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Simple Summary Borreliae are spirochaetes, which represent a heterogeneous phylum within bacteria. Spirochaetes are indeed distinguished from other bacteria for their spiral shape, which also characterizes Borreliae. This review describes briefly the organization of the phylum Spirocheteales with a digression about its pathogenicity and historical information about bacteria isolation and characterization. Among spirochaetes, Borrelia genus is here divided into three groups, namely the Lyme group (LG), the Echidna-Reptile group (REPG) and the Relapsing Fever group (RFG). Borreliae Part 1 deals with Lyme group and Echidna-Reptile group Borreliae, while the subject of Borreliae Part 2 is Relapsing Fever group and unclassified Borreliae. Lyme group Borreliae is organized here in sections describing ecology, namely tick vectors and animal hosts, epidemiology, microbiology, and Borrelia genome organization and antigen characterization. Furthermore, the main clinical manifestations in Lyme borreliosis are also described. Although included in the Lyme group due to their particular clinical features, Borrelia causing Baggio Yoshinari syndrome and Borrelia mayonii are described in dedicated paragraphs. The Borrelia Echidna-Reptile group has been recently characterized including spirochaetes that apparently are not pathogenic to humans, but infect reptiles and amphibians. The paragraph dedicated to this group of Borreliae describes their vectors, hosts, geographical distribution and their characteristics. Abstract Borreliae are divided into three groups, namely the Lyme group (LG), the Echidna-Reptile group (REPG) and the Relapsing Fever group (RFG). Currently, only Borrelia of the Lyme and RF groups (not all) cause infection in humans. Borreliae of the Echidna-Reptile group represent a new monophyletic group of spirochaetes, which infect amphibians and reptiles. In addition to a general description of the phylum Spirochaetales, including a brief historical digression on spirochaetosis, in the present review Borreliae of Lyme and Echidna-Reptile groups are described, discussing the ecology with vectors and hosts as well as microbiological features and molecular characterization. Furthermore, differences between LG and RFG are discussed with respect to the clinical manifestations. In humans, LG Borreliae are organotropic and cause erythema migrans in the early phase of the disease, while RFG Borreliae give high spirochaetemia with fever, without the development of erythema migrans. With respect of LG Borreliae, recently Borrelia mayonii, with intermediate characteristics between LG and RFG, has been identified. As part of the LG, it gives erythema migrans but also high spirochaetemia with fever. Hard ticks are vectors for both LG and REPG groups, but in LG they are mostly Ixodes sp. ticks, while in REPG vectors do not belong to that genus.

Simple Summary Following Borreliae Part 1, this second review describes Borreliae of the relapsing fever group (RFG) and unclassified Borreliae. The RFG is further divided according to vector transmission and geographical distribution in other subgroups, namely the soft-tick-borne relapsing fever (STBRF) group, the hard-tick-borne relapsing fever (HTBRF) one, the louse-borne relapsing fever (LBRF) group, and the Avian relapsing fever group. Where possible, according to the literature description, each sub-group of the RFG Borreliae is organized here in sections explaining the geographical distribution, the vectors, the hosts, the epidemiology, and the microbiology. In case of human infectiveness, clinical aspects are also discussed. Isolation and sequencing of Borrelia species is ongoing, and in addition to the groups mentioned in these reviews, there are Borreliae that at present cannot be cultivated, but according to sequencing data they share some characteristics with one specific group. Nevertheless, they still cannot be classified in one of them. This is the case of Borreliae with not-yet-identified pathogenicity for humans or animals, which are here named “unclassified Borreliae” and described separately, recalling the similarities with Borreliae already classified. In the future, we expect that those Borreliae are going to be characterized, including them in one of the previous groups. Abstract Borreliae of the relapsing fever group (RFG) are heterogenous and can be divided mainly into three groups according to vectors, namely the soft-tick-borne relapsing fever (STBRF) Borreliae, the hard-tick-borne relapsing fever (HTBRF) Borreliae, the louse-borne relapsing fever (LBRF) Borreliae, and the avian relapsing fever ones. With respect to the geographical distribution, the STBRF Borreliae are further subdivided into Old World and New World strains. Except for the Avian relapsing fever group Borreliae, which cause avian spirochetosis, all the others share infectivity in humans. They are indeed the etiological agent of both endemic and epidemic forms of relapsing fever, causing high spirochaetemia and fever. Vectors are primarily soft ticks of Ornithodoros spp. in the STBRF group; hard ticks, notably Ixodes sp., Amblyomma sp., Dermacentor sp., and Rhipicephalus sp., in the HTBRF group; and the louse pediculus humanus humanus in the TBRF one. A recent hypothesis was supported for a common ancestor of RFG Borreliae, transmitted at the beginning by hard-body ticks. Accordingly, STBRF Borreliae switched to use soft-bodied ticks as a vector, which was followed by the use of lice by Borrelia recurrentis. There are also new candidate species of Borreliae, at present unclassified, which are also described in this review.

