrodermatitis enteropathica, Wiskott-Aldrich syndrome, infantile acropustulosis, Rosai- Dorfman disease, xanthoma disseminatum, neonatal pustular melanosis, congenital candidiasis, perinatal listeriosis, perinatal herpes simplex, neonatal varicella. Since the auxiliary methods of lab are not always available, or lab results are sometimes extemporaneous, the physicians often needs to make quick decisions. The epidemiology is useful because it offers the appropriate mark to prioritize the diagnostic in specific cases

  13. Extreme population differences in the human zinc transporter ZIP4 (SLC39A4 are explained by positive selection in Sub-Saharan Africa.

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    Johannes Engelken

    2014-02-01

    Full Text Available Extreme differences in allele frequency between West Africans and Eurasians were observed for a leucine-to-valine substitution (Leu372Val in the human intestinal zinc uptake transporter, ZIP4, yet no further evidence was found for a selective sweep around the ZIP4 gene (SLC39A4. By interrogating allele frequencies in more than 100 diverse human populations and resequencing Neanderthal DNA, we confirmed the ancestral state of this locus and found a strong geographical gradient for the derived allele (Val372, with near fixation in West Africa. In extensive coalescent simulations, we show that the extreme differences in allele frequency, yet absence of a classical sweep signature, can be explained by the effect of a local recombination hotspot, together with directional selection favoring the Val372 allele in Sub-Saharan Africans. The possible functional effect of the Leu372Val substitution, together with two pathological mutations at the same codon (Leu372Pro and Leu372Arg that cause acrodermatitis enteropathica (a disease phenotype characterized by extreme zinc deficiency, was investigated by transient overexpression of human ZIP4 protein in HeLa cells. Both acrodermatitis mutations cause absence of the ZIP4 transporter cell surface expression and nearly absent zinc uptake, while the Val372 variant displayed significantly reduced surface protein expression, reduced basal levels of intracellular zinc, and reduced zinc uptake in comparison with the Leu372 variant. We speculate that reduced zinc uptake by the ZIP4-derived Val372 isoform may act by starving certain pathogens of zinc, and hence may have been advantageous in Sub-Saharan Africa. Moreover, these functional results may indicate differences in zinc homeostasis among modern human populations with possible relevance for disease risk.

  14. Diet in dermatology: Revisited

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    Kaimal Sowmya

    2010-01-01

    Full Text Available Diet has an important role to play in many skin disorders, and dermatologists are frequently faced with the difficulty of separating myth from fact when it comes to dietary advice for their patients. Patients in India are often anxious about what foods to consume, and what to avoid, in the hope that, no matter how impractical or difficult this may be, following this dictum will cure their disease. There are certain disorders where one or more components in food are central to the pathogenesis, e.g. dermatitis herpetiformis, wherein dietary restrictions constitute the cornerstone of treatment. A brief list, although not comprehensive, of other disorders where diet may have a role to play includes atopic dermatitis, acne vulgaris, psoriasis vulgaris, pemphigus, urticaria, pruritus, allergic contact dermatitis, fish odor syndrome, toxic oil syndrome, fixed drug eruption, genetic and metabolic disorders (phenylketonuria, tyrosinemia, homocystinuria, galactosemia, Refsum′s disease, G6PD deficiency, xanthomas, gout and porphyria, nutritional deficiency disorders (kwashiorkar, marasmus, phrynoderma, pellagra, scurvy, acrodermatitis enteropathica, carotenemia and lycopenemia and miscellaneous disorders such as vitiligo, aphthous ulcers, cutaneous vasculitis and telogen effluvium. From a practical point of view, it will be useful for the dermatologist to keep some dietary information handy to deal with the occasional patient who does not seem to respond in spite of the best, scientific and evidence-based therapy.

  15. The management of psoriasis through diet

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    Duarte G

    2012-08-01

    Full Text Available Gleison Duarte,1 Luan Oliveira Barbosa,2 Maria Elisa A Rosa11Dermatology Division, Alergodermoclin, Salvador, Bahia, Brazil; 2Escola Bahiana de Medicina e Saúde Pública Salvador, Bahia, BrazilAbstract: Diet is an important factor in the management of several dermatological diseases, such as dermatitis herpetiformis, acne vulgaris, gout, phrynoderma, pellagra, psoriasis, and acrodermatitis enteropathica. New concepts have emerged concerning the influence of diet on psoriasis. For example, diet has an adjuvant role in the management of several cardiovascular comorbidities that exhibit a higher-than-expected prevalence in psoriatic patients. Functional foods, such as yellow saffron and fish oil, may exert favorable effects on immune and cardiovascular functions. A gluten-free diet may promote significant clinical and histologic improvement. Folate supplementation may induce clinical improvement of psoriasis, but side effects may also occur. Diets rich in fresh fruits and vegetables are associated with a lower prevalence of psoriasis, and vegetarian diets were associated with clinical improvement. Additionally, many drug-diet interactions (retinoids, methotrexate, cyclosporine must be considered in patients with psoriasis. Therefore, in addition to current nutritional advice given to psoriasis patients, further studies are necessary in the role of diet in psoriasis therapy.Keywords: diet, lifestyle, psoriasis, recommendations, supplementation

