Search

Copyright of Journal der Deutschen Dermatologischen Gesellschaft is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Onychomycosis is a fungal infection of the fingernails and toenails. In Europe, tinea unguium is mainly caused by dermatophytes. The diagnostic workup comprises microscopic examination, culture and/or molecular testing (nail scrapings). Local treatment with antifungal nail polish is recommended for mild or moderate nail infections. In case of moderate to severe onychomycosis, oral treatment is recommended (in the absence of contraindications). Treatment should consist of topical and systemic agents. The aim of this update of the German S1 guideline is to simplify the selection and implementation of appropriate diagnostics and treatment. The guideline was based on current international guidelines and the results of a literature review conducted by the experts of the guideline committee. This multidisciplinary committee consisted of representatives from the German Society of Dermatology (DDG), the German‐Speaking Mycological Society (DMykG), the Association of German Dermatologists (BVDD), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ), the Working Group for Pediatric Dermatology (APD) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence‐based Medicine (dEBM) provided methodological assistance. The guideline was approved by the participating medical societies following a comprehensive internal and external review. [ABSTRACT FROM AUTHOR]

Background: The T indotineae population shows a high amount of terbinafine resistant isolates based on different point mutations of squalene epoxidase erg1 (ergosterol) gene. A significant proportion of these isolates also show azole resistance. Objectives: Elucidation of the molecular mechanism for azole resistance, especially the identification of mutations in the sterol 14‐α demethylase Erg11 genes, which encode for enzymes interacting with azoles. Methods: Sequencing of putative Erg11 genes and analysis of phenotypic resistance pattern using a microplate‐laser‐nephelometry‐based growth assay. Results: Four different types of Erg11B mutants were detected; two double mutants with Ala230Thr/Asp441Gly, respectively, Ala230/Tyr444His and single mutants with Gly443Glu, Tyr444Cys and Tyr444His. All isolates featured the wild type genotype of Erg11A. All strains demonstrated different combinations of Erg1 and Erg11 genotypes. Conclusion: Resistance against terbinafine and azoles developed several times independently within the T indotineae population. The challenge for fungal treatment is, therefore, that species identification is not enough for prediction of therapeutic efficacy of antifungals. In the future, it will also become important to analyse genes involved in resistance mechanisms. [ABSTRACT FROM AUTHOR]

Copyright of Journal der Deutschen Dermatologischen Gesellschaft is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Background and objective: Dermatophyte infections of the skin and nails are common worldwide and vary between geographical areas and over time. The aim of this study was to determine the epidemiological profile of dermatophytes in Germany with a focus on comparing children with adults. Patients and methods: In this retrospective multicenter study, mycological dermatophyte culture results in the period 01/2014 to 12/2016 were analyzed according to identified pathogen, age and gender of patients, and type of disease. Results: Of 1,136 infections (children: n = 88, adults: n = 1,048), 50.8 % were clinically classified as onychomycosis, followed by tinea pedis (34.6 %), tinea corporis (16.2 %), tinea manus (16.2 %), tinea capitis (2.5 %), and tinea faciei (1.2 %). The most frequent pathogen was Trichophyton (T.) rubrum (78.6 %), followed by T. interdigitale (14.3 %), T. benhamiae (3.2 %), T. mentagrophytes (2.1 %), and Microsporum canis (1.7 %). The fungal spectrum differed particularly in tinea corporis and tinea capitis between children and adults with a more diverse pathogen spectrum in children. Trichophyton tonsurans was rarely identified as cause for tinea corporis (2.7 %) or tinea capitis (3.3 %). Conclusions: Differences in pathogens and frequency of fungal infections between age groups should be considered for optimal selection of the appropriate therapeutic regimen. [ABSTRACT FROM AUTHOR]

In cystic fibrosis (CF) therapy, the recent approval of CF-transmembrane conductance regulator (CFTR) channel modulators is considered to be the major breakthrough. However, the current first-line approach based mainly on pulmonary function to measure effects of the novel therapy, tested by forced expiratory volumes in one second (FEV1), provides restricted sensitivity to detect early structural damages. Accordingly, there is a need for new sensitive surrogate parameters. Most interestingly, these should quantify inflammation that precedes a decline of pulmonary function. We present a novel method assessing inflammatory markers in the upper airways' epithelial lining fluid (ELF) obtained by nasal lavage (NL). In contrast to broncho-alveolar lavage, ELF sampling by NL is an attractive method due to its limited invasiveness which allows repeated analyses, even performed in a home-based setting. In a longitudinal cohort study (ClinicalTrials.gov, Identifier: NCT02311140), we assessed changes of inflammatory mediators in 259 serially obtained nasal lavages taken up to every second day before and during therapy with ivacaftor from ten CF patients carrying a G551D mutation. Patients were trained to sample NL-fluid at home, to immediately freeze and transfer chilled secretions to centers. Neutrophil Elastase, Interleukins IL-1β, IL-6 and IL-8 in NL were quantified. During 8-12 weeks of ivacaftor-treatment, median values of IL-1β and IL-6 significantly declined 2.29-fold (2.97→1.30 pg/mL), and 1.13-fold (6.48→5.72 pg/mL), respectively. In parallel, sweat tests and pulmonary function improved considerably. This is the first study assessing changes of airway inflammation on a day-to-day basis in CF patients receiving a newly administered CFTR-modulator therapy. It proves a decline of airway inflammation during ivacaftor-therapy. [ABSTRACT FROM AUTHOR]

Summary: Background: The Indian ITS genotype VIII Trichophyton mentagrophytes population shows a high amount of different erg1 (ergosterol) mutants encoding for squalene epoxidase, which catalyses the first step of ergosterol biosynthesis. Objectives: Illumination of the implication of point mutations at position Ala448Thr in single and double erg1 T mentagrophytes mutants because mutants of this type were abundantly found within the Indian fungal population. Methods: Growth in fluconazole or terbinafine containing medium was analysed using a microplate‐laser‐nephelometry (MLN)‐based growth assay. Results: Ala 448 Thr erg1 single mutants were terbinafine sensitive, but about 50% of isolates showed an increased fluconazole resistance, whereas 95% of the double mutants (Phe 397 Leu, Ala 448Thr) demonstrated combined terbinafine and increased fluconazole resistance. Conclusion: The new Indian T mentagrophytes populations show several point mutations in erg1. Point mutations at position 397 were previously described and cause terbinafine resistance. A large part of the double mutants exhibit resistance to terbinafine and fluconazole, demonstrating a selective advantage of the combination of both mutations. [ABSTRACT FROM AUTHOR]

