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PubMed2004

[Cutaneous symptoms of zinc deficiency in adults].

Malabsorption is frequently accompanied by skin symptoms, which are the most likely first manifestation of the disease. Skin lesions are mainly due to the deficiency of zinc, different vitamins, minerals, essential aminoacids, and other nutrients. The present paper demonstrates 3 patients with different types of skin symptoms primarily related to zinc deficiency, which occur in gastrointestinal diseases and alcohol abuse (acrodermatitis enteropathica, eczema craquele, hyperpigmentation).

Aged↗

PubMed2004

[Tick borne zoonosis: selected clinical and diagnostic aspects].

Tick-borne zoonotic infections are among the most diffuse vector borne diseases: these large group of infections is caused by different microorganisms: Babesia spp., Borrelia spp., Rickettsia spp., Ehrlichia spp., Francisella tularensis, Coxiella burnetii) and tick-borne encephalitis virus. Babesiosis is caused by the protozoa (sporozoa) Babesia microti and it is quite rare in humans in Europe. The ixodids ticks are the competent vectors. A few symptomatic cases have been reported, mainly in splenectomized patients. The laboratory diagnosis is made by the microscopic identification of the parasites within the red blood cells in blood smears. The serologic diagnosis, based mainly upon IFA and WB techniques has only an epidemiological interest. Lyme borreliosis (Lyme disease) has been recognized as the most frequent vector borne disease in mild climate areas. The etiologic agent is a spirochete, belonging to the Borrelia burgdorferi sensu lato complex: B. burgdorferi sensu stricto, B. garinii and B. afzelii. Several additional species of this geno-complex have been identified but their pathogenic capability for humans still needs to be elucidated. Lyme borreliosis is clinically divided into three different clinical stages: the early disease, the disseminated infection and the persistent infection. Individual stages are caused by the diffusion of the spirochetes to different anatomic districts of the body. The main clinical symptoms are, for each stage: the erythema chronicum migrans in the early infection, the peripheral nerves and joint involvement in disseminated diseases and the acrodermatitis chronica atrophica (ACA) with central nervous system involvement in the late disseminated infection. The microbiological diagnosis is achieved by serologic techniques (IFA, EIA, WB) and by isolation of the spirochetes (in vitro culture and DNA amplification methods). Tick-borne relapsing fever (TBRF) is occasionally transmitted to humans by the soft ticks Ornithodorus and is caused by Borrelia spp. Different borreliae are responsible for TBRF in various geographic areas. The laboratory diagnosis is based upon the identification of spirochetes in peripheral blood by microscopic observation of Giemsa stained smears. Rickettsiosis diseases are caused worldwide by the obligate intracellular bacteria belonging to the genus Rickettsia. In the Mediterranean area the most frequently identified rickettsia is R. conorii, that causes the so called Mediterranean spotted fever. The serologic detection of a specific antibody response by IFA techniques is the most prominent tool for the diagnosis. In addition, the PCR method can be applied. Bacteria of the genus Ehrlichia are well known pathogens in veterinary medicine. Since the last decade their zoonotic capability has emerged and E. chafeensis, E. canis and the so called human granulocytic agent (HGE) have been identified in human diseases following a tick bite. The ehrlichiosis is characterized, in human, by a mild fever associated with lymphoadenopathy. The diagnosis is made on the identification of morulae (the intracytoplasmatic inclusion of the growing rickettsiae) in the white cells of peripheral blood. In addition the molecular diagnosis is also possible by PCR. Tick-borne encephalitis (TBE) is the only viral arthropod-borne encephalitis in Europe: it is caused by a flavivirus and it can also be transmitted by the ingestion of goat raw milk. The more relevant epidemiological figure is limited to the Alps, in particular to the Northern side (Austria). Isolated cases have been reported also in Italy. TBE is a benign self-limiting illness that usually recovers without any reliquate. The laboratory diagnosis is obtained by isolating the virus in cell cultures from the CSF or blood of acute phase patients. Serology is anyway the main laboratory tool to perform this diagnosis. Complement fixation and EIA IgM are the most used methods: the latter technique is particularly sensitive in early infection.

Animals↗

PubMed2004

Necrolytic migratory erythema: first symptom of a glucagonoma. A case report.