  16. Clinical Features of 705 Borrelia burgdorferi Seropositive Patients in an Endemic Area of Northern Italy

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    Giuseppe Stinco

    2014-01-01

    Full Text Available Background. Lyme Borreliosis is a multisystemic infection caused by spirochetes of Borrelia burgdorferi sensu lato complex. The features of Lyme Borreliosis may differ in the various geographical areas, primarily between the manifestations found in America and those found in Europe and Asia. Objective. to describe the clinical features of Lyme Borreliosis in an endemic geographic area such as Friuli-Venezia Giulia in the Northeastern part of Italy. Methods. The medical records of patients resulted seropositive for Borrelia burgdorferi have been retrospectively recorded and analyzed. Results. Seven hundred and five patients met the inclusion criteria, 363 males and 342 females. Erythema migrans was the most common manifestation, detected in 437 patients. Other classical cutaneous manifestations included 58 cases of multiple erythema migrans, 7 lymphadenosis benigna cutis, and 18 acrodermatitis chronica atrophicans. The musculoskeletal system was involved in 511 patients. Four hundred and sixty patients presented a neurological involvement. Flu-like symptoms preceded or accompanied or were the only clinical feature in 119 patients. Comments. The manifestations of Lyme borreliosis recorded in this study are similar to the ones of other endemic areas in Europe, even if there are some peculiar features which are different from those reported in Northern Europe and in the USA.

  17. Skin Lesions Associated with Nutritional Management of Maple Syrup Urine Disease.

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    Uaariyapanichkul, Jaraspong; Saengpanit, Puthita; Damrongphol, Ponghatai; Suphapeetiporn, Kanya; Chomtho, Sirinuch

    2017-01-01

    Maple syrup urine disease (MSUD) is an inborn error of branched chain amino acids (BCAAs) metabolism. We report an infant with MSUD who developed 2 episodes of cutaneous lesions as a result of isoleucine deficiency and zinc deficiency, respectively. A 12-day-old male infant was presented with poor milk intake and lethargy. The diagnosis of MSUD was made based on clinical and biochemical data. Specific dietary restriction of BCAAs was given. Subsequently, natural protein was stopped as the patient developed hospital-acquired infections which resulted in an elevation of BCAAs. Acrodermatitis dysmetabolica developed and was confirmed to be from isoleucine deficiency. At the age of 6 months, the patient developed severe lethargy and was on natural protein exclusion for an extended period. Despite enteral supplementation of zinc sulfate, cutaneous manifestations due to zinc deficiency occurred. Skin lesions in MSUD patients could arise from multiple causes. Nutritional deficiency including isoleucine and zinc deficiencies can occur and could complicate the treatment course as a result of malabsorption, even while on enteral supplementation. Parenteral nutrition should be considered and initiated accordingly. Clinical status, as well as BCAA levels, should be closely monitored in MSUD patients.

  18. Maple Syrup Urine Disease Complicated with Kyphoscoliosis and Myelopathy

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    Jia-Woei Hou

    2016-10-01

    Full Text Available Maple syrup urine disease (MSUD is an autosomal recessive aminoacidopathy secondary to an enzyme defect in the catabolic pathway of the branched-chain amino acids (BCAAs: leucine, isoleucine, and valine. Accumulation of their corresponding keto-acids leads to encephalopathy if not treated in time. A newborn male patient was suspected to have MSUD after tandem mass study when he presented symptoms and signs suggestive neonatal sepsis, anemia, and diarrhea. Food restriction of BCAAs was started; however, acrodermatitis enteropathica-like skin eruptions occurred at age 2 months. The skin rashes resolved after adding BCAAs and adjusting the infant formula. At age 7 months, he suffered from recurrent skin lesions, zinc deficiency, osteoporosis, and kyphosis of the thoracic spine with acute angulation over the T11-T12 level associated with spinal compression and myelopathy. After supplementation of zinc products and pamidronate, skin lesions and osteopenia improved gradually. Direct sequencing of the DBT gene showed a compound heterozygous mutation [4.7 kb deletion and c.650-651insT (L217F or L217fsX223]. It is unusual that neurodegeneration still developed in this patient despite diet restriction. Additionally, brain and spinal magnetic resonance imaging, bone mineral density study, and monitoring of zinc status are suggested in MSUD patients.