Copyright of Der Hautarzt is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: An alarming increase in recalcitrant dermatophytosis has been witnessed in India over the past decade. Drug resistance may play a major role in this scenario. Objectives: The aim of the present study was to determine the prevalence of in vitro resistance to terbinafine, itraconazole and voriconazole in dermatophytes, and to identify underlying mutations in the fungal squalene epoxidase (SQLE) gene. Patients/Methods: We analysed skin samples from 402 patients originating from eight locations in India. Fungi were identified by microbiological and molecular methods, tested for antifungal susceptibility (terbinafine, itraconazole, voriconazole), and investigated for missense mutations in SQLE. Results: Trichophyton (T.) mentagrophytes internal transcribed spacer (ITS) Type VIII was found in 314 (78%) samples. Eighteen (5%) samples harboured species identified up to the T interdigitale/mentagrophytes complex, and T rubrum was detected in 19 (5%) samples. 71% of isolates were resistant to terbinafine. The amino acid substitution Phe397Leu in the squalene epoxidase of resistant T mentagrophytes was highly prevalent (91%). Two novel substitutions in resistant Trichophyton strains, Ser395Pro and Ser443Pro, were discovered. The substitution Ala448Thr was found in terbinafine‐sensitive and terbinafine‐resistant isolates but was associated with increased MICs of itraconazole and voriconazole. Conclusions: The high frequencies of terbinafine resistance in dermatophytes are worrisome and demand monitoring and further research. Squalene epoxidase substitutions between Leu393 and Ser443 could serve as markers of resistance in the future. [ABSTRACT FROM AUTHOR]

Background: Superficial fungal infections are often seen in day‐to‐day clinical practice, and their prevalence continues to rise worldwide. Over the years, a change in the pattern of dermatophytoses has been noted. Objectives: This study aimed to determine the epidemiologic profile of dermatophytes at the Department of Dermatology, University Hospital Jena, from 2007 to 2013. Methods: The retrospective study was carried out with a total of 4556 samples collected from 3607 patients suspected of superficial fungal infections during the 7‐year study period. Results: Among the 3607 suspected patients, 1951 (54.09%) were men and 1656 (45.91%) were women. Of 4556 samples, 703 (15.43%) samples were positive for fungal culture, which included 585 (83.21%) dermatophytes and 118 (16.79%) non‐dermatophytes. Trichophyton (T.) rubrum was the most common isolated pathogen in 73.33% of the dermatophyte cases. Among dermatophyte‐infected patients, men were most likely to be affected (63.48%) as well as those of higher age (61 to 80). The most commonly affected areas were nails (33.16%) and feet (33%). T rubrum was recurrently isolated in several regions with exception of the scalp where M canis (58.33%) was the most frequently isolated pathogen. About 16.04% of cases had a history of treatment taken prior to sampling. The majority of the affected individuals did not have any prior animal contact (77.26%). T benhamiae was exclusively associated with contact to guinea pigs. Conclusion: Trichophyton rubrum was the most frequently isolated pathogen in several regions except the scalp. New dermatophyte species emerged with time especially T benhamiae. [ABSTRACT FROM AUTHOR]

Exceedingly virulent pathogens and growing antimicrobial resistances require new therapeutic approaches. The zoophilic dermatophyte Trichophyton benhamiae causes highly inflammatory, cutaneous fungal infections. Recently, it could be shown that the plant-derived alkaloid tryptanthrin (TRP) exhibits strong anti-microbial activities against yeasts and dermatophytes. The aim of this study was to analyse the bioactivity of TRP under infectious conditions using an in-vitro dermatophytosis model employing fibroblasts and keratinocytes infected with T. benhamiae DSM6916. Analyses comprised determination of cell viability, effects on the innate immune response including expression and secretion of pro-inflammatory cytokines/chemokines as well as expression of various antimicrobial peptides (AMP), toll-like receptor (TLR) 2 and proliferation marker MKI67. T. benhamiae caused severe inflammation in the cutaneous cell models. TRP almost fully prevented T. benhamiae-derived damage of dermal fibroblasts and substantially reduced it in epidermal keratinocytes. A distinct down-regulation of the expression and secretion of pro-inflammatory cytokines was observed. Further, TRP promoted AMP expression, especially of HBD2 and HBD3, in keratinocytes even without fungal presence. This study provides crucial evidence that TRP is not only a strong antifungal agent but also potentially modulates the innate immune response. This makes it interesting as a natural antimycotic drug for adjuvant treatment and prevention of fungal re-infection. [ABSTRACT FROM AUTHOR]

Copyright of Journal der Deutschen Dermatologischen Gesellschaft is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Summary: Tinea capitis describes a dermatophyte infection of scalp and hair that predominately occurs in children. The diagnostic workup includes microscopic examination, culture and/or molecular tests. Treatment is guided by the specific organism involved and should consist of systemic agents as well as adjuvant topical treatment. The aim of the present update of the interdisciplinary German S1 guidelines is to provide dermatologists, pediatricians and general practitioners with a decision tool for selecting and implementing appropriate diagnostic and therapeutic measures in patients with tinea capitis. The guidelines were developed based on current international guidelines, in particular the 2010 European Society for Pediatric Dermatology guidelines and the 2014 British Association of Dermatologists guidelines, as well as on a review of the literature conducted by the guideline committee. This multidisciplinary committee consists of representatives from the German Society of Dermatology (DDG), the German‐Speaking Mycological Society (DMykG), the German Society for Hygiene and Microbiology (DGHM), the German Society of Pediatric and Adolescent Medicine (DGKJ) and the German Society for Pediatric Infectious Diseases (DGPI). The Division of Evidence‐based Medicine (dEBM) provided methodological assistance. The guidelines were approved by the participating medical societies following a comprehensive internal and external review. [ABSTRACT FROM AUTHOR]

