PURPOSE: S100B protein is widely used as a measure of glial activity or damage in several brain conditions. Central nervous system (CNS) infections can cause neurological sequelae because of parenchyma invasion. It is difficult to predict further neuronal damage in the CNS infection. The present study is aimed to evaluate the role of the cerebrospinal fluid (CSF) S100B protein as an indicator of neuronal damage in CNS infection. MATERIALS AND METHODS: We measured the concentration of CSF S100B protein in 62 patients with a CNS infection using an Enzyme-Linked Immunosorbent Assay. The patients with CNS infections were classified as having no neuronal damage (CNS-N) or as having neuronal damage (CNS+N) according to the presence of neurological change or structural lesions on brain MRI. RESULTS: The CSF S100B protein level of the CNS+N group (n=22, 0.235 microg/L, 0.10-2.18) was significantly higher than that of the CNS-N group (n=40, 0.087 microg/L, 0.06-0.12) and control group (n=40, 0.109 microg/L, 0.07-0.14, p<0.01). Using an arbitrary cut off value, S100B-positive CSF was detected in 2.5% of the CNS-N group and in 50% of the CNS+N group (p<0.05). CONCLUSION: These findings suggest that increased S100B protein levels in the CSF may be associated with the neuronal damage following CNS infections.
Adolescent ; Adult ; Aged ; Brain/pathology ; Central Nervous System Infections/cerebrospinal fluid/*pathology ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; S100 Calcium Binding Protein beta Subunit/*cerebrospinal fluid

No abstract available.
Mycobacterium*

Kerion celsi is a severe inflammatory type of tinea capitis that presents as a boggy mass studded with broken hairs, oozing purulent material from follicular orifices. This infection is caused most commonly by zoophilic or geophilic pathogens. Trichophyton(T.) rubrum is an anthropophilic dermatophyte that is found all over the world. It has become one of the most important causative agents in tinea unguium and tinea pedis. But, kerion celsi caused by T. rubrum is rare. Kerion celsi is uncommon in adult. We report a case of kerion celsi caused by T. rubrum in a 72-year-old woman. She presented with localized tender erythematous plaques with pustules with oozing purulent material on the frontal scalp. A fungal culture from tissue of the lesions was grown on Sabouraud's dextrose agar and showed typical whitish cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer region for clinical isolate was identical to that of T. rubrum strain UZ1588_14 (GenBank accession number KP326579.1). She was treated with 200 mg of oral itraconazole daily for 3 months. The skin lesions improved 1 month after treatment, and recurrence has not been observed.
Adult ; Agar ; Aged* ; Arthrodermataceae ; Base Sequence ; Female ; Glucose ; Hair ; Humans ; Itraconazole ; Onychomycosis ; Recurrence ; Scalp ; Skin ; Tinea Capitis* ; Tinea Pedis ; Trichophyton*

Mycobacterium (M.) fortuitum is a rapidly growing mycobacterium. It is classified as Runyon's group IV with M. abcessus and M. chelonae that are mostly found in water and soil. M. fortuitum infection usually occurs after trauma, surgery or procedures such as acupuncture that cause cutaneous or soft tissue manifestations. We report a case of cutaneous infection due to M. fortuitum in a 72-year-old woman with erythematous deep-seated nodules on her left hand. She inflicted a minor injury to her left hand in a farm. Culture from skin biopsy specimens on 3% Ogawa medium yielded bacterial colonies after 5 days. The microorganism was subsequently identified as M. fortuitum by PCR-restriction fragment length polymorphism analysis. The skin lesions were improved by antibiotic therapy with clarithromycin for 6 months.
Acupuncture ; Aged ; Biopsy ; Clarithromycin ; Female ; Hand ; Humans ; Mycobacterium ; Mycobacterium fortuitum ; Skin ; Soil

Scedosporium apiospermum is an asexual state of Pseudallescheria boydii which has been isolated from soil, sewage, and decaying vegetation. It can cause cutaneous infections by traumatic implantation of the contaminant due to penetrating injury. This ubiquitous fungus cause not only mycetoma, but also infections of variety of body sites including the skin. The localized skin infection due to this organism is much rare than mycetoma. We report a case of cutaneous S. apiospermum infection occurred in 80-year-old male. The skin lesion was manifested by a 8.0 x 4.0 cm-sized erythematous plaque with pustules and crusts on the dorsum of right hand. The fungal culture from the biopsy specimen on Sabouraud's dextrose agar showed white to gray colored cottony colonies of S. apiospermum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of S. apiospermum strain IHEM 23829. The patient was treated with oral fluconazole for 3 months.
Agar ; Aged, 80 and over ; Base Sequence ; Biopsy ; Fluconazole ; Fungi ; Glucose ; Hand ; Humans ; Male ; Mycetoma ; Pseudallescheria ; Scedosporium* ; Sequence Analysis, DNA* ; Sewage ; Skin* ; Soil

BACKGROUND AND PURPOSE: Chronic migraine (CM) has a significant impact on daily activities, and analgesic overuse is a major contributing factor to migraine transformation. Limited information is available on the functional consequences of CM stemming from analgesic overuse. This study evaluated the impact of the frequency of analgesic medication use on headache-related disability and clinical features in patients with CM. METHODS: Patients with CM were enrolled consecutively and classified into two groups according to their frequency of medication use: <15 days/month (CM-ML, n=52) and > or =15 days/month (CM-MH, n=68). All patients completed a structured questionnaire concerning the clinical features of their migraine, a validated version of the Migraine Disability Assessment questionnaire (MIDAS), and the Headache Impact Test-6 (HIT-6). RESULTS: The pain intensity, as measured by a visual analog scale, was greater in the CM-MH group than in the CM-ML group (8.5+/-0.2 vs. 7.7+/-0.3, mean+/-SD; p<0.05). In the disability domain, the MIDAS scores were significantly higher for CM-MH patients than for CM-ML patients (47.6+/-4.8 vs. 26.8+/-4.5, p<0.01). The impact from migraine, as measured by the HIT-6, was greater for CM-MH patients than for CM-ML patients (65.6+/-1.0 vs. 62.1+/-1.0, p<0.05). CONCLUSIONS: Our results indicate that the headache pain intensity and disability are greater in patients with CM who use medication frequently.
Headache ; Humans ; Migraine Disorders ; Surveys and Questionnaires

We report a case of tinea corporis arising in previous burn area which shows tinea imbricata-like clinical appearance in a 69-year-old male. He showed round, 5.0x5.0 cm sized, fine scaly, well-defined erythematous patch with concentrically arranged rings of scales on the right forearm. Histopathologically, PAS staining revealed fungal hyphae in the horney layer of the epidermis. Fungal culture of scales of the lesions on Sabouraud's dextrose agar showed typical Trichophyton verrucosum. He was treated with oral terbinafine (250 mg/day) and topical lanoconazole for 1 month. Skin lesions improved one month after the treatment, and recurrence has not been observed
Agar ; Aged ; Burns ; Epidermis ; Forearm ; Glucose ; Humans ; Hyphae ; Imidazoles ; Male ; Naphthalenes ; Recurrence ; Skin ; Tinea ; Trichophyton ; Weights and Measures

Dermatophytes usually do not invade beyond the epidermis. However, mechanical breakage of the skin resulting from scratching or trauma and immunocompromised state, such as diabetes mellitus, lymphoma, and long term steroid use may allow penetration of the fungi into dermis. We report a case of trichophytic granuloma of the thigh caused by Trichophyton(T.) rubrum in a 21-year-old chinese male, who showed a pruritic, 17x10 cm sized, erythematous to brownish patch with multiple papules on the left thigh for 3 months. Fungal culture of the biopsy specimen grew out typical white cottony colonies of T. rubrum. Histopathologic examination of the skin lesions showed chronic granulomatous inflammation and fungal elements in the dermis. After one month of itraconazole therapy (200 mg/day), lesions were completely cleared.
Arthrodermataceae ; Asian Continental Ancestry Group ; Biopsy ; Dermis ; Diabetes Mellitus ; Epidermis ; Fungi ; Granuloma ; Humans ; Inflammation ; Itraconazole ; Leg ; Lymphoma ; Male ; Skin ; Thigh ; Trichophyton ; Young Adult

Majocchi's granuloma is a well recognized but uncommon infection of dermal and subcutaneous layers that is caused by fungal organism. It often presents as plaques and papules on areas where trauma is common. Majocchi's granuloma appears usually in immunocompromised patient but can also appear in immunocompetent patient. Tinea incognito appears in various forms of skin diseases, but it is rarely presented as Majocchi's granuloma. We report a case of trichophytic granuloma of the knee caused by Trichophyton(T.) rubrum in a 70-year-old male, who showed a pruritic, 7.0 × 2.0 cm sized, erythematous scaly patches with multiple papules on the right knee for 2 months. Fungal culture of the biopsy specimen grew out typical white cottony colonies of T. rubrum. The nucleotide sequence of internal transcribed spacer for clinical isolate was identical to that of T. rubrum strain ATCC 52013 (GenBank accession number KX092384.1). Histiologic examination showed chronic granulomatous inflammation and fungal elements in the dermis. After one month of itraconazole 200 mg/day and sertaconzole cream treatment, the lesion was completely cleared.