  19. Homogeneous Inflammatory Gene Profiles Induced in Human Dermal Fibroblasts in Response to the Three Main Species of Borrelia burgdorferi sensu lato

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    Meddeb, Mariam; Carpentier, Wassila; Cagnard, Nicolas; Nadaud, Sophie; Grillon, Antoine; Barthel, Cathy; De Martino, Sylvie Josiane; Jaulhac, Benoît; Boulanger, Nathalie

    2016-01-01

    In Lyme borreliosis, the skin is the key site for bacterial inoculation by the infected tick and for cutaneous manifestations. We previously showed that different strains of Borrelia burgdorferi sensu stricto isolated from tick and from different clinical stages of the Lyme borreliosis (erythema migrans, and acrodermatitis chronica atrophicans) elicited a very similar transcriptional response in normal human dermal fibroblasts. In this study, using whole transcriptome microarray chips, we aimed to compare the transcriptional response of normal human dermal fibroblasts stimulated by 3 Borrelia burgdorferi sensu lato strains belonging to 3 main pathogenic species (B. afzelii, B. garinii and B. burgdorferi sensu stricto) in order to determine whether “species-related” inflammatory pathways could be identified. The three Borrelia strains tested exhibited similar transcriptional profiles, and no species-specific fingerprint of transcriptional changes in fibroblasts was observed. Conversely, a common core of chemokines/cytokines (CCL2, CXCL1, CXCL2, CXCL6, CXCL10, IL-6, IL-8) and interferon-related genes was stimulated by all the 3 strains. Dermal fibroblasts appear to play a key role in the cutaneous infection with Borrelia, inducing a homogeneous inflammatory response, whichever Borrelia species was involved. PMID:27706261

  20. Lyme disease – principles of diagnosis and treatment

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    Sławomir A. Pancewicz

    2014-06-01

    Full Text Available The paper discusses epidemiological and clinical data as well as therapeutic and diagnostic methods with regard to Lyme disease. Main manifestations of early (erythema migrans, borrelial lymphoma, Lyme carditis, neuroborreliosis and Lyme arthritis and late (neuroborreliosis, Lyme arthritis, acrodermatitis chronica atrophicans Lyme borreliosis are described and their treatment is discussed. The most useful antibiotics are doxycycline and ceftriaxone. It was noted that in most cases of Lyme disease the prognosis is good, and antibiotic treatment is very effective regardless of the stage of infection. Detection of specific anti-Borrelia burgdorferi antibodies in a patient with a history of a tick bite and clinical symptoms suggesting Lyme disease is necessary for diagnosis. The results of serological tests must be interpreted carefully and always in connection with the clinical picture. A seropositivity without clinical symptoms of the disease does not necessarily prove an active infection. Antibody serum titres should not be used to assess therapeutic efficacy or be regarded as an indication for a re-treatment. Current recommendations stress that detection of chemokine CXCL13, searching for B. burgdorferi antigens in the cerebrospinal fluid and urine, searching for B. Burgdorferi spheroplasts or L-forms as well as CD57+/CD3 subpopulation assessment as well as lymphocyte transformation test have no confirmed diagnostic significance in Lyme disease diagnostics.

  1. Zinc-induced copper deficiency: a report of three cases initially recognized on bone marrow examination.

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    Willis, Monte S; Monaghan, Sara A; Miller, Michael L; McKenna, Robert W; Perkins, Wiley D; Levinson, Barry S; Bhushan, Vikas; Kroft, Steven H

    2005-01-01

    Copper deficiency is a rare cause of sideroblastic anemia and neutropenia that often is not suspected clinically. The morphologic findings in bone marrow, while not pathognomonic, are sufficiently characteristic to suggest the diagnosis, leading to further testing to establish the correct diagnosis. Excess zinc ingestion is among the causes of copper deficiency. We present 3 cases of zinc-induced copper deficiency in which the diagnosis first was suggested on the basis of bone marrow examination. The first patient was a 47-year-old man with a debilitating peripheral neuropathy that had progressed during the previous 18 months, mild anemia, and severe neutropenia. The second was a 21-year-old man receiving zinc supplementation for acrodermatitis enteropathica in whom moderate normocytic anemia and neutropenia developed. The third patient was a 42-year-old man with anemia, severe neutropenia, and a peripheral neuropathy that had progressed during 8 months. The bone marrow findings in all cases suggested copper deficiency, which was confirmed by further laboratory testing and determined to be due to zinc excess. The morphologic features, clinical manifestations, differential diagnosis, and pathogenetic mechanisms are discussed.

  2. SPECIAL CHARACTERISTICS OF TREATMENT OF SEVERE ATOPIC DERMATITIS IN CHILDREN

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    D. Sh. Macharadze

    2013-01-01

    Full Text Available The article analyzes modern data on risk factors of severe course of atopic dermatitis in children: the role of alimentary and inhalant allergens, cutaneous infections, allergic reactions to drugs used in the treatment of disease. The most important questions of differential diagnosis of atopic dermatitis in children and the distinctive features of the illness, which may be mistaken for atopic dermatitis (primary immunodeficiencies, keratosis pilaris, psoriasis, enteropatic acrodermatitis; cutaneous bacterial and fungal infections, and drug-induced contact dermatitis to topical creams and ointments are discussed. Treatment of atopic dermatitis is based on modern approaches and includes recommendations on the use of emolents, anti-inflammatory drugs (topical glucocorticoids and calcineurin inhibitors. The article provides indications and contraindications to the administration of anti-inflammatory drugs. Special recommendations for use of cleansers and emolents at all degrees of severity of atopic dermatitis, which helps reduce the risk of side effects of topical corticosteroids, complications such as cutaneous infections and helps to maintain remission of disease are given. The importance of training programs patients is emphasized. Compliance of patients and/or their parents contributes to the achievement of the desired effect of the treatment of atopic dermatitis, which will improve the patients’ quality of life.