• In acutely ill antipsychotic-free schizophrenia patients: increase of TH2 system cytokine IL-13 (p = 0.039). • Decrease of TH1 system markers sICAM-1 (p = 0.011) and sIL-2R (p = 0.063). • Effect of sIL-2R decrease greater in the FEP subgroup (p = 0.01). • Increase of pro-inflammatory IL-6 not significant (p = 0.052). No group differences in: IL-4, IL-8, TNF-alpha, and IFN-gamma. • Findings support the notion of a TH1/TH2 imbalance particularly in the acute manifestation phase of schizophrenia. There is major evidence for the involvement of immunological processes in the pathophysiology of schizophrenia. Especially alterations of T-cell function and activation of the inflammatory response system appear to be linked to schizophrenia. A mild chronic inflammation process has been proposed and repeated findings of altered serum cytokine levels led to the hypothesis of a TH2 shift or cytokine imbalance in schizophrenia. We investigated serum levels of TH1 and TH2 related cytokines and immune markers in 25 patients suffering an acute schizophrenic episode (all unmedicated, 22 neuroleptica-naïve) at different stages of disorder (18 first episode, FEP; 7 recurrent episode, REP) compared to 25 age and sex matched healthy controls. In patients, we found an increase of the TH2 system cytokine IL-13 (p = 0.039) and a decrease of the TH1 system markers sICAM-1 (p = 0.011) and sIL-2R (p = 0.063, n. s.). Elevation of the pro-inflammatory cytokine IL-6 was not significant (p = 0.052). The effect of sIL-2R decrease was greater in the FEP subgroup (p = 0.01) of patients. We found no group differences in the other investigated immune markers: IL-4, IL-8, TNF-alpha, and Interferon-gamma, in which most readings were below the lower detection limit of the respective assay. Our findings support the notion of a TH1/TH2 imbalance particularly in the acute manifestation phase of schizophrenia. In the long run, this may lead to the identification of cytokine patterns that are applicable as trait or state markers, may be helpful in making or ensuring diagnosis or in monitoring therapy. [ABSTRACT FROM AUTHOR]

Summary: The disease burden of chronic‐relapsing and therapy‐refractory superficial dermatophytosis dramatically increased in India within the past 5‐6 years. In order to evaluate the prevalence of this trend, 201 skin scrapings were collected from patients from all parts of India and were tested for dermatophytes using both fungal culture and a PCR‐ELISA directly performed with native skin scrapings. Fungal culture material was identified by genomic Sanger sequencing of the internal transcribed spacer (ITS) region and the translation elongation factor (TEF)‐1α gene. In total, 149 (74.13%) out of the 201 samples showed a dermatophyte‐positive culture result. Out of this, 138 (92.62%) samples were identified as Trichophyton (T.) mentagrophytes and 11 (7.38%) as Trichophyton rubrum. The PCR‐ELISA revealed similar results: 162 out of 201 (80.56%) samples were dermatophyte‐positive showing 151 (93.21%) T mentagrophytes‐ and 11 (6.79%) T rubrum‐positive samples. In this study, we show for the first time a dramatic Indian‐wide switch from T rubrum to T mentagrophytes. Additionally, sequencing revealed a solely occurring T mentagrophytes "Indian ITS genotype" that might be disseminated Indian‐wide due to the widespread abuse of topical clobetasol and other steroid molecules mixed with antifungal and antibacterial agents. [ABSTRACT FROM AUTHOR]

Background: Application of controlled in vitro techniques can be used as a screening tool for the development of new hemostatic agents allowing quantitative assessment of overall hemostatic potential. Materials and methods: Several tests were selected to evaluate the efficacy of cotton gauze, collagen, and oxidized regenerated cellulose for enhancing blood clotting, coagulation, and platelet activation. Results: Visual inspection of dressings after blood contact proved the formation of blood clots. Scanning electron microscopy demonstrated the adsorption of blood cells and plasma proteins. Significantly enhanced blood clot formation was observed for collagen together with β-thromboglobulin increase and platelet count reduction. Oxidized regenerated cellulose demonstrated slower clotting rates not yielding any thrombin generation; yet, led to significantly increased thrombin-anti-thrombin-III complex levels compared to the other dressings. As hemostyptica ought to function without triggering any adverse events, induction of hemolysis, instigation of inflammatory reactions, and initiation of the innate complement system were also tested. Here, cotton gauze provoked high PMN elastase and elevated SC5b-9 concentrations. Conclusions: A range of tests for desired and undesired effects of materials need to be combined to gain some degree of predictability of the in vivo situation. Collagen-based dressings demonstrated the highest hemostyptic properties with lowest adverse reactions whereas gauze did not induce high coagulation activation but rather activated leukocytes and complement. [ABSTRACT FROM AUTHOR]

Candida-related infections have become a major problem in hospitals. The species identification of yeast is the prerequisite for the initiation of adequate antifungal therapy. In the present study, the connection between inherent UV resonance Raman (RR) spectral profiles of Candida species and taxonomic differences was investigated for the first time. UV RR in combination with statistical modeling was applied to extract taxonomic information from the spectral fingerprints for subsequent differentiation. The identification accuracies of independent batch cultures were determined by applying a leave-one-batch-out cross validation. The quality of differentiation can be divided into three levels. Within a defined taxonomic group comprising the species C. glabrata, C. guilliermondii, and C. haemulonii, the identification accuracy was low. On the next level, the identification results of C. albicans and C. tropicalis were characterized by high sensitivities of 98 and 95% but simultaneously challenged by false-positive predictions due to the misallocation of C. spherica (as C. albicans) and C. viswanathii (as C. tropicalis). The highest level of identification accuracies was reached for the species C. dubliniensis, C. krusei, C. africana, C. novergica, and C. parapsilosis. Reliable identification results were observed with accuracies ranging from 93 up to 100%. The species allocation based on the UV RR spectral profiles could be reproduced by the identification of independent batch cultures. We conclude that the introduced spectroscopic approach is capable of transforming the high-dimensional UV RR data of Candida species into clinically useful decision parameters.Graphical abstract [ABSTRACT FROM AUTHOR]

