Search

Fungal infections of the foot can be divided into three major varieties, all of which have differing pathophysiologic aspects with therapeutic implications. Interdigital infections involve an ecological interplay between dermatophytes and bacteria. Simple scaling types of infection are caused by dermatophyte invasion of the stratum corneum, whereas macerated, erosive infections are caused by selection and overgrowth of bacteria, particularly Brevibacterium epidermidis, Micrococcus sedantarius, and various gram-negative species. Bacterial production of methanethiol and other sulfur compounds leads to inhibition of dermatophytes and accounts for the lower recovery of dermatophytes from the most severe cases. Plantar surface infections consist of widespread, moccasin-type infection caused by Trichophyton rubrum and localized scaling infections with episodes of intense inflammation caused by Trichophyton mentagrophytes. The former is particularly associated with an atopic background. Therapy is difficult because of poor immune responses and difficulty in delivering a sufficient quantity of drugs to the lower layers of a thick stratum corneum. Intense inflammation in T. mentagrophytes infections is the result of an immune, contact allergic response to fungal antigens.

Background: Eosinophilic pustular folliculitis (EPF) was initially defined as a sterile folliculitis of unknown cause. Because attempts to demonstrate bacterial organisms have been unsuccessful, and antibiotic therapy is usually ineffective, a bacterial infection is not considered a plausible causative factor for this disease., Objective: Our purpose was to describe five patients with the clinical and histologic characteristics of EPF and to report the results of bacterial cultures., Methods: Biopsy specimens were examined and pustules were cultured., Results: In three of the five patients, Pseudomonas infection of the hair follicle was the cause of the disease as proven by repeated cultures and the response to specific therapy. Three patients had a systemic disorder known to cause immunologic alteration: AIDS in one and a myeloproliferative disorder in two., Conclusion: Although EPF was initially defined as a sterile folliculitis of unknown origin, three of our patients had an identifiable and treatable cause. We believe that these cases warrant the diagnosis of EPF.

A 58-year-old man with diabetes had fever and chills 5 days after ingestion of raw seafood. Nausea, vomiting, watery diarrhea, bilateral calf pain, and neck stiffness subsequently developed. Generalized edema and ecchymotic patches with a vesiculobullous eruption appeared on the extremities. Four blood cultures were positive for Vibrio cholerae non-01. The patient was successfully treated with antibiotics. This is the first documented case of V. cholerae non-01 septicemia with cutaneous lesions and meningitis in Taiwan.

Background: There is no agreement as to whether papular acrodermatitis of childhood caused by hepatitis B virus can be differentiated from other papulovesicular acrolocated syndromes., Objective: We attempted to establish whether such differentiation is possible comparing histories, signs, and symptoms of all patients who have been previously diagnosed as having papular acrodermatitis of childhood or papulovesicular acrolocated syndromes., Methods: Files of 308 patients hospitalized in the past three decades were studied. Photographs were examined by a panel of experts to determine whether it was possible to distinguish between papular acrodermatitis of childhood and papulovesicular acrolocated syndromes solely on the basis of cutaneous signs., Results: The retrospective analysis confirmed a significant overlapping of the two types of the disease. The blind survey of photographs of the patients revealed that a distinction between the forms was not clinically possible., Conclusion: Acrodermatitis is a self-limiting cutaneous response to different viruses; clinical differences are probably due to individual characteristics of each patient rather than the causative virus.