Page 23 - SPD Review Winter 2014

Literature Review - Winter 2014

gression-free survival of 89% after initial therapy. None developed multisystem as blood cultures were negative. Prior to delivery mother reported rash on her

disease. Those with skin/multisystem disease had a 3-year, progression-free inner thighs. Acquisition of this infection is unknown, but the authors remind

survival of 44% with vinblastine/prednisone therapy and risk-organ involve- us that Trichophyton are transmitted by human contact with fungal spores and

ment did not correlate with failure to achieve non-active disease. Finally, those are found in warm, humid soil. Given the warm, humid air in the controlled pre-

with multisystem disease had higher frequency of circulating BRAF-V600E cells mature infant environment it is possible it was transmitted from a healthcare

compared to skin-limited disease (8 of 11 vs 1 of 13, respectively). While further worker or transmitted vertically. This case adds to the differential diagnosis of

prospective multicenter trials need to be done, this report suggests that the pre-term cutaneous neonatal infectious eruptions.

absence of circulating BRAF-V600E cells a possible marker for identifying less- (Submitted by Maria Elena Miyar, MD)

aggressive skin-limited LCH and perhaps potential therapeutic alternatives for

multisystem LCH with circulating BRAF-V600E cells.
Fritz SA, Hogan PG, Singh LN. Contamination of Environmental Surfaces with

(Submitted by Maria Elena Miyar, MD)
Staphylococcus aureus in Households with Children Infected with Methicil-

lin-Resistant S aureus. JAMA Pediatr. 2014;168(11):1030-1038.

 INFECTIOUS DISEASES
In this study done in St. Louis, investigators enrolled ifty children who had ac-

tive or recent culture-positive MRSA. Patients were swabbed in the nares, axil-

Dietz RM, Stewart MS, Fuller EN, Paugh HC, Morelli JG, Wright R. An un- lae, and inguinal folds to detect colonization. For each of the patients, 21 house-

usual presentation of dermatophytosis in a premature infant. J Pediatr. hold surfaces (living room, bathroom, kitchen, and bedroom locations), as well

2014;165(5):1063.
as pet dogs and cats when present, were sampled for the presence of MRSA.

46% of households of affected children had MRSA recovered from one or more

An ex-24 week female, born via vaginal delivery following premature rupture household surface. In most cases, the strain type matched the patient’s isolate.

of membranes, was found to have fever and photodistributed erythematous The most frequent positive household sites were the patient’s bed linens, tele-

papules and pustules on the back and posterior arms in the location of prior vision remote control, and bathroom hand towel. 12% of dogs and 7% of cats

phototherapy exposure for treatment of hyperbilirubinemia. Broad spectrum were colonized. Patients that were colonized with MRSA were more likely to

antibiotics and antifungal therapy were initiated and a skin biopsy, tissue cul- have contaminated household surfaces, and a greater density of persons living

ture, and skin scraping were done. Numerous fungal organisms were seen in in the space was associated with a higher likelihood of MRSA-contaminated

the stratum corneum and hair follicles. Given concern for aspergillosis, ampho- surfaces. The frequency of household cleaning did not correlate with the likeli-

tericin was started. At 2 weeks of age necrotizing enterocolitis with colonic hood of having a contaminated household surface.

perforation developed, but no aspergillus was found. Later, on day 23 a fungal (Submitted by Megha Tollefson, MD)

tissue culture revealed Trichophyton rubrum, which was isolated to the skin

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