  3. Skin Lesions Associated with Nutritional Management of Maple Syrup Urine Disease

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    Jaraspong Uaariyapanichkul

    2017-01-01

    Full Text Available Introduction. Maple syrup urine disease (MSUD is an inborn error of branched chain amino acids (BCAAs metabolism. We report an infant with MSUD who developed 2 episodes of cutaneous lesions as a result of isoleucine deficiency and zinc deficiency, respectively. Case Presentation. A 12-day-old male infant was presented with poor milk intake and lethargy. The diagnosis of MSUD was made based on clinical and biochemical data. Management and Outcome. Specific dietary restriction of BCAAs was given. Subsequently, natural protein was stopped as the patient developed hospital-acquired infections which resulted in an elevation of BCAAs. Acrodermatitis dysmetabolica developed and was confirmed to be from isoleucine deficiency. At the age of 6 months, the patient developed severe lethargy and was on natural protein exclusion for an extended period. Despite enteral supplementation of zinc sulfate, cutaneous manifestations due to zinc deficiency occurred. Discussion. Skin lesions in MSUD patients could arise from multiple causes. Nutritional deficiency including isoleucine and zinc deficiencies can occur and could complicate the treatment course as a result of malabsorption, even while on enteral supplementation. Parenteral nutrition should be considered and initiated accordingly. Clinical status, as well as BCAA levels, should be closely monitored in MSUD patients.

  4. Lyme borreliosis

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    Steere, Allen C.; Strle, Franc; Wormser, Gary P.; Hu, Linden T.; Branda, John A.; Hovius, Joppe W. R.; Li, Xin; Mead, Paul S.

    2017-01-01

    Lyme borreliosis is a tick-borne disease that predominantly occurs in temperate regions of the northern hemisphere and is primarily caused by the bacterium Borrelia burgdorferi in North America and Borrelia afzelii or Borrelia garinii in Europe and Asia. Infection usually begins with an expanding skin lesion, known as erythema migrans (referred to as stage 1), which, if untreated, can be followed by early disseminated infection, particularly neurological abnormalities (stage 2), and by late infection, especially arthritis in North America or acrodermatitis chronica atrophicans in Europe (stage 3). However, the disease can present with any of these manifestations. During infection, the bacteria migrate through the host tissues, adhere to certain cells and can evade immune clearance. Yet, these organisms are eventually killed by both innate and adaptive immune responses and most inflammatory manifestations of the infection resolve. Except for patients with erythema migrans, Lyme borreliosis is diagnosed based on a characteristic clinical constellation of signs and symptoms with serological confirmation of infection. All manifestations of the infection can usually be treated with appropriate antibiotic regimens, but the disease can be followed by post-infectious sequelae in some patients. Prevention of Lyme borreliosis primarily involves the avoidance of tick bites by personal protective measures. PMID:27976670

  5. Chronic Lyme borreliosis associated with minimal change glomerular disease: a case report.

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    Florens, N; Lemoine, S; Guebre-Egziabher, F; Valour, F; Kanitakis, J; Rabeyrin, M; Juillard, L

    2017-02-06

    There are only few cases of renal pathology induced by Lyme borreliosis in the literature, as this damage is rare and uncommon in humans. This patient is the first case of minimal change glomerular disease associated with chronic Lyme borreliosis. A 65-year-old Caucasian woman was admitted for an acute edematous syndrome related to a nephrotic syndrome. Clinical examination revealed violaceous skin lesions of the right calf and the gluteal region that occurred 2 years ago. Serological tests were positive for Lyme borreliosis and skin biopsy revealed lesions of chronic atrophic acrodermatitis. Renal biopsy showed minimal change glomerular disease. The skin lesions and the nephrotic syndrome resolved with a sequential treatment with first ceftriaxone and then corticosteroids. We report here the first case of minimal change disease associated with Lyme borreliosis. The pathogenesis of minimal change disease in the setting of Lyme disease is discussed but the association of Lyme and minimal change disease may imply a synergistic effect of phenotypic and bacterial factors. Regression of proteinuria after a sequential treatment with ceftriaxone and corticosteroids seems to strengthen this conceivable association.