Biocompatibility of six different compression stockings and cytotoxic effects were determined using HaCaT keratinocytes, L929 mouse fibroblasts, primary adult and juvenile keratinocytes Cells were quantified using a luminometric ATP assay and the photometric BCA test. Cytotoxic effects were determined by LDH release. An area-based extraction ratio of 1.25 cm2:mL could be shown to be superior to the weight-based extraction of test material. Extraction medium should be an acidic sweat solution as this helps to recreate in vivo conditions. Monolayer cultures of HaCaT keratinocytes or L929 mouse fibroblasts should be used for testing. Primary adult keratinocytes or primary juvenile keratinocytes can also be used. For the latter, testing under DMEM with FCS is recommended to achieve comparable results. It was found that the compression stockings tested exhibited no negative influence on cell viability in vitro and no direct cytotoxic effects measured as release of LDH. Hence, good biocompatibility could be asserted. [ABSTRACT FROM AUTHOR]

Bactericidal materials gained interest in the health care sector as they are capable of preventing material surfaces from microbial colonization and subsequent spread of infections. However, commercialization of antimicrobial materials requires proof of their efficacy, which is usually done using in vitro methods. The ISO 22196 standard (Japanese test method JIS Z 2801) is a method for measuring the antibacterial activity of daily goods. As it was found reliable for testing the biocidal activity of antimicrobially active materials and surface coatings most of the laboratories participating in this study used this protocol. Therefore, a round robin test for evaluating antimicrobially active biomaterials had to be established. To our knowledge, this is the first report on inaugurating a round robin test for the ISO 22196 / JIS Z 2801. The first round of testing showed that analyses in the different laboratories yielded different results, especially for materials with intermediate antibacterial effects distinctly different efficacies were noted. Scrutinizing the protocols used by the different participants and identifying the factors influencing the test outcomes the approach was unified. Four critical factors influencing the outcome of antibacterial testing were identified in a series of experiments: (1) incubation time, (2) bacteria starting concentration, (3) physiological state of bacteria (stationary or exponential phase of growth), and (4) nutrient concentration. To our knowledge, this is the first time these parameters have been analyzed for their effect on the outcome of testing according to ISO 22196 / JIS Z 2801. In conclusion, to enable assessment of the results obtained it is necessary to evaluate these single parameters in the test protocol carefully. Furthermore, uniform and robust definitions of the terms antibacterial efficacy / activity, bacteriostatic effects, and bactericidal action need to be agreed upon to simplify communication of results and also regulate expectations regarding antimicrobial tests, outcomes, and materials. [ABSTRACT FROM AUTHOR]

Summary: Deep trichophytosis is relatively uncommon. The infection of the bearded area is also known as sycosis barbae or tinea barbae and can be caused by various fungal species, most often zoophilic fungi. We report on an 80‐year‐old male patient with severe sycosis barbae who had no animal contact and was treated with systemic antibiosis without improvement. Microbial and mycological investigations using swabs from oozing lesions revealed Staphylococcus haemolyticus and Candida parapsilosis. Histology demonstrated fungal elements in hair follicles. Paraffin‐embedded material was subjected to further mycological analysis. For molecular diagnostics DNA was prepared from paraffin sections for real‐time polymerase chain reaction (RT‐PCR). For sequencing, DNA was isolated from paraffin‐embedded skin tissue and the ITS region of the rDNA was selected. Sequencing of the ITS2 region of rRNA revealed a 100% accordance with Trichophyton (T.) verrucosum. Treatment with oral terbinafine achieved a complete remission. Sycosis barbae is an important differential diagnosis for infections of the bearded area. Nucleic acid amplification techniques (NAAT) are more and more used for direct examination of dermatophytes in clinical samples, eg T. verrucosum. NAAT are also used as culture confirmation tests for identification of rare dermatophytes like T. verrucosum. Today, singleplex and multiplex quantitative real‐time PCR (qRT‐PCR) assays for the detection of the most common dermatophytes including T. verrucosum in clinical specimens are available. Recently, an ITS2 PCR assay has been successfully used for direct detection of T. verrucosum in paraffin‐embedded formalin‐fixed skin tissue. The PCR is fast and highly specific. The sensitivity of direct molecular detection of the dermatophytes both in native clinical material, and in paraffin‐embedded skin tissue can been increased. [ABSTRACT FROM AUTHOR]

Senescent cells contribute to tissue aging and dysfunction. Therefore, detecting senescent cells in skin is of interest for skin tumor diagnostics and therapy. Here, we studied the transition into senescence of human dermal fibroblasts (HDFs) in a three-dimensional (3D) human fibroblast-derived matrix (FDM). Senescent and proliferating cells were imaged by Raman spectroscopy (RS) and Fourier transform infrared (FTIR) spectroscopy. The obtained averaged spectra were analyzed using PLS-LDA. For these 3D cultured cells, RS and FTIR could clearly distinguish senescent from proliferating cells. For both techniques, we detected senescence-associated alterations in almost all cellular macromolecules. Furthermore, we identified different biochemical properties of 3D compared to two-dimensional (2D) cultured cells, indicating that cells in their natural, skin-like 3D environment act differently than in (2D) cell cultivations in vitro. Compared to 2D cultured cells, cells grown in 3D models displayed a sharper contrast between the proliferating and senescent state, also affecting the abundance of biomolecules including nucleic acids. The training accuracies of both vibrational spectroscopic techniques were ＞96%, demonstrating the suitability of these label-free measurements for detecting these cellular states in 3D skin models. [ABSTRACT FROM AUTHOR]

Tinea capitis is a dermatophyte infection common among prepubertal children in sub-Saharan Africa and mainly caused by Trichophyton and Microsporum species. Accurate identification is challenging as conventional methods like culture and microscopy are slow andmostly based on morphological characteristics, whichmake them less sensitive and specific. Modern molecular methods, like polymerase chain reaction (PCR) assays, are gaining acceptance and are quick as well as accurate. The aim of this study was to investigate the clinical patterns of tinea capitis and to accurately identify themost common causative dermatophytes affecting the scalps of children aged 1 to 16 years attending the Skin Clinic at Mbarara University of Science and Technology (MUST), Mbarara, Uganda, East Africa, using both conventional mycological methods and PCR-ELISA for detection of dermatophyte DNA. One hundred fifteen clinical samples from children from Western Uganda attending the MUST Skin Clinic with a clinical diagnosis of tinea capitis were analyzed. T. violaceum was identified as the most common causative agent, followed by M. audouinii, T. soudanense, and T. rubrum. The early identification of the causative agent of tinea capitis is a prerequisite for the effective management of the disease, the identification of probable source and the prevention of spreading. Children with tinea capitis in Western Uganda should be treated by systemic therapy rather than topical preparations to ensure high cure rates as the most common causative dermatophytes T. violaceum exhibits an endothrix rather than ectothrix invasion of the hair follicle. [ABSTRACT FROM AUTHOR]

