RESUMO
Psoriasis is an immune-mediated skin disorder. Imbalance of gut microbial populations has been implicated in many diseases. We aimed to investigate whether there were differences in gut microbiota in psoriasis patients vs non-psoriasis controls and between psoriasis severity groups. 55 psoriasis patients and 27 controls were included. V3-V4 regions of the 16S rRNA gene of fecal samples were analyzed using Illumina MiSeq. Bioinformatic analysis was performed. We found changes in gut microbiome composition depending on their psoriasis status as determined by weighted unifrac (p < 0.05), in particular an increase in Firmicutes and depletion of Bacteroidetes in psoriasis patients. Additionally, the Faecalibacterium and Blautia genus were higher in psoriasis patients while Bacteroides and Paraprevotella in non-psoriasis controls (p < 0.05, LDA score > 2). Moderate-to-severe psoriasis patients had lower biodiversity than mild psoriatic patients (p = 0.049). No differences for beta-diversity were found. We developed a Psoriasis-Microbiota Index (PMI), which discriminated among psoriasis patients and controls with sensitivity: 0.78 and specificity: 0.79. Furthermore, we performed a meta-analysis with published data to validate this index. We demonstrated gut dysbiosis in psoriasis patients, suggesting a role in psoriasis pathophysiology. Furthermore, we developed a PMI with the potential to discriminate between psoriasis patients and controls across different populations, which could be used as a biomarker in the clinical practice.
Assuntos
Microbioma Gastrointestinal , Metagenômica , Psoríase/diagnóstico , Psoríase/microbiologia , Adolescente , Adulto , Bacteroides , Bacteroidetes , Biodiversidade , Biomarcadores/metabolismo , Clostridiales , Biologia Computacional , Estudos Transversais , Faecalibacterium , Feminino , Firmicutes , Genoma Humano , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Masculino , Pessoa de Meia-Idade , RNA Ribossômico 16S/genética , Adulto JovemRESUMO
BACKGROUND: There is an obvious need for more prompt and specific biomarkers of bacterial infections in generalized pustular psoriasis patients. OBJECTIVE: The aim of this study was to evaluate the diagnostic properties and define appropriate cut-off values of procalcitonin and C-reactive protein in predicting bacterial infection in generalized pustular psoriasis patients. METHODS: Sixty-four generalized pustular psoriasis patients hospitalized from June 2014 to May 2017 were included in this retrospective study. The values of procalcitonin, C-reactive protein, details of infection, and other clinical parameters were analyzed. RESULTS: Receiver operating characteristic curve analysis generated similar areas (p=0.051) under the curve for procalcitonin 0.896 (95% CI 0.782-1.000) and C-reactive protein 0.748 (95% CI 0.613-0.883). A cut-off value of 1.50ng/mL for procalcitonin and 46.75mg/dL for C-reactive protein gave the best combination of sensitivity (75.0% for procalcitonin, 91.7% for C-reactive protein) and specificity (100% for procalcitonin, 53.8% for C-reactive protein). Procalcitonin was significantly positively correlated with C-reactive protein levels both in the infected (r=0.843, p=0.040) and non-infected group (r=0.799, p=0.000). STUDY LIMITATIONS: The sample size and the retrospective design are limitations. CONCLUSIONS: The serum levels of procalcitonin and C-reactive protein performed equally well to differentiate bacterial infection from non-infection in generalized pustular psoriasis patients. The reference value of procalcitonin and C-reactive protein applied to predicting bacterial infection in most clinical cases may not be suitable for generalized pustular psoriasis patients. C-reactive protein had better diagnostic sensitivity than procalcitonin; however, the specificity of procalcitonin was superior to that of C-reactive protein.
