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    <recommendedItem id="20090101_19_743"
                     title="AAD: Tattoos Linked to Nontuberculous Mycobacterial Infections"
                     score="-0.005"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAD/tb/13228?impressionId=1265744617209"
                     
      SAN FRANCISCO, March 11 -- Skin irritations in a fresh tattoo may harbor nontuberculous mycobacterial infection that can be overlooked or misdiagnosed, according to a small patient series reported here.
              &lt;p&gt; 
              &lt;p&gt;Even with appropriate antibiotics, the skin infections can take months to clear, researchers said.
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              &lt;p&gt;All of the patients involved had other diagnoses before physicians identified the real culprit, &lt;em&gt;Mycobacterium chelonae&lt;/em&gt;, according Lisa Drage, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues at the American Academy of Dermatology meeting.
              &lt;p&gt; 
              &lt;p&gt;In all cases, the &lt;em&gt;M. chelonae&lt;/em&gt; isolates proved susceptible to macrolide antibiotics.
              &lt;p&gt; 
              &lt;p&gt;&quot;The incidence of rapidly growing mycobacterium associated with tattoos is unknown, and the world&apos;s literature is limited,&quot; the investigators concluded in a poster presentation.
              &lt;p&gt; 
              &lt;p&gt;&quot;Our series highlights the variable clinical presentation and delayed diagnosis of rapidly growing mycobacterial infections,&quot; they continued.
              &lt;p&gt; 
              &lt;p&gt;&quot;While tissue culture is the gold standard for diagnosis, isolation of rapidly growing mycobacterium remains a challenge. Treatment of &lt;em&gt;M. chelonae&lt;/em&gt; should be guided by susceptibility studies and may be required for up to six months.&quot;
              &lt;p&gt; 
              &lt;p&gt;Most pathogenic species of nontuberculous mycobacteria have been associated with skin and soft-tissue infections. However, the rapidly emerging mycobacteria, which include &lt;em&gt;M. chelonae&lt;/em&gt;, have become increasingly important causes of localized cutaneous infections, the investigators said.
              &lt;p&gt; 
              &lt;p&gt;Dr. Drage and colleagues described a community outbreak of &lt;em&gt;M. chelonae&lt;/em&gt; associated with tattoos traced to a single artist at a single establishment. The index case was a 49-year-old man, who developed red papules within a tattoo on his upper left arm within a week of application.
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              &lt;p&gt;Despite the skin eruptions, the man had a second tattoo applied to the left side of his chest. Within two weeks, more than 100 small pustules and red papules developed within the chest tattoo site.
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              &lt;p&gt;Following punch biopsy of the chest site, histopathologic examination revealed lymphohistiocytic infiltrate, but no organisms were identified on staining. Acid-fast bacilli smears also were negative. Culture of the specimen grew &lt;em&gt;M. abscessus/chelonae&lt;/em&gt;, subpecies &lt;em&gt;chelonae&lt;/em&gt;.
              &lt;p&gt; 
              &lt;p&gt;The investigators began empiric therapy with clarithromycin, and susceptibility testing confirmed sensitivity to macrolides. The skin lesions had improved at three-week follow-up and continued to improve but did not completely clear until six months.
              &lt;p&gt; 
              &lt;p&gt;A review of medical records revealed five additional cases of &lt;em&gt;M. chelonae&lt;/em&gt; infection associated with tattoos from October 2007 to May 2008. All of the cases arose within two weeks of tattoo creation. However, the median time from tattoo to diagnosis was 17.6 weeks.
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              &lt;p&gt;The skin lesions had a variable appearance that included pink, red, and purple papules; scaly papules; granulomatous papules; lichenoid papules; pustules; and plaques. All of the lesions were concentrated in an area of gray wash within the tattoo.
              &lt;p&gt; 
              &lt;p&gt;All of the patients sought medical care as soon as the skin eruptions occurred, and they were treated unsuccessfully with topical and oral antibiotics and topical steroids. Subsequently, &lt;em&gt;M. chelonae&lt;/em&gt; was isolated from three biopsy specimens, two tissue cultures, and one swab culture of a pustule.
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              &lt;p&gt;Four patients were treated with clarithromycin and one with azithromycin. The sixth patient was lost to follow-up. All of the treated patients had complete clearance of skin lesions and have had no recurrences.
              &lt;p&gt; 
              &lt;p&gt;The investigators concluded that physicians should consider rapidly growing mycobacterial infections in any patient who has skin lesions that arise within a new tattoo.
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&lt;tr&gt;&lt;td&gt;Dr. Drage reported no financial relationships.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
       
    </recommendedItem>
    <recommendedItem id="20090101_19_1706"
                     title="ICD: Herpes Virus Linked to Psoriasis"
                     score="-0.007"
                     href="http://www.medpagetoday.com/MeetingCoverage/ICD/tb/14470?impressionId=1265744617209"
                     
       PRAGUE, June 1 -- More than half of a group of patients with psoriasis tested positive for human herpes virus 8 (HHV-8), suggesting infection might play a role in the etiology of the disease, according to data reported here.
              &lt;p&gt; 
              &lt;p&gt;The prevalence of HHV-8 was more than four times higher in biopsy specimens of patients with psoriasis than in an age-matched control group without psoriasis, Samar Samoud, M.D., of Farhat Hached Hospital in Sousse, Tunisia, and colleagues said in a poster presentation at the International Congress of Dermatology.
              &lt;p&gt; 
              &lt;p&gt;&quot;Our data suggest for the first time that HHV-8 may play a role in psoriasis,&quot; the investigators concluded. &quot;However, no conclusions can be drawn on the etiologic and pathogenetic role of HHV-8 in this disease. Further investigation of this association is needed.&quot;
              &lt;p&gt; 
              &lt;p&gt;Several viruses have been associated with provocation or exacerbation of psoriasis. Although the viruses have been detected in psoriatic skin, their role in the etiology and pathogenesis of the disease has not been elucidated.
              &lt;p&gt; 
              &lt;p&gt;HHV-8 has been identified in several proliferative diseases, including Kaposi sarcoma and body cavity-based B-cell lymphoma. Dr. Samoud and colleagues sought to determine whether it might also be associated with psoriasis, and if so, to what extent.
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              &lt;p&gt;Skin samples were obtained from 40 patients with psoriasis, ages 12 to 76 and from 40 age-matched volunteers who did not have the skin condition.
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              &lt;p&gt;Investigators used an immunofluorescence assay to identify HHV-8 antibodies in the specimens.
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              &lt;p&gt;Dr. Samoud reported that specimens from 22 of 40 patients with psoriasis (55%) were positive for HHV-8 antibodies compared with five of 40 (12.5%) individuals in the control group (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001).
              &lt;p&gt; 
              &lt;p&gt;However, when the investigators compared HHV-8 status with psoriasis disease activity, they found no correlation.
              &lt;p&gt; 
              &lt;p&gt;&lt;table cellspacing=&quot;0&quot; hspace=&quot;1&quot; style=&quot;border-style:solid; border-width:1px; border-color:#8dabbc; font-family:arial; font-size:12px; background-color:#DBE9F2; padding:5px 5px 5px 5px;&quot;&gt;
&lt;tr&gt;&lt;td&gt; Dr. Samoud and his co-investigators reported no competing interests.&lt;/td&gt;&lt;/tr&gt;&lt;/table&gt;
    </recommendedItem>
    <recommendedItem id="20090101_1_189"
                     title="TRI: Erectile Dysfunction Drug Linked to Throat Problem"
                     score="-0.008"
                     href="