Zusammenfassung Hintergrund Die Bestimmung von spezifischen IgE-Antikörpern spielt eine zentrale Bedeutung bei der Diagnostik von Bienen- und Wespengiftallergien. In den letzten Jahren wurden die komponentenbasierte Diagnostik (CRD) eingeführt, die die Bestimmung spezifischer IgE-Antikörper gegen die Allergene Api m 1, Ves v 1, Ves v 5 und Pol d 5 sowie kreuzreaktive Kohlenhydratdeterminanten (CCDs) erlaubt. Hierdurch soll vor allem bei Probanden mit Doppelsensibilisierungen die klinische Relevanz der einzelnen Sensibilisierungen besser beurteilt werden können. Probanden und Methodik Die spezifischen IgE-Antikörper-Bestimmungen an 143 Probanden mit Bienen- und/oder Wespengiftallergie erfolgten mit den extraktbasierten ImmunoCAP®-Allergenen i1 und i3 sowie den ImmunoCAP®-Allergenkomponenten i208-211 und o214 (Api m 1, Ves v 1, Ves v 5, Pol d 5, CCD). Bei Doppelsensibilisierten wurde zusätzlich ein Inhibitionstest durchgeführt. An einem Teilkollektiv der Studienpopulation erfolgten sIgE-Bestimmungen gegen Api m 1, Api m 4, Pol d 5 und Ves v 5 mittels Allergiechip (ISAC®, n = 44). Ergebnisse Die Sensitivität von Ves v 5 bei isolierten Wespengiftallergikern betrug 78,5 %, gemeinsam mit Ves v 1 stieg diese auf 92,3 %. Die Sensitivität von Api m 1 bei isolierten Bienengiftallergikern betrug 25 %. Die komponentenbasierte Diagnostik und Inhibitionstests bei Doppelsensibilisierten lieferten divergente Ergebnisse. Die CRD mittels ISAC®-Allergiechip erbrachte deutliche Unterschiede vor allem im Hinblick auf die Diagnostik von Api m 1 und CCDs. Schlussfolgerungen Die CRD bereichert das diagnostische Spektrum, sofern sie nicht allein sondern zusätzlich zu den etablierten Verfahren eingesetzt wird. Sie sollte neben Ves v 5 stets die Bestimmung der IgE-Antikörper gegen Ves v 1 umfassen. [ABSTRACT FROM AUTHOR]

Background The measurement of specific IgE (sIgE) antibodies plays a key role in the diagnosis of honeybee and wasp venom allergy. In recent years, component-resolved diagnosis (CRD) has been introduced, which allows for the measurement of sIgE antibodies against Api m 1, Ves v 1, Ves v 5, and Pol d 5, as well as cross-reactive carbohydrate determinants (CCDs). These tests are intended to help determine the clinical relevance of any given sensitization, especially in patients with dual sensitization. Patients and methods Specific IgE antibody levels were measured in 143 patients with bee and/or wasp venom allergy using the extract-based ImmunoCAP® allergens i1 and i3 as well as the ImmunoCAP® allergen components i208-211 and O214 (Api m 1, Ves v 1, Ves v 5, Pol d 5, CCDs). In patients with dual sensitization, inhibition testing was also performed. In a subgroup of the study population, sIgE to Api m 1, Api m 4, Pol d 5, and Ves v 5 were determined using the ISAC® allergy microarray ( n = 44). Results The sensitivity of Ves v 5 in patients with isolated wasp venom allergy was 78.5 %; in combination with Ves v 1, that figure increased to 92.3 %. The sensitivity of Api m 1 in individuals with isolated bee venom allergy was 25 %. CRD and inhibition testing in individuals with dual sensitization showed divergent results. CRD using the ISAC® allergy microarray showed marked differences, especially with regard to Api m 1 and CCDs. Conclusion Component-resolved tests are a valuable addition to the diagnostic spectrum as long as they are used in combination with established procedures. Apart from Ves v 5, measuring IgE antibodies to Ves v 1 should always be included in the diagnostic workup. [ABSTRACT FROM AUTHOR]

The genus Corynebacteria or Diphtheroids are aerobic, non-sporulating, pleomorphic Gram-positive and catalase-positive bacilli. Corynebacteria are a usual part of the human microbiome, but they may cause characteristic skin diseases. Corynebacterium minutissimum was fi rst isolated from erythrasma, but it is also involved in pitted keratolysis. The dominant species in trichobacteriosis (syn. trichomycosis) is C. tenuis. Diagnosis, differential diagnoses and treatment options are discussed in this review. [ABSTRACT FROM AUTHOR]

Background: Removal of nonvital tissue is an accepted method to eradicate biofilms and to stimulate wound healing. Debridement using a monofilament polyester fiber pad has clinically been shown to be effective as well as pain and trauma free. Methods: For in vitro determination of the cleansing capacity of this product compared to gauze swabs, a wound debridement model was used with glass plates coated with a bovine serum albumin solution, stained with hematoxylin. Both products were moistened and fixed to a weight connected to a regulated motor and were then pulled over the holding device with the coated glass plate under standardized conditions (power = 0.067 N/cm2, velocity = 1.6 cm/s). Results: At a low coating concentration (0.5%) both products were equally effective, but at a high concentration (1.5%) cleansing did not occur after 5 wipes. When wiping the plates 15 times, the debridement pad cleansed significantly (p < 0.001) better than gauze. When consecutively wiping 4 coated plates with a single debridement pad or swab, the pad exhibited and maintained a significantly higher cleansing capacity while gauze quickly lost its effect. Conclusion: Our in vitro test results indicated a higher cleansing capacity of the debridement pad compared to gauze swabs. [ABSTRACT FROM AUTHOR]

This study reports in vitro lipophilic antioxidant, inhibition of ʅ-amylase and antibacterial activities of extracts of peel and pulp of citrus samples from Aceh, Indonesia. HPLC (high-performance liquid chromatography), phytochemical, and FTIR (fourier transform infrared) analysis detected carotenoids, flavonoids, phenolic acids and terpenoids, contributing to the biological potencies. Most peel and pulp extracts contained lutein and lower concentrations of zeaxanthin, α-carotene, β-carotene and β-cryptoxanthin. The extracts also contained flavanone glycosides (hesperidin, naringin and neohesperidin), flavonol (quercetin) and polymethoxylated flavones (sinensetin, tangeretin). L-TEAC (lipophilic trolox equivalent antioxidant capacity) test determined for peel extracts higher antioxidant capacity compared to pulp extracts. All extracts presented α-amylase inhibitory activity, pulp extracts showing stronger inhibitory activity compared to peel extracts. All extracts inhibited the growth of both gram (+) and gram (-) bacteria, with peel and pulp extracts of makin showing the strongest inhibitory activity. Therefore, local citrus species from Aceh are potential sources of beneficial compounds with possible health preventive effects. [ABSTRACT FROM AUTHOR]

Background: Application of cold atmospheric pressure plasmas (CAPs) in or on the human body was termed ‘plasma medicine’. So far, plasmas were utilized for sterilization of implants, other heat-sensitive products, or employed for chemical surface modifications. By now, CAPs are further used effectively for wound treatment. The present study analyses the effect of a plasma jet with air or nitrogen as process gas, previously evaluated for antimicrobial efficacy, on human cells using a 3D skin model. Methods: CAP treatment of 3D skin models consisting of a keratinocyte-containing epidermal layer and a fibroblast/collagen dermal matrix was performed using the Tigres plasma MEF technology. To evaluate the effects on the 3D skin models, the following plasma parameters were varied: process gas, input power, and treatment time. Results: Low CAP doses exhibited good cell compatibility. Increasing input power or elongating treatment intervals led to detrimental effects on 3D skin model morphology as well as to release of inflammatory cytokines. It was further observed that air as process gas was more damaging compared to nitrogen. Conclusions: Treatment of 3D skin models with the plasma MEF nozzle using air or nitrogen is reported. A clearly dose- and time-dependent effect of CAPs could be observed in which the CAP based on nitrogen exhibited higher cell compatibility than the CAP generated from air. These settings might be recommended for medical in vivo applications such as wound decontamination. [ABSTRACT FROM AUTHOR]

Carotenoid contents of peel and pulp of local citrus fruits from Aceh were investigated using HPLC equipped with DAD detector and LC-MS. Most of the citrus samples investigated mainly contained lutein and zeaxanthin. Jeruk takengon ( Citrus nobilis) had a more complex carotenoid profile and the highest carotenoid contents compared to other citrus fruits studied here, and peel contained higher carotenoid contents than pulp. ( Z)-Violaxanthin and ( all- E)-violaxanthin were the main carotenoids of the peel, while ( all- E) β-cryptoxanthin and ( Z)-violaxanthin were the main carotenoids of the pulp of jeruk takengon. Determination of the lipophilic antioxidant capacity (L-TEAC) of the carotenoid extracts of jeruk takengon showed promising antioxidant potential. The peel extract showed stronger antioxidant capacity than the pulp extract, and saponification further improved the antioxidant capacity. Investigating the inhibition of α-amylase activity resulted in a moderate α-amylase inhibition by jeruk takengon due to the carotenoid contents and the contribution of some flavonoids. Pulp extracts exhibited better inhibition activity than peel extracts, and saponification led to a reduction of the α-amylase inhibition activity. Antibacterial activity tests showed that jeruk takengon could inhibit the growth of K. pneumonia and S. aureus, and saponification enhanced the antibacterial activities. In general, the peel extracts showed biological potential due to the relatively strong in vitro antioxidant, antibacterial and α-amylase inhibitory activity. In addition, these by-products of food processing may serve as potential carotenoid sources. [ABSTRACT FROM AUTHOR]

In cystic fibrosis (CF) patients' airways, inflammatory processes decisively contribute to remodeling and pulmonary destruction. The aims of this study were to compare upper airway (UAW) inflammation in the context of Staphylococcus aureus and Pseudomonas aeruginosa colonization in a longitudinal setting, and to examine further factors influencing UAW inflammation. Therefore, we analyzed soluble inflammatory mediators in noninvasively obtained nasal lavage (NL) of CF patients together with microbiology, medication, and relevant clinical parameters. NL, applying 10 mL of isotonic saline per nostril, was serially performed in 74 CF patients (326 samples). Concentrations of the inflammatory mediators' interleukin (IL)-1β, IL-6, IL-8, matrix metalloproteinase (MMP)-9, and its anti-protease TIMP-1 were quantified by bead-based multiplexed assay, neutrophil elastase (NE) via ELISA. Culture-based microbiology of the upper and lower airways (LAW), as well as serological and clinical findings, were compiled. Our results indicate that UAW colonization with S. aureus significantly impacts the concentration of all measured inflammatory mediators in NL fluid except TIMP-1, whereas these effects were not significant for P. aeruginosa. Patients with S. aureus colonization of both the UAW and LAW showed significantly increased concentrations of IL-1β, IL-6, IL-8, MMP-9, and slightly elevated concentrations of NE in NL fluid compared to non-colonized patients. This work elaborates a survey on S. aureus' virulence factors that may contribute to this underestimated pathology. Serial assessment of epithelial lining fluid by NL reveals that colonization of the UAW with S. aureus contributes more to CF airway inflammatory processes than hitherto expected. [ABSTRACT FROM AUTHOR]

The diagnostic workup of cutaneous fungal infections is traditionally based on microscopic KOH preparations as well as culturing of the causative organism from sample material. Another possible option is the detection of fungal elements by dermatohistology. If performed correctly, these methods are generally suitable for the diagnosis of mycoses. However, the advent of personalized medicine and the tasks arising therefrom require new procedures marked by simplicity, specificity, and swiftness. The additional use of DNA-based molecular techniques further enhances sensitivity and diagnostic specificity, and reduces the diagnostic interval to 24-48 hours, compared to weeks required for conventional mycological methods. Given the steady evolution in the field of personalized medicine, simple analytical PCR-based systems are conceivable, which allow for instant diagnosis of dermatophytes in the dermatology office (point-of-care tests). [ABSTRACT FROM AUTHOR]

