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Furunculosis, caused by Aeromonas salmonicida, poses a significant threat to both salmonid and non-salmonid fish in diverse aquatic environments. This study explores the genomic intricacies of re-emergent A. salmonicida outbreaks in Atlantic salmon (Salmo salar). Previous clinical cases have exhibited pathological characteristics, such as periorbital hemorrhages and gastrointestinal abnormalities. Genomic sequencing of three Chilean isolates (ASA04, ASA05, and CIBA_5017) and 25 previously described genomes determined the pan-genome, phylogenomics, insertion sequences, and restriction-modification systems. Unique gene families have contributed to an improved understanding of the psychrophilic and mesophilic clades, while phylogenomic analysis has been used to identify mesophilic and psychrophilic strains, thereby further differentiating between typical and atypical psychrophilic isolates. Diverse insertion sequences and restriction-modification patterns have highlighted genomic structural differences, and virulence factor predictions can emphasize exotoxin disparities, especially between psychrophilic and mesophilic strains. Thus, a novel plasmid was characterized which emphasized the role of plasmids in virulence and antibiotic resistance. The analysis of antibiotic resistance factors revealed resistance against various drug classes in Chilean strains. Overall, this study elucidates the genomic dynamics of re-emergent A. salmonicida and provides novel insights into their virulence, antibiotic resistance, and population structure.

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RESUMEN Introducción: Las infecciones cutáneas por Staphylococcus aureus, se presentan con alta frecuencia en la comunidad. La forma superficial de esta es la foliculitis. Una extensión hacia el tejido subcutáneo da como resultado la formación de una lesión supurativa local llamada forúnculo. Aproximadamente el 20 % de los pacientes con forúnculo presentan una o más recidivas durante el año siguiente, y cierto número presenta forunculosis recidivante crónica durante meses o años. Objetivo: Conocer el comportamiento de los niveles de IgE y las subclases de IgG expresadas en pacientes y controles, para inferir el patrón de la respuesta inmune a la infección. Métodos: Se realizó un estudio prospectivo donde se determinaron las subclases de inmunoglobulina G (IgG) y los niveles de inmunoglobulina E (IgE) en suero de 25 enfermos con lesiones cutáneas por Staphylococcus aureus, y 25 controles sanos, provenientes del banco de sangre. Se elaboró un antígeno (Bacterina de Staphylococcus aureus) y en su enfrentamiento se procedió con la metodología de normalización y validación de ensayos inmunoenzimáticos para cuantificar IgG humana. Los resultados se expresaron en densidades ópticas y gráficamente como la relación matemática (IgG1/3) para Th1 e (IgE/IgG4) para Th2, en el suero de los pacientes. Resultados: Se obtuvo respuesta IgG1 e IgG4 en pacientes y controles y respuesta IgE anti Staphylococcus aureus en pacientes. Conclusiones: Como Staphylococcus aureus es flora normal de la piel, los controles ya han tenido contacto con él, lo que provoca el desarrollo de respuesta Th1 (IgG1) y anticuerpos bloqueadores (IgG4). Contrariamente, los enfermos desarrollan respuesta Th2 (IgE) y la infección.

ABSTRACT Introduction: Staphylococcus aureus skin infections occur with high frequency in the community. Folliculitis is its superficial form. An extension into the subcutaneous tissue results in the formation of a local suppurative lesion known as a furunculosis. Approximately 20% of patients with a furuncle have one or more recurrences over the next year, and a certain number have chronic relapsing furunculosis for months or years. Objective: to know the manifestation of IgE levels and IgG subclasses expressed in patients and controls, to infer the pattern of the immune response to infection. Methods: we conducted a prospective study where immunoglobulin G (IgG) subclasses and immunoglobulin E (IgE) levels were determined in serum of 25 ill patients with Staphylococcus aureus skin lesions, and 25 healthy controls, from the blood bank. An antigen (Staphylococcus aureus bacterin) was elaborated and in its confrontation, the normalization and validation methodology of immunoenzymatic assays to quantify human IgG was carried out. The results were expressed in optical densities and graphically as the mathematical ratio (IgG1/3) for Th1 and (IgE/IgG4) for Th2, in the serum of the patients. Results: IgG1 and IgG4 responses were obtained in patients and controls, and anti-Staphylococcus aureus IgE responses in patients. Conclusions: the controls have already had contact with Staphylococcus aureus, as it is normal flora of the skin, which causes the development of Th1 response (IgG1) and antibodies blockers (IgG4). On the contrary, ill patients develop a Th2 response (IgE) and the infection.

