Infectious Complications of Atopic dermatitis. Is AD a skin problem or an immune problem?

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1 Infectious Complications of Atopic dermatitis Peck Y. Ong, MD Associate Professor of Clinical Pediatrics, Division of Clinical Immunology and Allergy, Children s Hospital Los Angeles, Department of Pediatrics, University of Southern California, Keck School of Medicine. Disclosure: none. Is AD a skin problem or an immune problem? Grice et al. J Invest Dermatol 1975; 64:

2 Number of patients with psoriasis (n=2,375) or atopic dermatitis (n=473) showing concurrent infections Type of Infection Viral Psoriasis AD p (n) (%) (n) (%) <0.001 Bacterial Eczema herpeticum < <0.001 Adapted from Christophers and Henseler. Arch Dermatol Res 1987; 279: S48-S51. Decreased defensin in AD Ong et al. N Engl J Med 2002; 347: Th2 cytokines suppress defensin expression Ong et al. N Engl J Med 2002; 347:

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4 Ong PY and Leung DYM. Clin Rev Allergy Immunol. 2016;51:

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6 Angeles. All Rights Reserved. 6

7 Case reports of patients with atopic dermatitis and bacteremia/infectious endocardititis 1 Pike et al 3.5/M VSD Severe S. aureus IE tricuspid v. Vegetectomy, VSD repair 2 Grabczynska et al 24/M Previous IE Recent flare MSSA IE 3 Kobayashi et al 33/M Adult onset (92) 39.9 MSSA IE aortic v. Valve replacement 4 Harada et al 24/F Febrile MSSA IE mitral v. Vegetectomy 5 Conway et al 18/M Moderate (89) 39.0 MSSA IE mitral v. Valve replacement 6 Conway et al 45/M Recent flare NA NA MSSA IE mitral v. Valve replacement 7 Onoda et al 16/M Severe (90) 39.5 MRSA IE aortic v. Valve replacement, annulus repair 8 Onoda et al 14/M Severe S. aureus IE mitral v. Vegetectomy, commissure repair 9 Satchell et al 50/F Severe NA NA S. aureus IE mitral v. Valve repair 10 Hoeger et al 2/M Severe (60) 40.5 MSSA Bacteremia, cellulitis 11 Hoeger et al 4/F VSD Severe (69) 40.1 MSSA Bacteremia VSD repair 12 Current case 1 17/M Moderate (95) 38.0 MSSA Bacteremia, skin abscess Abscess drainage 13 Current case 2 36/F Adult onset (85) 39.5 MSSA IE, meningitis Valve replacement Case reports of patients with atopic dermatitis and musculoskeletal infections 1 Kitamura et al 15/F Recent flare (72) 38 Staph aureus Septic arthritis hip Joint irrigation 2 Boiko et al 3/M Severe Afebrile MRSA, Strep viridans Osteomyelitis phalanx Debridement 3 Boiko et al 4/F Severe Afebrile MSSA, Strep viridans Osteomyelitis phalanx Debridement 4 Boiko et al 2/F Severe Afebrile MSSA, β hemolytic group B Strep Osteomyelitis Debridement 5 Sharma et al 4/M Severe Afebrile MSSA Osteomyelitis fibula Debridement 6 Nassif et al 60/M Severe MRSA Septic bursitis mid-tibial, olecranon Benenson et al. Amer J Med

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9 Sun D and Ong PY. Immunol Allergy Clin North Am. 2017;37:

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11 Ong PY and Leung DYM. Clin Rev Allergy Immunol. 2016;51: Reynolds AH and Joos HA. Pediatrics. 1958;22:

12 Reynolds AH and Joos HA. Pediatrics. 1958;22: Eczema vaccinatum and smallpox vaccinations Anticipated smallpox vaccine events DoD (n= 730,580) DHHS (n= 40,422) Preventable Eczema vaccinatum 0 0 Progressive vaccinia 0 0 Fetal vaccinia 0 0 Contact transmission-nosocomial 0 0 Contact transmission-not 50 Secondary 0 Nosocomial 2 Tertiary Auto-inoculation non-ocular Auto-inoculation ocular 16 3 Not preventable Generalized vaccinia 35 Suspect 2 Suspect All mild, no sequela 8 Probable 1 Confirmed Post-vaccination encephalitis 1 1 Poland GA et al Vora et al. Clin Infect Dis 2008; 46:

13 MMWR May 18, 2007 / 56(19); Bacterial taxonomic classifications in the AD skin microbiome. Kong H H et al. Genome Res. 2012;22: