Journal articles on the topic 'Diagnostical skin diseases'

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) are a collection of diseases, characterised by destruction and inflammation of small and medium vessels. Microscopic Polyangiitis (MPA) is part of an ANCA-associated vasculitis (AAV).The clinical signs diverge and disturba number of organs such as the kidneys, lungs, stomach and intestine. Skin manifestations such as purpuric, urticarial, nodular, ulcerative, livedoid and necrotic skin lesions were common as in other vaso-occlusive disorder. Morphology and added features aid the diagnostic approach. Here, we report a diagnostically challenging case of microscopic polyangiitis with progressive glomerulonephritis.

The confocal laser scanning microscopy in vivo is a promising study method to visualize cell structures of epidermis and papillary dermis without affecting the skin integrity, which provides for a resolution and contrast similar to those characteristic of the classical histology examination. Goal. To assess the confocal laser scanning microscopy in vivo (CLSM) technique for diagnosing actinic keratosis, psoriasis vulgaris and rosacea vs. the classical histology examination. Study materials. The article describes the results obtained by using the confocal laser scanning microscopy in vivo technique vs. the histology examination in 10 patients with erythematous actinic keratosis, 10 patients with extensive psoriasis and 10 patients with erythematous and papulous rosacea. Results. The article describes diagnostically significant signs of the diseases detected by using the confocal laser scanning microscopy in vivo as well as the potential of this method in terms of diagnosing inflammatory skin diseases.

Neopterin is a non-specific marker of immunological response of human body of cellular type. It belongs to the chemical group known as pteridines. Neopterin has been widely associated with inter alia viral infections, bacterial infections (by intracellular living bacteria), parasitic infections, skin burns or autoimmune diseases. Neopterin is a very important parameter diagnostically not only in diagnosis and monitoring of treatment but also a reliable indicator of macrophages’ activity. Most frequently neopterin concentration is measured in body fluids like blood, serum or urine, but it may be used as an indicator in other body fluids.

Canine atopic dermatitis is a common clinical entity, characterized by pruritus due to sensitization against common enviromental allergens. It has been proven that there is strong breed predisposition. Genetically programmed dogs overproduct reaginic antibodies (IgE and/or IgGd) after their exposure to airborne allergens (dust mites, epithelia, pollens and molds) which consequently fix themselves to the mast cells of the skin. After reexposure to the same allergens these cells degranulate, with subsequent release of many pharmacologically active substances (histamine, leucotrienes, Prostaglandines etc). However, this is a rather simplistic explanation; the true pathogenesis of atopy is more complicated and still not well understood. Clinical signs first appear between 6 months and 3 years of age. Pruritus, the mainstay of atopy, can be seasonal or perennial. Skin lesions, appearing in later, are attributed to pruritus and/or to secondary complications (staphylococcal pyoderma, seborrhea, dry skin, Malassezia dermatitis). The diagnosis, based on history and clinical findings, necessitates exclusion of other pruritic skin diseases and identification of the offending allergens by using the intradermal test and/or serology (ELISA, RAST). The latter method is diagnostically inferior to intradermal skin test due to the high rate of false positive reactions. Therapeutic options include avoidance of the allergens responsible for sensitization, systemic therapy with glucocorticoids, antihistamines and essential fatty acids in various combinations, topical antipruritic therapy, hyposensitization which is the best therapeutical modality for the perennial form of the disease and management of secondary complications as well as of other concurrent allergic skin diseases, such as food and flea allergy.

Nowadays, HIV infection is one of the leading health problems. Its clinical signs are extremely diverse and are associated with many diseases, including rheumatic diseases. This paper describes the course of articular syndrome in a patient with HIV infection. In the patient given, asymmetric arthritis of the left wrist, first metacarpophalangeal, and knee joints with no damage to the skin and mucous membranes or enthesitis, a negative HLA-B27 test, and the whole clinical picture, as well as no convincing evidence of rheumatic diseases might suggest the presence of arthritis associated with HIV infection. The diagnosis of HIV infection was verified using enzyme immunoassay. Today, knowledge continues to accumulate about the features of the course of joint damages and another rheumatic disease in the presence of HIV infection. The possibility of its existence to mask a rheumatic disease, as well as the mutual aggravation of any of the diseases and AIDS, should be taken into account in the practice of physicians of all specialties, especially in the inpatient setting where difficult and diagnostically difficult cases concentrate.