Necrolytic migratory erythema (NME) is a rare skin condition consisting of migrating areas of erythema with blisters that heal with hyperpigmentation. NME is a pathognomonic feature of a glucagonoma. When confronted with a xerosis cutis one should always exclude the possibility of a NME caused by a glucagonoma as demonstrated in this case report where the rash was wrongly attributed to an acrodermatitis enteropathica due to zinc deficiency. We describe a case of a glucagonoma with its classic features, diagnosis and treatment.

Deficiency Diseases↗

PubMed1992

[Arrhythmia and swelling of all extremities].

A 54-year-old patient complained about palpitations secondary to ventricular arrhythmias over a period of several years and severe fatigue for months. Later on arthralgia of the left shoulder and diffuse swelling of both hands and feet appeared. An elevated B. burgdorferi antibody titer and later on in the course the characteristic cutaneous aspect of acrodermatitis chronica atrophicans supported the diagnosis of Lyme-Borreliosis with affection of multiple organs. Under intravenous antibiotic treatment with 2 g Ceftriaxone per day for two weeks the symptoms regressed completely. The clinical findings occurring in this patient are discussed.

Arrhythmias, Cardiac↗

PubMed2005

Disseminated and chronic Lyme borreliosis in Norway, 1995 - 2004.

Lyme borreliosis is the most common tickborne infection in Norway. All clinical manifestations of Lyme borreliosis other than erythema migrans are notifiable to Folkehelseinstituttet, the Norwegian Institute of Public Health. During the period 1995-2004 a total of 1506 cases of disseminated and chronic Lyme borreliosis were reported. Serological tests were the basis for laboratory diagnosis in almost all cases. The annual numbers of cases showed no clear trend over the period, but varied each year between 120 and 253 cases, with the highest number of cases reported in 2004. Seventy five per cent of cases with information on time of onset were in patients who fell ill during the months of June to October. There was marked geographical variation in reported incidence rates, with the highest rates reported from coastal counties in southern and central Norway. Fifty six per cent of the cases were in males and 44% in females. The highest incidence rate was found in children aged between 5 and 9 years. Neuroborreliosis was the most common clinical manifestation (71%), followed by arthritis/arthralgia (22%) and acrodermatitis chronica atrophicans (5%). Forty six per cent of patients were admitted to hospital. Prevention of borreliosis in Norway relies on measures to prevent tick bites, such as use of protective clothing and insect repellents, and early detection and removal of ticks. Antibiotics are generally not recommended for prophylaxis after tick bites in Norway.

Adolescent↗

PubMed2005

Necrolytic migratory erythema associated with hyperglucagonemia and neuroendocrine hepatic tumors.

We present a 61-year-old man with a 2-year history of persistent disseminated, psoriasiform annular pruritic lesions, acrodermatitis, weight loss, anemia and diabetes. Histopathology of the affected skin showed nonspecific subacute psoriasiform dermatitis. The computed tomographic scan of the abdomen revealed multiple hepatic tumors. Histopathological examination of ultrasound-guided needle biopsy from a hepatic lesion demonstrated a neuroendocrine tumor. Somatostatin-receptor scintigraphy with radio-labelled octreotide confirmed the likelihood of the neuroendocrine nature of the hepatic tumors and excluded the presence of other such lesions throughout the rest of the body, including the pancreas. The serum glucagon level was markedly increased. The diagnosis of necrolytic migratory erythema associated with hyperglucagonemia and neuroendocrine hepatic tumors was made and therapy with the long-acting somatostatin analogue octreotide was started. The skin changes resolved after the initiation of therapy, but no improvement of other symptoms was observed. Having reached the final stage of the disease, which was further complicated by congestive heart failure, the patient died one year later. As no autopsy was performed, we were unable to establish whether the hepatic tumors represented a metastatic process of previously undetected pancreatic glucagonoma or if they were extra-pancreatic glucagon-secreting tumors. The correct diagnosis of necrolytic migratory erythema is important, since it might be the clue for early detection of glucagonoma or of extra-pancreatic glucagon-secreting tumors.

Antineoplastic Agents, Hormonal↗

PubMedDate not supplied

Transient zinc deficiency in a breast fed, premature infant.

