ISSN:0011-9059    

DOI:10.1111/j.1365-4362.1993.tb02760.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0011-9059    

DOI:10.1111/j.1365-4362.1993.tb02761.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0011-9059    

DOI:10.1111/j.1365-4362.1993.tb02762.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The role of the snake is ambivalent in the Bible. The primeval serpent was instrumental in the exile of Adam and Eve from Eden, but It did not really lie. The fruit of the tree did provide knowledge of good and evil and humankind has been blessed (cursed?) with that knowledge ever since (Gen 3:1–24

ISSN:0011-9059    

DOI:10.1111/j.1365-4362.1993.tb02763.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0011-9059    

DOI:10.1111/j.1365-4362.1993.tb02764.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground. We report our experience with two patients with adult onset of chickenpox in the setting of longstanding steroid therapy for nephrotic syndrome. Ours is a 430‐bed tertiary care teaching hospital. The Wellesley Hospital, Toronto, Ontario. Both patients presented as self‐referrals to the emergency department.Methods. The clinical suspicion of chickenpox was rapidly confirmed in both cases by a Tzanck smear preparation, by viral cultures of the vesicle, serology, and skin biopsy. In both patients therapy with high dose acyclovir, 10 mg/kg q8h, intravenously, was instituted based on clinical presentation.Results. Delay in clinical recognition and treatment in our first case resulted in death due to multiorgan failure (MOF). Improved awareness and rapid treatment of the second patient had a favorable outcome with no sequelae.Conclusions. Chickenpox is not only a childhood illness. Although rare in the adult population, it is associated even in the nonimmunocompromised host with increased morbidity and mortality. Steroid therapy predisposes to early dissemination and a potentially fatal outcome. Adults with immunosuppression should receive prompt systemic treatment with acyclo

ISSN:0011-9059    

DOI:10.1111/j.1365-4362.1993.tb02765.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground. Tinea capitis in children is widely reported, whereas there have been only isolated reports on involvement of sites other than the scalp. The purpose of this study was to examine the epidemiological features and treatment responses of dermatophytosis of children in Kuwait.Methods. Epidemiological features and the treatment responses of 202 consecutive children with dermatophytosis were studied.Results. The 202 children constituted 44% of the total dermatophytic infections seen during a period of 1 year. Tinea capitis was the most commonly encountered infection (78%), followed by tinea corporis, tinea faciei, tinea cruris and manus, respectively.Microsporum caniswas the most prevalent species (96%) in this region. A history of pets at home could be elicited in 52% of the cases. A familial occurrence of similar infections was seen in 56% of the patients. In patients with tinea capitis, addition of topical clotrimazole or ketoconazole to oral griseofulvin produced better therapeutic results compared to griseofulvin alone or in combination with selenium sulfide shampoo.Conclusions. Tinea capitis is the most common dermatophytic infection in children. Thirty percent of the children may have dermatophytosis at sites other than the scalp. A combination of topical clotrimazole or ketoconazole with oral griseofulvin is superior to griseofulvin alone or in combination with selenium sulfide shampoo in the treatment of tinea capitis.

ISSN:0011-9059    

DOI:10.1111/j.1365-4362.1993.tb02766.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground. Leishmaniasis recidiva cutis (LRC) consists of active lesions around or inside the scar of classical cutaneous leishmaniasis (CL). In the literature it is considered as an hyperergic form of CL because the patients show a strong response to intradermal testing with leishmania antigen and, histologically, the parasites are scarce or absent; a well‐organized granuloma is always observed.Methods. Three patients from Bahia (Brazil) with LRC were evaluated by clinical examination, biopsies, skin tests with leishmania antigen, serology, and culture. In addition, a specific lymphocyte blastogenesis test was done and the species of leishmania characterized.Results. The disease was caused by bothL. amazonensis and L braziliensisand serological titers varied from 1/16 to 1/64. The patients presented histologic and immunologic aspects different from those referred to in the literature. From four biopsies obtained only two presented a granulomatous reaction and parasites varied from absent to a parasite index 3. In one patient an absence of T cell response to leishmania antigen was observed in the first evaluation with restoration of the response after cure. In the other two, the degree of the specific proliferative response was lower than that usually observed in patients with classical CL.Conclusions. These findings indicate that New World LRC can not be considered a hyperergic form of CL. With respect to its clinical aspects and response to treatment, LRC must be considered as an entity different from the classical C

