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Topical gentian violet for the treatment of methicillin-resistant Staphylococcus aureus
P2305
P2307
Shewanella algae infection overlying angiokeratoma circumscriptum Karthik Krishnamurthy, Saint Barnabas Hospital, Bronx, NY, United States; Cindy Hoffman, DO, Saint Barnabas Hospital, Bronx, NY, United States; Yekaterina Kleydman, DO, North ShoreePlainview Hospital, Plainview, NY, United States Shewanella spp. are unusual and rare sources of skin infection. These emerging human pathogens are saprophytic, Gram-negative motile rods, whose most unique characteristic is the production of hydrogen sulfide. Shewanella was first isolated from dairy products and classified as Achromobacter putrefaciens by Curtiss in 1931. A common isolate from putrid fish, it was later reclassified under Pseudomonas spp. Recently, based on growth characteristics and genetic sequencing, the organism now occupies its own genus, Shewanella. Two species have been found in clinical specimens, namely S putrefaciens and Shewanella algae. Although Shewanella infection in humans is rare, S algae has recently been recognized as the predominant human pathogen within the genus. Important differential b-hemolytic characteristics between the species include the ability to produce colonies on sheep blood agar, to grow at 428C and in hypertonic sodium chloride, to reduce nitrate, and to produce acid from maltose. Human infections with Shewanella are rare, although the number of reported cases has been increasing. The pathogen is not usually found in human wounds and is infrequently recovered from clinical specimens. In the past, cases of human Shewanella infections reported have been mainly from geographic areas with warm climates or during especially warm summers in temperate climates. Shewanella can be found in seawater, fresh water, fish, and soil. Therefore, infection with the pathogen must now be considered if a history of marine or freshwater contact is obtained. Previously reported, the organism has been associated with otitis media, infections of preexisting ulcers of the lower limbs, and systemic infections in patients with severe debility, liver disease, end-stage renal disease, or malignancy. Primary bacteremia with a fulminant course has also been documented in immunocompromised patients. We present a 16-year-old female with a newonset, greenish-black, malodorous, viscous plaque overlying her congenital angiokeratoma circumsciptum, a rare vascular malformation. Preliminary cultures grew Pseudomonas spp.; however; the patient did not clinically respond to appropriate treatment. A second culture obtained revealed S algae, which is sensitive to gentamicin.
Topical gentian violet for the treatment of methicillin-resistant Staphylococcus aureus Daniel Siegel, MD, SUNY Downstate, Brooklyn, NY, United States; Michael Berry, MD, SUNY Downstate, Brooklyn, NY, United States; Wei Lee, MD, PhD, SUNY Downstate, Brooklyn, NY, United States The problem of methicillin-resistant Staphylococcus aureus (MRSA) and the ineffectiveness of commonly prescribed treatments may lead to an epidemic from virulent strains. Gentian violet (GV) has been used for decades worldwide for the treatment of a wide range of infections ranging from Gram-negative and Grampositive bacteria to both fungal and candidal infections. GV has proven to be a safe and cost effective medication, with the only side effects in humans being that of rare contact sensitization and also the inconvenience of staining of clothes. Previous clinical studies have shown GV to be extremely effective against MRSA with eradication of MRSA in 100% of patients in some studies. In our study, the bactericidal effect of GV against seven strains of MRSA was studied in vitro. Varying concentrations of GV were incubated with 2.1 3 107 CFU/mL in medium and incubated at 378C for 24 hours. Minimum inhibitory concentration of gentian violet to MRSA was between 0.00015% and 0.00063% for all seven strains. These in vitro results, along with previously published clinical data, favorable side effect profile, and cost suggest that gentian violet may be one of the more useful drugs for the treatment of the skin lesions infected with MRSA. Commercial support: None identified.
Commercial support: None identified.
P2308
Leprosy Terrance Brogan, Indiana University Medical Center, Indianapolis, IN, United States This poster abstract is a description of a case of leprosy that presented in Indianapolis with generalized, recurrent subcutaneous asymptomatic nodules. In addition, the patient’s wife noted a several month history of darkening of his facial skin with a graying discoloration. After a prolonged extensive evaluation, a diagnosis of lepromatous leprosy was made. This case describes the evaluation and work-up for leprosy in an area of the United States with a low incidence. The subcutaneous nodules are consistent with leprosy, but the gray discoloration in the face and ears is rare and to date has not been published in the literature.