Zusammenfassung Die Labordiagnose einer Pilzinfektion der Haut basiert traditionell auf dem Nativpräparat und der Anzucht des Erregers aus dem klinischen Material. Auch der dermato- histologischer Nachweis von Pilzelementen ist möglich. Diese Methoden sind, sofern sie korrekt ausgeführt werden, in der Regel zum Pilznachweis geeignet. Im Zuge der personalisierten Medizin und den daraus erwachsenden Aufgaben werden jedoch neue Verfahren erforderlich, welche einfach, spezifisch und schnell sind. Der zusätzliche Einsatz von DNA-basierten molekularen Methoden erhöht die Empfindlichkeit sowie die diagnostische Spezifität und reduziert die zum Teil wochenlange Durchführungszeit der konventionellen mykologischen Diagnostik auf 24 bis 48 Stunden. Im Zuge der stetigen Weiterentwicklung im Bereich der personalisierten Medizin sind einfache Analysensysteme auf PCR-Basis denkbar, die in der Hautarztpraxis eine Dermatophyten-Sofort-Diagnostik erlauben (Point-of-Care-Tests). [ABSTRACT FROM AUTHOR]

Background: Most studies provide evidence that the skin flush response to nicotinic acid (niacin) stimulation is impaired in schizophrenia. However, only little is known about niacin sensitivity in the ultra-high risk (UHR) phase of psychotic disorders. Methods: We compared visual ratings of niacin sensitivity between adolescents at UHR for psychosis according to the one year transition outcome (UHR-T n = 11; UHR-NT n = 55) with healthy controls (HC n = 25) and first episode schizophrenia patients (FEP n = 25) treated with atypical antipsychotics. Results: Contrary to our hypothesis niacin sensitivity of the entire UHR group was not attenuated, but significantly increased compared to the HC group, whereas no difference could be found between the UHR-T and UHR-NT groups. As expected, niacin sensitivity of FEP was attenuated compared to HC group. In UHR individuals niacin sensitivity was inversely correlated with omega-6 and -9 fatty acids (FA), but positively correlated with phospholipase A2 (inPLA2) activity, a marker of membrane lipid repair/remodelling. Conclusions: Increased niacin sensitivity in UHR states likely indicates an impaired balance of eicosanoids and omega-6/-9 FA at a membrane level. Our findings suggest that the emergence of psychosis is associated with an increased mobilisation of eicosanoids prior to the transition to psychosis possibly reflecting a “pro-inflammatory state”, whereas thereafter eicosanoid mobilisation seems to be attenuated. Potential treatment implications for the UHR state should be further investigated. [ABSTRACT FROM AUTHOR]

Bacterial nanocellulose (BNC) is chemically identical with plant cellulose but free of byproducts like lignin, pectin, and hemicelluloses, featuring a unique reticulate network of fine fibers. BNC sheets are mostly obtained by static cultivation. Now, a Horizontal Lift Reactor may provide a cost efficient method for mass production. This is of particular interest as BNC features several properties of an ideal wound dressing although it exhibits no bactericidal activity. Therefore, BNC was functionalized with the antiseptics povidone-iodine (PI) and polihexanide (PHMB). Drug loading and release, mechanical characteristics, biocompatibility, and antimicrobial efficacy were investigated. Antiseptics release was based on diffusion and swelling according to Ritger-Peppas equation. PI-loaded BNC demonstrated a delayed release compared to PHMB due to a high molar drug mass and structural changes induced by PI insertion into BNC that also increased the compressive strength of BNC samples. Biological assays demonstrated high biocompatibility of PI-loaded BNC in human keratinocytes but a distinctly lower antimicrobial activity against Staphylococcus aureus compared to PHMB-loaded BNC. Overall, BNC loaded with PHMB demonstrated a better therapeutic window. Moreover, compressive and tensile strength were not changed by incorporation of PHMB into BNC, and solidity during loading and release could be confirmed. [ABSTRACT FROM AUTHOR]

Hemocompatibility of aqueous solutions of antimicrobial 6-deoxy-6-aminoethyleneamino (AEA) cellulose with different degrees of substitution (DS, 0.54–0.92) was investigatedin vitro. The AEA cellulose derivatives were synthesized by tosylation of cellulose and subsequent nucleophilic substitution with 1,2-diaminoethane. The structure was confirmed by elemental analysis as well as by FTIR and NMR spectroscopies. Markers for coagulation (thrombin generation, aPTT, PT, blood clotting, thrombocyte activation) and membrane integrity (hemolysis) were measured in human whole blood, human platelet-rich plasma, human pooled plasma, and erythrocytes suspension. AEA cellulose with a low DS of 0.54 showed the highest hemocompatibilityin vitro, suggesting the possibility of biomedical applications. [ABSTRACT FROM AUTHOR]

Background. In cystic fibrosis (CF) the upper (UAW) and lower airways (LAW) are reservoirs for pathogens like Pseudomonas aeruginosa. The consecutive hosts’ release of proteolytic enzymes contributes to inflammation and progressive pulmonary destruction. Objectives were to assess dynamics of protease : antiprotease ratios and pathogens in CF-UAW and LAW sampled by nasal lavage (NL) and sputum before and after intravenous- (IV-) antibiotic therapy. Methods. From 19 IV-antibiotic courses of 17 CF patients NL (10 mL/nostril) and sputum were collected before and after treatment. Microbiological colonization and concentrations of NE/SLPI/CTSS (ELISA) and MMP-9/TIMP-1 (multiplex bead array) were determined. Additionally, changes of sinonasal symptoms were assessed (SNOT-20). Results. IV-antibiotic treatment had more pronounced effects on inflammatory markers in LAW, whereas trends to decrease were also found in UAW. Ratios of MMP-9/TIMP-1 were higher in sputum, and ratios of NE/SLPI were higher in NL. Remarkably, NE/SLPI ratio was 10-fold higher in NL compared to healthy controls. SNOT-20 scores decreased significantly during therapy (P=0.001). Conclusion. For the first time, changes in microbiological patterns in UAW and LAW after IV-antibiotic treatments were assessed, together with changes of protease/antiprotease imbalances. Delayed responses of proteases and antiproteases to IV-antibiotic therapy were found in UAW compared to LAW. [ABSTRACT FROM AUTHOR]