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RESUMEN Introducción: lesión típica ocasionada por el Staphylococcus aureus es el furúnculo o cualquier otro absceso localizado. Objetivo: describir el comportamiento del proteinograma y los niveles de inmunoglobulinas séricas. Métodos: se realizó un estudio longitudinal prospectivo con 70 pacientes portadores de forúnculos infectados por Staphylococcus aureus, que acudieron a las consultas de Inmunología en varias localidades de Villa Clara. Resultados: se determinaron las fracciones proteicas por método de elusión; se cuantificaron las inmunoglobulinas séricas por inmunodifusión radial simple, según edad, sexo y color de la piel de los pacientes. Se contrastaron las variables bajo la prueba de Ji cuadrado, con una significación de confianza del 95 %. Predominaron los pacientes con el color de la piel blanca sobre los no blancos. En la electroforesis de proteínas se obtuvieron resultados normales para las proteínas totales y la fracción gamma. Para la albúmina, fracción alfa 1, alfa 2 y beta globulina se obtuvieron valores bajos, por encima del 95 % válido. Conclusiones: todas las inmunoglobulinas resultaron normales o altas, según los intervalos de referencia para cada grupo de edad. Al correlacionar los valores de las inmunoglobulinas con las fracciones de la electroforesis, fue llamativo el resultado obtenido en la correlación entre la IgA y la fracción beta. De manera general, los anticuerpos no mostraron variaciones significativas en sus correlaciones, lo cual evidenció un pobre papel en la infección. Se concluyó que los valores de alfa 1, alfa 2 y beta globulina pueden tener importancia en la enfermedad.

ABSTRACT Introduction: the typical lesion caused by Staphylococcus aureus is the furuncle or any other localized abscess. Objective: to describe the manifestation of the proteinogram and serum immunoglobulin levels. Methods: a prospective longitudinal study was carried out in 70 patients with furuncles infected by Staphylococcus aureus, who came to the Immunology consultations from various locations of Villa Clara. Results: protein fractions were determined by elution method; serum immunoglobulins were quantified according to age, gender and skin color of the patients by simple radial immunodiffusion. Variables were contrasted under the Chi-square test, with 95% confidence significance. White patients predominated over non-white ones. Normal results were obtained for total proteins and gamma fraction in protein electrophoresis. Low values were obtained for albumin, alpha 1, alpha 2 and beta globulin fraction, above 95% valid. Conclusions: all immunoglobulins were normal or high, according to the reference intervals for each age group. The result obtained in the correlation between IgA and the beta fraction was striking when correlating the immunoglobulin values with the electrophoresis fractions. In general, the antibodies did not show significant variations in their correlations, which evidenced a poor role in infection. We concluded that alpha 1, alpha 2 and beta globulin values may be important in the disease.

