La Grenade L, Manns A, Fletcher V, Derm D, Carberry C, Hanchard B, Maloney E M, Cranston B, Williams N P, Wilks R, Kang E C, Blattner W A
Department of Medicine, University of the West Indies, Kingston, Jamaica.
Arch Dermatol. 1998 Apr;134(4):439-44. doi: 10.1001/archderm.134.4.439.
To define the clinical and laboratory features associated with infective dermatitis (ID) and confirm its association with human T-lymphotrophic virus type I (HTLV-I).
A case series of patients with ID were compared with patients with atopic dermatitis (AD), which is an important disease in the differential diagnosis of ID.
Patients were recruited from dermatology and pediatric clinics at the University Hospital of the West Indies and the Bustamante Children's Hospital, Kingston, Jamaica.
Clinical and laboratory features of patients with AD were compared with those of patients with ID.
Consecutive patients older than 1 1/2 years diagnosed as having ID (n=50) and AD (n=35) were enrolled based on clinical findings.
The mean ages of patients with ID and AD were 6.9 and 7.8 years, respectively. Histologically, both diseases were predominantly chronic dermatitis with propensity for skin colonization with Staphylococcus aureus and beta-hemolytic streptococci; however, the distribution of sites of skin involvement differed. Infection with HTLV-I was the most distinguishing feature among patients with ID, with seropositive results in 100%; only 5 (14%) of the 35 patients with AD had results seropositive for HTLV-I. Infective dermatitis was further characterized by dermatopathic lymphadenitis in 16 (67%) of 24 patients with palpable nodes. Anemia, lymphocytosis, and low albumin and elevated serum globulin levels were more prevalent among patients with ID. Significant elevations of IgA, IgD, and IgG levels were observed among patients with ID compared with those with AD. However, both patients with AD and those with ID had levels of IgD and IgE elevated above the normal range. T-cell subsets among patients with ID revealed T-cell activation with a high percentage of HLA-DR antigen positivity, elevated CD4 (2.4 x 10(9)/L) and CD8 (1.4 x 10(9)/L) cell counts, with an increased CD4/CD8 ratio of 1:73.
Infective dermatitis is a distinct clinical entity associated with HTLV-I, which plays a role in the pathogenesis and immune perturbations observed.
明确与感染性皮炎（ID）相关的临床和实验室特征，并证实其与I型人类嗜T淋巴细胞病毒（HTLV-I）的关联。
将一系列ID患者与特应性皮炎（AD）患者进行比较，AD是ID鉴别诊断中的一种重要疾病。
患者来自牙买加金斯敦西印度大学医院和布斯塔曼特儿童医院的皮肤科和儿科诊所。
比较AD患者和ID患者的临床和实验室特征。
根据临床检查结果，纳入年龄超过1.5岁、诊断为ID（n = 50）和AD（n = 35）的连续患者。
ID患者和AD患者的平均年龄分别为6.9岁和7.8岁。组织学上，两种疾病均以慢性皮炎为主，易合并金黄色葡萄球菌和β溶血性链球菌皮肤定植；然而，皮肤受累部位的分布有所不同。HTLV-I感染是ID患者最显著的特征，血清学阳性率为100%；35例AD患者中只有5例（14%）HTLV-I血清学阳性。24例可触及淋巴结的患者中有16例（67%）出现感染性皮炎伴皮肤病理淋巴结炎。贫血、淋巴细胞增多、低白蛋白血症和血清球蛋白水平升高在ID患者中更为常见。与AD患者相比，ID患者的IgA、IgD和IgG水平显著升高。然而，AD患者和ID患者的IgD和IgE水平均高于正常范围。ID患者的T细胞亚群显示T细胞活化，HLA-DR抗原阳性率高，CD4（2.4×10⁹/L）和CD8（1.4×10⁹/L）细胞计数升高，CD4/CD8比值增加至1:73。
感染性皮炎是一种与HTLV-I相关的独特临床实体，HTLV-I在其发病机制和观察到的免疫紊乱中起作用。