Leukemia cutis (LC) is described as cutaneous infiltration by neoplastic leukocytes into the epidermidis, dermis, or subcutis, resulting in clinically various skin lesions. When the infiltrate is characterized by neoplastic granulocytic precursors, LC is defined as granulocytic sarcoma. Multiple, erythematous, and infiltrated papules and nodules localized on the legs, arms, and trunk are the most common clinical presentation. Here we report a case of granulocytic sarcoma in a patient with a previous diagnosis of acute myeloid leukemia currently in hematological remission.

In the present study, we describe the use of electrochemotherapy as alternative therapy for primary cutaneous marginal zone B-cell lymphomas in patients unsuitable for surgery or radiotherapy. Our experience refers to three patients with primary cutaneous marginal zone B-cell lymphomas related to Borrelia burgdorferi infection, treated with specific antimicrobial therapy and electrochemotherapy.

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We report the occurrence of Staphylococcus lugdunensis cutaneous infection with sporotrichoid distribution of the left lower limb of a 60-year-old man. Recent studies have confirmed that Staphylococcus lugdunensis is a significant pathogen in causing skin and soft tissue infections that usually manifest in abscesses, surgical wound infections, and cellulitis. It used to be considered a skin commensal bacteria, but if unrecognized it can lead to fulminant endocarditis, meningitis, skin abscesses, peritonitis, and spondylodiscitis.

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Background: Borrelia burgdorferi has been associated with primary cutaneous B-cell lymphoma, in particular with cutaneous marginal zone B cell lymphoma. Ixodes ticks, which are vectors of Borrelia burgdorferi, can also transmit many other microorganisms such as Anaplasma phagocytophilum and Rickettsia helvetica. Nowadays data on the frequency of these co-infections are still conflicting, but in our geographical area (north-eastern of Italy) they appear rather frequently. Aim: To investigate the presence of co-infections with Anaplasma phagocytophilum and Rickettsia helvetica, in patients with proven Borrelia burgdorferi-related cutaneous marginal zone B cell lymphoma. Methods: Four consecutive patients with a histopathological diagnosis of cutaneous marginal zone B cell lymphoma were investigated for the presence of Borrelia burgdorferi with conventional serology and with PCR, and for the presence of Anaplasma phagocytophilum and Rickettsia helvetica with conventional serology. Results: Serologic test for Borrelia burgdorferi was positive in 2 cases, while PCR assays for Borrelia burgdorferi performed on DNA from the biopsy and peripheral blood was positive in all four patients. Serologic analysis for Rickettsia helvetica was positive in one patient, while serologic analysis for Anaplasma phagocytophilum was positive in all patients. Conclusions: Our case series have revealed a co-infection between Borrelia burgdorferi and Anaplasma phagocytophilum in all patients with cutaneous marginal zone B cell lymphoma. Therefore more comprehensive analyses on the co-existence of Anaplasma phagocytophilum infection should be performed in patients with Borrelia burgdorferi-related cutaneous marginal zone B cell lymphoma.

The basal cell carcinoma (BCC) assessment in dermoscopy is based on the recognition of specific characteristics synthesized and described as classical and non-classical criteria, but which may not necessarily present all at the same time. Consequently, a deep knowledge in detecting the aforementioned dermoscopic criteria is crucial in diagnosis. The aim of the study was to evaluate which criteria are more frequently recognized among a group of low-experienced dermoscopists when confronted with the difficult diagnosis of BCC with a diameter lower than 5 mm. We examined 100 BCC finding that data displays a full agreement only for one classical criterion, the lack of pigmented network (Fleiss' κ = 1), while among other classical criteria only arborizing vessels and ulceration exhibit a good agreement among observers (Fleiss' κ > 0.40). Analyzing non-classical criteria, only blue-whitish veil and blue in-focus dots show a good agreement among low-experience observers (Fleiss' κ > 0.40). It is evident that in small size BCC classic dermoscopic criteria are often substituted by non-classical criteria, which represent the neoplasm's early phase. Thus, it is of importance, especially for low-experience dermoscopists, to analyze even the non-classical criteria in order to obtain a diagnosis of early BCC. © 2016 Japanese Dermatological Association