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Background: Canine eosinophilic folliculitis is a dermatological disease of acute onset with development of erosive to ulcerative papular lesions, especially on the nasal bridge, that may cause severe skin abnormalities leading to discomfort and pain to the patient. The aim of this report was to characterize a case of a canine eosinophilic folliculitis with papular, ulcerative and crusting dermatitis on the nasal bridge, papules on eyelid and pinna, with confirmed diagnosis based on aspiration cytology, history and response to immunosuppressive therapy with glucocorticoid. Case: An 1-year-old intact Daschund was attended showing an acute onset (over 4 h) of generalized urticarial reaction and nonpruriginous lesion at the muzzle with mild serosanguineous exudate, which persisted for 96 h when the dog was evaluated. It was observed a papular and ulcerative dermatitis with serosanguineous exudate and hematic crusts at nasal bridge, papules measuring 2 mm in diameter in the medial and lateral canthus of the left eyelid, ulcerative papule with hematic crust in the border of left ear pinna, multifocal papules on the skin, dyskeratosis and generalized hair loss. The patient was anesthetized for blood sampling (CBC and serum biochemistry), lesions fine-needle aspiration, scraping and imprint for cytological examination, bacterial culture and nasal turbinates radiography. Fragments for histopathological evaluation were also collected. Erythrogram and platelet evaluation were unremarkable. Leukogram revealed leukocytosis (neutrophilia, lymphocytosis, monocytosis and eosinophilia). Serum biochemistry revealed hyperalbuminemia and discrete hyperproteinemia; values of alanine aminotransferase, creatinine and globulins were within normal range. In cytological examination, intense cellularity was observed with predominance of eosinophils (60%), neutrophils (35%), macrophages performing cytophagocytosis (5%) and degenerated cells. There was no bacterial growth within 48 h after incubation of nasal bridge lesion swab. There were no abnormalities identified at radiographic evaluation of nasal turbinates. As the patient was already with antibiotic therapy and steroidal anti-inflammatory, it was opted to maintain it, since interruption between the day of examination and laboratory results could cause more prejudice than benefit, corticosteroid dose, however, was readjusted (prednisone 2 mg/kg/per os/every 24h). After 1 week of treatment the owner reported significant improvement of clinical signs without any further complaint. Discussion: Typically, type I hypersensitivity reactions such as insect bites do not exceed clinical signs of erythema, local edema and pruritus, with spontaneous remission of clinical signs within few hours after exposure to the antigen. Eosinophilic folliculitis, however, may cause more severe clinical alterations, such as pain, apathy and hyporexia. Nasal bridge is the predominant site described to be affected in cases of eosinophilic folliculitis, being auricular pinna, thorax and limbs considered atypical presentations which can delay proper diagnosis, since in endemic regions for diseases such as visceral leishmaniasis, infectious etiology may be listed first. Differential diagnosis also includes superficial pyoderma, juvenile cellulitis, pemphigus foliaceus and pharmacodermia. The case described in this report emphasize the importance of an accurate diagnosis as well as an early and adequate treatment in order to promote satisfactory response. Also, highlights inadequate use of antimicrobials as a direct consequence of lack of laboratorial investigation.

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Abstract The severe bacterial diseases discussed herein are those that present dermatological lesions as their initial manifestations, for which the dermatologist is often called upon to give an opinion or is even the first to examine the patient. This review focuses on those that evolve with skin necrosis during their natural history, that is, necrotizing fasciitis, Fournier gangrene, and ecthyma gangrenosum. Notice that the more descriptive terminology was adopted; each disease was individualized, rather than being referred by the generic term "necrotizing soft tissue infections". Due to their relevance and increasing frequency, infections by methicillin-resistant Staphylococcus aureus (MRSA) were also included, more specifically abscesses, furuncle, and carbuncle, and their potential etiologies by MRSA. This article focuses on the epidemiology, clinical dermatological manifestations, methods of diagnosis, and treatment of each of the diseases mentioned.

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The severe bacterial diseases discussed herein are those that present dermatological lesions as their initial manifestations, for which the dermatologist is often called upon to give an opinion or is even the first to examine the patient. This review focuses on those that evolve with skin necrosis during their natural history, that is, necrotizing fasciitis, Fournier gangrene, and ecthyma gangrenosum. Notice that the more descriptive terminology was adopted; each disease was individualized, rather than being referred by the generic term "necrotizing soft tissue infections". Due to their relevance and increasing frequency, infections by methicillin-resistant Staphylococcus aureus (MRSA) were also included, more specifically abscesses, furuncle, and carbuncle, and their potential etiologies by MRSA. This article focuses on the epidemiology, clinical dermatological manifestations, methods of diagnosis, and treatment of each of the diseases mentioned.