Determination of the effects of a myeloperoxidase formulation on wounds inoculated with Staphylococcus aureus using a porcine model Stephen Davis, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Joel Gil, University of Miami Miller School of Medicine, Miami, FL, United States; Roberto Perez, University of Miami Miller School of Medicine, Miami, FL, United States; Yan Rivas, University of Miami Miller School of Medicine, Miami, FL, United States As part of the normal inflammatory process, human phagocytes employ myeloperoxidase (MPO) to eliminate bacteria from wounds. Staphylococcal species have been estimated to infect more than 70% of wounds because of the prevalence of the bacteria on the skin and the high incidence of resistance to antimicrobial treatments. It has been suggested that chronicity of wounds can be associated with a persistent elevation in bacterial counts, resulting in a prolonged and more intense inflammatory response. Herein, we present research conducted to investigate the ability to combat Staphylococcus aureus infection in a porcine partial thickness wound model using a broad-spectrum MPO containing formulation (E-101 solution) that in vitro kills Gram-positive and -negative bacteria. Swine were used in the study because of the similarities of porcine skin to human skin. Deep partial thickness wounds (10 3 7 3 0.5 mm) were made on each animal using a specialized electrokeratome. Wounds (6 per treatment) were inoculated with S aureus. Wounds were treated with a high or low concentration of E-101 solution, placebo, saline, or mupirocin, which served as a positive control. Untreated wounds served as a negative control. Treatments were applied 20 minutes after inoculation, 4 hours after initial treatment, and 24 hours after initial treatment, at which time the bacteria were recovered using catalase solution and a neutralizing solution for mupirocin. Recovered bacteria were plated on mannitol salt agar using the Spiral Plater System and the Log CFU/mL determined after overnight incubation. Treatment with E-101 solution reduced the 8 Log CFU/mL of challenge pathogens recovered from the untreated wounds by 3 Log (P\.01). There was no difference in the placebo, saline, or untreated groups. As expected, mupirocin cream resulted in no detectable wound bacteria. These results indicate that treatment with this broad-spectrum MPO containing formulation is effective in reducing the number of S aureus in wounds, which may have important clinical implications compared to drugs that lack its ability to kill Gram-positive and -negative bacteria.
Commercial support: None identified.
Commercial support: US Army/Exoxemis Inc.
P2306
AB108
J AM ACAD DERMATOL
MARCH 2009
P2307
Shewanella algae infection overlying angiokeratoma circumscriptum Karthik Krishnamurthy, Saint Barnabas Hospital, Bronx, NY, United States; Cindy Hoffman, DO, Saint Barnabas Hospital, Bronx, NY, United States; Yekaterina Kleydman, DO, North ShoreePlainview Hospital, Plainview, NY, United States Shewanella spp. are unusual and rare sources of skin infection. These emerging human pathogens are saprophytic, Gram-negative motile rods, whose most unique characteristic is the production of hydrogen sulfide. Shewanella was first isolated from dairy products and classified as Achromobacter putrefaciens by Curtiss in 1931. A common isolate from putrid fish, it was later reclassified under Pseudomonas spp. Recently, based on growth characteristics and genetic sequencing, the organism now occupies its own genus, Shewanella. Two species have been found in clinical specimens, namely S putrefaciens and Shewanella algae. Although Shewanella infection in humans is rare, S algae has recently been recognized as the predominant human pathogen within the genus. Important differential b-hemolytic characteristics between the species include the ability to produce colonies on sheep blood agar, to grow at 428C and in hypertonic sodium chloride, to reduce nitrate, and to produce acid from maltose. Human infections with Shewanella are rare, although the number of reported cases has been increasing. The pathogen is not usually found in human wounds and is infrequently recovered from clinical specimens. In the past, cases of human Shewanella infections reported have been mainly from geographic areas with warm climates or during especially warm summers in temperate climates. Shewanella can be found in seawater, fresh water, fish, and soil. Therefore, infection with the pathogen must now be considered if a history of marine or freshwater contact is obtained. Previously reported, the organism has been associated with otitis media, infections of preexisting ulcers of the lower limbs, and systemic infections in patients with severe debility, liver disease, end-stage renal disease, or malignancy. Primary bacteremia with a fulminant course has also been documented in immunocompromised patients. We present a 16-year-old female with a newonset, greenish-black, malodorous, viscous plaque overlying her congenital angiokeratoma circumsciptum, a rare vascular malformation. Preliminary cultures grew Pseudomonas spp.; however; the patient did not clinically respond to appropriate treatment. A second culture obtained revealed S algae, which is sensitive to gentamicin.