Background: Wound infection plays an important role in compromised wound healing. A high bioburden impairs healing and leads to formation of a chronic wound. Distinctly higher pH values were observed in chronic wounds compared to acute wounds. However, there is only limited knowledge of pH dependency on the antibacterial efficacy of common antimicrobial substances. Methods: This study investigated the pH influence on the antimicrobial efficacy of povidone (PVP)-iodine, silver nitrate, chlorhexidine, octenidine and polihexanide against Staphylococcus aureus and Pseudomonas aeruginosa using the agar diffusion test and microplate laser nephelometry. Results: The bactericidal activity of chlorhexidine and octenidine was mainly pH-independent in a pH range of 5.0-9.0. In contrast, polihexanide showed a significant efficacy increase at a higher pH. It was also found that the influence of the pH on antiseptics differs among species of bacteria. For instance, S. aureus exhibited an increasing sensitivity against silver nitrate with rising pH whereas the effect on P. aeruginosa was found to be distinctly decreased. The antimicrobial effect of PVP-iodine was strongly diminished with rising pH. Conclusions: The shift towards higher pH values in chronic wounds compared to acute wounds makes it imperative to know whether the antimicrobial efficacy of applied antimicrobial substances is altered by different pH levels. The results suggest that application of polihexanide might be advantageous for the management of wound infections, as both S. aureus and P. aeruginosa exhibited an increased susceptibility with rising pH. © 2015 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Candida albicans, the important human fungal pathogen uses multiple evasion strategies to control, modulate and inhibit host complement and innate immune attack. Clinical C. albicans strains vary in pathogenicity and in serum resistance, in this work we analyzed sequence polymorphisms and variations in the expression levels of two central fungal complement evasion proteins, Gpm1 (phosphoglycerate mutase 1) and Pra1 (pH-regulated antigen 1) in thirteen clinical C. albicans isolates. Four nucleotide (nt) exchanges, all representing synonymous exchanges, were identified within the 747-nt long GPM1 gene. For the 900-nt long PRA1 gene, sixteen nucleotide exchanges were identified, which represented synonymous, as well as non-synonymous exchanges. All thirteen clinical isolates had a homozygous exchange (A to G) at position 73 of the PRA1 gene. Surface levels of Gpm1 varied by 8.2, and Pra1 levels by 3.3 fold in thirteen tested isolates and these differences influenced fungal immune fitness. The high Gpm1/Pra1 expressing candida strains bound the three human immune regulators more efficiently, than the low expression strains. The difference was 44% for Factor H binding, 51% for C4BP binding and 23% for plasminogen binding. This higher Gpm1/Pra1 expressing strains result in enhanced survival upon challenge with complement active, Factor H depleted human serum (difference 40%). In addition adhesion to and infection of human endothelial cells was increased (difference 60%), and C3b surface deposition was less effective (difference 27%). Thus, variable expression levels of central immune evasion protein influences immune fitness of the human fungal pathogen C. albicans and thus contribute to fungal virulence. [ABSTRACT FROM AUTHOR]

Antibacterial activity of dressings containing antimicrobials is mostly evaluated using in vitro tests. However, the various methods available differ significantly in their properties and results obtained are influenced by the method selected, micro-organisms used, and extraction method, the degree of solubility or the diffusability of the test-compounds. Here, results on antimicrobial activity of silver-containing dressings obtained by agar diffusion test (ADT), challenge tests (JIS L 1902, AATCC 100), and extraction-based methods (microplate laser nephelometry (MLN), luminescent quantification of bacterial ATP (LQbATP)) using Staphylococcus aureus and Pseudomonas aeruginosa were evaluated. Furthermore, the effect of the pH on antibacterial efficacy of these dressings was investigated. All silver-containing dressings exerted antimicrobial activity in all in vitro tests and results correlated considerably well. Differences were observed testing the agent-free basic materials. They did not exhibit any antimicrobial effects in the ADT, MLN or LQbATP, since these methods depend on diffusion/extraction of an active agent. However, they showed a strong antimicrobial effect in the challenge tests as they possess a high absorptive capacity, and are able to bind and sequester micro-organisms present. Therefore, it seems recommendable to choose several tests to distinguish whether a material conveys an active effect or a passive mechanism. In addition, it could be shown that release of silver and its antimicrobial efficacy is partially pH-dependent, and that dressings themselves affect the pH. It can further be speculated that dressings’ effects on pH and release of silver ions act synergistically for antimicrobial efficacy. [ABSTRACT FROM AUTHOR]

Purpose: Latex allergy can be diagnosed by different test methods such as IgE quantification, Western blot, cellular antigen stimulation test (CAST), and in vivo methods [e.g. skin prick test (SPT)]. Phadia provides two modern methods using recombinant latex allergens: ImmunoCAP and the Immuno Solid-phase Allergen Chip (ISAC), which enables simultaneous determination of specific IgE against five latex allergens. We compared the diagnostic sensitivity of the ISAC test kit and the conventional Hev b 5-spiked ImmunoCAP latex extract. Methods: Forty sera were sampled from subjects with suspected natural rubber latex (NRL) allergy. These patients had positive SPT to NRL extract, positive NRL Western blots, and positive results in the CAST. All sera were analysed using the ISAC and recombinant NRL ImmunoCAP allergens and compared to the results of 20 negative control sera. Results: Only 22 of the 40 subjects (55 %) showed positivity to at least one latex allergen on the ISAC (sensitivity ISAC 55 %). The sensitivity of the ImmunoCAP latex extract was 70 %. The most frequently detected sensitization was against Hev b 6.01 ( n = 12). When the serum samples were tested with all recombinant ImmunoCAP allergens, three additional sensitizations against latex could be detected compared to the ISAC. Conclusions: Microarrays do offer many potential benefits such as elegant simultaneous determination of sensitizations against different NRL allergens with minimal amounts of serum. However, a negative NRL test result should be regarded with caution and at least be confirmed by other in vitro methods. [ABSTRACT FROM AUTHOR]