Latest on Infectious Disease at Maui Derm

The infectious disease update at the virtual Maui Derm NP+PA Fall 2021 conference presented by Ted Rosen, MD, professor of dermatology at Baylor College of Medicine in Houston, Texas, and Sheila Fallon Friedlander, MD, professor emeritus at the University of California, San Diego School of Medicine covered a variety of conditions including Seoul virus, Lyme disease, and COVID-19.

Early in his presentation, Rosen said that >60% of emerging infectious disease are zoonotic. One such disease is Seoul virus, which is a hantavirus. It’s spread from rats to humans via urine, saliva, and droppings. Symptoms of the disease include fever, headache, conjunctivitis, and dermatologic findings include facial flushing and morbilliform truncal rash. The disease course is typically mild, but renal failure or hypotension can occur. Rosen recommended asking patients who present with fever, flushing, and a rash about the presence of a pet rat in the home.

Rosen then discussed some treatment option presented in the past several months. A study of treatment for recalcitrant warts found hat intralesional cidofovir (dilution 15 mg/ml) that was injected every 4 weeks, for a total of an average of 3.5 treatments led to 97.6% resolution of the warts. Some potential downsides include the need to local anesthesia because of pain due to the injection and the expense of the compound. A phase 2 study of 0.7% cantharidin with a precision applicator applied every 22 days for up to 4 applications to treat molluscum contagiosum found 48.5% complete clearance and 90.4% reduction in lesions. A trial of using topical 1% encapsulated terbinafine hydrochloride gel to treat tinea capitis had 4 weeks of treatment and found 8 out of 10 participants had a complete cure.

Studies have found that ticks in some areas are expanding the types of host that they will feed on, which means that ticks may be entering habitats that were previously free of them. Rosen highlighted key points of combating Lyme disease including: ticks should be removed by mechanical means; prophylactic antibiotic therapy should be given only to people within 72 hours of the removal of a high-risk tick that was attached for more than 36 hours and the dose should be a single 200 mg doxycycline dose for adults and a single 4.4 mg/kg dose for children; and if a patient has persistent, but nonspecific symptoms following the recommended treatment of Lyme disease but there is no evidence of reinfection or treatment failure, prolonged antibiotic therapy is not recommended according to Rosen.

Both Rosen and Fallon-Friedlander discussed COVID-19. Rosen highlighted that the disease was the leading cause of death in the United States for 2020, surpassing cancer and major cardiovascular events. Fallon-Friedlander focused on the pediatric COVID-19 experience, stressing that with the Delta variant and undervaccinated areas have led the disease to become significant in children. She closed her presentation by underscoring the need to vaccinate and wear a mask, not only to protect those who aren’t eligible for vaccines, but to reduce the risk of a highly vaccine-resistant variant emerging because it would have a significant advantage over the variants that are susceptible.

Reference

1. Rosen T, Fallon-Friedlander S. Update on Infectious Diseases 2021. Presented at Maui Derm NP+PA Fall 2021; September 30 to October 2, 2021; live in Asheville, North Carolina, and virtual.