Infectious Diseases

FRIDAY, Nov. 15, 2024 (HealthDay News) -- The burden of superficial cutaneous fungal infections (SCFIs) among outpatient visits in the United States is high and increasing, according to a study published online Oct. 30 in the Journal of the American Academy of Dermatology.Sarah L. Spaulding, from the Yale School of Medicine in New Haven, Connecticut, and colleagues characterized trends in the prevalence of SCFIs from 2005 to 2016 by analyzing ambulatory visits in the United States using the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey.The researchers found that from 2005 to 2016, there was an estimated average of 6,001,852 annual visits for SCFIs in the United States, with 72,022,226 visits during the study period. Of this total, 20.5, 12.2, 12.0, 6.7, and 6.0 percent were tinea unguium, tinea pedis, tinea corporis, tinea cruris, and tinea capitis, respectively. An estimated average of 1,104,258,333 annual ambulatory visits occurred in the United States from 2005 to 2016, with more than 13 billion visits overall; of all visits, SCFIs generally accounted for 0.54 percent. A significantly increasing trend in annual SCFIs was observed."These findings highlight the importance of health care providers being able to identify, treat, and, when necessary, refer patients with SCFIs, as a high burden of disease is associated with a significant negative impact on the individual and population levels," the authors write.Several authors disclosed ties to the pharmaceutical industry.<a target="_blank" rel="noopener noreferrer" href="https://www.jaad.org/article/S0190-9622(24)03049-4/abstract">Abstract/Full Text (subscription or payment may be required)</a>

SCFIs account for about 0.54 percent of all ambulatory visits, with trend in annual SCFIs increasing

Burden of Superficial Cutaneous Fungal Infection Quantified in U.S.

FRIDAY, Nov. 8, 2024 (HealthDay News) -- COVID-19 is associated with long-term risk for autoimmune and autoinflammatory connective tissue disorders, according to a study published online Nov. 6 in JAMA Dermatology.Yeon-Woo Heo, M.D., from the Yonsei University Wonju College of Medicine in South Korea, and colleagues conducted a retrospective cohort study to examine the long-term risk for autoimmune and autoinflammatory diseases after COVID-19. The analysis included individuals with confirmed COVID-19 from Oct. 8, 2020, to Dec. 31, 2022 (3,145,388 patients) and controls who participated in the general health examination in 2018 (3,767,039 controls) with an observation period of more than 180 days.The researchers found that COVID-19 was significantly associated with an increased risk for alopecia areata, alopecia totalis, vitiligo, Behçet disease, Crohn disease, ulcerative colitis, rheumatoid arthritis, systemic lupus erythematosus, Sjögren syndrome, ankylosing spondylitis, and bullous pemphigoid (adjusted hazard ratios, 1.11, 1.24, 1.11, 1.45, 1.35, 1.15, 1.09, 1.14, 1.13, 1.11, and 1.62, respectively). Demographic factors, including male and female sex, age younger than 40 years, and age 40 years and older, showed diverse associations with the risk for autoimmune and autoinflammatory outcomes in subgroup analyses. Higher risk was also seen in association with severe COVID-19 infection requiring intensive care unit admission, the delta period, and not being vaccinated."Understanding the specific vulnerabilities and disease patterns among different subgroups is crucial for mitigating the long-term impact of the pandemic on global health," the authors write.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2825849">Abstract/Full Text (subscription or payment may be required)</a><a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamadermatology/article-abstract/2825853">Editorial (subscription or payment may be required)</a>

Demographic factors, including sex, age younger than 40 years, age 40 years and older, showed diverse associations with risk for outcomes

COVID-19 Linked to Long-Term Risk for Autoimmune, Autoinflammatory Disease

THURSDAY, Oct. 31, 2024 (HealthDay News) -- Doctors in New York City are chronicling the first known U.S. cases of sexually transmitted ringworm (Trichophyton mentagrophytes).Until now, transmission of the fungal infection through skin-to-skin sexual contact has been rare, although cases have been reported in Southeast Asia and France since 2021, researchers reported. These have been a subtype of T. mentagrophytes called TMVII.The new report, published in the Oct. 31 issue of the U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, states that the first U.S. case of sexually transmitted TMVII was reported in June, and "four additional TMVII infections were diagnosed during April-July 2024 in New York City among men who have sex with men."The rash appeared "on the [patients'] face, buttocks, or genitals, and was successfully treated with antifungal medications," said a team led by dermatologist Avrom Caplan, M.D., of NYU Langone Health in New York City.According to the report, all five cases of sexually transmitted ringworm so far documented in the United States involved gay or bisexual men in their 30s who had multiple sex partners.It is unclear how TMVII make its way to the United States, although the man whose case of fungal infection was reported in June said he had recently traveled to several countries in Europe. All five patients had reported recent sexual contact with other men. In all five cases, common antifungal medications cleared up the patients' rashes.The bottom line for clinicians, as well as sexually active people: Be aware "that TMVII can spread through sexual contact and cause lesions on the genitals, buttocks, face, trunk, or extremities," Caplan's team said.They noted that only lab tests can confirm T. mentagrophytes infection, which some people may initially mistake for "eczema, psoriasis, or other dermatologic conditions."The infection can be treated and cured, but takes time. According to the researchers, "patients might require oral antifungal therapy for up to 3 months and should take the treatment until lesions have fully resolved." That is important, because as long as the rash is present, infected people must avoid skin-to-skin contact with others to avoid passing the infection on. They should also avoid sharing personal items, Caplan and team said. Finally, they added, patients should resist the urge to use steroid antifungal creams to treat the rash, since these can "worsen tinea [ringworm] infection."<a target="_blank" rel="noopener noreferrer" href="https://www.cdc.gov/mmwr/volumes/73/wr/mm7343a5.htm">More Information</a>

