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Eduardo Calonje MD, DipRCPath, in McKee’s Pathology of the Skin, 2020
Tóm lược đại ý quan trọng trong bài
Pitted keratolysis (keratolysis plantare sulcatum) is an unusual bacterial infection of plantar skin occurring predominantly, but not exclusively, in humid tropical regions of the world.13 The condition has been recorded in soldiers and paddy field workers, but may even be encountered among office workers.47 Although the cause of the disease remained elusive for many years, it was later ascribed to infection withCorynebacterium spp. Two additional Gram-positive organisms have since been implicated:Kytococcus (formerlyMicrococcus)sedentarius andDermatophilus congolensis.13,8,9 The disease occurs predominantly in young men. Children are rarely affected.10 Frequent presenting symptoms include hyperhidrosis, malodor, or even sliminess of the feet.2,7,11 Soreness and pruritus may also occur.D. congolensis causes a variety of dermatitides in domesticated herbivores, and it has been suggested that human infections with the latter organism result from contact with infected animals or contaminated soil.12
As indicated by the name, pitted keratolysis is associated with superficial pitlike erosions of the stratum corneum of the plantar skin. These coalesce to form characteristic crateriform defects which are concentrated on the pressure-bearing areas of the foot (Figs 18.237 and18.238). The circular crateriform pits measure 0.7mm or more in diameter and appear to be distributed along the plantar furrows.13,11,13 Cerebriform maceration is sometimes seen.11 Rarely, the palms may be involved.3,14 The dermatoscopic appearances are said to be characteristic.13 Primary hyperhidrosis has been identified as a risk factor.15 In one report, treatment of hyperhidrosis with botulinum toxin injection led to resolution of pitted keratolysis, suggesting that hyperhidrosis itself plays a pathogenetic role in the condition.16 Additional risk factors include prolonged occlusion with shoes, barefooted walking, maceration, and prolonged contact with water. Pitted keratolysis may occur concurrently with erythrasma and trichobacteriosis, resulting in the so-called corynebacterial triad.3
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David DeLong, in The Laboratory Rabbit, Guinea Pig, Hamster, and Other Rodents, 2012
Dermatophilus congolensis is an actinomycete that infects the skin of many species, producing a superficial, purulent dermatitis with abundant crust formation. Rabbits are susceptible to infection with D. congolensis and have been used as experimental models to study the disease (Abu-Samra and Imbabi, 1976; Abu-Samra and Walton, 1981; Bucek et al., 1992; How and Lloyd, 1990). Only one spontaneous case has been reported, and that was in a cottontail rabbit (S. floridanus). The rabbit had typical lesions, consisting of scabs and heavy encrustations overlying a layer of purulent material. The foot pads, rear legs, and perineum were most severely affected (Shotts and Kistner, 1970). If dermatophilosis is suspected, direct smears of purulent material should be made. D. congolensis can be identified as two or more long parallel rows of Gram-positive cocci.
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Pablo Fernández-Crehuet MD PhD, in Canadian Medical Association Journal, năm ngoái
A 23-year-old man was referred with a one-year history of malodorous exudative lesions on the soles of both feet. His condition seemed temporally related to the use of occlusive footwear at work and was associated with a burning sensation. On physical examination, multifocal, cerebriform maceration and crateriform pitting with superficial erosions were seen on both soles. The pitting became more prominent when the patients feet were water soaked. Examination with a Wood light showed no fluorescence. These skin findings are characteristic of pitted keratolysis. We prescribed clindamycin 1% topical solution twice a day and solution of aluminum chlorohydrate 25% alcoholic solution as antiperspirant. Two weeks later, the patients condition had improved substantively.
Pitted keratolysis is common among athletes and individuals in professions with greater use of occlusive footwear.1 Patients may experience hyperhidrosis, foot odour and sometimes itching or burning while walking, although most cases are asymptomatic. The lesions tend to be multiple, superficial rounded depressions, 0.5 to 7 mm in diameter, affecting mainly weight-bearing areas of the soles. Palms are less commonly involved. The condition is caused by an infection of the stratum corneum byKytococcus sedentarius (formerlyMicrococcus spp.), thoughDermatophilus congolensis andCorynebacterium spp. have also been implicated.2 Bacteria proliferate and produce proteinases that destroy the stratum corneum, producing the characteristic craters or pits. The odour linked to pitted keratolysis is due to the production of sulphur compounds.