A 5-month-old-male was observed for an acrodermatitis enteropathica-like skin eruption evolving since the second month. He was born prematurely at 27 weeks and his neonatal course was complicated by respiratory distress syndrome, sepsis and subependimary haemorrhage. He was fed with breast milk from the second day of life, fortified initially by a protein mineral supplement containing zinc. Serum zinc concentration was low and the mother's serum and milk had normal zinc values. Oral zinc supplementation was introduced with total clearing after three weeks. Treatment lasted 22 months and no relapse was observed after discontinuation. Premature infants have a negative zinc balance mainly secondary to inadequate stores and high requirements. The relevance of these factors is illustrated by the present case where symptomatic zinc deficiency developed despite maternal milk with normal zinc content and a milk fortifier containing zinc.

Breast Feeding↗

PubMed2006

[Borreliosis--increasing clinical problem].

Lyme disease (LD) is due to infection with Borrelia burgdorferi (B. burgdorferi). We analysed some aspects of epidemiology and clinical manifestation of borreliosis. We tried to estimate the efficiency of diagnostic methods and treatment. We analyzed medical documentation of 300 patients with LD treated in our department between 1993-2001. The diagnosis was made according to Lyme Disease Foundation's criteria. Patients suffering from LD were divided into 3 groups according to stages of the disease. The most frequent manifestation of LD was erythema migrans (EM). The number of LD cases had increased during the observation time. The exposition to tick-bites was greater during summer and early autumn. The great number of patients with EM was observed at the same time. Cases of Lyme arthritis (LA), disseminated EM, Lyme carditis (LC) and neuroborreliosis represented the group number 2. LA, uveitis and acrodermatitis chronica atrophicans (ACA) were diagnosed in the third group of patients. Serological markers of B. burgdorferi infection were found in about 50% of cases of EM and in each patient in group 2 and 3. Complete recovery after antibiotic therapy was observed in every case in early LD and partial one in the late stage.

Adolescent↗

PubMed1991

Acquired zinc deficiency in breast-fed infants.

Zinc deficiency in breast-fed infants is a rare disease caused by a low level of zinc in their mother's milk. Premature infants are more vulnerable to develop zinc deficiency than full-term infants because, despite their high zinc requirements, they have insufficient body stores of zinc and a poor capability to absorb zinc from the gut. The clinical aspect of zinc deficiency is acrodermatitis enteropathica, in which the severity is proportional to the zinc level. The patients respond well to oral zinc supplements.

Breast Feeding↗

PubMed1991

A review and update of the clinical uses of cyclosporine in dermatology.

Cyclosporine is a hitherto unique immunosuppressive agent that has provided a new approach to therapy in autoimmune diseases and has been increasingly used as a molecular tool for the investigation of immune regulation. It has produced excellent therapeutic responses in the treatment of psoriasis, acrodermatitis continua of Hallopeau, pyoderma gangrenosum, lichen planus, pityriasis lichenoides chronica, Behçets disease, and alopecia areata. Cyclosporine's mechanism of action, side effects, pharmacokinetics, and guidelines for patient monitoring, are discussed in this article.

Alopecia↗

PubMed1991

Comments on the course and classification of Lyme borreliosis.

On the basis of answers by clinicians to a questionnaire concerning the classification and staging of Lyme borreliosis, the following classification is proposed: EARLY LYME BORRELIOSIS Localized infection: Erythema migrans and borrelial lymphocytoma without signs or symptoms of disseminated infection. (Regional lymphadenopathy and/or minor constitutional symptoms may be present). Early disseminated infection: Multiple erythema migrans-like skin lesions. Early manifestations of neuroborreliosis, arthritis, carditis or other organ involvement. LATE LYME BORRELIOSIS Chronic infection: Acrodermatitis chronica atrophicans. Neurologic, rheumatic or other organ manifestations--persistent or remitting for at least 12 (or 6) months.

Erythema Chronicum Migrans↗

PubMed1991

Cutaneous manifestations of Lyme borreliosis. Clinical definitions and differential diagnoses.