All five known cases involved men who have sex with men; the rashes cleared up with antifungal treatments

First Cases of Sexually Transmitted Ringworm Reported in the U.S.

WEDNESDAY, March 27, 2024 -- Skin surface temperature measures differ between cases of cellulitis and pseudocellulitis, according to a study published online March 27 in JAMA Dermatology.Michael S. Pulia, M.D., Ph.D., from the University of Wisconsin-Madison School of Medicine and Public Health, and colleagues validated the differences in skin surface temperatures between patients with cellulitis and those with pseudocellulitis in a prospective diagnostic validation study conducted among patients presenting to the emergency department with acute dermatologic lower-extremity symptoms. The final sample included 204 patients, 92 of whom had a consensus diagnosis of cellulitis.The researchers found that all skin surface temperature measures (mean temperature, maximum temperature, and gradients) differed significantly between cellulitis and pseudocellulitis. The maximum temperature of the affected limb was 33.2 and 31.2 degrees Celsius for those with cellulitis and pseudocellulitis, respectively. The optimal temperature measure was the maximal temperature, with a cut point of 31.2 degrees Celsius in the affected skin, yielding a mean negative predictive value of 93.5 percent and a sensitivity of 96.8 percent. For all three measures, the sensitivity remained above 90 percent, while there was considerable variation seen in specificity (asymmetry, leukocytosis, tachycardia, and age 70 years or older prediction model; maximum temperature of the affected limb; and combination measure: 22.0, 38.4, and 53.9 percent, respectively)."Surface thermal imaging may represent a useful adjunct to the clinical assessment of cellulitis (reducing overdiagnosis), but additional validation of diagnostic performance and cutoff values in more diverse populations is needed," the authors write.

Researchers find all skin surface temperature measures differ significantly between cellulitis and pseudocellulitis

Do Skin Surface Temperature Measures Differ for Cellulitis, Pseudocellulitis?

THURSDAY, Dec. 14, 2023 (HealthDay News) -- Black patients are more likely to be diagnosed with disseminated manifestations of Lyme disease (LD) and experience longer time to appropriate treatment, according to a research letter published online Dec. 12 in JAMA Network Open.Samuel J. Starke, M.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues conducted a cross-sectional study to analyze data from patients with suspected untreated or posttreatment LD. Initial LD presentations were classified as erythema migrans (EM) only; disseminated neurologic, cardiac, or joint disease; or symptoms only, without objective signs. Racial distributions were examined across groups.The final sample included 1,395 patients; differences were most marked among Black patients, and subsequent analyses compared 1,334 Black and White patients. The researchers found that Black patients had 4.93 times the odds of disseminated disease compared with the EM-only group, after controlling for age and gender. Men also had higher odds of disseminated disease (odds ratio, 1.61). The odds of being in the symptoms-only group were independently higher for Black patients (odds ratio, 2.07), for women (odds ratio, 1.39), and with younger age (odds ratio, 1.12 per 10 years). Compared with White patients, Black patients had a significantly longer median time to appropriate antibiotic treatment (35 versus seven days); this was significant among patients with EM (26 versus four days)."We identified several racial differences in the clinical presentation and treatment of LD," the authors write. "Efforts are needed to increase patient and clinician awareness to ensure equitable reductions in disease burden."One author had a patent issued for deep learning for Lyme disease diagnosis.<a target="_blank" rel="noopener noreferrer" href="https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2812776">Abstract/Full Text</a>

Black patients have significantly longer median time to appropriate antibiotic treatment than Whites

Blacks More Likely to Have Disseminated Manifestations of Lyme Disease

The reported estimated global seroprevalence of
 
 Borrelia burgdorferi sensu lato
 
 (
 
 Bb
 
 ) is 14.5 percent, according to a systematic review and meta-analysis published online June 13 in
 
 BMJ Global Health.
 




 Yan Dong, from the Institute for Tropical Medicine at Kunming Medical University in China, and colleagues conducted a systematic review to describe the global seroprevalence and sociodemographic characteristics of
 
 Bb
 
 in human populations. Data were synthesized narratively, stratified by outcome types. A total of 137 studies were eligible for full-text screening and meta-analyses included 89 studies, with 158,287 participants.