Assuntos
Infecções Bacterianas/sangue , Proteína C-Reativa/análise , Pró-Calcitonina/sangue , Psoríase/sangue , Psoríase/microbiologia , Adulto , Biomarcadores/sangue , Temperatura Corporal , Feminino , Humanos , Contagem de Leucócitos , Masculino , Pessoa de Meia-Idade , Neutrófilos , Valores de Referência , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Adulto JovemRESUMO
Abstract Background There is an obvious need for more prompt and specific biomarkers of bacterial infections in generalized pustular psoriasis patients. Objective The aim of this study was to evaluate the diagnostic properties and define appropriate cut-off values of procalcitonin and C-reactive protein in predicting bacterial infection in generalized pustular psoriasis patients. Methods Sixty-four generalized pustular psoriasis patients hospitalized from June 2014 to May 2017 were included in this retrospective study. The values of procalcitonin, C-reactive protein, details of infection, and other clinical parameters were analyzed. Results Receiver operating characteristic curve analysis generated similar areas (p = 0.051) under the curve for procalcitonin 0.896 (95% CI 0.782-1.000) and C-reactive protein 0.748 (95% CI 0.613-0.883). A cut-off value of 1.50 ng/mL for procalcitonin and 46.75 mg/dL for C-reactive protein gave the best combination of sensitivity (75.0% for procalcitonin, 91.7% for C-reactive protein) and specificity (100% for procalcitonin, 53.8% for C-reactive protein). Procalcitonin was significantly positively correlated with C-reactive protein levels both in the infected (r = 0.843, p = 0.040) and non-infected group (r = 0.799, p = 0.000). Study limitations The sample size and the retrospective design are limitations. Conclusions The serum levels of procalcitonin and C-reactive protein performed equally well to differentiate bacterial infection from non-infection in generalized pustular psoriasis patients. The reference value of procalcitonin and C-reactive protein applied to predicting bacterial infection in most clinical cases may not be suitable for generalized pustular psoriasis patients. C-reactive protein had better diagnostic sensitivity than procalcitonin; however, the specificity of procalcitonin was superior to that of C-reactive protein.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Psoríase/microbiologia , Psoríase/sangue , Infecções Bacterianas/sangue , Proteína C-Reativa/análise , Pró-Calcitonina/sangue , Valores de Referência , Temperatura Corporal , Biomarcadores/sangue , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Estatísticas não Paramétricas , Contagem de Leucócitos , NeutrófilosRESUMO
In Argentina, NDM metallo-ß-lactamase was first reported in 2013. By now, it has disseminated throughout the country in diverse Gram negative bacteria. Here, we report the case of a paediatric patient that underwent a 1-year hospitalisation due to erythrodermic psoriasis in 2014 and received multiple antimicrobial treatments. During his stay, five isolates were obtained from rectal swabs (rs) or blood culture (bc) suspicious of carbapenemase production: a K. quasipneumoniae subsp. quasipneumoniae (rs), Citrobacter freundii (rs), Escherichia coli (bc), Enterobacter cloacae (rs), and a Serratia marcescens (bc). The isolates were studied with broth microdilution, biparental conjugation and plasmid and whole genome sequencing (Illumina). All isolates harboured an 138,998-bp type 1 IncC plasmid that carried blaNDM-1, bleMBL, blaCMY-6, rmtC, aac(6')-Ib, and sul1 resistance genes. Additionally, the blaNDM-plasmids contained ISKpn8 an insertion sequence previously described as associated only to blaKPC. One isolate, a colistin-resistant E. coli, also carried a mcr-1-containing an IncI2 plasmid, which did not harbour additional resistance. The whole genome of K. quasipneumoniae subsp. quasipneumoniae isolate was fully sequenced. This isolate harboured, additionally to blaNDM, three plasmid-mediated quinolone resistance genes: qnrB4, qnrB52 and aac(6')-Ib-cr1. The E. cloacae isolate also harboured qnrA1. These findings alert to the underestimated horizontal dissemination of multidrug-resistant plasmids limiting treatment options with last resort antimicrobials.
Assuntos
Enterobacteriaceae/genética , Enterobacteriaceae/isolamento & purificação , Plasmídeos/genética , Antibacterianos/farmacologia , Criança , Pré-Escolar , Farmacorresistência Bacteriana/genética , Enterobacteriaceae/classificação , Enterobacteriaceae/efeitos dos fármacos , Escherichia coli/genética , Transferência Genética Horizontal , Hospitais , Humanos , Filogenia , Psoríase/microbiologiaRESUMO
BACKGROUND: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. METHODS: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. RESULTS: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. CONCLUSION: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.