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Pediculosis capitis is the most frequent ectoparasitosis around the world. The infestation is caused by Pediculus humanus capitis (head louse), which affects hair, scalp, and skin. It rarely presents with more symptoms and in the majority of the cases, it shows a benign course if treated properly. We present the case of a nursery school girl with head lice infestation for 18 months. She did not improve after the shampoo treatment. This case was associated with furunculosis, skin lesions, multiple adenopathies, and anemia. Initially, the presence of boils, alopecia, and lymphadenopathy was evident. The persistence of pediculosis capitis and intense scratching induced changes on skin integrity, facilitating opportunistic bacterial superinfection that led to impetiginization, furunculosis, excoriations, hematic scabs, anemia, alopecia, and lymphadenopathies. Pediculosis capitis affected the patient triggering psychological, economic, social, and other health problems. The patient presented uncommon symptoms (furunculosis, anemia, fever, alopecia, and adenopathies) resulting from the persistence of risk factors and the absence of head inspection and mechanical removal of insects. The education about the risk factors, as well as sanitary controls, are essential to contain the infestation.

La pediculosis capitis es la ectoparasitosis más frecuente a nivel mundial. La infestación es causada por Pediculus humanus capitis (piojo de la cabeza) y afecta el cabello, el cuero cabelludo y la piel. Rara vez se manifiesta con otro tipo de sintomatología y, por lo general, su curso es benigno si se trata adecuadamente. Se presenta el caso de una menor con pediculosis capitis de 18 meses de evolución, asociada con forúnculos, lesiones cutáneas, múltiples adenopatías y anemia, que no mejoró tras la aplicación del champú. Inicialmente, llamó la atención la presencia de forúnculos, alopecia y adenopatías. La persistencia de la pediculosis capitis y el rascado intenso alteraron la integridad de la epidermis y facilitaron las infecciones secundarias por bacterias patógenas y oportunistas que produjeron impétigo, forunculosis, excoriaciones, costras hemáticas, anemia, alopecia y linfadenopatías. La pediculosis capitis afectó notoriamente a la paciente al causarle problemas psicológicos y de salud, agudizados por su condición económica y social. La paciente presentó manifestaciones clínicas poco frecuentes (forunculosis, anemia, fiebre, alopecia y adenopatías), lo cual se vio facilitado por la persistencia de los factores de riesgo y el hecho de que no se le inspeccionaba la cabeza ni se removían los insectos. La educación sobre los factores de riesgo y el control sanitario es indispensable para controlar la infestación.

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La pediculosis capitis es la ectoparasitosis más frecuente a nivel mundial. La infestación es causada por Pediculus humanus capitis (piojo de la cabeza) y afecta el cabello, el cuero cabelludo y la piel. Rara vez se manifiesta con otro tipo de sintomatología y, por lo general, su curso es benigno si se trata adecuadamente. Se presenta el caso de una menor con pediculosis capitis de 18 meses de evolución, asociada con forúnculos, lesiones cutáneas, múltiples adenopatías y anemia, que no mejoró tras la aplicación del champú. Inicialmente, llamó la atención la presencia de forúnculos, alopecia y adenopatías. La persistencia de la pediculosis capitis y el rascado intenso alteraron la integridad de la epidermis y facilitaron las infecciones secundarias por bacterias patógenas y oportunistas que produjeron impétigo, forunculosis, excoriaciones, costras hemáticas, anemia, alopecia y linfadenopatías. La pediculosis capitis afectó notoriamente a la paciente al causarle problemas psicológicos y de salud, agudizados por su condición económica y social. La paciente presentó manifestaciones clínicas poco frecuentes (forunculosis, anemia, fiebre, alopecia y adenopatías), lo cual se vio facilitado por la persistencia de los factores de riesgo y el hecho de que no se le inspeccionaba la cabeza ni se removían los insectos. La educación sobre los factores de riesgo y el control sanitario es indispensable para controlar la infestación.

Pediculosis capitis is the most frequent ectoparasitosis around the world. The infestation is caused by Pediculus humanus capitis (head louse), which affects hair, scalp, and skin. It rarely presents with more symptoms and in the majority of the cases, it shows a benign course if treated properly. We present the case of a nursery school girl with head lice infestation for 18 months. She did not improve after the shampoo treatment. This case was associated with furunculosis, skin lesions, multiple adenopathies, and anemia. Initially, the presence of boils, alopecia, and lymphadenopathy was evident. The persistence of pediculosis capitis and intense scratching induced changes on skin integrity, facilitating opportunistic bacterial superinfection that led to impetiginization, furunculosis, excoriations, hematic scabs, anemia, alopecia, and lymphadenopathies. Pediculosis capitis affected the patient triggering psychological, economic, social, and other health problems. The patient presented uncommon symptoms (furunculosis, anemia, fever, alopecia, and adenopathies) resulting from the persistence of risk factors and the absence of head inspection and mechanical removal of insects. The education about the risk factors, as well as sanitary controls, are essential to contain the infestation.