Background: The territorial expansion and increased population size of haematophagous arthropods (i.e., the castor bean tick Ixodes ricinus (Ixodida: Ixodidae) and the deer ked Lipoptena cervi (Diptera: Hippoboscidae)) has enhanced the risk of human infestations in Europe. The aim of our study was to present skin lesions induced by tick and deer ked bites in patients from recreational forest regions in southeastern Poland and pay attention to features of skin changes that may be useful in differential diagnosis. Methods: We compare the skin lesions after I. ricinus and L. cervi bite and draw attention to the biological and ecological traits of both ectoparasites, which may be diagnostically relevant for determination of the cause of skin symptoms reported by patients. Results: I. ricinus bites lead to development of erythematous-infiltrative poorly demarcated lesions with a centrally located bite mark, which usually disappears within one to several days. In turn, L. cervi bites leave irregularly shaped scattered erythematous papules. The papules may persist for up to one year and are accompanied by itching. Conclusions: Correct assessment of the clinical picture and its association with an arthropod bite (e.g., tick or deer ked) is highly important for further diagnostic procedures (i.e., differentiation of skin lesions developing in tick-borne diseases and, consequently, correct choice of pharmacological therapy). I. ricinus and L. cervi differ in their developmental cycles and rhythms of activity, which indicates that both species should be considered potential causative agents in the differential diagnosis of skin lesions when the patient has been bitten by an arthropod in autumn and winter months.

A Hanseníase é um problema de saúde pública, devido a sua endemicidade em todo território brasileiro. Esta afecção crônica é causada pela Mycobacterium leprae, um bacilo álcool-ácido resistente, de alta infectividade e baixa patogenicidade. Relaciona-se com uma grande variedade de lesões cutâneas. O objetivo deste artigo é apresentar um caso de hanseníase virchowiana diagnosticado em fase avançada e com manifestações clínicas exuberantes; caso que, felizmente, é pouco comum, na atualidade. Palavras-chave: Hanseníase. Hanseníase Virchowiana. Doenças endêmicas. Leprosy is a public health problem due to its endemicity throughout Brazil. This chronic disease is caused by Mycobacterium leprae, a bacillus resistant acid-high infectivity and low pathogenicity. It relates to a variety of skin lesions. The aim of this paper is to present a case of lepromatous leprosy diagnosed at an advanced stage and with exuberant clinical manifestations; case, fortunately, is not common today. Keywords: Leprosy. Leprosy, lepromatous. Endemic diseases.

Cobalamin (vitamin B12) is a complex compound, which is classified as a water-soluble vitamin. Absorption of cobalamin in the gut and its transport to cells is a unique process, in which many proteins are involved. The loss of function of these proteins causes serious cell homeostasis disturbance, which may result in the dysfunction of many tissues and organs. Vitamin B12, a cofactor of methionine synthase, provides methylation process and nucleic acid synthesis. Cobalamin is also necessary for methylmalonyl-CoA mutase activity. The enzyme synthesizes succinyl-CoA, an intermediate in tricarboxylic acid cycle. Vitamin B12 deficiency is an important and current health problem. It may be caused by insufficient dietary intake, age, or disease-related malabsorption and genetic defects of mechanisms involved in the absorption, transport and metabolism of cobalamin. Hypocobalaminemia can also result from long-term pharmacotherapy with medicines: metformin, proton pump inhibitors (e.g. omeprazole) and H2-receptor antagonists (e.g. ranitidine). Significant clinical symptoms of cobalamin deficiency include hematological abnormalities, mainly megaloblastic anemia, as well as neurological disorders resulting from degeneration within the nervous system. Early diagnosis and starting treatment with vitamin B12 increase chances for a complete cure. Therefore, the diagnostically important symptom of hypocobalaminemia may be skin manifestations, mainly hyperpigmentations, but also premature graying of hair. The aim of this review article was to summarize the current state of knowledge on the biological function of cobalamin, as well as the causes and consequences of its deficiency at the molecular, cellular, tissue and organism level.

Background. There is a need to assess the diagnostic significance of the symptoms of nail damage, as well as available effective methods for diagnosing psoriatic arthritis in the early stages. Aims. To study of the occurrence of symptoms of psoriatic onychodystrophy in patients with psoriatic arthritis and assessment of the diagnostic significance of the ultrasound method for diagnosing enthesitis as an early symptom of psoriatic arthritis among patients with onychodystrophy and without psoriatic arthritis in case history. Methods. It was a prospective clinical study based on the Clinic of Skin and Venereal Diseases of the Military Medical Academy. We made the clinical assessment of symptoms of onychodystrophy among patients with and without psoriatic arthritis and the evaluation of the diagnostic significance of the ultrasound method for diagnosing psoriatic arthritis under the control of magnetic resonance imaging of the joints. Results. 45 patients with psoriatic arthritis and 134 patients with psoriasis without arthritis were examined. Psoriatic onychodystrophy was significantly more common in the group of patients with psoriatic arthritis (p = 0.028). The most characteristic symptoms of onychodystrophy in patients with psoriatic arthritis are oil spots and symptom combinations: oil spots and subungual hyperkeratosis, onycholysis and subungual hyperkeratosis, pits and longitudinal ridges, oil spots and longitudinal ridges. The ultrasound method for the diagnosis of psoriatic arthritis has shown its high diagnostic significance (Se = 81.8%, Sp = 88.0%). The most characteristic symptoms of arthritis on ultrasound examination are hypoechoic structures of the Achilles tendons and the presence of fluid in the peri- and retro-Achilles bursa. Conclusions. The symptom of oil spots and combinations of oil spots with subungual hyperkeratosis, onycholysis with subungual hyperkeratosis, pits with longitudinal ridges and oil spots with longitudinal ridges can be considered diagnostically significant in the examination of early psoriatic arthritis, and the ultrasound method is highly effective in diagnosing early manifestations of arthritis.

