I Al-Saimary, S Bakr, K Al-Hamdi
atopic dermatitis ad, bacteria, patient skin.
I Al-Saimary, S Bakr, K Al-Hamdi. Bacterial Skin Colonization In Patients With Atopic Dermatitis / Eczema Syndrome. The Internet Journal of Dermatology. 2005 Volume 4 Number 2.
From a total of 286 cases of AD patients, 94.4% and 86.36% yielded positive cultures of eczematous lesions and healthy area of AD skin. Twenty various bacterial types and a total of 959 and 744 isolates were identified from each of above areas respectively.
Atopic dermatitis (AD) is a chronic, pruritic eczematous disease that early always begins in infantilhood and childhood and follows a remitting / flaring course that may continue throughout life(1). It develops as a result of a complex interrelationship of environmental, immunologic, genetic and pharmacologic factors (2). It may be exacerbated by infection, psychological stress, seasonal of climate changes, irritants, and allergens(3). The rapid rise in prevalence of AD is thought to be primarily related to changes in our environment. A number of factors can trigger AD, including irritants foods, aerollergens, and infection(4).
The skin of patients with AD is characterized by higher levels of colonization by aerobes(5). Significantly higher colony forming units per surface unit could be isolated from clinically normal skin of patients with AD than from corresponding skin sites in normal controls(6). Acute exudative lesion yielded a mean of 107 colony forming units (CFU)/cm2. Thus, the atopic skin must provide a favorable environment for the colonization and multiplication of aerobic bacteria(5). Coagulase-positive staphylococci (
There is no previous study in Iraq - in especially - detailed bacterial colonization of atopic skin, so this study was found necessary to determine the bacterial types and numbers of each eczematous lesions and healthy areas from patients skin with atopic dermatitis.
Materials & Methods
A total of (286) patients suffering from atopic dermatitis syndrome in various age groups and both sexes were included in this study. The patients attending the out patients of dermatology department of fourth main hospitals in Basrah providence (out patients based study), and AD diagnosed under supervision of dermatologists based on a criteria of (8,9,10). The study was carried out during period from November 2003 to July 2005.
Brain Heart Infusion Broth (BHIB) saturated skin swabs from both eczematous lesions and healthy area were cultured on primary isolation media: Blood Agar Base BAB (Oxoid), MacConkey Agar MA and Nutrient Agar NA (Himedia) and then incubated at 37°c for 24-48 hrs aerobically(11). Samples that cultured on Chocolate Agar (CA) in addition to NA were incubated under CO2 in candle jar at the same temperature and period time mentioned above(11).
Enumeration of a total bacterial counts per cm2 of the same above sites were carried by using a serial dilution technique of Nutrient Broth (HiMedia) and then culturing on NA(11).
Four types of Api-technique (bioMerieux, France) as a rapid identification system were used for identification the various bacterial isolates based on enclosed instructions of supplied company:
Api Staph: identification system for staphylococci.
Api 20 Strept: identification system for streptococci.
Api 20 E: identification system for Enterobacteriaceae and other Gram-negative rods.
And Api 20 A: identification system for anaerobes.
Chi-Square test and ANOVA test were carried by using computer program , SPSS . ver.11.
Table (1) illustrate all bacterial types isolated from eczematous lesions and nearly healthy areas. The total numbers of positive cultures (270,247) cases from 286 studied AD cases in percentages (94.4, 86.36) from eczematous and healthy area respectively. In general, twenty bacterial types were isolated from both area separately and (959,744) isolates with isolation ratio (3.35:1, 2.6:1) isolates: case were identified in each above area respectively. The percentages of bacterial occurrence in eczematous lesions and healthy areas respectively were as follow: (P< 0.05) :
Table (2) illustrated modes of isolation of bacterial types from both areas of AD patients. It has been found that the double bacterial agents was predominant in each eczematous lesions and healthy area in percentages (44.11, 41.29) respectively followed by other modes, with significant differences between modes of isolation (P< 0.05).
Figure (1): showed distribution of bacterial types in eczematous lesions and healthy areas of skin of AD patients as previous described.
The means of bacterial number measured for studied areas of AD patients showed in figure (2). The bacterial numbers ranged from (0.02-92.0) X 105 cell (CFU)/cm2 in eczematous lesions and (0.11-23.0) X 103 cell (CFU)/cm2 in healthy areas with very highly significant differences between means of bacterial numbers within the same areas and between each studied area (P< 0.001).
BACTERIAL TYPES : 1 :STAPH AUREUS , 2 : STAPH EPIDERMIDIS , 3: STAPH XYLOSUS , 4 : STAPH , 5 : STAPH CAPITIS , 6 : STAPH HOMINIS , 7 : STREPT PYOGENES , 8 : STREPT FAECALIS , 9 : STREPT MUTANS , 10: E.COLI , 11 : ENTEROBACTER SP. , 12 : KLEBSIELLA SP. , 13 : ACINETOBACTER SP. , 14: PROTEUS SP. , 15: PS AERUGINOSA ,6: PR ACNES , 17: PR GRANULOSUM , 18: H INFLUENZAE , 19: BACTEROID SP. , 20 : CORYNEBACTERIUM SP.
ISOLATION MODES : ( AS SHOW IN FIGURES ) DEPEND ON ABOVE NUMBERS- 1 : 1 , 2: 2 , 3 : 1&2 , 4 : 1&2&7 , 5 : 1&2&8 , 6: 1&7 , 7 : 1&9 , 8 : 2&8 , 9 : 2&4 , 10 : 2&6 , 11 : 2&7 , 2: 2&8 , 13 : 2&9 , 14: 2&10 , 15: 2&10&11&17 , 16: 1&10&17&19&20 , 17: 7&11&13&16&20 , 18 : 4&6&9&10&14&18&20 19 : 3&5&8 , 20: 6&9&10&13&14 , 21: 1&6&8&15&16&18 , 22: 10&15&18&20 , 23 : 12&17&19&20 , 24: NO GROWTH .
Our results revealed that
Our knowledge concerning the complex interaction between microbes ad skin inflammation of atopic dermatitis has improved dramatically and today the Gram-positive bacterium,
Recent studies confirmed results of our study such as Brook, et al. (1996) that found 36%, 20%, and 44% of aerobic, an aerobic, and mixed respectively isolated from AD patients, these bacteria were
Others demonstrated that the colonization density of eczematous lesions can reach 107 CFU/cm2(15).And the skin of 100% of AD patients may colonized with
Also Heaton, et al. (2003) illustrated that the incidence of
Many modern studies illustrated the factors whose relevance to the increased colonization of atopic dermatitis skin with bacteria -in general- and with
There are a highly occurrence and variation of bacterial types in eczematous lesions and healthy areas of skin of AD patients, with highly numbers of bacteria in the first above area in comparison with the second that indicate presence of highly infections in the lesional skin. Also
IHSAN EDAN AL-SAIMARY; Assist. Prof. Dept. Microbiology, Coll. Medicine. Univ. Basrah, PO BOX 696 Ashar, Basrah, IRAQ E-mail : Ihsanalsaimary@yahoo.com