The main differential diagnosis includes tinea pedis, verrucae, punctate palmoplantar keratoderma and palmoplantar hypokeratoses.3
The diagnosis is clinical.2,3 Cultures, if taken, show gram-positive coccobacilli or bacilli. Examination with a Wood light is not reliable for diagnosis and may be negative or show coral-red fluorescence whenCorynebacterium spp. is implicated.2 Dermoscopy usually reveals abundant pits with well-marked walls that sometimes show the bacterial colonies.4 A potassium hydroxide examination of the lesions can exclude tinea pedis.3
Figure 1. Multifocal, cerebriform maceration and crateriform pitting with superficial erosions in both soles of a 23-year-old man with a one-year history of foot discomfort and odour associated with the use of occlusive footwear.
Changing footwear and socks regularly as well as airing out or rotating shoes is key to management. Topical antibiotics are the first line of medical treatment.1,3 Erythromycin 1% (solution or gel), clindamycin, fusidic acid or mupirocin 2% are recommended.1,3 Botulinum toxin or iontophoresis for localized treatment of sweating may be useful.1 There is also evidence for adding benzoyl peroxide to the antibiotics treatment.5 Prognosis is excellent, and lesions usually resolve in three to four weeks.
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Margaret L. Delano, … Wendy J. Underwood, in Laboratory Animal Medicine (Second Edition), 2002
Dermatophilus congolensis is an aerobic, gram-positive, filamentous bacterium with branching hyphae. Dermatophilosis is a chronic bacterial skin disease characterized by crustiness and exudates accumulating at the base of the hair or wool fibers (Scanlan et al., 1984).
Animals will be painful but will not be pruritic. Two forms of the disease exist in sheep: mycotic dermatitis (also known as lumpy wool) and strawberry foot rot. Mycotic dermatitis is characterized by crusts and wool matting, with exudates over the back and sides of adult animals and about the face of lambs. Strawberry foot rot is rare in the United States but is characterized by crusts and inflammation between the carpi and/or tarsi and the coronary bands. Animals will be lame. In goats and cattle, similar clinical signs of crusty, suppurative dermatitis are seen; the disease is often referred to as cutaneous streptothricosis in these species. Lesions in younger goats are seen along the tips of the ears and under the tail.
Diagnosis is based on clinical signs as well as the typical microscopic appearance on stained skin scrapings, cultures, and serology.
The disease occurs worldwide, and the Dermatophilus organism is believed to be a saprophyte. Transmission occurs by direct or indirect contact and is aggravated by prolonged wet wool or hair associated with inclement weather. Biting insects may aid in transmission.
Lymphadenopathy as well as liver and splenic changes may be observed. Histopathologically, superficial epidermal layers are necrotic and crusted with serum, white blood cells, and wool or hair. Dermal layers are hyperemic and edematous and may be infiltrated with mononuclear cells.
Lesions typically begin around the muzzle and hooves and the dorsal midline.
Potash alum and aluminum sulfate have been used as wool dusts in sheep to prevent dermatophilosis. Minimizing moist conditions is helpful in controlling and preventing the disease. In addition, controlling external parasites or other factors that cause skin lesions is important. Lesions will resolve during dry periods.
Animals can be treated with antibiotics such as penicillin and oxytetracycline. Treating the animals with povidone-iodine shampoos or chlorhexidine solutions is also useful in clearing the disease.
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Wendy J. Underwood DVM, MS, DACVIM, … Adam Schoell DVM, DACLAM, in Laboratory Animal Medicine (Third Edition), năm ngoái
Etiology
Dermatophilus congolensis is a gram-positive, nonacid-fast, facultative anaerobic actinomycete. Dermatophilosis is a chronic bacterial skin disease characterized by crustiness and exudates accumulating at the base of the hair or wool fibers. Various strains can be present within a group of animals experiencing an outbreak. The natural habitat of the organism is unknown as it has not been successfully isolated from soil.
Clinical Signs
Animals will be painful but not pruritic. Two forms exist in sheep, mycotic dermatitis (also known as lumpy wool) and strawberry footrot. Mycotic dermatitis is characterized by crusts and wool matting with exudates over the back and sides of adult animals and about the face of lambs. Strawberry footrot is rare in the United States but is characterized by crusts and inflammation between the carpi and/or tarsi and the coronary bands. Animals will be lame. In goats and cattle, similar clinical signs of crusty, suppurative dermatitis are seen; the disease is often referred to as cutaneous streptothricosis in these species. In cattle, most lesions are raised, matted tufts of hair and are distributed over the head, dorsal surfaces of the neck and body toàn thân. Lesions in younger goats are seen along the tips of the ears and under the tail. Most affected animals will recover within 34 weeks and lesions have little effect on overall health. Animals that develop severe generalized infections often lose condition. Movement and eating become difficult if the feet, lips and muzzle are involved. Cattle with lesions over 50% of their bodies are likely to become seriously ill. Rare human infections have occurred from handling diseased animals.