 The researchers found that the reported estimated global seroprevalence of
 
 Bb
 
 was 14.5 percent, and Central Europe, Eastern Asia, and Western Europe were the top three regions of
 
 Bb
 
 seroprevalence (20.7, 15.9, and 13.5 percent, respectively). After eliminating confounding risk factors, the risk of false-positive
 
 Bb
 
 antibody detection was increased with methods lacking western blotting (WB) confirmation compared to methods using WB confirmation (odds ratio, 1.9). Other factors associated with
 
 Bb
 
 seropositivity were age ≥50 years, male sex, residence in rural area, and suffering tick bites.




 "A more accurate characterization of the global distribution of
 
 Bb
 
 infection would guide the circulating epidemiology of Lyme borreliosis and identify risk factors for the disease, which could inform the development of public health response policies and Lyme borreliosis control programs," the authors write.




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Factors associated with Bb seropositivity include male sex, age ≥50 years, residence in rural areas, suffering tick bites

Global Seroprevalence of Tickborne Lyme Disease About 14.5 Percent

THURSDAY, May 25, 2023 (HealthDay News) -- U.S. health officials are bracing for the possibility that mpox could surge again this summer as cases mount in several states.On Thursday, the U.S. Centers for Disease Control and Prevention reported 21 more cases of mpox, with Illinois, New York, and Maryland reporting the most new infections. Illinois had nine, while New York and Maryland reported three each. Several other states -- Alabama, Arizona, Florida, Louisiana, Texas, Utah, and Virginia -- each reported one new case, CBS News reported.The CDC is already investigating a cluster of cases in the Chicago area, which have predominantly been reported in men who have sex with men and include several cases of individuals who have been vaccinated. It is possible the virus has evolved with mutations that evade the two-dose vaccine.Other mutations have been seen in the virus that causes mpox, according to the CDC. Some strains of the mpox virus also showed signs of resistance to the antiviral drug tecovirimat (TPOXX), the CDC noted in a study. The study was posted on a preprint server online and has not been published in a peer-reviewed journal.A shift in vaccine strategy is now being considered, the experts said. "We've already, really immediately after seeing the Chicago cluster, convened folks within the U.S. government to discuss what the data is that we have and if there needs to be any change," said Demetre Daskalakis, M.D., deputy director of the White House national mpox response, CBS News reported.Americans should still get the two-dose Jynneos vaccine to guard against mpox infection, Daskalakis said, because it is still expected to be able to limit a resurgence. "We are on it, from the perspective of having the scientific discussions and are obviously, as sort of demonstrated in the track record of the response, really adjust[ing] our strategy based on what science is showing us," he added.U.S. cases are still at less than three per day, with 32 infections diagnosed in May so far. A total of 41 mpox cases were diagnosed in April, CBS News reported.

U.S. cases are still at less than three per day, with 32 infections diagnosed in May so far

More Mpox Cases Reported as Health Officials Fear a Summer Resurgence

FRIDAY, May 19, 2023 (HealthDay News) -- The JYNNEOS vaccine seems to be effective for preventing mpox disease, with better protection conferred from a two-dose series, according to a study published online May 18 in the New England Journal of Medicine.Nicholas P. Deputy, Ph.D., from the U.S. Centers for Disease Control and Prevention in Atlanta, and colleagues conducted a case-control study to examine the effectiveness of JYNNEOS vaccination in preventing medically attended mpox disease among adults. Data were included for 2,193 case patients with an mpox diagnosis code or positive orthopoxvirus or mpox virus laboratory result and 8,319 control patients with an incident diagnosis of HIV infection or a new or refill order for preexposure prophylaxis against HIV infection.The researchers found that 25 case patients and 335 controls received two doses (full vaccination), which had an estimated adjusted vaccine effectiveness of 66.0 percent. In addition, 146 case patients and 1,000 controls received partial vaccination (one dose), which had an estimated adjusted vaccine effectiveness of 35.8 percent."JYNNEOS vaccine was effective at reducing the risk of mpox disease, with effectiveness that appeared to be greater among persons who completed the two-dose series," the authors write. "In addition to vaccination, persons might benefit from strategies to prevent or reduce the risk of acquiring or transmitting mpox."

Two-dose series offers better protection, with vaccine effectiveness of 66.0 percent compared with 35.8 percent for one-dose

JYNNEOS Vaccine Seems Effective for Preventing Mpox

TUESDAY, May 16, 2023 (HealthDay News) -- Public health officials are urging people at risk for contracting mpox to get vaccinated, as they are concerned that a slowdown in infections since last summer may not continue.In an official update posted Monday on its Health Alert Network, the U.S. Centers for Disease Control and Prevention warned: "Spring and summer season in 2023 could lead to a resurgence of mpox as people gather for festivals and other events."The CDC is investigating a cluster of mpox cases in the Chicago area. It included 12 confirmed cases and one probable case. All involved men between the ages of 24 and 46 years. Among the 13 cases, nine had received the two-dose Jynneos vaccine. Four had traveled recently to New York City, New Orleans, and Mexico.Previous outbreaks were mostly related to international travel, but the virus spread rapidly across the world last spring through person-to-person contact. Cases disproportionately affected gay and bisexual men and transgender people, according to the CDC. The outbreak prompted a campaign for people at risk to get vaccinated. Despite breakthrough cases, vaccination can reduce infection severity, the CDC said.Symptoms of the virus include a blister-like rash, fever, chills, swollen lymph nodes, aches, and fatigue. It can be fatal for those with weakened immune systems.The World Health Organization last week declared that mpox was no longer a global health emergency, but that does not mean the work is over, said WHO Director-General Tedros Adhanom Ghebreyesus. The disease continues to affect communities in all regions, he said.

