Complement Inhibitors from Scabies Mites Promote Streptococcal Growth A Novel Mechanism in Infected Epidermis?

? Angela Mika1, Simone L. Reynolds1,2, Darren Pickering1, David McMillan1, Kadaba S. Sriprakash1, David J. Kemp1, Katja Fischer1* 1 Infectious Diseases Program, Biology Department, Queensland Institute of Medical Research, Herston, Brisbane, Australia Received October 27, 2011; Accepted January 27, 2012; Published July 17, 2012 Abstract Background : Scabies is highly prevalent in socially disadvantaged communities such as indigenous populations and in developing countries. Generalized itching causes discomfort to the patient; however, serious complications can occur as a result of secondary bacterial pyoderma, commonly caused by Streptococcus pyogenes (GAS) or Staphylococcus aureus. In the tropics, skin damage due to scabies mite infestations has been postulated to be an important link in the pathogenesis of disease associated with acute rheumatic fever and heart disease, poststreptococcal glomerulonephritis and systemic sepsis. Treatment of scabies decreases the prevalence of infections by bacteria. This study aims to identify the molecular mechanisms underlying the link between scabies and GAS infections.

Methodology/Principal Findings GAS bacteria were pre-incubated with blood containing active complement, phagocytes and antibodies against the bacteria, and subsequently tested for viability by plate counts. Initial experiments were done with serum from an individual previously exposed to GAS with naturally acquired anti-GAS antibodies. The protocol was optimized for large-scale testing of low-opsonic whole blood from non-exposed human donors by supplementing with a standard dose of heat inactivated human sera previously exposed to GAS. This allowed an extension of the dataset to two additional donors and four proteins tested at a range of concentrations. Shown first is the effect of scabies mite complement inhibitors on human complement using ELISA-based complement activation assays. Six purified recombinant mite proteins tested at a concentration of 50 g/ml blocked all three complement activation pathways. Further we demonstrate in human

whole blood assays that each of four scabies mite complement inhibitors tested increased GAS survival rates by 215 fold. Conclusions/Significance We propose that local complement inhibition plays an important role in the development of pyoderma in scabies infested skin. This molecular link between scabies and bacterial infections may provide new avenues to develop alternative treatment options against this neglected disease.

Relationship Between Distribution, Severity of Acne Vulgaris and Smoking

AZIMI H, MD: Asistant Professor of Dermatology (Corresponding author) Department of Dermatology, Sina Hospital, Tabriz University of Medical Science Medical Journalof Vol. 30 No. 2 Tabriz University of Medical Sciences Summer 2008

Abstract

Background and Objectives: Acne vulgaris is a self-limiting skin disorder involving pilosebaceous units of

adulescences. Several factors have been suggested to influence acne including medication, climate, stress, diet, mensturation, genetic and sex. There are contradictory reports on the relationship between acne and cigarette smoking. The objective of this study was to examine the relation between distribution, severity of acne and smoking in a case control study.

Materials and methods: During 1 year of study a questioner on smoking habits, distribution, severity of acne was filled for 110 patients with acne Vulgaris alone and 110 patients suffering from acne Vulgaris and smoking, attending in the Sina clinic. Data were analysed by SPSS.

Results: This study was carried out on 110 smokers (106 male, 4 female) and 110 nonsmokers ( 105 male, 5 female ). The mean age for beginning of acne was 16.11 (SD=2.3) & 16.44 (SD= 2.31) for smokers & non- smokers respectively. The mean age of patient was 22.89(SD= 4.59) and 24.47 (SD= 6.72) as compared above. There wasnt any significant difference of acne severity between two groups, no association between site involvement and smoking could be found in smoker group but in the respect to non-smokers, The anterior aspect of chest was commonly involved (P= 0.036 ). A significant relationship between acne severity and number of cigarettes smoked daily observed (P= 0.02).

Conclusion:

An association between acne severity & cigarette smoking was found in this study and the involvement of anterior chest was more common.

Current Concepts on the Diagnosis and Pathogenesis of Drug-induced Hypersensitivity Syndrome Tetsuo SHIOHARA,*1 Yoko KANO,*2 Ryo TAKAHASHI*3 JMAJ 52(5): 347352, 2009

Abstract Drug-induced hypersensitivity syndrome (DIHS) is a life-threatening, multi-organ system reaction. The clinical picture of this syndrome is highly variable and not so distinctive that the diagnosis can be made on clinical grounds: this syndrome is often missed in the differential diagnosis of patients presenting with fever, rash, and lymphadenopathy, probably due to a lack of awareness. This syndrome has several unique features: they include the delayed onset, paradoxical deterioration of clinical symptoms after withdrawal of the causative drug, and unexplained cross-reactivity to unrelated multiple drugs. These features cannot be solely explained by drug etiology. We have demonstrated that human herpesvirus 6 (HHV-6) can be specifically reactived 23 weeks after the onset and the test for detecting HHV-6 reactivation has become the gold standard test for identifying patients with DIHS. This review briefly discusses many of the important changes that explain the diversity of the clinical symptoms of DIHS.