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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-98-100
Karabayeva Indira, independent reseacher Republican specialized scientific practical center of dermatology and venereology, Uzbekistan E-mail: Ikarabaeva.73@mail.ru
Clinical aspects of zooanthroponous microsporia in present — day conditions
Abstract: clinical features of microsporia in children were studied in up- to- date conditions.Typical clinical picture of microsporia of hairy part of the head and smooth skin was revealed in 185 (84%) patients. Atypical forms of microsporia made up 35 (16%) patients. Atypical forms of microsporia are divided into trichophytoid, infiltrative-suppurative, psoriasis form and seborrhek forms.
Keywords: microsporia, atypical forms, children.
Microsporia or ringworm are the most common diseases with mycotic etiology in pediatric practice [2; 8]. Microsporia- a fungus disease from the group of dermatophyte, which is common in man and in animals. It affects the skin and hair, eyebrows, eyelash and lanugo of smooth skin [2; 3]. Analysis of registration of morbidity by the Republic for the last 5 years showed, that the growth of intensive index from 1,3 (in 2009) to 2,6 (in 2013) to 100 thousand population [l]was noted.Alarm condition is still among children contingent by the morbidity with microsporia.So from general number of patients with microsporia children under 18 made up in 2009 -61,5%, in 2010 -63,7%, in 2011-61,5%, in 2012 -59,8%, in 2013-58,9% [1; 5]. 20-fold growth of microsp oria in newborns was marked by the data of literature for the last 20 years. Mycosis has a high contagiosity and in children it may proceed as epidemic outbreak [4; 8].The main source of infection is cats, mainly stray ones.
Infection occurs in the contact with sick animals or through subjects infected by their hair [3]. One of the reasons of the growth of morbidity with mycosis is impertinence of diagnostics of microsporia as a result of changes of epidemiology and clinics of infection in recent years [8]. In current conditions the clinical course of mycosis is different by significant polymorphism, increase the number of obliterated, subclinical and recurrent forms.Usual clinical forms of difficulties in diagnostics do not cause, but atypical manifestations of the disease may serve as a reason of diagnostic pitfall, irrational treatment, irregular conducting of antiepidemic measures [6; 7].
The purpose of the work- to study the clinical features of microsporia in children in current conditions.
Materials and methods
220 children at the age from 2months to 14 with microsporia hospitalized to the department of mycology of the RSSPMC of der-
Clinical aspects of zooanthroponous microsporia in present — day conditions
matology and venereology of the Health Ministry of the Republic of Uzbekistan were under the observation. Of them 138 (62,7%) — male, 82 (37,3%) — female. The occurrence of morbidity was predominantly in patients at the age of 4-11, making up 65,3% from general number of patients.The duration of disease in 154 (75%) patients was from 2 weeks till 1month, in 44 (20%) — made up 1,53 months, in11 (5%) — 4-6 months, in 7 (3%) — from 7 months till 1 year and in 4 (2%) more than 1 year. Chronic duration of microsporia (from 4 months to 1 year), conditioned untimely diagnostics and irrational treatment was marked in 22 (10%) patients.
Results and discussion
Microsporia of hairy part of the head was diagnosed in 100 (45,3%), microsporia of smooth skin — in 60 (27,3%), mixed form (hairy part ofthe head and smooth skin) — in 60 (27,3%) children. In 6 (9,7%) along with affection of hairy part of the head, the disease proceeded with involving in mycotic process of setaceous hair of eyebrow and eyelash.Typical clinical picture of microsporia ofhairy part of the head and smooth skin was revealed in 185 (84%) patients.
For the typical clinical picture of microsporia of smooth skin caused by Microspore was typically appeared with sharply boundary spots, straitening oval or oval forms by size from1,0 to 3,0-4,0cm in diameter withclear boundary, slightly raised edges with presented, separate bladders, serous scabs, scales. Central part of pale — pink color with scaly peeling.On the hairy part of the head the single, big foci with straightening — rounded or oval shape in size from 2,0-4,0 to 6,0-8,0 cm in diameter, coating with grey asbestoshaped scales with obliterated inflammatory appearance of the skin were observed. In the nidus of affection of hair were broken to the level 5-8 mm. For the clinical pictures of microsporia caused by rusty microspore the presence of more excessive eruptions which is localized on the edge zone of hairy part of the head with simultaneous affection of adjacent fields of smooth skin (forehead, temple and neck) was typical.By our data in recent years atypical forms of microsporia made up 48 (16%) patients. Atypical forms of microsporia are one of the causes of diagnostic pitfalls.Considering of microsporia the mycosis of childhood, specialist in skin and venereal diseases do not always carry out mycological examinations in adults.