An outbreak in Chicago of the virus formerly called monkeypox has public health officials on edge

CDC Warns That Mpox Could Make a Summer Return

WEDNESDAY, May 10, 2023 -- Skin lesions were frequently the first sign of mpox infection during the 2022 mpox outbreak, according to a study published in the May issue of the Journal of the American Academy of Dermatology.Sonya Prasad, from Massachusetts General Hospital in Boston, and colleagues characterized skin lesion morphology, symptomatology, and outcomes of mpox infection over time based on patient cases from the American Academy of Dermatology/International League of Dermatological Societies Dermatology COVID-19, Mpox, and Emerging Infections Registry, maintained by heath care professionals.Data were entered for 101 cases in 13 countries from Aug. 4 to Nov. 13, 2022, mainly by dermatologists (92 percent). The researchers found that 39 percent of patients had fewer than five lesions. In more than half of cases (54 percent), the first sign of infection was skin lesions. Papules (36 percent), vesicles (17 percent), and pustules (20 percent) predominated in the first one to five days of infection. Pustules were most common (36 percent) by days 6 to 10, followed by erosions/ulcers and crusts/scabs (27 and 24 percent, respectively). After day 11, crusts/scabs were the predominant morphology. There were 10 cases of morbilliform rash. In 13 percent of the cases, scarring occurred."These findings reinforce deviations in skin findings in the current mpox outbreak compared to prior mpox outbreaks -- notably the presence of skin lesions prior to the onset of systemic illness and the presence of fewer than 20 skin or mucocutaneous lesions overall," the authors write.

39 percent of patients had fewer than five lesions; papules, vesicles, pustules predominated in first five days of infection

Skin Lesions Often First Sign of Mpox Infection in 2022 Outbreak

Reported cases of gonorrhea, syphilis, and congenital syphilis in 2020 surpassed those of 2019, while chlamydia cases decreased, according to a report published by the U.S. Centers for Disease Control and Prevention.




 Researchers from the CDC identified reported cases of sexually transmitted diseases (STDs) in the United States during 2020 and examined trends in diagnoses. In addition, the impact of COVID-19 on STD trends was explored.




 According to the report, initial decreases were seen across STDs, especially during the initial shelter-in-place orders in March and April 2020. However, compared with 2019, at the end of 2020, reported cases of gonorrhea and primary and secondary syphilis increased 10 and 7 percent, respectively. Reported cases of congenital syphilis were up nearly 15 percent in 2020 compared with 2019 and were increased 235 percent compared with 2016. There was a 13 percent decline in reported cases of chlamydia in 2020 compared with 2019; this decline was likely due to decreased screening and underdiagnosis during the pandemic. This also contributed to an overall decrease in the number of reported STDs in 2020, which decreased from 2.5 million in 2019 to 2.4 million in 2020. The decline in reported STD cases seen during the first part of 2020 was likely due to multiple factors, including reduced frequency of in-person health care services and diversion of public health staff from STD work to the COVID-19 response.




 "If we are to make lasting progress against STDs in this country, we have to understand the systems that create inequities and work with partners to change them," Leandro Mena, M.D., M.P.H., the director of the CDC Division of STD Prevention, said in a statement. "No one can be left behind."




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Initial decrease across STDs reported during early part of 2020; decrease in chlamydia continued through 2020 but likely reflects underdiagnosis

Gonorrhea, Syphilis, Congenital Syphilis Levels Up in 2020

MONDAY, Feb. 6, 2023 (HealthDay News) – A central Ohio measles outbreak among children who were not fully vaccinated is now over, public health officials announced Saturday.




 Columbus Health
 <a class="rm-stats-tracked" href="https://twitter.com/ColumbusHealth/status/1622238622303805440" target="_blank">
 declared
 </a>
 the outbreak finished with no new cases after a period of 42 days -- the equivalent of two measles virus incubation periods. In all, 85 children were known to be infected in the outbreak, including 36 who were hospitalized, city health department
 <a class="rm-stats-tracked" href="https://public.tableau.com/app/profile/columbus/viz/MeaslesPublicReport/MeaslesPublicReport?publish=yes" target="_blank">
 data
 </a>
 show. All but five of the children were 5 years and younger. None of the children died.




 "We've had low vaccination rates for MMR [measles, mumps, and rubella] in our community for years, but we've never had a measles outbreak like we have now. So, it did take us by surprise," Mysheika Roberts, M.D., M.P.H., health commissioner for the city of Columbus, told
 
 CNN
 
 .