Abstract Background Primary varicella infection is usually self-limited in immunocompetent hosts, whereas it can be quite severe in immunocompromised hosts. Atypical presentations of varicella in immunocompromised hosts can be diagnostically challenging, without laboratory testing. Varicella is an occupational hazard for susceptible healthcare providers (HCP). It assumes importance in infection prevention and control, due to the possibility of spread to other susceptible coworkers and patients. Methods This outbreak investigation report is from a 300-bed cancer care hospital in South India. A 62-year-old male patient with lymphoplasmacytic non-Hodgkin’s lymphoma was admitted on October 1 with features of bronchopneumonia and extensive skin lesions, 2 months after his last chemotherapy cycle. The patient was received in the emergency department (ED) and later shifted to the intensive care unit (ICU) due to worsening clinical condition. The clinical picture was more in favor of Stevens–Johnson syndrome, but oral acyclovir therapy was given considering a differential diagnosis of varicella. His condition deteriorated further requiring ventilator support and on the 19th day of admission, the patient succumbed to his illness and passed away. From October 14 to 19, eight HCP presented with vesicular eruptions and fever, clinically diagnosed as having varicella. This aroused the suspicion of an outbreak. An emergency outbreak control group meeting was convened to assess and address the situation. Results All outbreak cases were confirmed as varicella, clinically. Contacts, including patients assigned to HCP involved in the outbreak were traced, and their varicella immune status was assessed. Nonimmune contacts were given oral acyclovir prophylaxis as per CDC recommendations. Other HCP in the hospital were offered first dose of varicella vaccine based on their varicella immune status. With these infection prevention and control measures in place, no additional cases were identified. Being a hospital in low- to middle-income country, it was not routine practice to vaccinate susceptible HCP, after screening of varicella immune status at the time of recruitment. In the wake of the outbreak, assessment of immunity against varicella, and vaccination of susceptible HCP, is being followed up meticulously. Conclusion Varicella can present with atypical symptoms, especially in the immunocompromised host. Suspected cases should be isolated until sensitive PCR studies are done. Varicella immune status of HCP should be assessed at recruitment and vaccination should be offered to susceptible individuals. Implementation and infection prevention and control measures can help prevent and mitigate varicella outbreaks within healthcare facilities.

Merkel cell carcinomas (MCC) are highly aggressive skin malignancies, resulting in death of more than one-third of patients with increasing incidences over the past decades. The carcinogenesis is associated with Merkel cell polyomavirus (MCPyV) infection and/or ultraviolet-induced DNA mutations. Diagnosis is made by histology and specific immunohistochemical stains. Among them, cytokeratin 20 (CK20) expression represents indeed the most important marker. The treatment consists of either wide local excision to achieve clear margins accompanied by nodal dissection or radiation therapy. In advanced stage diseases, survival rates still remain low, but immunotherapy with PD-L1 and PD-1 inhibitors are promising. The increasing incidence, the rapidly and aggressive clinical course as well as some unsolved diagnostic and therapeutic challenges underline the need for a better understanding of MCC. Therefore, the aim of this short review was to present an overview of the current literature regarding diagnosis and treatment of MCC patients.

