Date: 26 November 2013
Biofilms on bronchial epithelial cells in vitro.
Copyright:
Images kindly donated by Frank-Michael C. Müller, Pediatric Pulmonology, Cystic Fibrosis Centre and Infectious Diseases, Department of Pediatrics III, University of Heidelberg, Im Neuenheimer Feld 430, D-69120 Heidelberg, Germany.
Notes:
Confocal scanning laser microscopy (CLSM), using CAAF(green) Fun1(red) stained biofilm. The red color of the FUN 1 cell stain was localized in dense aggregates in the cytoplasm of metabolically active cells. Thus, areas of red fluorescence represented metabolically active cells, and green fluorescence indicated cell wall-like polysaccharides, while yellow areas represented dual staining.
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This patient with ABPA and chronic cavitary pulmonary aspergillosis has been stabilized on voriconazole treatment for >5 years. She had a degree of photosensitivity most of that time, noticed early in the course of voriconazole treatment. She is oxygen and wheelchair dependent and doesn’t go outside very much, so most of her light exposure has been indoor light. She developed rough scaly patches over her face, neck and lower arms. Dermatological review indicated multiple solar keratoses”. Skin biopsy from the right forearm confirmed this clinical diagnosis – “skin showing hyperkeratosis with a little parakeratosis and acanthosis. The keratinocytes have a glassy appearance but show nuclear atypia with dyskeratotic cells, and occasional suprabasal mitoses. The intraepidermal sweat ducts are spared. Appearances suggest an actinic keratosis with moderate to severe dysplasia.” These features are characteristic of a low grade premalignant change.
She was treated with local 5-fluorouracil cream (Efudix) (3 cycles) to the affected lesions. These photos were taken at the apogee of inflammation. The inflammation resolved after discontinuing the cream. This reaction is expected with application of this mild chemotherapy agent. Alternative or supplementary treatments include cryotherapy, curettage and cautery, if necessary. Following treatment her skin was much softer and considerably improved. Voriconazole has been stopped, and posaconazole substituted.
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Patient NG -ocular redness and erythema due to voriconazole.