 Cases were initially
 <a class="rm-stats-tracked" href="https://www.columbus.gov/publichealth/press/Measles-Outbreak-in-Local-Child-Care-Facility/" target="_blank">
 reported
 </a>
 in November and early December. Health officials said they began "sounding the alarm" early to fight the outbreak. They provided information about the ability of the virus to spread easily, and they promoted the importance of getting young children vaccinated against the virus, Roberts said.




 "In addition, we've had family members of individuals who have been infected with measles who have been very vocal and said they made a mistake -- they should have gotten their child vaccinated. And I think that has helped as well," Roberts added.




 In Central Ohio, the outbreak spread in small pockets of families that had opted out of vaccinating their children,
 
 CNN
 
 reported. They were influenced by "false information that was distributed about the MMR vaccine being associated with autism," Roberts explained.




 <a class="rm-stats-tracked" href="https://www.cnn.com/2023/02/05/health/measles-outbreak-ohio-over/index.html" target="_blank">
 
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 Article
 </a>

Outbreak declared finished with no new cases after a period of 42 days, or the equivalent of two measles virus incubation periods

Measles Outbreak in Ohio Declared Over After 85 Cases

Mpox cases reported in cisgender women represent 2.7 percent of all reported cases, according to research published in the Jan. 6 issue of the U.S. Centers for Disease Control and Prevention
 
 Morbidity and Mortality Weekly Report
 
 .




 Lisa P. Oakley, Ph.D., from the CDC Mpox Emergency Response Team, and colleagues examined transmission of mpox in cisgender women and among pregnant persons.




 The researchers identified mpox in 769 cisgender women aged 15 years and older during May 11 to Nov. 7, 2022, representing 2.7 percent of all reported mpox cases. Overall, 44, 25, and 23 percent of cases with available data occurred in cisgender women who were non-Hispanic Black or African American, non-Hispanic White, and Hispanic or Latino, respectively. Seventy-three percent of cisgender women with available data reported sexual activity or close intimate contact as the likely route of exposure, with mpox lesions reported most often on the legs, arms, and genitals. Twenty-three cases of mpox were reported in pregnant or recently pregnant persons, all of whom identified as cisgender women. Four of these pregnant persons required hospitalization for mpox, and 11 received tecovirimat, with no reports of adverse reactions.




 "Cases of mpox have occurred primarily among adult gay, bisexual, and other men who have sex with men during the current outbreak; however, any person, including cisgender women, can also acquire infection," the authors write. "Public health efforts should include more emphasis on cisgender women who might be at increased risk for exposure."




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2.3 percent of all reported mpox cases were in cisgender women, 44 percent of whom were non-Hispanic Black

Mpox Cases Reported in Cisgender Women

Monkeypox infection is rare among children and adolescents, and infections are usually not severe, according to research published in the Nov. 4 issue of the U.S. Centers for Disease Control and Prevention
 
 Morbidity and Mortality Weekly Report
 
 .




 Ian Hennessee, Ph.D., from the CDC Monkeypox Emergency Response Team, and colleagues examined data on monkeypox in children and adolescents aged younger than 18 years to characterize epidemiologic and clinical features.




 The researchers found that during May 17 to Sept. 24, 2022, 25,038 monkeypox cases were reported in the United States; during this period,
 
 Monkeypox virus
 
 infections were identified in 83 persons aged younger than 18 years, accounting for 0.3 percent of reported cases. Twenty-eight children aged 0 to 12 years had monkeypox; 64 percent were boys and most had direct skin-to-skin contact with an adult with monkeypox caring for the child in the household setting. Of the 55 adolescents aged 13 to 17 years with monkeypox, 89 percent were male, and the most common presumed exposure route was male-to-male sexual contact (66 percent). Most of the children and adolescents with monkeypox were non-Hispanic Black or African American and Hispanic or Latino (47 and 35 percent, respectively). Eighty-nine percent of the children were not hospitalized, none received intensive care unit-level care, and there were no deaths.




 "Public health messaging should emphasize transmission prevention guidelines for persons with monkeypox who interact with newborns, infants, and children in household settings," the authors write.




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Monkeypox virus infection among &lt;18s accounted for 0.3 percent of reported cases; most children were not hospitalized

Monkeypox Infection Rare in Children, Adolescents Younger Than 18

For patients with tinea corporis/cruris (TCC), efficacy is significantly higher with 400 mg itraconazole compared with 100 or 200 mg, but considerable additional cost is incurred, according to a study published online Sept. 14 in
 
 JAMA Dermatology
 
 .




 Ananta Khurana, M.D., from the Vajpayee Institute of Medical Sciences in New Delhi, India, and colleagues compared cure rates, treatment durations, safety profiles, and relapse rates of itraconazole 100, 200, and 400 mg/day for adults with treatment-naive TCC involving at least 5 percent body surface area. A total of 149 participants were randomly assigned to one of three treatment groups.




