Prevalence and treatment of Staphylococcus aureus colonization in patients with mycosis fungoides and Sézary syndrome

IF 11 1区 医学 Q1 DERMATOLOGY
R. Talpur, R. Bassett, M. Duvic
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引用次数: 157

Abstract

Background Mycosis fungoides (MF) and Sézary syndrome (SS), variants of cutaneous T-cell lymphoma, may arise from antigen-driven clonal expansion and accumulation of helper-memory T cells. Superantigens from Staphylococcus aureus can stimulate T cells.

Objectives (i) To determine the prevalence of S. aureus carriage in nares and skin in patients with MF/SS compared with historical rates in other conditions. (ii) To determine whether eradication of S. aureus carriage is associated with clinical improvement.

Methods Skin and nares cultures were performed prospectively. Patients with positive nares and skin cultures were treated with oral antibiotics and intranasal mupirocin 2% and samples were taken for reculturing at 3 days, 4 weeks and 8 weeks. An exact binomial test was used to compare the carriage rates among different groups.

Results Among 106 patients with MF/SS, 67 (63%) had skin colonization and 57 (54%) had nasal colonization. Staphylococcus aureus was isolated from 44 patients, 33 (31%) each from skin and nares. Colonization was highest in erythrodermic SS (48%), similar to atopic dermatitis (64%), and lowest in MF without erythroderma (26%), psoriasis (21%), and the general population (10%). Oral and topical antibiotics eradicated S. aureus colonization in nares in 28 of 33 (85%) patients and in MF skin lesions in 30 of 33 (91%) patients at 4–8 weeks, with rapid clinical improvement seen in 58% of S. aureus-colonized patients.

Conclusions Staphylococcal carriage in nares and skin lesions of patients with MF is similar to that in atopic dermatitis. Eradication of staphylococci from the skin is possible with treatment and was associated with clinical improvement.

蕈样真菌病和ssamzary综合征患者金黄色葡萄球菌定植的流行及治疗
真菌样霉菌病(MF)和ssamzary综合征(SS)是皮肤T细胞淋巴瘤的变体,可能由抗原驱动的克隆扩增和辅助记忆T细胞的积累引起。来自金黄色葡萄球菌的超级抗原可以刺激T细胞。目的(i)确定MF/SS患者鼻腔和皮肤中金黄色葡萄球菌携带的患病率,并与其他情况下的历史发生率进行比较。(ii)确定根除金黄色葡萄球菌携带是否与临床改善有关。方法前瞻性进行皮肤和鼻腔培养。鼻腔和皮肤培养阳性患者给予口服抗生素和鼻内2%莫匹罗星治疗,并于第3天、第4周和第8周取标本进行再培养。采用精确的二项检验来比较不同组间的运载率。结果106例MF/SS患者中,皮肤定植67例(63%),鼻腔定植57例(54%)。44例患者分离到金黄色葡萄球菌,其中皮肤和鼻腔各33例(31%)。定植在红皮病SS中最高(48%),与特应性皮炎相似(64%),在无红皮病的MF中最低(26%),牛皮癣(21%)和一般人群中最低(10%)。在4-8周时,口服和局部抗生素根除了33例患者中28例(85%)的鼻腔金黄色葡萄球菌定植,33例患者中30例(91%)的MF皮肤病变,58%的金黄色葡萄球菌定植患者的临床迅速改善。结论MF患者鼻腔及皮损的葡萄球菌携带情况与特应性皮炎相似。通过治疗,从皮肤上根除葡萄球菌是可能的,并与临床改善有关。
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来源期刊
British Journal of Dermatology
British Journal of Dermatology 医学-皮肤病学
CiteScore
16.30
自引率
3.90%
发文量
1062
审稿时长
2-4 weeks
期刊介绍: The British Journal of Dermatology (BJD) is committed to publishing the highest quality dermatological research. Through its publications, the journal seeks to advance the understanding, management, and treatment of skin diseases, ultimately aiming to improve patient outcomes.
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