At the IVth international Conference on Lyme borreliosis the cutaneous manifestations and differential diagnoses were reviewed. Erythema migrans (EM) is a spontaneously healing erythematous lesion occuring at the site of borrelial inoculation. Typically it is homogeneous or is annular with centrifugal spreading. Atypical variants may also occur. Borrelial lymphocytoma (BL) generally presents as a bluish-red nodule. Histologically there is a dense polyclonal lymphocytic infiltrate. Predilection sites are the ear and the breast. It may appear secondarily to EM or be the first manifestation of Lyme borreliosis. EM and BL are early, localized cutaneous manifestations, but sometimes extracutaneous signs or symptoms of disseminated disease may appear simultaneously with either of these lesions. Multiple EM-like lesions, occurring as a result of hematogenous spread, are the cutaneous markers of disseminated disease. Acrodermatitis chronica atrophicans is a chronic skin lesion which is generally seen on the extremities. It starts with an inflammatory phase with bluish-red discoloration, which years to decades later may be followed by an atrophic phase. Sclerotic skin lesions may also develop. Important differential diagnoses are granuloma annulare, malignant lymphoma, benign lymphoreticular infiltrations and sclerotic lesions of non-borrelial origin, collagenoses and circulatory insufficiency.

Diagnosis, Differential↗

PubMed1991

Joint manifestations of Lyme borreliosis in Europe.

Our clinical and serological studies have shown that Lyme arthritis is not a rare manifestation of Lyme borreliosis in Europe. The significance of serological findings for Lyme arthritis have more often remained uncertain in consideration of potential differential diagnoses than was to be expected on the basis of specificity controls. Various joint manifestations in the course of Lyme borreliosis have been distinguished. The succession or the coexistence of intermittent attacks of arthralgias and arthritis has been pointed out as particular indications of Lyme arthritis. We have noted diffuse hand and finger swelling as a striking feature of early Lyme arthritis. Generally, Lyme arthritis has been attributable to Stage 3 of the disease. The most pathognomonic manifestation has been intermittent knee arthritis. The pattern of joint involvement has shown similarities to that in postenteric and postveneral reactive arthritides, in particular as regards the occurence of dactylitis (sausage digits) and heel involvement. However, we have not seen sacroiliitis and Reiter's syndrome. As distinguished from typical Lyme arthritis, peculiar joint manifestations have been noted in association with acrodermatitis chronica atrophicans. Typing of Class I and II histocompatibility antigens did not give evidence of any immunogenetic basis for Lyme arthritis.

Arthritis, Infectious↗

PubMed1991

Neurological manifestations of Lyme borreliosis: clinical definition and differential diagnosis.

Neurological manifestations occur in early disseminated Lyme Borreliosis and in the chronic late stage. Two of them, Bannwarth's syndrome and acrodermatitis chronica atraphicans-associated neuropathy, were known as well defined clinical entities many years prior to the detection of their causative agent. Soon after B. burgdorferi was identified and serologic tests became available, many reports were published which attributed to a large variety of different neurological disorders to Lyme borreliosis. In many cases the diagnosis was primarily based on serodiagnostic results. Yet some scepticism is indicated since 10-30% of the population in endemic areas have been found to be seropositive. While prior to 1983 and before the availability of serodiagnostic tests neurological manifestations of Lyme borreliosis were recognized by a minority of neurologists, they now seem to be overdiagnosed. Therefore clear diagnostic criteria have to be set up. They include the clinical picture, other preceding or concomitant diseases of the Lyme borreliosis complex, serodiagnostic results, cerebrospinal fluid findings, demonstration of intrathecal specific antibody synthesis, results of nerve biopsies, response to adequate antibiotic therapy and exclusion of other diseases. The significance of each of these criteria depends on the clinical involvement and on the stage of Lyme borreliosis.

Diagnosis, Differential↗

PubMed1990

[What is new in genetically-induced hair diseases?].

A profound knowledge of specific genetically determined anomalies of the hair may be of considerable value in the diagnosis of genetic syndromes. We give a review of a few recent developments in the field of genetic hair diseases. For example, the brittle hair due to sulphur deficiency (trichothiodystrophy) is nowadays regarded as genetically heterogeneous; three different syndromes can be distinguished: BIDS syndrome, Tay syndrome, and PIBIDS syndrome. Polarization microscopy revealed a striking resemblance of the hair anomalies found in trichothiodystrophy syndromes and those in acrodermatitis enteropathica. This surprising result indicates similar pathophysiological mechanisms. The Comèl-Netherton syndrome--long regarded as representing two different diseases--has recently been recognized as a clinically variable, but genetically homogeneous syndrome, which is most likely based on a single mutation ("lumping"). Minor's sweat test allows the recognition of women heterozygous for X-linked hypohidrotic ectodermal dysplasia and may help to appreciate seemingly non-specific hair findings, such as diffuse alopecia.