Diagnosis
Diagnosis is based on clinical signs as well as the typical microscopic appearance on stained skin scrapings and crusts, cultures and serology. The organism can be isolated via culture and/or skin biopsy.
Epizootiology and Transmission
The disease occurs worldwide and the Dermatophilus organism is believed to be a saprophyte. Transmission occurs by direct contact with infected animals, although contaminated environments and biting insects are also suspected indirect methods of transmission. Development of disease may be influenced by factors such as prolonged wetness, high humidity, high temperatures, and ectoparasites such as ticks and lice which serve to reduce the natural barriers of the skin.
Necropsy Findings
Death is unusual so necropsy is not often performed.
Prevention and Control
Potash alum and aluminum sulfate have been used as wool dusts in sheep to prevent dermatophilosis. Minimizing moist conditions is helpful in controlling and preventing the disease. In addition, controlling external parasites or other factors that cause skin lesions is important. Lesions will resolve during dry periods.
Treatment
Animals can be treated with antibiotics such as penicillin and oxytetracycline as the organism is susceptible to a wide range of antibiotics. Antimicrobial therapy is augmented by topical applications of lime sulfur as well as control of ectoparasites and biting flies. Treating the animals with povidone iodine shampoos or chlorhexidine solutions also is useful in clearing the disease.
Research Complications
D. congolensis is a zoonotic organism. Research personnel must be trained in zoonosis and should fully understand the risks of working with infected animals.
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Bradley L. Njaa, in Pathologic Basis of Veterinary Disease (Sixth Edition), 2017
Dermatophilosis (Streptothrichosis)
Dermatophilosis (also known as streptothrichosis) is caused by Dermatophilus congolensis and is a zoonotic bacterium of the skin and mucosae of the nose, commissures of the lips, distal or proximal limbs, and ears but may proliferate virtually anywhere on the body toàn thân. The bacterium prefers moist areas and requires the integrity (i.e., barrier) of the skin to be impaired. Thus damaged skin with scabs and crusts on the face and ears are sites of colonization by D. congolensis in younger animals. D. congolensis is transferred during nursing from damp and traumatized skin of the inguinal region of lactating dams to the ears of nursing kids (Fig. 20-34). Colonization begins by invasion of flagellated zoospores that penetrate the epidermis and reach the level of the basement membrane, in which they transform to a filamentous structure. They also penetrate into the dermis and follicular adnexa, inciting a prominent neutrophilic response. This acute inflammation halts further invasion. However, residual bacteria colonies are able to invade nascent, regenerated epidermis. This cycle of bacterial growth, inflammation, and epidermal regeneration leads to the multilaminated pustular crusts so typical of dermatophilosis. Damage to the cutaneous barrier system can also be caused by other invasive bacteria, fungi, or ectoparasites such as mites and ticks. Macroscopically, lesions are characterized by a crusting and exudative dermatitis (see Chapter 17) with thick crusts covering an epidermis that is ulcerated and hemorrhagic. Microscopically, crusts are made of alternating layers of markedly parakeratotic hyperkeratosis, degenerate neutrophils, and coagulative necrosis, all laden with D. congolensis. It can be identified by its filamentous structure with longitudinal and transverse septa (see Fig. 17-48).
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David B. Taylor, in Reference Module in Biomedical Sciences, 2020
Dermatophilosis is a pustular and crusting dermatitis in sheep, goats, cattle, horses, cats, and rabbits caused by Dermatophilus congolensis, a facultative anaerobic, branching Actinomyces. Although D. congolensis has a worldwide distribution, most cases of dermatophilosis are observed in the moist tropics (Zaria, 1993). On cattle, lesions on the lower body toàn thân and legs are usually attributed to tick bites or initial damage to the epidermis by vegetation. However, lesions on the backs have been attributed to flies (Stewart, 1972). Richard and Pier (1966) demonstrated transmission of D. congolensis from rabbit to rabbit with stable flies. However, Philpoot and Ezeh (1978) found transmission from bovine to bovine by Stomoxys spp. to be rare and conclude that they are probably not primary vectors because of their predilection to bite on the lower body toàn thân and legs whereas the dermatophilosis lesions were on the back of the cattle.
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Howard B. Pride, in Pediatric Dermatology, 2008
Superficial pits on the plantar foot with foul odor (toxic sock syndrome)
Corynebacterium species, Micrococcus sedentarius, or Dermatophilus congolensis
Clindamycin or erythromycin topically
Clinical presentation
Pitted keratolysis is a superficial infection, seen almost exclusively on the weight-bearing areas of the plantar foot and around the toes. It is more common in males, particularly those whose feet are excessively sweaty, in a wet environment, or in boots for long periods. It is associated with a noxious, socially isolating odor and slimy texture but is otherwise asymptomatic. Small, 12-mm, noninflamed craters that coalesce into larger depressed patches are noted on exam (Figure 4-14).