  6. Cutaneous Lyme borreliosis: Guideline of the German Dermatology Society

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    Hofmann, Heidelore; Fingerle, Volker; Hunfeld, Klaus-Peter; Huppertz, Hans-Iko; Krause, Andreas; Rauer, Sebastian; Ruf, Bernhard

    2017-01-01

    This guideline of the German Dermatology Society primarily focuses on the diagnosis and treatment of cutaneous manifestations of Lyme borreliosis. It has received consensus from 22 German medical societies and 2 German patient organisations. It is the first part of an AWMF (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V.) interdisciplinary guideline: “Lyme Borreliosis – Diagnosis and Treatment, development stage S3”. The guideline is directed at physicians in private practices and clinics who treat Lyme borreliosis. Objectives of this guideline are recommendations for confirming a clinical diagnosis, recommendations for a stage-related laboratory diagnosis (serological detection of IgM and IgG Borrelia antibodies using the 2-tiered ELISA/immunoblot process, sensible use of molecular diagnostic and culture procedures) and recommendations for the treatment of the localised, early-stage infection (erythema migrans, erythema chronicum migrans, and borrelial lymphocytoma), the disseminated early-stage infection (multiple erythemata migrantia, flu-like symptoms) and treatment of the late-stage infection (acrodermatitis chronica atrophicans with and without neurological manifestations). In addition, an information sheet for patients containing recommendations for the prevention of Lyme borreliosis is attached to the guideline. PMID:28943834

  7. [Zinc and chronic enteropathies].

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    Giorgi, P L; Catassi, C; Guerrieri, A

    1984-01-01

    In recent years the nutritional importance of zinc has been well established; its deficiency and its symptoms have also been recognized in humans. Furthermore, Acrodermatitis Enteropathica has been isolated, a rare but severe disease, of which skin lesions, chronic diarrhoea and recurring infections are the main symptoms. The disease is related to the malfunctioning of intestinal absorption of zinc and can be treated by administering pharmacological doses of zinc orally. Good dietary sources of zinc are meat, fish and, to a less extent, human milk. The amount of zinc absorbed in the small intestine is influenced by other nutrients: some compounds inhibit this process (dietary fiber, phytate) while others (picolinic acid, citric acid), referred to as Zn-binding ligands (ZnBL) facilitate it. Citric acid is thought to be the ligand which accounts for the high level of bioavailability of zinc in human milk. zinc absorption occurs throughout the small intestine, not only in the prossimal tract (duodenum and jejunum) but also in the distal tract (ileum). Diarrhoea is one of the clinical manifestations of zinc deficiency, thus many illnesses distinguished by chronic diarrhoea entail a bad absorption of zinc. In fact, in some cases of chronic enteropathies in infants, like coeliac disease and seldom cystic fibrosis, a deficiency of zinc has been isolated. Some of the symptoms of Crohn's disease, like retarded growth and hypogonadism, have been related to hypozinchemia which is present in this illness. Finally, it is possible that some of the dietary treatments frequently used for persistent post-enteritis diarrhoea (i.e. cow's milk exclusion, abuse and misuse of dietary fiber like carrot and carub powder, use of soy formula) can constitute a scarce supply of zinc and therefore could promote the persistency of diarrhoea itself.

  8. Nail psoriasis: clinical features, pathogenesis, differential diagnoses, and management

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    Haneke E

    2017-10-01

    Full Text Available Eckart Haneke1–4 1Department of Dermatology, Inselspital, University of Bern, Bern, Switzerland; 2Dermatology Practice Dermaticum, Freiburg, Germany; 3Centro de Dermatología Epidermis, Instituto CUF, Porto, Portugal; 4Department of Dermatology, University Hospital, Gent, Belgium Abstract: Psoriasis is the skin disease that most frequently affects the nails. Depending on the very nail structure involved, different clinical nail alterations can be observed. Irritation of the apical matrix results in psoriatic pits, mid-matrix involvement may cause leukonychia, whole matrix affection may lead to red lunulae or severe nail dystrophy, nail bed involvement may cause salmon spots, subungual hyperkeratosis, and splinter hemorrhages, and psoriasis of the distal nail bed and hyponychium causes onycholysis whereas that of the proximal nail fold causes psoriatic paronychia. The more extensive the involvement, the more severe is the nail destruction. Pustular psoriasis may be seen as yellow spots under the nail or, in case of acrodermatitis continua suppurativa, as an insidious progressive loss of the nail organ. Nail psoriasis has a severe impact on quality of life and may interfere with professional and other activities. Management includes patient counseling, avoidance of stress and strain to the nail apparatus, and different types of treatment. Topical therapy may be tried but is rarely sufficiently efficient. Perilesional injections with corticosteroids and methotrexate are often beneficial but may be painful and cannot be applied to many nails. All systemic treatments clearing widespread skin lesions usually also clear the nail lesions. Recently, biologicals were introduced into nail psoriasis treatment and found to be very effective. However, their use is restricted to severe cases due to high cost and potential systemic adverse effects. Keywords: nail psoriasis, etiology, pathology, quality of life, impact, treatment