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The authors describe a case of infratentorial epidural abscess caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a patient with a recent history of cutaneous furunculosis. This 29-year-old male presented with an occipital headache associated with fever, vomiting, and neck stiffness. Admission magnetic resonance imaging showed a retrocerebellar epidural abscess. Antimicrobial therapy was started, and the patient underwent craniectomy for evacuation of the abscess. Cultures of the surgical specimen were consistent with CA-MRSA. Postoperatively, the patient's condition improved with the resolution of symptoms, and he was discharged home with indication of 6 weeks of antibiotic therapy. Furunculosis is a very rare cause of intracranial epidural abscess but should be considered as a source of infection in an immunocompetent patient.

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[This corrects the article DOI: 10.11604/pamj.2018.29.10.14447.].

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Los abscesos renales son patologías infrecuentes, pero de alta morbi-mortalidad si no son diagnosticados temprano y tratados precozmente. Su vaga e inespecífica sintomatología: dolor abdominal o lumbar, fiebre o mal estado general hacen que su diagnostico sea a veces tardío. La ecografía y/o la TAC dan el diagnóstico en el 100 por ciento de los casos lo que hace posible su tratamiento temprano. El objetivo de este artículo es poner de relieve que el absceso renal es una causa de urgencia urológica a tener presente en pacientes fundamentalmente del sexo femenino, con síntomas de dolor abdominal o fiebre sin clara focalidad urológica.MATERIAL Y MÉTODOS: Se presenta el caso de una adolescente de 16 años con antecedente reciente de forunculosis cutánea supurada en rodilla derecha, que acudió a urgencias por dolor en flanco derecho y fosa iliaca derecha de 10 días de evolución sin fiebre ni síntomas miccionales. Se nos consultó para su valoración, siendo la ecografía el método diagnóstico que se utilizó para la localización de un absceso renal derecho subcapsular de 44 mm en polo superior, y posteriormente para su drenaje percutáneo al no responder porcompleto al tratamiento antibiótico i.v. El cultivo del material purulento del drenaje percutáneo aisló un Staphyloccocus aureus no meticilin resistente. El tratamiento antibiótico i.v asociado a drenaje percutáneo seguido de cloxacilina oral a su alta, curó a la paciente. A raíz de este caso se revisan las series y revisiones sobre abscesos renales de los últimos 10 años, con un total de 179 pacientes, y las publicaciones sobre abscesos renales por Staphyloccocus aureus con tan sólo 13 casos. CONCLUSIONES: Los abscesos renales han de tenerse en cuenta entre las urgencias urológicas. Su diagnóstico y tratamiento percutáneo es mayormente radiológico, reservándose la cirugía abierta o la nefrectomía para abscesos > de 5 cm o pacientes sépticos...

Renal abscesses are infrequent pathologies, but with a high morbidity-mortality if they are not diagnosed and treated early. Its vague and unspecific symptomatology: abdominal or lumbar pain, fever or poor general state, make its diagnosis late sometimes. The ultrasound and/or TAC provide a 100 percent diagnosis of the cases where its early treatment is possible. The objective of this article is to give importance to the fact that renal abscess is a cause of an urological emergency to keep in mind in patients, particularly females with symptoms of abdominal pain or fever without a clear urological focus. MATERIAL AND METHODS: The case of a 16-year-old adolescent is presented with a recent history of festered cutaneous furunculosis on the right knee. She went to the emergency room due to pain on the right side and right illiac fosa with 10 days evolution without fever or urinary symptoms. She came to us for its evaluation, an ultrasound was used for diagnosis to locate a right subcapsular renal abscess of 44 mm on the superior pole, and later for its percutaneous drainage when it did not completely responded to I.V. antibiotic treatment. The culture of the purulent material of the percutaneous drainage isolated a resistant non-methicillin Staphyloccocus aureus. The I.V. antibiotic treatment associated to percutaneous drainage followed by oral cloxacillin upon release cured the patient. CONCLUSIONS: Renal abscesses have to be taken into account among the urological emergencies. Their diagnosis and percutaneous treatment is mainly radiological, leaving open surgery or nephrectomy for abscesses > 5cm or with septic patients...