ISSN:0011-9059    

DOI:10.1111/j.1365-4362.1993.tb02767.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

AbstractBackground. Epidermodysplasia verruciformis (EV) is a rare cutaneous disorder characterised by persistent, refractory infection with human papillomaviruses (HPV). Although EV does not seem to have racial or geographic preference, there is a scarcity of reports on its occurrence in Africans.Methods. Twenty Africans with EV were studied, and the literature on this condition in Africans was reviewed. Virologic studies were performed on 10 patients.Results. Three types of lesions were observed: flat warts, pityriasis versicolor‐like macules, and seborrheic keratosis‐like changes. Malignant transformation occurred in only one patient, HPV–3 was isolated only from flat warts, HPV–5 and HPV–17 were isolated only from pv‐like lesions, whereas an Hpv–5‐related type was found in all three types of changes, HPV–5‐related type revealed DNA that was related but not identical to any of the viruses in the HPV–5 group. This particular type was isolated from all five South African patients with EV in whom virologic studies were performed.Conclusions. The benign nature of EV in dark‐skinned Africans has been confirmed. Four HPV types have been isolated, of which HPV‐related type was found in all South African patients with EV and in all types of skin changes, regardless of their morphology. African patients with EV frequently present seborrhe

ISSN:0011-9059    

DOI:10.1111/j.1365-4362.1993.tb02768.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

A 34‐year‐old white man was admitted to the hospital for treatment of cyclosporine toxicity. He was referred to the dermatology service for the evaluation of two lesions that had been present for 4 weeks on the dorsum of his left hand. The patient stated that he had cut his hand on a fence and later cleaned his aquarium two weeks before the skin lesions appeared. The past medical history was significant for a cadaveric renal transplant in 1984 for renal agenesis of the left kidney and obstructive nephropathy of the right kid‐ney. His oral medications included methylprednisolone, dil‐tiazem, ranitidine, cyclosporine, and ketoconazole. The recent addition of ketoconazole for oral thrush was felt to have caused the cyclosporine toxicity.The patient was cushingoid in appearance with promi‐nent generalized hypertrichosis. The vital signs and the chest examination were normal. Skin examination revealed a 6‐mm tense vesicle with surrounding erythema with an adjacent 5‐mm firm linear papule (Fig. 1). There was no lymphadenopathy. Both lesions were biopsied, hemisec‐tioned, and sent for routine light microscopy and for fungal, atypical mycobacterial, and bacterial cultures.Laboratory studies were significant for a blood urea ni‐trogen of 56 mg/dL, creatinine of 2.6 mg/dL, WBC of 13,100/mm13, and a cyclosporine level of 2333 ng/mL (thera‐peutic level 100–300 ng/mL). X‐ray of the left hand showed no abnormality. Chest x‐ray and computerized axial tomog‐raphy scan revealed a widened superior mediastinum sec‐ondary to mediastinal lipomatosis. Tissue cultures grew Nocardia asteroides. Bacterial and mycobacterial cultures, including atypical mycobacteria, were negative.The biopsy showed a mixed cellular infiltrate with scat‐tered multinucleated giant cells and focal microabscesses. Brown and Brenn stain showed gram‐positive filamentous organisms.A modified Fite stain (Fig. 2) demonstrated acid‐fast filamentous organisms. The patient was diagnosed as having primary cutaneous nocardiosis with no evidence of dissemination. He was treated with trimethoprim sulfamethoxazole (TMP/SMX), one tablet orally four times daily, with resolution of the skin lesions within 3 weeks, but the patient developed neurolog‐ic toxicity and elevation of his serum creatinine with this therapy. He was unable to tolerate a lower dose of TMP/SMX and the medication was changed to sulfisoxazole 500 mg orally four times daily, with plans to continue the treatment for 12 months.There has been no recurre

ISSN:0011-9059    

DOI:10.1111/j.1365-4362.1993.tb02769.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY