Cases reported "Skin Diseases, Infectious"

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1/28. Use of differential reinforcement to treat medical non-compliance in a paediatric patient with leukocyte adhesion deficiency.

    Leukocyte Adhesion Deficiency (LAD) is a rare immuno-deficiency disorder which results in chronic infections, such as gingivitis, necrotic skin infections and gastrointestinal ulcers. This case describes an 18-year-old male who was non-compliant during an inpatient hospitalization with several aspects of his complex medical regimen, particularly his wound care, physical therapy and use of his crutches. The patient's dressing change protocol was task analysed in order to create a structured, predictable routine by having the subject complete small, discrete steps. A differential reinforcement programme was implemented to provide the patient with tangible reinforcement for general compliance with his treatment, including compliance with dressing changes and physical therapy. Over a 1-month period, the subject's overall compliance with his medical regimen achieved an average of approximately 87%. His compliance with physical therapy and dressing changes both improved to 87 and 80%, respectively, by the end of his hospitalization. During the last week of his hospitalization, the use of his crutches was task analysed and included in his reinforcement programme using a changing criterion design. His average use of his crutches also improved to 80%.
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ranking = 1
keywords = complex
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2/28. Diagnostic odyssey of a cutaneous mycobacteriosis rare in central europe.

    Cutaneous infection with mycobacterium chelonae is an uncommon disease, although this atypical mycobacterium is an acid-fast bacillus ubiquitous in the environment. It is often misdiagnosed and treated as a fungal or common bacterial infection. We report a case of disseminated atypical mycobacterial skin infection of a 72-year-old woman who was treated with different topical and systemic antimycotic and antibiotic drugs over a period of 5 months without remarkable improvement. Eventually, repeated tissue cultures on special medium and performance of PCR led to the diagnosis of M. chelonae infection. The patient was treated successfully with oral clarithromycin within 8 weeks. In case of abscessing cutaneous infection, M. chelonae should be considered in the differential diagnosis of prolonged disease when common antibiotics are not effective after 2-4 weeks of treatment.
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ranking = 59724.012132976
keywords = mycobacterium, bacillus
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3/28. Systemic nocardiosis following allogeneic bone marrow transplantation.

    Five cases of systemic nocardia infection were diagnosed among 301 allogeneic bone marrow transplant recipients. A sixth case included in this report received her transplant at another institution. The cumulative annual incidence rate of this infection was 1.75%. All patients had been treated previously for acute graft-versus-host disease (GVHD). At the time of diagnosis of systemic nocardia infection, a median of 198 (range 148-1121) days after transplantation, all patients had extensive chronic GVHD and were taking 2 to 3 immunosuppressive medications. Prior to diagnosis of nocardia infection patients had experienced multiple opportunistic infections, including infections with Mycobacterium avium-intracellulare, pneumocystis carinii, and cytomegalovirus antigenemia. Treatment with trimethoprim-sulfamethoxazole (TMP-SMX), ceftriaxone, or carbapenem antibiotics resulted in a median survival of 219 days from the time of diagnosis and an actuarial 1-year survival of 40%. All patients who received more than 2 weeks of therapy were cured of their infections. Notably, 5/6 patients in this cohort were unable to take TMP-SMX because of myelosuppression. In comparison with randomly selected control patients, the use of pentamidine for prevention of P. carinii infection was associated with a marginal increase in the risk of nocardia infection. We postulate that the use of TMP-SMX may be of benefit in the prophylaxis of infections other than P. carinii in patients with chronic GVHD.
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ranking = 43166.905967528
keywords = avium-intracellulare
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4/28. Lepromatous leprosy in a heart transplant recipient.

    Northern louisiana is not an area for indigenous cases of leprosy. Limited data are available on the occurrence of leprosy in organ transplant recipients. No cases have been reported in heart transplant recipients. Mr J.R. is a 68-year-old man from Shreveport, louisiana. He underwent orthotopic heart transplantation in March 1996. He presented in March 2000 with a maculopapular skin rash and intermittent hand swelling for 5 months. He also complained of intermittent burning of his feet for a year. The skin lesions were of two types - a fine red migratory, intermittent maculopapular rash over the upper torso and a raised, larger, violaceaous lesion on his hands. Neurological examination revealed complete loss of protective sensation in the right foot by filamentous test and some loss in the left foot. Punch skin biopsies from his right arm and right chest lesion revealed abundant acid-fast bacilli (AFB). Histopathologic examination revealed perivascular, interstitial and perineural granulomatous inflammation and a large number of AFB organisms within histiocytes. culture of the skin biopsy specimen was negative for mycobacterium tuberculosis or atypical mycobacterium. polymerase chain reaction (PCR) performed for mycobacterium leprae was positive. The patient was treated with a modified regimen consisting of dapsone 100 mg qd, ethionamide 250 mg qd, and minocycline 100 mg qd. His skin rash and neurological symptoms have resolved.
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ranking = 59659.560635257
keywords = mycobacterium
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5/28. Lichenoid and granulomatous dermatitis associated with atypical mycobacterium infections.