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Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complet

Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complet

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Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complet

Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complet

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Background: The eosinophilic furunculosis is an uncommon skin disease that affects young dogs aged between two and five years. Sex predilections are not noted. Most reported cases have been in large breeds with abundant access to the outdoors like public gardens and parks. The exact pathogenesis remains unknown but the pattern of lesions development suggests involvement reaction to insect bites and arthropods. The time between contact with the agent and the appearance of lesions is short, often less than 24 h. The skin lesions appear suddenly in the face, usually on the dorsal muzzle and/ or periocular region, pinnae and lips. More rarely on the trunk, chest and legs and it is characterized by predominantly hemorrhagic ulcers with edema. Pustules, nodules and plaques rapidly fistulate and drain serosanguinous exudates. Pruritus is variable, but may be severe. Severely affected dogs may be febrile, lethargic and anoretic. Peripheral blood eosinophilia is seen in the majority of cases. Clinical differential diagnosis include demodicosis, dermatophytosis, nasal deep bacterial folliculitis and furunculosis, pemphigus foliaceus, pemphigus erythematosus and drug reactions. None of these diseases share the fulminant rapid onset of eosinophilic furunculosis. The diagnosis is based on history, clinical signs, cytology and skin biopsies. The treatment involves oral steroids until complete remission of lesions and the antibiotic therapy is indicated in cases of associated bacterial infection. Case: The patient was a 4-year-old, male Pit Bull dog attended in a small animal clinic in Niteroi-Rio de Janeiro, which presented ulcerated, exudative lesions on the dorsal muzzle and right leg. After sedation, clinical examination was performed and an exudate was collected from the ulcerated skin lesion for cytopathological analysis .The slide containing the lesion impression was stained by a quick panoptic method. In order to collect samples, the dog was sedated with a combination of ketamine hydrochloride and acepromazine and a skin fragment was collected from the nasal bridge lesion with a 6 mm punch after local anesthesia with 2% lidocaine hydrochloride. The specimen was fixed in 10% buffered formalin and sent for histopathological analysis. The cytopathological exam revealed a marked eosinophilic inflammation. Histopathological examination revealed ulcerated skin. The epidermis was moderately acanthotic with mild espongiosis and the dermis was characterized by intense eosinophilic folliculocentric inflammations. An extensive folicular rupture, eosinophilic mural foliculitis were presented and PAS staining did not identify fungal structures. Oral prednisone (2 mg/Kg) at 24h intervals was prescribed until complete remission of the lesions. After fifteen days of glucocorticoids therapy, involution of the skin lesions was observed by physical examination and was also reported by the owner. Discussion: The eosinophilic furunculosis is an acute, severe predominantly facial disease of outdoor dogs, which occurrence is rare. The diagnosis and treatment of this disease are frequently neglected because they are not included in the differential diagnosis of diverse cutaneous infections. In view of the scarcity of reports and to alert veterinarians that the disease should be included in the differential diagnosis with other bacterial diseases, this report described a case of canine eosinophilic furunculosis.