 The researchers found no significant difference between the 100- and 200-mg groups in terms of the difference in cure rate, while the differences between the 100- and 400-mg groups and the 200- and 400-mg groups were significant. Mean treatment durations differed significantly for the 100- and 400-mg groups and the 200- and 400-mg groups, but the difference for the 100- and 200-mg groups was not significant. Overall, 47.4 percent of patients relapsed after treatment, with comparable relapse rates seen across groups. None of the patients discontinued drugs due to adverse effects. A 63 and 120 percent higher cost was seen in achieving cure with the 200-mg and 400-mg doses, respectively, versus the 100-mg dose.




 "The itraconazole 400-mg dose achieves a higher cure rate than the 100- and 200-mg doses, but an almost 120 percent incremental cost in achieving cure with this dose may not justify its routine use," the authors write.




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400-mg dose of itraconazole achieves higher cure rate, but cost is 120 percent greater compared with 100-mg dose

Is Efficacy of Itraconazole for Tinea Corporis/Cruris Higher With Greater Dose?

Compassionate use of tecovirimat is well tolerated for the treatment of monkeypox, according to a research letter published online Aug. 22 in the
 
 Journal of the American Medical Association
 
 .




 Angel N. Desai, M.D., M.P.H., from the University of California Davis Medical Center in Sacramento, and colleagues examined adverse events and clinical resolution of systemic symptoms and lesions in an uncontrolled cohort study of 25 patients with laboratory-confirmed monkeypox, who were treated with tecovirimat on a compassionate use basis. Nine of the patients had HIV, one had received the smallpox vaccine more than 25 years earlier, and four received one dose of the JYNNEOS vaccination after onset of symptoms.




 The researchers found that systemic symptoms, lesions, or both were present for a mean of 12 days at the time of treatment. The most common systemic symptoms were fever, headache, and fatigue. Twenty-three of the patients had genital and/or perianal lesions; 13 patients had fewer than 10 lesions over their entire body. All patients had lesion-associated pain. One patient received 21 days of treatment, while the rest received 14 days of treatment. On day 7 of therapy, 10 patients (40 percent) had complete resolution of lesions, while by day 21, 23 (92 percent) had resolution of lesions and pain. Tecovirimat was generally well tolerated, and none of the patients discontinued therapy. On day 7 of therapy, the most common adverse events included fatigue, headache, nausea, itching, and diarrhea (28, 20, 16, 8, and 8 percent, respectively).




 "Oral tecovirimat was well tolerated by all patients with monkeypox infection, with minimal adverse effects. However, adverse effects could not always be differentiated from symptoms related to the infection," the authors write.




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By day 21, 23 of 25 patients had resolution of lesions and pain; none of the patients discontinued treatment

Tecovirimat Well Tolerated for Treatment of Monkeypox

Monkeypox manifests with dermatologic and systemic clinical infections, according to a report published online July 21 in the
 
 New England Journal of Medicine
 
 .




 John P. Thornhill, M.D., Ph.D., from Queen Mary University of London, and colleagues describe the presentation, clinical course, and outcomes of 528 monkeypox infections diagnosed between April 27 and June 24, 2022, at 43 sites in 16 countries.




 The researchers found that 98 percent of the people with infection were gay or bisexual men (median age, 38 years), 41 percent had HIV, and 75 percent were White. In 95 percent of the persons with infection, transmission was suspected to have occurred through sexual activity. Among the cases included, 95 percent presented with a rash; 64 percent had &lt;10 lesions and 73 and 41 percent had anogenital and mucosal lesions, respectively. Fever, lethargy, myalgia, and headache were common systemic features preceding the rash (62, 41, 31, and 27 percent, respectively); lymphadenopathy was reported in 56 percent. In 29 percent of the 377 persons tested, concomitant sexually transmitted infections were reported. The median incubation period was seven days among the 23 persons with a clear exposure history. In 29 of 32 persons in whom seminal fluid was analyzed, monkeypox virus DNA was detected. Five percent of the persons were given antiviral treatment; 13 percent were hospitalized, mainly for pain management, soft-tissue superinfection, pharyngitis limiting oral intake, eye lesions, acute kidney injury, myocarditis, and infection-control purposes. There were no deaths reported.




 "Without widely available treatment or prophylaxis, rapid case identification is vital to containment," the authors write.




 <a class="rm-stats-tracked" href="https://www.nejm.org/doi/full/10.1056/NEJMoa2207323" target="_blank">
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95 percent of 528 cases presented with rash; 73 and 41 percent had anogenital and mucosal lesions, respectively

Manifestations of Monkeypox Described in Case Series

Many older women remain sexually active, according to the results of the latest University of Michigan National Poll on Healthy Aging.




 Preeti Malani, M.D., from the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor, and colleagues asked a national sample of 1,225 older women (aged 50 to 80 years) about sexual activity, intimacy, and symptoms commonly associated with menopause.