Topical gentian violet for the treatment of methicillin-resistant Staphylococcus aureus Daniel Siegel, MD, SUNY Downstate, Brooklyn, NY, United States; Michael Berry, MD, SUNY Downstate, Brooklyn, NY, United States; Wei Lee, MD, PhD, SUNY Downstate, Brooklyn, NY, United States The problem of methicillin-resistant Staphylococcus aureus (MRSA) and the ineffectiveness of commonly prescribed treatments may lead to an epidemic from virulent strains. Gentian violet (GV) has been used for decades worldwide for the treatment of a wide range of infections ranging from Gram-negative and Grampositive bacteria to both fungal and candidal infections. GV has proven to be a safe and cost effective medication, with the only side effects in humans being that of rare contact sensitization and also the inconvenience of staining of clothes. Previous clinical studies have shown GV to be extremely effective against MRSA with eradication of MRSA in 100% of patients in some studies. In our study, the bactericidal effect of GV against seven strains of MRSA was studied in vitro. Varying concentrations of GV were incubated with 2.1 3 107 CFU/mL in medium and incubated at 378C for 24 hours. Minimum inhibitory concentration of gentian violet to MRSA was between 0.00015% and 0.00063% for all seven strains. These in vitro results, along with previously published clinical data, favorable side effect profile, and cost suggest that gentian violet may be one of the more useful drugs for the treatment of the skin lesions infected with MRSA. Commercial support: None identified.
Commercial support: None identified.
P2308
Leprosy Terrance Brogan, Indiana University Medical Center, Indianapolis, IN, United States This poster abstract is a description of a case of leprosy that presented in Indianapolis with generalized, recurrent subcutaneous asymptomatic nodules. In addition, the patient’s wife noted a several month history of darkening of his facial skin with a graying discoloration. After a prolonged extensive evaluation, a diagnosis of lepromatous leprosy was made. This case describes the evaluation and work-up for leprosy in an area of the United States with a low incidence. The subcutaneous nodules are consistent with leprosy, but the gray discoloration in the face and ears is rare and to date has not been published in the literature.
Determination of the effects of a myeloperoxidase formulation on wounds inoculated with Staphylococcus aureus using a porcine model Stephen Davis, MD, University of Miami Miller School of Medicine, Miami, FL, United States; Joel Gil, University of Miami Miller School of Medicine, Miami, FL, United States; Roberto Perez, University of Miami Miller School of Medicine, Miami, FL, United States; Yan Rivas, University of Miami Miller School of Medicine, Miami, FL, United States As part of the normal inflammatory process, human phagocytes employ myeloperoxidase (MPO) to eliminate bacteria from wounds. Staphylococcal species have been estimated to infect more than 70% of wounds because of the prevalence of the bacteria on the skin and the high incidence of resistance to antimicrobial treatments. It has been suggested that chronicity of wounds can be associated with a persistent elevation in bacterial counts, resulting in a prolonged and more intense inflammatory response. Herein, we present research conducted to investigate the ability to combat Staphylococcus aureus infection in a porcine partial thickness wound model using a broad-spectrum MPO containing formulation (E-101 solution) that in vitro kills Gram-positive and -negative bacteria. Swine were used in the study because of the similarities of porcine skin to human skin. Deep partial thickness wounds (10 3 7 3 0.5 mm) were made on each animal using a specialized electrokeratome. Wounds (6 per treatment) were inoculated with S aureus. Wounds were treated with a high or low concentration of E-101 solution, placebo, saline, or mupirocin, which served as a positive control. Untreated wounds served as a negative control. Treatments were applied 20 minutes after inoculation, 4 hours after initial treatment, and 24 hours after initial treatment, at which time the bacteria were recovered using catalase solution and a neutralizing solution for mupirocin. Recovered bacteria were plated on mannitol salt agar using the Spiral Plater System and the Log CFU/mL determined after overnight incubation. Treatment with E-101 solution reduced the 8 Log CFU/mL of challenge pathogens recovered from the untreated wounds by 3 Log (P\.01). There was no difference in the placebo, saline, or untreated groups. As expected, mupirocin cream resulted in no detectable wound bacteria. These results indicate that treatment with this broad-spectrum MPO containing formulation is effective in reducing the number of S aureus in wounds, which may have important clinical implications compared to drugs that lack its ability to kill Gram-positive and -negative bacteria.
Commercial support: None identified.
Commercial support: US Army/Exoxemis Inc.
P2306
AB108
J AM ACAD DERMATOL
MARCH 2009