It is possible to reveal these forms of disease by only complex mycological investigations (microscopy of pathological material, fluorescent and cultural diagnostics).
At present one of the typical epidemiological features of microsporia is acceleration of morbidity cases with mycosis among young children and in adults elder than 18.
Microsporia of children at an early age, including newborns (0-3 years old) was detected in 39 (13%) cases. If early classic clinical pictures of microsporia in children at an early age on hairy part of the head were the presence of single, big with wide peripheral surface, insignificant inflammatory effect, without broken of hair, torpid course, in our observations microsporia had the features of mycosis in children at elder age group.
At the same time on the hairy part of the head as a rule multiple erythematous- squamous foci with broken hair and typical whitish clutches are appeared.The nidus on the smooth skin usually has erythematous- squamous character, without specific platen, reminding seborrheic dermatitis or allergic eruptions.Microsporia of adults (18 years old and over than 18) —was observed in 22 (7,3%) cases. The foci ofmicrosporia are localized on the trunk as erythematous-squamous eruptions reminding parapsoriasis, seborrheic dermatitis and not often the nidus of mycosis had the form "iris" or a symptom "ring in the ring" similar with rubromycosis of smooth skin. As a result of combing may be joined pyodermia, which intensifies
atypicalness of mycosis. In one case the nidus of microsporia was located in pubic zone and it remembered us the clinical picture of zooanthroponosis trichophyte of this localization. All atypical forms of microsporia were divided into trichophytosis 19 (39,6%), infiltrative -suppurated — 21 (43,8%), psoriasis formed — 4 (8,3%), seborrheic forms — 4 (8,3%) patients.
Trichophytoid form ofmicrosporia was diagnosed in 14 (39,6%), mainly this form was occurred in school children at an elder age with complicated allergic anamnesis (atopic dermatitis, allergic rhinitis, asthma). Loose, chronic course was specific for it with duration from 4-6 months to 1year.At the same time the nidus of mycosis is localized on the hairy part of the head or boundary zones of forehead, temporal area and on the skin of the trunk.On smooth skin the nidus were presented by less peeling, unsharp inflammatory or hypopig-mentation spots. The edges of the nidus of affection are fuzzy, outlines are indefinable. These forms ofmicrosporia can be taken to seborrhea group, seborrheic — dermatitis, streptococcal impetigo, and pityriasis versicolor, chronic trichophytosis are necessary to differentiate.
On the hairy skin of the head such form appeared with diffuse or focal peeling, falling out and thinness of the hair, usually dull, broken in different levels. Later on may be developed deluted hair as rounded or bigger nidus with polycyclic contours.
Deep (infiltrative -suppurated) forms of microsporia were diagnosed in 15 (43,8%)patients.
Infiltrative -suppurative nidus of mycosis were big, confluent, rising over the skin with foci on the hairy part of the head. This is usually conglomerations from fused and suppurated painful follicles; perifolliculitis.Their surface was covered by rudepurulent scabs with agglutinated hair. In removal of scabs and hair from openings ofhair follicles the matter was discharged. In the nidus of affection of the hair were broken into different levels from healthy skin (4-5mm) and they resembled the clinics of zooanthroponosis trichophytosis.
Regional lymph — nodes were painful and extended. In patients expressed symptoms of intoxication were observed. On smooth skin the nidus were rounded form in size from 2,0x 3,0cmindiameterto-children palm with clear borders and distinctive peripheral wall containing from small micro vesicles and pustule. The affected skin in the nidus was swollen, infiltrated and hyperemic. The diagnosis of microsporia in this group of patients was determined after getting of fungus in culture.