 According to the results of the survey, two in five women (43 percent) say they have been sexually active in the past year (defined as caressing, foreplay, masturbation, or intercourse), with more positive responses from younger women (aged 50 to 64 years; 53 percent) versus older women (aged 65 to 80 years; 30 percent). Overall, nearly two-thirds of women reported being satisfied (29 percent "very" and 33 percent "somewhat") with their sexual activity in the past year. Just over one-quarter of women reported that menopause-related symptoms interfered with their ability to be sexually active (14 percent "a lot" and 14 percent "somewhat").




 "As this new report notes, it's important for women to feel empowered to take control of their own health and to initiate discussions with their health care provider, including discussions around sex and intimacy, to contemplate potential treatment options," Teresa A. Keenan, Ph.D., from AARP Research, said in a statement. "With many years of postmenopausal life ahead, their concerns are too important to ignore."




 <a class="rm-stats-tracked" href="https://www.healthyagingpoll.org/reports-more/report/womens-health-sex-intimacy-and-menopause" target="_blank">
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Authors say women should speak to their providers about sexual health, including the impact of menopause-related symptoms

Nearly Four in 10 Older Women Remain Sexually Active

There is a lack of evidence-based clinical management guidelines for monkeypox (MPX), according to a review published online Aug. 16 in
 
 BMJ Global Health
 
 .




 Eika Webb, M.B.B.S., from Liverpool School of Tropical Medicine in the United Kingdom, and colleagues conducted a systematic review and identified MPX guidelines providing treatment and supportive care recommendations. A total of 14 guidelines were included, from 2,026 records screened.




 The researchers found that most guidelines were of low quality (median score, 2 out of 7), lacked detail, and covered only a narrow range of topics. Most of the guidelines focused on adults; five, three, and three provided some advice for children, pregnant women, and people living with HIV, respectively. Treatment guidance was mainly limited to antiviral advice; cidofovir was advised in seven guidelines (four for severe MPX only), while four and one guidelines advised tecovirimat and brincidofovir, respectively. Recommendations on supportive care and treatment of complications were provided in only one guideline. Vaccination was recommended as postexposure prophylaxis (PEP) in all guidelines. Vaccinia immune globulin was advised as PEP for severe cases in people with immunosuppression in three guidelines.




 "Urgent investments into research to identify optimal treatment and prophylaxis strategies are needed for the whole population, in any setting, to benefit patient care and outcomes," the authors write.




 <a class="rm-stats-tracked" href="https://gh.bmj.com/content/7/8/e009838" target="_blank">
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Treatment guidance mainly limited to antiviral advice, vaccination recommended as postexposure prophylaxis

Clinical Management Guidelines Lacking for Monkeypox

For adults aged 50 years or older, those with a COVID-19 diagnosis have an increased risk for developing herpes zoster, according to a study published online March 9 in Open Forum Infectious Diseases.
 Amit Bhavsar, M.B.B.S., from GSK in Wavre, Belgium, and colleagues compared the incidence of herpes zoster in those aged 50 years and older diagnosed with COVID-19 and those never diagnosed with COVID-19. A total of 394,677 individuals with COVID-19 were matched to 1,577,346 individuals without COVID-19 by age, sex, herpes zoster risk factors, and health care cost level.
 The researchers found that the risk for herpes zoster was increased for individuals diagnosed with COVID-19 versus those without (adjusted incidence rate ratio, 1.15). The increased risk was more pronounced after COVID-19 hospitalization (adjusted incidence rate ratio, 1.21).
 "This is the first epidemiological evidence linking prior COVID-19 infection with increased shingles risk among older adults, who are already at heightened risk of shingles due to age-related decline in immunity," Temi Folaranmi, M.D., vice president and vaccines therapeutic area head of U.S. Medical Affairs at GSK, said in a statement. "It is important that health care professionals are aware of this potential increased risk so patients can be diagnosed and treated early if they develop shingles following COVID-19. These results also highlight the importance of preventative measures, such as vaccination, to protect the health and well-being of older adults who are at risk for vaccine-preventable diseases like COVID-19 and shingles."
 Several authors disclosed financial ties to the GSK group of companies.

Increased herpes zoster risk found for those with versus without COVID-19, with more pronounced risk following COVID-19 hospitalization

Incidence of Herpes Zoster Up for >50s With COVID-19 Diagnosis

Certain lots of Jergens moisturizer have been recalled because they may be contaminated with bacteria that pose a risk to people with weakened immune systems.




 
 Pluralibacter gergoviae
 
 bacteria typically pose little medical risk to healthy people, according to Kao USA Inc., which has recalled 3-ounce and 10-ounce Jergens Ultra Healing Moisturizer products. But other individuals with health problems could be more susceptible to infection. The pathogen is an ongoing problem for the cosmetics industry.




 Along with announcing the recall, Kao USA said the products have been removed from warehouses. It is also working with retailers to ensure the lotions are removed from store shelves.