Assuntos
Doenças da Unha/patologia , Unhas/patologia , Onicomicose/patologia , Estudos Transversais , Diagnóstico Diferencial , Humanos , Doenças da Unha/microbiologia , Unhas/microbiologia , Neutrófilos , Onicomicose/microbiologia , Paraceratose , Psoríase/microbiologia , Psoríase/patologiaRESUMO
Abstract: Background: Of all nail disorders seen in dermatology offices, half of them are due to onychomycosis. The main differential diagnosis is nail psoriasis. The objective of this study was to compare the microscopic findings, other than the presence of fungi, in the clipping of onychomycosis versus normal nails and nail psoriasis. Methods: Cross-sectional study of onychomycosis cases, analyzed by clipping and compared with data on normal nails and those with nail psoriasis. Results: Sixty-two onychomycosis samples were compared with 30 normal nails and 50 nails with psoriasis. In onychomycosis, measurement of subungual region, serous lakes, neutrophils and number of layers of parakeratosis are more intense than in psoriasis. Onychocariosis is less common in psoriasis, while bacteria are more frequent. The nail transition zone is more commonly blurred and irregular in onychomycosis. Conclusion: Clipping helps in the differential diagnosis of onychomycosis and nail psoriasis and may be useful even when fungi are not found.
Assuntos
Humanos , Onicomicose/patologia , Doenças da Unha/patologia , Unhas/patologia , Paraceratose , Psoríase/microbiologia , Psoríase/patologia , Estudos Transversais , Onicomicose/microbiologia , Diagnóstico Diferencial , Doenças da Unha/microbiologia , Unhas/microbiologia , NeutrófilosRESUMO
The authors present the immunopathologic findings of Toll-like receptor 2 in psoriasis. This novel work shows positive staining within the dermal capillaries in psoriatic lesions. Neither normal skin nor lesional skin in eczema showed similar staining. The authors postulate how the activation of this innate immune system reactant plays a significant role in psoriasis and show how it may be associated with a cascade of events that begins with streptococcus and ends with psoriasis.
Assuntos
Imunidade Inata/imunologia , Psoríase/microbiologia , Psoríase/fisiopatologia , Infecções Estreptocócicas/imunologia , Receptor 2 Toll-Like/metabolismo , Biomarcadores/sangue , Feminino , Humanos , Masculino , Prognóstico , Psoríase/etiologia , Medição de Risco , Coloração e Rotulagem , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/fisiopatologia , Streptococcus/imunologia , Streptococcus/patogenicidadeRESUMO
BACKGROUND:: Psoriasis is a chronic inflammatory disease that affects the skin and joints and has a multifactorial etiology. Recently, it has been suggested that Helicobacter pylori infection may contribute as a trigger for the development of the disease. OBJECTIVES:: To determine the prevalence of H. pylori seropositivity in patients with psoriasis and to evaluate the relation between disease severity and H. pylori infection. METHODS:: H. pylori infection was assessed in psoriatic patients and controls by using H. pylori IgG quantitative enzyme immunoassay (ELISA test). The patients were classified according to the severity of the disease (PASI score). RESULTS:: One hundred and twenty six patients with psoriasis (73 females and 53 males); mean age 50.48 years; 65 patients (51.59%) had severe psoriasis, 40 (31.75%) moderate psoriasis and 21 (16.67%) mild psoriasis. Twenty one healthy volunteers included as a control group, mean age of 41.05 years, 13 females and 8 males. One hundred and eleven patients with psoriasis tested serologically, 80 (72.07%) were seropositive compared with 7 positive volunteers (33.33%; P=0.002). Forty-nine (75.38%) patients with severe psoriasis were positive, 25 (62.50%) with moderate psoriasis were positive and 6 (28.57%) with mild psoriasis were positive (P=0.045). Study limitations: none. CONCLUSIONS:: H. pylori infection influences the development of psoriasis and severity of the disease.
