Primary cutaneous aspergillosis near central venous catheters in patients with the acquired immunodeficiency syndrome

Hunt, Steven J.

doi:10.1001/archderm.128.9.1229

Cited by 28 publications

(34 citation statements)

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“…11 Some of the defects in SLOS have been postulated to result from the dysfunction of the cholesterol-modi®ed hedgehog proteins. 14,15 Similar effects on hedgehog signaling may occur in patients with XCDP2 and could be useful in explaining developmental defects in these patients.…”

Section: Discussionmentioning

confidence: 90%

“…1±13 Skin involvement can be classi®ed either as (i) primary, following direct inoculation of Aspergillus organisms at sites of skin injury (e.g. intravenous catheter sites, traumatic inoculation, occlusive dressings, burns, or surgery), 1,8,9,12,14 or (ii) secondary, from hematogenous spread, most commonly following a pulmonary portal of entry, 10 or from contiguous extension from a neighboring cavity such as the maxillary sinus. 11,15 The most frequent causative organism is Aspergillus¯avus, but A. fumigatus, A. niger, A. terreus, A. nidulans, A. glaucus, and A. ustus have also been reported.…”

Section: Discussionmentioning

confidence: 99%

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Cholesterol metabolsim defect associated with Conradi–Hunerman–Happle syndrome

2000

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We present a 6-week-old black girl with Conradi-Hunerman-Happle syndrome (CHS). The mother had no past medical history of illness, and the pregnancy progressed normally to a spontaneous vaginal delivery at 36 weeks. There was no known significant family history. A diagnosis of chondrodysplasia punctata was made at birth from physical examination and X-ray findings. On physical examination at 6 weeks, a koala face, a saddle nose, and a right-sided cataract were noted (Fig. 1a,b). There was unilateral left-sided ichthyosis well demarcated at the midline, with whorled brown fine scale following Blashko's lines on the patient's right side. Orthopedic complications were bilateral but were more pronounced on the left side. There was bilateral shortening of the humerus, with polydactyly of the right hand, arachnodactyly of the left fingers, bilateral clubbing, and mild contractures of the feet. X-Rays showed multiple calcifications along the spine, proximal and distal femoral epiphysis, and proximal humeral epiphysis (Fig. 2). The patient was treated with emollients (aquaphor) twice daily with continuing improvement in ichthyosis. The clubbed feet were treated with splinting and the polydactyly was corrected by surgery. Ophthalmology was to follow the patient for her right-sided cataract. At the patient's 4-month follow-up, the ichthyosis showed a marked improvement with some residual hypo- pigmented atrophoderma noted. The distribution remained unchanged. Biopsies taken of ichthyotic lesions showed compact hyperkeratosis and follicular plugging. Vesicles within the stratum corneum contained amorphous material (Fig. 3a,b). The granular cell layer was thickened with retained oval nuclei. The epidermal and adnexal epithelium were disorganized. Increased apoptotic/dyskeratotic keratinocytes were seen within the epidermis, but were most evident within the follicular epithelium. Ultrastructural studies showed saccular dilations of the acellular space within the stratum corneum. These acellular spaces were filled with unprocessed lamellated pleated sheets and vesicle complexes and processed lamellae. Dyskeratotic cells were seen within the stratum spinosum. Red blood cell (RBC) plasmalogen levels and polyunsaturated fatty acids (PUFA), including decosahexaenoic acid (DHA), were within normal limits. Plasma very long chain fatty acids (VLCFA), including C26 : 0/C22 : 0 ratios, phytanic and pristanic acids, plasmalogen, and phytanic/pristanic ratios, trihydroxycholestanic acid (THCA) and dihydroxycholestanoic acid (DHCA) including their ratios, THCA/cholic acid and DHCA/chenodeoxycholic acid, and PUFAs including DHA were within normal limits. Urine organic acids and piecolic acid were within normal limits. Despite these normal values, there was an increase in cholest-8(9)-en-3beta-ol of 6.8 microg/mL (normal, 0.01-0.10 microg/mL) and an increase in 8-dehydrocholesterol (5.1 microg/mL) (normal, <0.10 microg/mL).

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Cholesterol metabolsim defect associated with Conradi–Hunerman–Happle syndrome

2000

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“…62,63 Adhesives may also promote overgrowth of yeasts and saprophytic fungi. 64,65 Therefore, any site exposed to adhesive materials should VOLUME 5 | NUMBER 6 | NOVEMBER/DECEMBER 2013 be monitored for evidence of localized or systemic infection. Signs and symptoms of localized bacterial infection include increased pain, edema, erythema, warmth, or suppuration (eg, presence of pustules, folliculitis, or furunculosis).…”

Section: Infection Preventionmentioning

confidence: 99%

“…66Y70 For example, one study demonstrated that 59 of 80 tape specimens (74%) collected at various clinical areas in one hospital were found to be colonized by pathogenic bacteria. 65 More recently, Harris and colleagues 70 documented that 11 of 21 samples (52%) of partially used surgical adhesive tapes collected from several clinical areas of three hospitals in Australia were contaminated with multiresistant organisms (methicillin-resistant Staphylococcus aureus and/or vancomycin-resistant enterococci). 70 These reports represent case studies or investigations with small sample sizes where only rates of colonization were determined.…”

Section: Infection Preventionmentioning

confidence: 99%

Medical Adhesives and Patient Safety

McNichol

Lund

Rosén

et al. 2013

Journal of the Dermatology Nurses' Association

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Skin injury related to medical adhesive usage is a prevalent but underrecognized complication that occurs across all care settings and among all age groups. If proper technique for application and/or removal of adhesive products is not used, tissue trauma can occur, impacting patient safety and quality of life and increasing healthcare costs. Little guidance exists in the literature regarding appropriate selection and proper use of adhesive products to minimize medical adhesiveYrelated skin injury, as well as best practices for skin care preventive strategies, application and removal techniques, and assessment and treatment of such injuries. In an effort to define best practices for prevention of such injury, a consensus panel of 23 recognized key opinion leaders convened to establish consensus statements on the assessment, prevention, and treatment of medical adhesiveYrelated skin injury. The consensus summit was held in December 2012 and was made possible by an unrestricted educational grant from 3M. This document details the consensus definitions and statements and identifies research priorities for development of new adhesive technologies and protocols for skin protection.

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“…causing PCA include A. fumigatus , A. niger , A. flavus , A. terreus and A. ustus. 6,7 Cutaneous aspergillosis can result from haematogenous dissemination or by extension to skin from a contiguous anatomic site or following trauma. Contributing factors include trauma from arm boards, burns, peripheral and central venous catheters, use of contaminated dressing materials and aerosolization of fungi during building renovations.…”

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confidence: 99%