  9. Chronic Lyme; diagnostic and therapeutic challenges.

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    Ljøstad, U; Mygland, Å

    2013-01-01

    In this review, we aim to discuss the definition, clinical and laboratory features, diagnostics, and management of chronic Lyme. Chronic Lyme is a rare condition caused by long-lasting and ongoing infection with the spirochete Borrelia burgdorferi (Bb). The most common manifestations are progressive encephalitis, myelitis, acrodermatitis chronica atrophicans with or without neuropathy, and arthritis. Chronic Lyme is not considered to present with isolated subjective symptoms. Direct detection of Bb has low yield in most manifestations of chronic Lyme, while almost 100% of the cases are seropositive, that is, have detectable Bb IgG antibodies in serum. Detection of Bb antibodies only with Western blot technique and not with ELISA and detection of Bb IgM antibodies without simultaneous detection of Bb IgG antibodies should be considered as seronegativity in patients with long-lasting symptoms. Patients with chronic Lyme in the nervous system (neuroborreliosis) have, with few exceptions, pleocytosis and production of Bb antibodies in their cerebrospinal fluid. Strict guidelines should be applied in diagnostics of chronic Lyme, and several differential diagnoses, including neurological disease, rheumatologic disease, post-Lyme disease syndrome, chronic fatigue syndrome, and psychiatric disease, should be considered in the diagnostic workup. Antibiotic treatment with administration route and dosages according to current guidelines are recommended. Combination antimicrobial therapy or antibiotic courses longer than 4 weeks are not recommended. Patients who attribute their symptoms to chronic Lyme on doubtful basis should be offered a thorough and systematic diagnostic approach, and an open and respectful dialogue. © 2012 John Wiley & Sons A/S.

  10. Tick-borne encephalopathies : epidemiology, diagnosis, treatment and prevention.

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    Günther, Göran; Haglund, Mats

    2005-01-01

    Tick-borne encephalopathies constitute a broad range of infectious diseases affecting the brain and other parts of the CNS. The causative agents are both viral and bacterial. This review focuses on the current most important tick-borne human diseases: tick-borne encephalitis (TBE; including Powassan encephalitis) and Lyme borreliosis. Rocky Mountain spotted fever (RMSF) and Colorado tick fever (CTF), less common tick-borne diseases associated with encephalopathy, are also discussed. TBE is the most important flaviviral infection of the CNS in Europe and Russia, with 10 000-12 000 people diagnosed annually. The lethality of TBE in Europe is 0.5% and a post-encephalitic syndrome is seen in over 40% of affected patients, often producing a pronounced impairment in quality of life. There is no specific treatment for TBE. Two vaccines are available to prevent infection. Although these have a good protection rate and good efficacy, there are few data on long-term immunity. Lyme borreliosis is the most prevalent tick-borne disease in Europe and North America, with >50 000 cases annually. Localised early disease can be treated with oral phenoxymethylpenicillin (penicillin V), doxycycline or amoxicillin. The later manifestations of meningitis, arthritis or acrodermatitis can be treated with oral doxycycline, oral amoxicillin or intravenous ceftriaxone; intravenous benzylpenicillin (penicillin G) or cefotaxime can be used as alternatives. The current use of vaccines against Lyme borreliosis in North America is under discussion, as the LYMErix vaccine has been withdrawn from the market because of possible adverse effects, for example, arthritis. RMSF and CTF appear only in North America. RMSF is an important rickettsial disease and is effectively treated with doxycycline. There is no treatment or preventative measure available for CTF.

  11. Gender disparity between cutaneous and non-cutaneous manifestations of Lyme borreliosis.

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    Franc Strle

    Full Text Available Cutaneous manifestations of Lyme borreliosis in Europe include erythema migrans (EM and acrodermatitis chronica atrophicans (ACA; the most common non-cutaneous manifestations are Lyme neuroborreliosis (LNB and Lyme arthritis. The purpose of this study was to evaluate the gender distribution of patients with these clinical manifestations of Lyme borreliosis. Data on gender were obtained from the clinical records of patients with Lyme borreliosis aged ≥15 years who had been evaluated at the University Medical Center Ljubljana, Ljubljana, Slovenia. Among 10,539 patients diagnosed with EM, 6,245 (59.3% were female and among 506 ACA patients 347 (68.6% were female. In contrast, among the 60 patients with Lyme arthritis only 15 (25% were female (p<0.0001 for the comparison of gender with EM or ACA and among the 130 patients with LNB only 51 (39.2% were females (p<0.0001for the comparison of gender with EM or ACA. Although the proportion that was female in the LNB group was greater than that of patients with Lyme arthritis, this difference did not reach statistical significance (p = 0.10. Although older individuals are more likely to be female in the general Slovenian population, the age of patients with cutaneous versus non-cutaneous manifestations was not the explanation for the observed differences in gender. In conclusion, patients with cutaneous manifestations of Lyme borreliosis were predominantly female, whereas those with non-cutaneous manifestations were predominantly male. This provocative finding is unexplained but may have direct relevance to the pathogenesis of Lyme borreliosis.