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Se realizó un estudio en dos etapas: una primera de casos y controles, analítica y transversal, y una segunda de etapa de intervención longitudinal, prospectiva en los pacientes con forunculosis recidivante. El universo lo constituyeron los pacientes menores de 20 años que asistieron a la consulta de inmunología en el periodo 2006-2010. La muestra fue de 89 pacientes con forunculosis que accedieron a participar en el estudio, y un grupo control de 182 pacientes con síntomas respiratorios ligeros. Se precisó la edad, género, color de la piel y los valores de inmunoglobulinas. Se realizó un exudado nasofaríngeo a convivientes. Se impuso el tratamiento en tres grupos: uno solamente con antibióticos específico para la forunculosis, un segundo grupo recibió tratamiento de convivientes y un tercero del abordaje del segundo grupo, recibió el uso de inmunomoduladores. Los resultados mostraron una asociación de la forunculosis a los niños de mayor edad y de color de piel blanca, además de mostrar una asociación estadística muy significativa entre la presencia de al menos un conviviente con exudado positivo a Staphylococcus aureus (S. aureus) y la posibilidad de desarrollar la forunculosis recidivante. Se hace necesario el uso de antibióticos específicos combinados, el abordaje terapéutico de los convivientes y el uso de inmunomoduladores para lograr el éxito en el tratamiento.

A two- stages study was conducted: the first included the cases and controls, analytical and cross-sectional; and the second stage with a longitudinal and prospective intervention in patients suffering from relapsing furunculosis. The target group was comprised of patients under 20 years old attending to immunology clinic during 2006-2010; the sample, 89 patients with furunculosis who agreed to participate in the study, and a control group of 182 patients with mild respiratory symptoms. Age, gender, skin colour, immunoglobulin levels and nasopharyngeal smear in those presenting coexistence were the variables analyzed. A treatment in three groups was followed: one (1) only with specific antibiotic therapy for furunculosis, besides a second group followed the treatment of those with coexistence, and a third one, with the approach of the second group receiving immunomodulators. Results showed furunculosis in association with children of older ages and white skin, besides a very significant statistical association with at least, one of them, showing coexistence with a positive smear of Staphylococcus aureus (S. aureus) and the possibility to develop relapsing furunculosis. Combined-specific antibiotics are required, as well as the use of the therapeutic approach of those presenting coexistence and immunomodulators to achieve a successful treatment.

RESUMO

Staphylococcus aureus resistente à meticilina (MRSA), outrora isolado especificamente em ambientes hospitalares, vem sendo identificado como causador de infecções cutâneas em pacientes da comunidade. Neste artigo, é relatado um caso do sul do Brasil com furunculose por CA-MRSA. O microrganismo isolado foi submetido a exames de PCR para o gene mecA e para o gene que codifica a leucocidina de Panton-Valentine. Esses exames permitiram a identificação genotípica do CA-MRSA.

Methicillin-resistant Staphylococcus aureus (MRSA), particularly isolated at hospital setting, has been identified in cutaneous infections of community patients. This paper reports a case of furunculosis from the southern Brazil. Dermatologists must be attentive to this emergent etiological diagnosis. The isolated microorganism was subjected to PCR for gene mecA and to PCR for the gene that encodes the leukocidin of Panton-Valentine. These exams enabled genotypic identification of CA-MRSA.

Assuntos

RESUMO

Se realizó un estudio clínico controlado tipo evaluación de tecnología, para evaluar la eficacia del tratamiento homeopático en pacientes afectados de forunculosis recurrente diagnosticados en el Instituto Superior de Medicina Militar "Dr. Luis Díaz Soto". Se seleccionaron 100 pacientes. Cada paciente constituyó su propio control, se tomó como referencia las manifestaciones clínicas y la respuesta al tratamiento. Los medicamentos homeopáticos fueron seleccionados según los criterios de similitud local, además del bioterápico en correspondencia con el microorganismo encontrado. Se logró una curación del 97,0 % de los tratados con la combinación medicamento homeopático y bioterápico, y se redujo la aparición de recidivas. Los medicamentos más utilizados fueron Hepar Sulphur, Silicea y el bioterápico Staphylococcinum.

patients suffering from recurrent furunculosis diagnosed at "Dr. Luis Díaz Soto" Military Central Hospital. 100 patients were selected. Every patient was his own control. The clinical manifestations and the response to treatment were taken as a reference. The homeopathic drugs were selected according to the local similitude criteria, in addition to the biotherapy drug in correspondence with the microorganism found. 97.0 of the treated with the combination of homeopathic and biotherapy drugs were cured, and the appearance of relapses decreased. The most used drugs were Hepar Sulphur, Sisea and Staphylococcinum biotherapy drug.