Bacterial Pathogens Associated with Hidradenitis Suppurativa, France – Volume 20, Number 12—December 2014 – Emerging Infectious Disease journal – CDC

 

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Emerging Infectious Diseases
www.cdc.gov/eid
Vol. 20
No. 12, December 2014

Bacterial Pathogens Associated with Hidradenitis Suppurativa, France

AUTHORS: Hélène Guet-Revillet, Hélène Coignard-Biehler, Jean-Philippe Jais, Gilles Quesne, Eric Frapy, Sylvain Poirée, Anne-Sophie Le Guern, Anne Le Flèche-Matéos, Alain Hovnanian, Paul-Henry Consigny, Olivier Lortholary, Xavier Nassif, Aude Nassif, and Olivier Join-Lambert

WEB: http://wwwnc.cdc.gov/eid/article/20/12/14-0064_article
PDF: http://wwwnc.cdc.gov/eid/pdfs/vol20no12_pdf-version.pdf

KEYPOINTS:

“Altogether, our study demonstrates that HS lesions are associated with bacterial species that can cause abscesses and severe infections. Compared with S. aureus or S. pyogenes, the low pathogenicity of these bacteria could account for the chronicity of suppuration of HS lesions that can last for years. In addition, the particular propensity of HS patients to develop recurrent or chronic skin infections highly suggests that HS is not primarily an infectious disease but a predisposing condition that allows these low pathogenic species to cause soft tissue and skin infections.”

“In the absence of clear pathophysiology, HS is considered to be an inflammatory disease and has no satisfactory medical treatment.“

“These data demonstrate that anaerobes, actinomycetes, and streptococci of the milleri group are specifically associated with HS lesions. “

“Histopathologic studies of noninflammatory areas of the skin of HS patients have shown the presence of dilated and distorted hair follicles. These anatomic abnormalities are thought to be caused by the hyperkeratinization of the follicular infundibulum, which can lead to dilatation and rupture and release of bacteria within the dermis. “

“The current hypothesis is that the HS primary event is a hyperkeratinization of the follicular infundibulum, followed by follicular occlusion, dilatation and rupture; the spread of bacterial and cellular remnants would trigger the local inflammatory response. “

“This event may predispose S. lugdunensis and anaerobic bacteria to cause nodules and abscesses in HS. Conversely, chronic suppurating HS lesions are deep abscesses drained by interconnected epithelialized sinus tracts. Colonization of these deep-seated lesions by anaerobic bacteria, streptococci of the Milleri group, and actinomycetes may account for chronic inflammation.”

“The pathophysiology of HS is mostly unknown and probably multifactorial, including genetic, infectious, hormonal, and immunologic factors. Approximately one third of HS patients have a familial history of HS. Familial HS is transmitted with a dominant autosomal inheritance pattern, and mutations in the gamma secretase genes have been associated with a subset of familial cases. “

“These findings suggest that suppurative lesions associated with HS may be of infectious origin.”

“this study demonstrates that bacterial pathogens known to cause soft tissue and skin infections are found in HS lesions. The unexpected efficacy of wide spectrum antimicrobial treatments for HS highly suggests that these bacteria are partly causative agents for suppurative hidradenitis and should be considered to be treatment targets. “

“the particular propensity of HS patients to develop recurrent or chronic skin infections highly suggests that HS is not primarily an infectious disease but a predisposing condition that allows these low pathogenic species to cause soft tissue and skin infections.”

“The prevalence of HS is estimated to be as high as 1% to 2% in the general population, and the disease has a serious effect on quality of life, placing it among the most distressing conditions observed in dermatology. It is therefore of major public health concern.”

“Most patients have a mild form of the disease, manifested as painful large and deep-seated nodules.“

“In contrast, patients with severe HS have chronic, painful, suppurating lesions that persist for years. Chronic lesions usually involve multiple areas connected by inflamed and suppurating sinus tracts surrounded by hypertrophic scars.”

“Recently, the rifampin-clindamycin drug combination was reported to substantively improve HS lesions, and our research team showed that complete healing of HS lesions can be obtained by using the rifampinmoxifloxacin-metronidazole drug combination.”

Source: Medscape CME Activity – Volume 20, Number 12—December 2014 – Emerging Infectious Disease journal – CDC

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