Chronic spontaneous urticaria (CSU) is perceived as a difficult to manage disease with negative impact on quality of life. The aim of this study was to highlight how to improve the care of people with CSU, using the methodology of narrative medicine. From June 2014 to March 2015, CSU-diagnosed patients and their physicians were asked to record their experiences of the condition in writing. Fourteen healthcare teams participated: 41% considered CSU as a challenge to overcome, while 22% experienced CSU as a big commitment. The number of professional involved was evaluated as insufficient in 11 hospitals. Seventy-five percent of the 190 Italian patients had visited 3 or more physicians before receiving a final diagnosis, with a perceived waste of time and resources. The therapeutic pathways were described as unsatisfactory in 83% of cases. As a result, anger and frustration were life-dominant emotions in 92% of patients. The critical points of the care pathway are related to organizational issues and lack of awareness.

Dermoscopy, in expert hands, increases accuracy, sensitivity and specificity in diagnosis of pigmented skin lesions of a single operator, compared with clinical examination. Simplified algorithmic methods have been developed to help less expert dermoscopists in diagnosis of melanocytic lesions. This study included 125 melanocytic skin lesions divided into melanocytic nevi, dysplastic nevi and thin melanomas (

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We describe the case of an elderly woman who acquired a Mycobacterium marinum infection following skin exposure to the bacteria through a small wound on her right ring finger, obtained while preparing fish. The resultant sporotrichoid nodules of the right hand and the distal forearm, refractory to the initial therapy with doxycycline and rifampicin, were successfully treated with oral regimen of clarithromycin.

Malignant melanoma presenting as a giant cutaneous mass is rarely observed in clinical practice. A few patients with giant melanoma have been reported, Herein, we document our experience with a patient with giant cutaneous melanoma of the abdomen and review the features of previously reported individuals.

Introduction : Nailfold videocapillaroscopy (NVC) is a non-invasive imaging technique widely used to investigate microvascular abnormalities in different connective tissue diseases (CTDs). Methods : We conducted a retrospective study where we analysed 415 patients submitted to NVC. Patients with scleroderma-like pattern were selected to investigate if there are specific NCV changes, which discriminate among the different CTDs. Ninety-one patients met this requirement and had a diagnosis of CTD. For each patient the following abnormalities were observed: enlarged and giant capillaries, oedema, loss and rarefaction of capillaries, long loops and minor dystrophies. Results : Multivariate analyses did not reveal any specific modification among the analysed co-variables for scleroderma (SS) and dermatomyositis (DM). For the others CTDs analysed in this study, logistic regression revealed that some of the capilloroscopic features could be indicative of specific diseases. Of note, the presence of megacapillaries with long loops in a scleroderma-like pattern seems to be highly indicative for a diagnosis of systemic lupus erythaematosus (SLE). Conclusions : Our data showed that in CTDs with a scleroderma-like pattern, the NVC variables alone are not able to discriminate for a specific diagnosis of CTD. Nevertheless, there are some NVC features, which could strongly address the differential diagnosis toward a specific CTD.

Secukinumab, a fully human monoclonal antibody, neutralizes interleukin-17A, a cornerstone cytokine driving the multiple manifestations of psoriasis. This post-hoc analysis of the SUPREME study was performed to determine the sustainability of response to secukinumab in terms of Psoriasis Area and Severity Index (PASI) 90 in patients with moderate-to-severe plaque psoriasis. Based on PASI 90 response at week 16, patients were stratified as PASI 90 responders (PASI90R, n = 337) or non-responders (PASI90NR, n = 72). At week 20, 94.2% (n = 295/313) achieved PASI 90/100 response in PASI90R, with response maintained through week 48 (89.6%, n = 189/211). An increased proportion of patients achieved PASI 90/100 response in PASI90NR (week 20: 29.9%, n = 20/67; week 48: 57.1%, n = 20/35). Overall, 64.4% patients achieved absolute PASI score = 0 at week 24 with response sustained to week 48 (66.9%). Secukinumab showed sustained and stable efficacy in maintaining PASI 90 response in patients with moderate-to-severe plaque psoriasis up to week 48.