Ectodermal Dysplasia↗

PubMed1990

Detection of serum antibodies against Borrelia burgdorferi with some commercially available serological tests.

Sixty-three sera were analysed for antibodies against Borrelia burgdorferi with an in-house indirect immunofluorescence assay. Thirty-nine sera were positive (titer greater than or equal to 256), seven borderline (titer 128) and 17 negative (titer less than or equal to 64). These results were compared with results obtained with four different commercial assays for detection of such antibodies. Indirect immunofluorescence tests yielded most positive results. The flagellin ELISA test detected antibodies in patients with erythema chronicum migrans (ECM) more often than the other test systems. Sera from patients with acrodermatitis chronica atrophicans (ACA) were positive in all systems. The serological diagnosis of borreliosis is difficult and direct methods for detecting the presence of the microbe are highly needed.

Antibodies, Bacterial↗

PubMed1990

[Lyme borreliosis: underdiagnosed?--overtreated?].

Lyme borreliosis is a tick-borne mediated systemic inflammatory disorder caused by a newly recognized spirochete, Borrelia burgdorferi. Its clinical hallmark is an early expanding skin lesion, erythema chronicum migrans (ECM) which may be followed weeks to months later by neurological, cardiac, or joint abnormalities. Symptoms may be associated with any of these systems alone or in combination. All stages of Lyme borreliosis may respond to antibiotics, but treatment of early disease is the most successful. Foci of Lyme borreliosis are widely distributed within the USA and Europe and the disorder appears to be worldwide. Although there are some variations in clinical expression between the USA and Europe, the various syndromes, Erythema migrans (Afzelius), Meningopolyneuritis [Garin-Bujadoux, Bannwarth (MPN)] are now generally subsumed under the name Lyme borreliosis. B. burdorferi is also responsible for an early skin lesion, Borrelia lymphozytom [Lymphadenosis cutis benigna (LCB)], and for a late one, Acrodermatitis chronica atrophicans (ACA), both seen primarily in Europe. In the USA joint abnormalities are the leading abnormalities in the later manifestation of the disease. Lyme borreliosis grew up in the last ten years as a new nosologic entity with some aspects for an infectious etiology of rheumatic disease.

Anti-Bacterial Agents↗

PubMedDate not supplied

High expression of multinucleated giant cells in cultures of peripheral blood cells from HIV infected patients.

Multinucleated giant cells (MGCs) were detected in cell lines established from peripheral blood lymphocytes of patients with: (a) acquired immunodeficiency syndrome (AIDS) and lymphadenopathy syndrome (LAS), (b) chronic active hepatitis (CAH), (c) papular acrodermatitis (PA) negative for hepatitis B virus antigens but positive for EBV, and (d) epidermolysis bullosa acquisita positive for EBV. All the cell lines established, including those established from AIDS and LAS patients, were examined for the presence of human immunodeficiency virus (HIV) by indirect immunofluorescence with monoclonal antibodies directed against the HIV antigens p17 and p24 and for the presence of reverse transcriptase. All the cell lines were found to be negative for HIV. While the cell lines obtained from AIDS patients still express MGCs after more than two years in culture, their supernatants are negative for reverse transcriptase activity and carry phenotypic markers characteristic of B cells. From the LAS and chronic active hepatitis patients we obtained a monolayer of adherent cells almost completely represented by MGCs that lasted for six and four months, respectively. After this period of time a proliferation process took place. Both the cell lines obtained carry B cell phenotypic markers, but MGCs are still a characteristic only for the LAS-derived cell culture. Non infected patients or normal subjects express MGCs only during the early stage of the cultue. The correlation between the presence of MGCs and a retrovirus infection is discussed in the light of the role of MGCs in the pathogenesis of AIDS.

Cell Line↗