Diagnosis
The diagnosis is often obvious upon entering the exam room when a rancid, suffocating odor can be immediately detected. The examination is usually diagnostic, although a KOH scraping may help differentiate tinea pedis. Culture and superficial shave biopsies are seldom needed. Plantar warts can be excluded by paring with a scalpel blade.
Pathogenesis
Pitted keratolysis is a superficial infection of the stratum corneum with Corynebacterium species, Micrococcus sedentarius, or Dermatophilus congolensis. The stratum corneum is digested by proteolytic enzymes produced by the organisms.
Treatment
Various topical regimens work very well. Clindamycin or erythromycin in a 2% solution and mupirocin are effective. Aluminum chloride (Drysol or Certain Dry) will help control sweating and patients should try to keep their feet dry as much as possible. Oral erythromycin, clindamycin, and tetracycline are effective but not usually necessary.
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Jules J. Berman, in Taxonomic Guide to Infectious Diseases, 2012
Infectious species:
Actinomyces gerencseriae (dental plaque)
Actinomyces israelii (actinomycosis)
Arcanobacterium haemolyticum, formerly Corynebacterium haemolyticum (pharyngitis)
Corynebacterium diphtheriae (diphtheria)
Corynebacterium minutissimum (erythrasma)
Corynebacterium pseudotuberculosis (ulcerative lymphangitis in horses and cattle, rarely causing lymphadenitis in humans)
Corynebacterium jeikeium (sepsis)
Dermatophilus sp. (dermatophilosis, pitted keratolysis)
Dermatophilus congolensis (dermatophilosis, mud fever, pitted keratolysis)
Mycobacterium abscessus (chronic pulmonary disease, wound infections, in immune-compromised patients)
Mycobacterium avium (persistent cough, can cause disseminated disease, including bone marrow infection, in immune-compromised individuals, collarstud abscess of neck lymph node in children)
Mycobacterium haemophilum (collarstud abscess of neck lymph node in children)
Mycobacterium intracellulare (persistent cough, can cause disseminated disease in immune-compromised individuals)
Mycobacterium scrofulaceum (cervical lymphadenitis in children)
Mycobacterium chelonae (granulomatous and acute inflammatory infections of skin and soft tissues)
Mycobacterium fortuitum (pulmonary diseases, post-surgical wound abscesses, sepsis with multi-organ involvement)
Mycobacterium kansasiim (aquarium granuloma)
Mycobacterium leprae (leprosy, Hansen disease)
Mycobacterium lepromatosis (leprosy, Hansen disease)
Mycobacterium malmoense (cervical lymphadenitis in children, pulmonary disease in adults with pre-existing lung conditions)
Mycobacterium marinum (aquarium granuloma)
Mycobacterium paratuberculosis (suspected to cause some cases of Crohns disease)
Mycobacterium simiae (granulomatous lung disease)
Mycobacterium szulgai (tuberculosis-like pulmonary infection, disseminated disease in immune-compromised individuals)
Mycobacterium tuberculosis complex, including Mycobacterium caprae, Mycobacterium tuberculosis, Mycobacterium africanum, Mycobacterium bovis, Mycobacterium bovis BCG, Mycobacterium microti, Mycobacterium canettii, Mycobacterium pinnipedii, Mycobacterium mungi (tuberculosis)
Mycobacterium tuberculosis (tuberculosis)
Mycobacterium ulcerans (Buruli ulcer)
Mycobacterium xenopi (Mycobacterium xenopi pneumonia)
Nocardia asteroides (nocardiosis)
Nocardia brasiliensis (nocardiosis)
Nocardia caviae (nocardiosis)
Nocardia farcinica (nocardiosis)
Nocardia nova (nocardiosis)
Nocardia otitidiscaviarum (nocardiosis)
Rhodococcus equi, formerly Corynebacterium equi, formerly Bacillus hoagii, formerly Corynebacterium purulentus, formerly Mycobacterium equi, formerly Mycobacterium restrictum, formerly Nocardia restricta, formerly Proactinomyces restrictus (chronic pulmonary infection simulating tuberculosis)
Tropheryma whipplei, formerly Tropheryma whippelii (Whipple disease)
Actinomadura madurae (mycetoma, maduromycosis, madura foot)
Actinomadura pelletieri (mycetoma)
Gardnerella vaginalis, formerly Corynebacterium vaginalis, formerly Haemophilus vaginalis (vaginosis)
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