Assuntos
Infecções por Helicobacter/complicações , Helicobacter pylori , Psoríase/microbiologia , Adulto , Estudos de Casos e Controles , Ensaio de Imunoadsorção Enzimática , Feminino , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/imunologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Soroepidemiológicos , Índice de Gravidade de DoençaRESUMO
Abstract: BACKGROUND: Psoriasis is a chronic inflammatory disease that affects the skin and joints and has a multifactorial etiology. Recently, it has been suggested that Helicobacter pylori infection may contribute as a trigger for the development of the disease. OBJECTIVES: To determine the prevalence of H. pylori seropositivity in patients with psoriasis and to evaluate the relation between disease severity and H. pylori infection. METHODS: H. pylori infection was assessed in psoriatic patients and controls by using H. pylori IgG quantitative enzyme immunoassay (ELISA test). The patients were classified according to the severity of the disease (PASI score). RESULTS: One hundred and twenty six patients with psoriasis (73 females and 53 males); mean age 50.48 years; 65 patients (51.59%) had severe psoriasis, 40 (31.75%) moderate psoriasis and 21 (16.67%) mild psoriasis. Twenty one healthy volunteers included as a control group, mean age of 41.05 years, 13 females and 8 males. One hundred and eleven patients with psoriasis tested serologically, 80 (72.07%) were seropositive compared with 7 positive volunteers (33.33%; P=0.002). Forty-nine (75.38%) patients with severe psoriasis were positive, 25 (62.50%) with moderate psoriasis were positive and 6 (28.57%) with mild psoriasis were positive (P=0.045). Study limitations: none. CONCLUSIONS: H. pylori infection influences the development of psoriasis and severity of the disease.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Psoríase/microbiologia , Helicobacter pylori , Infecções por Helicobacter/complicações , Índice de Gravidade de Doença , Ensaio de Imunoadsorção Enzimática , Estudos de Casos e Controles , Estudos Soroepidemiológicos , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/imunologiaRESUMO
La Psoriasis es una enfermedad crónica de la piel, de etiología y patogenia aún desconocida. Se ha propuesto una posible asociación entre la levadura Malassezia y la exacerbación de lesiones cutáneas en pacientes con psoriasis. OBJETIVO: Determinar frecuencia y distribución de especies de Malassezia en pacientes con psoriasis y en un grupo control sano. MATERIAL Y MÉTODO: Se evaluaron 25 pacientes con psoriasis y 55 sanos como grupo control. Se recolectó muestras de piel de 4 sitios anatómicos y se realizó un examen microscópico directo (EMD) con recuento de levaduras y cultivo en medio de Dixon modificado. Las levaduras aisladas se identificaron según características macro y micromorfológicas y pruebas bioquímicas. RESULTADOS: Un total de 396 muestras de escamas de piel de 4 sitios anatómicos obtenidas de 80 pacientes (55 sanos y 25 con psoriasis). Un 67,5% (54/80) de los pacientes presentaron un EMD positivo y la tasa de recuperación por cultivo fue 58,7% (47/80). De las 396 muestras analizadas, un 28 % (111/396) fueron positivas al EMD y un 25,2% (100/396) al cultivo. Las especies aisladas fueron: M. furfur, M. globosa, M. slooffiae y M. sympodialis. CONCLUSIONES: La presencia de Malassezia en la muestra global fue 77,5 %. El sitio anatómico más afectado fue espalda y pecho y las especies identificadas corresponden a las descritas en la literatura internacional, en sujetos sanos y con psoriasis, pero con diferente frecuencia. Se requerirán estudios adicionales para ayudar a dilucidar el posible rol de Malassezia en la exacerbación de lesiones en los pacientes con psoriasis.
Psoriasis is a chronic skin disease of unknown etiology. A possible association between psoriasis exacerbation and Malassezia species has been proposed. AIM: To determine the frequency and distribution of Malassezia species in psoriasis patients and a healthy control group. MATERIAL AND METHODS: 25 psoriatic patients and 55 healthy controls were studied. In each one of them skin scrapings samples were collected, from 4 anatomical sites. KOH yeast count and culture in modified Dixon agar were done. The isolated yeasts were identified according to macroscopic, microscopic and physiologic features. RESULTS: In 80 patients (55 healthy and 25 psoriatic), a total of 396 skin scrapings samples from 4 different anatomical sites were obtained. A total of 67.5% of the patients presented a positive KOH, and the recovery rate per culture was 58.7%. Out of the 396 analyzed samples, 28% (111/396) resulted positive to microscopic examination and 25,2% (100/396) positive on culture. The isolated species were: M. furfur, M globosa, M. slooffiae y M. sympodialis. CONCLUSIONS: The global frequency of Malassezia in the studied sample was 77.5%. It was more frequently detected on the posterior trunk and chest. We found the same species reported worldwide, in healthy and psoriatic patients, but in different frequency. Further research will be needed to clarify a possible role of this yeast on the exacerbation of skin lesions in psoriatic patients.