  12. Utilization of serology for the diagnosis of suspected Lyme borreliosis in Denmark: Survey of patients seen in general practice

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    Skarphedinsson Sigurdur

    2010-11-01

    Full Text Available Abstract Background Serological testing for Lyme borreliosis (LB is frequently requested by general practitioners for patients with a wide variety of symptoms. Methods A survey was performed in order to characterize test utilization and clinical features of patients investigated for serum antibodies to Borrelia burgdorferi sensu lato. During one calendar year a questionnaire was sent to the general practitioners who had ordered LB serology from patients in three Danish counties (population 1.5 million inhabitants. Testing was done with a commercial ELISA assay with purified flagella antigen from a Danish strain of B. afzelii. Results A total of 4,664 patients were tested. The IgM and IgG seropositivity rates were 9.2% and 3.3%, respectively. Questionnaires from 2,643 (57% patients were available for analysis. Erythema migrans (EM was suspected in 38% of patients, Lyme arthritis/disseminated disease in 23% and early neuroborreliosis in 13%. Age 0-15 years and suspected EM were significant predictors of IgM seropositivity, whereas suspected acrodermatitis was a predictor of IgG seropositivity. LB was suspected in 646 patients with arthritis, but only 2.3% were IgG seropositive. This is comparable to the level of seropositivity in the background population indicating that Lyme arthritis is a rare entity in Denmark, and the low pretest probability should alert general practitioners to the possibility of false positive LB serology. Significant predictors for treating the patient were a reported tick bite and suspected EM. Conclusions A detailed description of the utilization of serology for Lyme borreliosis with rates of seropositivity according to clinical symptoms is presented. Low rates of seropositivity in certain patient groups indicate a low pretest probability and there is a notable risk of false positive results. 38% of all patients tested were suspected of EM, although this is not a recommended indication due to a low sensitivity of

  13. Antibody profile to Borrelia burgdorferi in veterinarians from Nuevo León, Mexico, a non-endemic area of this zoonosis.

    Science.gov (United States)

    Skinner-Taylor, Cassandra M; Flores, Maria S; Salinas, José A; Arevalo-Niño, Katiushka; Galán-Wong, Luis J; Maldonado, Guadalupe; Garza-Elizondo, Mario A

    2016-01-01

    Lyme disease is a tick-borne disease caused by infections with Borrelia. Persons infected with Borrelia can be asymptomatic or can develop disseminated disease. Diagnosis and recognition of groups at risk of infection with Borrelia burgdorferi is of great interest to contemporary rheumatology. There are a few reports about Borrelia infection in Mexico, including lymphocytoma cases positive to B. burgdorferi sensu stricto by PCR and a patient with acrodermatitis chronica atrophicans. Veterinarians have an occupational risk due to high rates of tick contact. The aim of this work was to investigate antibodies to Borrelia in students at the Faculty of Veterinary Medicine and Zootechnics, at Nuevo León, Mexico, and determine the antibody profile to B. burgdorferi antigens. Sera were screened using a C6 ELISA, IgG and IgM ELISA using recombinant proteins from B. burgdorferi, B. garinii and B. afzelii. Sera with positive or grey-zone values were tested by IgG Western blot to B. burgdorferi sensu stricto. All volunteers reported tick exposures and 72.5% remembered tick bites. Only nine persons described mild Lyme disease related symptoms, including headaches, paresthesias, myalgias and arthralgias. None of the volunteers reported erythema migrans. Nine samples were confirmed by IgG Western blot. The profile showed 89% reactivity to OspA, 67% to p83, and 45% to BmpA. Positive sera samples shared antibody reactivity to the markers of late immune response p83 and BmpA, even if individuals did not present symptoms of Lyme arthritis or post-Lyme disease. The best criterion to diagnose Lyme disease in our country remains to be established, because it is probable that different strains coexist in Mexico. This is the first report of antibodies to B. burgdorferi in Latin American veterinarians. Veterinarians and high-risk people should be alert to take precautionary measures to prevent tick-borne diseases.

  14. Lichen Sclerosus

    Directory of Open Access Journals (Sweden)