ObjectiveAutomated syndromic surveillance using mobile devices is an emerging public health focus that has a high potential for enhanced disease tracking and prevention in areas with poor infrastructure. Pacific Northwest National Laboratory sought to develop an Android mobile application for syndromic biosurveillance that would i) use the phone camera to take images of human faces to detect individuals that are sick through a machine learning (ML) model and ii) collect image data to increase training data available for ML models. The initial prototype use case is for screening and tracking the health of soldiers for use by the Department of Defense’s Disease Threat Reduction Agency.IntroductionInfectious diseases present with multifarious factors requiring several efforts to detect, prevent, and break the chain of transmission. Recently, machine learning has shown to be promising for automated surveillance leading to rapid and early interventions, and extraction of phenotypic features of human faces [3, 5]. In addition, mobile devices have become a promising tool to provide on-the-ground surveillance, especially in remote areas and geolocation mapping [4].Pacific Northwest National Laboratory (PNNL) combines machine learning with mobile technology to provide a groundbreaking prototype of disease surveillance without the need for internet, just a camera. In this android application, VisionDx, a machine learning algorithm analyses human face images and within milliseconds notifies the user with confidence level whether or not the person is sick. VisionDx comes with two modes, photo and video, and additional features of history, map, and statistics. This application is the first of its kind and provides a new way to think about the future of syndromic surveillance.MethodsData. Human healthy (n = 1096) and non-healthy (n = 1269) facial images met the criteria for training the Machine Learning model after preprocessing them. The healthy images were obtained from the Chicago face database [6] and California Institute of Technology [2]. There are no known collections of disease facial images. Using open source image collection/curation services, images were identified by a variety of keywords, including specific infectious diseases. The criteria for image inclusion was 1. a frontal face was identified using OpenCV library [1], and 2. the image contained signs of disease through visual inspection (e.g., abnormal color, texture, swelling).Model. To identify a sick face from a healthy one, we used transfer machine learning and experimented with various pretrained Convolutional Neural Networks (CNN) from Google for mobile and embedded vision applications. Using MobileNet, we trained the final model with our data and deployed it to our prototype mobile app. Google Mobile Vision API and TensorFlow mobile were used to detect human faces and run predictions in the mobile app.Mobile Application. The Android app was built using Android Studio to provide an easily navigable interface that connects every action between tabbed features. The app features (i.e., Map, Camera, History, and Statistics) are in tab view format. The custom-made camera is the main feature of the app, and it contains face detection capability. A real-time health status detection function gives a level of confidence based the algorithm results found on detected faces in the camera image.ResultsPNNL's prototype Android application, VisionDx, was built with user-friendly tab views and functions to take camera images of human faces and classify them as sick or healthy through an inbuilt ML model. The major functions of the app are the camera, map, history, and statistics pages. The camera tab has a custom-made camera with face detection algorithm and classification model of sick or healthy. The camera has image or video mode and results of the algorithm are updated in milliseconds. The Statistics view provides a simple pie chart on sick/healthy images based on user selected time and location. The Map shows pins representing all labeled images stored, and the History displays all the labeled images. Clicking on an image in either view shows the image with metadata, i.e., model confidence levels, geolocation, and datetime.The CNN model prediction accuracy has ~98% validation accuracy and ~96% test accuracy. High model performance shows the possibility that deep learning could be a powerful tool to detect sickness. However, given the limited dataset, this high accuracy also means the model is most likely overfit to the data. The training set is limited: a. the number of training images is small compared to the variability in facial expressions and skin coloring, and b. the sick images only contained overt clinical signs. If trained on a larger, diverse set of data, this prototype app could prove extremely useful in surveillance efforts of individual to large groups of people in remote areas, e.g., to identify individuals in need of medical attention or get an overview of population health. In effort to improve the model, VisionDx was developed as a data collection tool to build a more comprehensive dataset. Within the tool, users can override the model prediction, i.e., false positive or false negative, with a simple toggle button. Lastly, the app was built to protect privacy so that other phone aps can't access the images unless shared by a user.ConclusionsDeveloped at PNNL for the Defense Threat Reduction Agency, VisionDx is a novel, camera-based mobile application for real-time biosurveillance and early warning in the field without internet dependency. The prototype mobile app takes pictures of faces and analyzes them using a state-of-the-art machine learning model to give two confidence levels of likelihood of being sick and healthy. With further development of a labeled dataset, such as by using the app as a data collection too, the results of the algorithm will quickly improve leading to a ground-breaking approach to public health surveillance.References1. Bradski G. (n.d.) The OpenCV Library. Retrieved Sept 30, 2018 at http://www.drdobbs.com/open-source/the-opencv-library/1844043192. Computational Vision: Archive. (1999). Retrieved Sept 22, 2018 at http://www.vision.caltech.edu/html-files/archive.html3. Ferry Q, Steinberg J, Webber C, et al (2014). Diagnostically relevant facial gestalt information from ordinary photos. ELife, 3, e02020.4. Fornace KM, Surendra H, Abidin TR, et al (2018). Use of mobile technology-based participatory mapping approaches to geolocate health facility attendees for disease surveillance in low resource settings. International Journal of Health Geographics, 17(1), 21. https://doi.org/10.1186/s12942-018-0141-05. Lopez DM, de Mello FL, G Dias, CM, et al (2017). Evaluating the Surveillance System for Spotted Fever in Brazil Using Machine-Learning Techniques. Frontiers in Public Health, 5. https://doi.org/10.3389/fpubh.2017.003236. Ma DS, Correll J, Wittenbrink B. (2015) The Chicago face database: A free stimulus set of faces and norming data. Behavior Research Methods, 47(4), 1122–1135. https://doi.org/10.3758/s13428-014-0532-5