    BACKGROUND: Lichenoid and granulomatous dermatitis defines a distinctive pattern of cutaneous inflammation that may be part of the morphologic spectrum of idiopathic lichenoid reactions such as lichen planus and as well may be seen with lichenoid drug reactions, endogenous T-cell dyscrasias and as a feature of certain systemic diseases especially Crohn's disease and rheumatoid arthritis. RESULTS: We encountered three cases of lichenoid and granulomatous dermatitis in which the basis was one of primary cutaneous Mycobacterium infection. In all three cases acid fast stains revealed pathogenic organisms and as well cultures were positive for mycobacterium kansasii in one case and mycobacterium marinum in another. Other features included a prominent perineural and periadnexal lymphocytic infiltrate. CONCLUSIONS: The differential diagnosis of lichenoid and granulomatous dermatitis should also encompass primary cutaneous Mycobacterium infection in addition to the other more characteristic entities associated wtih this distinctive reaction pattern. Infection with Mycobacterium induces a TH1 dominant response which would hence produce an infiltrate.
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ranking = 238638.24254103
keywords = mycobacterium
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6/28. rosacea-like lesions due to familial mycobacterium avium-intracellulare infection.

    Mycobacterium avium-intracellulare (MAI) is a non-tuberculous, nonlepromatous or "atypical" mycobacterium now seen frequently in patients with acquired immunodeficiency syndrome (AIDS). In the past decade, the incidence appears to have increased in non-AIDS patients. Although cutaneous involvement is rare, two brothers without detectable immune defects who both presented with cutaneous MAI infection are described; the older brother also has disseminated disease. The cutaneous presentation of MAI, as well as immune and genetic defects that may predispose to mycobacterial infection, are discussed.
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ranking = 275494.0904729
keywords = mycobacterium, avium-intracellulare
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7/28. Non-cultivable mycobacteria in ulcers of the skin.

    In biopsies of 54 patients suffering from chronic dermatological lesions (mostly ulcers of the skin) acid-fast bacilli were found in 14. In these 14 cases in 4 were lesions caused by M. tuberculosis, in 1 the lesion was caused by M. avium-intracellulare, in 1 the lesion was caused by M. fortuitum and in 2 the lesions were caused by non-cultivable mycobacteria (Feldmann-Hershfield ulcer?). In 2 cases the cultures were heavily contaminated, and the diagnosis remained uncertain. In the remaining 4 cases the mycobacteria were considered occasional isolates without clinical significance.
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ranking = 43166.905967528
keywords = avium-intracellulare
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8/28. Primary cutaneous bacillus cereus infection in neutropenic children.

    A review of culture reports for a five-year period at St Jude Children's research Hospital yielded 10 cases of primary cutaneous bacillus cereus infection in neutropenic patients treated for cancer or aplastic anaemia. Vesicles or pustules were seen only on the limbs. The infections, all of which arose in the spring or summer, responded to antibiotics. In neutropenic patients B cereus should thus be regarded as a possible cause of isolated vesicles.
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ranking = 257.80599087483
keywords = bacillus
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9/28. Sepik granuloma.

    An unusual infection occuring in the East Sepik Province of papua new guinea is reported. The patients come from villages on the Sepik River or its tributaries. The lesions consist of cutaneous nodules and papillomas which are slowly progressive. An unidentified organism, apparently a gram positive bacillus, is seen in large numbers in the lesions; a natural habitat in soil or water or on vegetation seems likely.
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ranking = 64.451497718707
keywords = bacillus
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10/28. A papular eruption associated with human T cell lymphotropic virus type III disease.

    The clinical spectrum of human T cell lymphotropic virus type III (HTLV-III) disease is associated with myriad cutaneous findings, commonly of infectious origin. A clinically characteristic, yet histologically nonspecific, papular eruption was observed in seven of thirty-five patients followed up for HTLV-III disease (acquired immunodeficiency syndrome and the related complex). Noncoalescing 2- to 5-mm skin-colored papules of the head, neck, and upper trunk typify the lesions. Histologically, a chronic perivascular infiltrate of mononuclear cells was regularly present. The eruption was often, but not always, pruritic. The clinical course was chronic. Many patients had persistent lesions for more than 9 months; however, the number of papules tended to wax and wane with time. Although the cause of this eruption is unknown, it is sufficiently distinct and frequent to be recognized by clinicians as a cutaneous sign of human retrovirus infection.
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ranking = 1
keywords = complex
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