    Şeniz Ergin

    2012-06-01

    Full Text Available Lichen sclerosus is a progressive, inflammatory dermatosis characterized with porcelain white sclerotic plaques most commonly in the anogenital area of postmenopausal women. Children and men can also be affected. Extragenital involvement may occur. Even though the etiology is unknown; autoimmune, genetic, hormonal and infectious factors are suggested. Lichen sclerosus is associated with autoimmune diseases such as thyroid disease, alopecia areata, vitiligo, diabetes and pernicious anemia. An increased incidence of autoantibodies to the extracellular matrix protein 1 is shown in sera of patients with lichen sclerosus. Familial occurence and an association with HLA DQ7 supports the presence of genetic factors in its etiology. However, the role of estrogen and androgens could not be demonstrated as etiologic factors. Clinical similarity with acrodermatitis chronica atrophicans led researches to be held for the detection of Borrelia burgdorferi antibodies ended with conflicting results. Disease may be triggered with trauma in the presence of genetic predisposition. Pruritus is the main symptom. Pain, burning and dysesthesia may occur. Lichen sclerosus may be confused with sexual abuse in girls. Furthermore, it is more severe in the presence of sexual abuse. If not treated it leads to permanent anatomical disorders in the anogenital region. It is one of the most common cause of acquired phimosis in boys. Meatal stenosis and urinary obstruction may develop. Erectile dysfunction and dyspareunia due to introital stenosis may cause psychosexual problems in men and women. Perianal involvement causes constipation in women and girls. Long-standing anogenital lesions have the risk of developing squamous cell carcinoma. Verrucous carcinoma rarely occurs. Extragenital symptoms do not have similar risks. Ultra-potent topical corticosteroids are used as the first line therapy. In the case of unresponsiveness to corticosteroids the alternative approaches are

  15. Lichen Sclerosus

    Directory of Open Access Journals (Sweden)

    Şeniz Ergin

    2012-06-01

    Full Text Available Lichen sclerosus is a progressive, inflammatory dermatosis characterized with porcelain white sclerotic plaques most commonly in the anogenital area of postmenopausal women. Children and men can also be affected. Extragenital involvement may occur. Even though the etiology is unknown; autoimmune, genetic, hormonal and infectious factors are suggested. Lichen sclerosus is associated with autoimmune diseases such as thyroid disease, alopecia areata, vitiligo, diabetes and pernicious anemia. An increased incidence of autoantibodies to the extracellular matrix protein 1 is shown in sera of patients with lichen sclerosus. Familial occurence and an association with HLA DQ7 supports the presence of genetic factors in its etiology. However, the role of estrogen and androgens could not be demonstrated as etiologic factors. Clinical similarity with acrodermatitis chronica atrophicans led researches to be held for the detection of Borrelia burgdorferi antibodies ended with conflicting results. Disease may be triggered with trauma in the presence of genetic predisposition. Pruritus is the main symptom. Pain, burning and dysesthesia may occur. Lichen sclerosus may be confused with sexual abuse in girls. Furthermore, it is more severe in the presence of sexual abuse. If not treated it leads to permanent anatomical disorders in the anogenital region. It is one of the most common cause of acquired phimosis in boys. Meatal stenosis and urinary obstruction may develop. Erectile dysfunction and dyspareunia due to introital stenosis may cause psychosexual problems in men and women. Perianal involvement causes constipation in women and girls. Long-standing anogenital lesions have the risk of developing squamous cell carcinoma. Verrucous carcinoma rarely occurs. Extragenital symptoms do not have similar risks. Ultra-potent topical corticosteroids are used as the first line therapy. In the case of unresponsiveness to corticosteroids the alternative approaches are

  16. [Clinico-epidemiologic characteristics of Lyme disease treated at the Infectious Disease in Novy Sad 1993-1998].

    Science.gov (United States)

    Vukadinov, J; Canak, G; Brkić, S; Samardzija, N M; Aleksić-Dordević, M; Turkulov, V; Cik-Nad, E; Lalosević, V

    2001-01-01

    Borrelia burgdorferi, the etiological agent of Lyme disease, is transmitted by the bite of Ixodes ricinus, registered in all parts of Yugoslavia. Vectors are very active in spring and early summer and the disease has a seasonal distribution. Generally speaking, there are three defined stages of the disease, but some of them can be misdiagnosed or really absent. Serological analysis of Lyme disease is very difficult to interpret, especially in later stages, so confirmation by immunoblot assays is recommended. The aim of this study was to present some epidemiologic and clinical characteristics of Lyme disease in Vojvodina in the period from 1993-1998. Throughout this period, 1.659 persons with tick bite were registered, whereas 560 with diagnosed Lyme disease have been treated at the Clinic for Infectious Diseases in Novi Sad. In 511 patients (91.25%) we registered the first stage of the disease, in 42 (7.50%) the second stage and in 7 (1.25%) the third stage of the disease. The mean age of patients with erythema migranes was 38.67 years, mean incubation period was 9.37 days, and tick was removed from the skin after 2.29 days on average. Most of the identified tick bites originated from suburban areas (50.29%), they predominantly occurred in May and June (63.01%), and most of the ticks were removed improperly (57.67%). Dominant clinical manifestations of the second stage were acute meningitis (9.52%), Bannwarth's syndrome (9.52%), arthralgia and arthritis (50%), skin lesions (14.28%), cardiac disorders (11.90%) and mild liver lesions (2.38%) and generalized lymphadenopathy (2.38%). Chronic neuroborreliosis (42.85%), acrodermatitis chronica atrophicans (28.57%) and chronic arthritis were dominant clinical manifestations of the third stage. Up to 81.63% of patients with late stage of disease had a history of previous tick bite. One third of patients were asymptomatic in the first stage of the disease. Improper treatment of the first stage resulted in development of