Papula-squamous or psoriasisformed forms of microsporia was registered in 3 (8,3%) patients. Eruption as usual was located on the smooth skin, on the chest and lateral surface of the trunk. The nidus consisted of papule which were merged in the plague with polycyclic contours that in the surface were noted expressed peeling and a slight infiltration. On the hairy part of the head were single, big foci of straightly-rounded or oval contours in size from 2,0-4,0 to 6,0-8,0 cm in diameter, covered by grey asbestosform flakes with insignificant inflammatory process of the skin.
Erythematous — swollen or seborrheic form of microsporia was diagnosed in 3 (8,3%)children at an early age.Observations showed that the main cause of the development of this form was using of corticosteroid creams and as a result of untimely diagnostics of mycosis or self-treatment of patients. In these cases the foci of mycosis were localized principally on seborrheic zones of facial skin, shoulder, interscapular area and in the chest. The foci of affection on smooth skin in these patients were disseminated, multiple, small, bright — red color, round- oval sometimes irregular forms with sizes from 1,0-2,0 cm to 3,0-5,0 cm in diameter. In some foci the borders are fuzzy, peripheral walls are absent. Peeling with scale — scabs was observed on the surface of foci.
Such clinical forms of microspore can be accepted mistakenly for multiform exudative erythema, toxicodermia, pityriasis rosea of Jiber, allergic dermatitis, which it delays the term of establishment of diagnosis.
Conclusion
1. In the least suspicion to microsporia it is necessary to go to the specialist -dermatologist, which it allows to diagnose this
disease in a short time and to administer rational treatment in time.
2. Belated diagnostics and because of irrational therapy increases atypicalness of clinical manifestations leading to chronic course of mycosis and its dissemination. Such patients are the foci of unidentified infection and they increase unfavorable epidemiological condition.
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DOI: http://dx.doi.org/10.20534/ESR-16-9.10-100-103
Kasimova Mukhlisakhon Saidakbarkhodjayevna, Phd student of the Institute of Immunology of the Academy of Sciences of the Republic of Uzbekistan E-mail: muhlisakasimova25@gmail.com Ismailova Adolat Abdurakhimovna, Head of the Laboratory of immunopathology and immunopharmacology of the Institute of Immunology of the Academy of Sciences of the Republic of Uzbekistan, MD Tulabaeva Gavkhar Mirakbarovna, Head of the Department of Cardiology with the course of Gerontology of the Tashkent Institute of Postgraduate Medical Education, MD
The significance of inflammatory mediators in the clinical interpretation of patients with stable angina of II-III fc
Abstract: This article presents the results of a study on inflammatory mediators in patients with ishemic heart disease stable angina of II-III FC with postinfarction cardiosclerosis in anamnesis and without it. It had been fond significant higher levels of CRP and pro-inflammatory cytokines IL-6 and TFN-a in patients with stable angina with postinfarction cardiosclerosis in anamnesis. The relationship between these indicators revealed according to the correlation analysis.
Keywords: ischemic heart disease, stable angina, postinfarction cardiosclerosis, inflammatory markers, cytokines.
Topicality. The cardiovascular disease for the past 50 years, firmly holds the primacy among the causes of death in the developed world [7]. The most common form of chronic ischemic heart disease (IHD) is stable angina (SA) [14]. The atherosclerosis ofthe coronary arteries is the pathological basis of coronary heart disease. The local and systemic signs of nonspecific inflammatory process in atherosclerosis observed at an early stage lesion of blood vessel walls. It is known that arteriosclerosis — is a chronic inflammatory process, and even at the early stages of atherogenesis — intra- and
extracellular lipid sediments and the formation of lipid spots inflammatory cells already present (macrophages and T lymphocytes) [2]. These cells, activating, secrete large amounts of cytokines, chemo-kines, and matrix metalloproteinases that cause the progression of atherosclerotic foci [2; 6].
Among the basic mechanisms of pathogenesis of atherosclerosis of arterial vessels the importance given to the inflammatory process, which, according to P. Libby theory, accompanies all its stages [10]. It is known that cytokines have regulatory multidirectional im-