 The recalled products were manufactured between Oct. 1, 2021, and Oct. 18, 2021. The lot codes for the 3-ounce size (UPC 019100109971 for single bottles and 019100267114 for a pack of three) can be found on the back of the bottle printed in black ink and are: ZU712851, ZU712871, ZU712911, ZU722881, ZU712861, ZU712881, and ZU722851. The lot codes for the 10-ounce size (UPC 019100109988) can be found on the bottom of the bottle printed in black ink: ZU722741, ZU722781, ZU732791, ZU732811, ZU722771, ZU732781, ZU732801, and ZU732821.




 Consumers with the recalled products should call the company at 1-800-742-8798 for a free product coupon. Any health problems caused by the use of the recalled products should be reported to the U.S. Food and Drug Administration MedWatch Program by phoning 1-888-463-6332 or by going to the
 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/medwatch-fda-safety-information-and-adverse-event-reporting-program" target="_blank">
 MedWatch website
 </a>
 .




 Kao USA said the investigation to determine the scope of the problem is continuing and that it is working to improve cleaning and sanitization practices to avoid similar issues in the future.




 <a class="rm-stats-tracked" href="https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/kao-usa-conducts-voluntary-recall-jergensr-ultra-healing-moisturizer" target="_blank">
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Jergens Moisturizer Recalled Due to Bacteria Risk

The U.S. Preventive Services Task Force (USPSTF) recommends syphilis screening for asymptomatic, nonpregnant adolescents and adults at increased risk for infection. This recommendation forms the basis of a draft recommendation statement published Feb. 15 by the USPSTF.




 Michelle H. Henninger, Ph.D., from the Kaiser Permanente Center for Health Research in Portland, Oregon, and colleagues conducted a systematic review to reaffirm the evidence for the USPSTF 2016 recommendation for syphilis screening in asymptomatic, nonpregnant adults and adolescents at increased risk for infection. Three key questions were addressed, with one fair-quality study used to address each question. The researchers found that the proportion of men who have sex with men (MSM) screened annually increased, and the mean number of tests per MSM was associated with an increase in the proportion of early latent syphilis infections identified and a decrease in the proportion of secondary syphilis infections identified. An online risk calculator had an area under the curve of 0.69 for predicting syphilis incidence within the next three months. In a third study, emotional stress was found to be a common experience for individuals before and after testing, with factors associated with increased stress including history of injected drug use, Black race/ethnicity, and single marital status.




 Based on these findings, the USPSTF reaffirmed the grade A recommendation for syphilis screening for asymptomatic, nonpregnant adults and adolescents at increased risk for infection. The USPSTF concludes that there is substantial net benefit for syphilis screening for those at increased risk for infection.




 The draft evidence review and recommendation statement are available for public comment from Feb. 15 through March 14, 2022.




 <a class="rm-stats-tracked" href="https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/syphilis-infection-nonpregnant-adults-adolescents-1" target="_blank">
 Draft Evidence Review
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 <a class="rm-stats-tracked" href="https://www.uspreventiveservicestaskforce.org/uspstf/draft-recommendation/syphilis-infection-nonpregnant-adults-adolescents-1" target="_blank">
 Draft Recommendation Statement
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Grade A recommendation reaffirms 2016 recommendation for asymptomatic, nonpregnant adults and teens at increased risk

USPSTF Still Advises Syphilis Screening for At-Risk Teens, Adults

Persons experiencing homelessness (PEH) are more likely to have first-line antibiotic coverage for methicillin-resistant
 
 Staphylococcus aureus
 
 (MRSA), although the odds of group A
 
 Streptococcus
 
 (GAS) skin and soft tissue infections (SSTIs) are significantly higher among PEH, according to a research letter published online Feb. 9 in
 
 JAMA Dermatology
 
 .




 Adam Zakaria, from the University of California San Francisco School of Medicine, and colleagues examined the association between homelessness and GAS SSTIs in a retrospective cross-sectional analysis of inpatients between March 2018 and March 2020. Overall, 181 patients with SSTIs with microbiology data were included in the analysis.




 The researchers found that the rates of ecthyma (21 versus 3 percent) and ectoparasitic disease (8 versus 0.8 percent) were significantly higher for PEH. At the time of dermatology consultation, significantly higher rates of first-line MRSA coverage (91 versus 70 percent) and nonsignificantly reduced rates of first-line GAS coverage (30 versus 47 percent) were seen for PEH. Overall, 42 and 33 percent of PEH had GAS-positive cultures and MRSA-positive cultures, respectively; among those with stable housing, the corresponding proportions were 15 and 23 percent. After adjustment for confounding variables, the odds of GAS SSTI were significantly higher for PEH relative to those with stable housing (odds ratio, 4.25) and the odds of MRSA SSTI were nonsignificantly higher (odds ratio, 1.49).




 "Future studies are needed to demonstrate causation, establish a more precise effect size estimate, and evaluate outcomes among PEH receiving empirical GAS coverage for SSTI," the authors write.




 One author disclosed financial ties to the pharmaceutical industry.




 <a class="rm-stats-tracked" href="https://jamanetwork.com/journals/jamadermatology/fullarticle/2788628" target="_blank">
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However, first-line antibiotic coverage against MRSA more often given to persons experiencing homelessness

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