Signo de BOTE en molusco contagioso, la inflamación puede ser buena!

Published in Dermatology

Journal Scan / Research · March 20, 2020

The Molluscum Contagiosum BOTE Sign — Infected or Inflamed?

Pediatric Dermatology

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• The authors conducted a retrospective review of 56 children with inflamed molluscum contagiosum, or the "beginning of the end" (BOTE) sign and suspected secondary infection. Fever was present in 12.5% of these patients and, prior to diagnosis, systemic antibiotics had been used to treat 62.5% of patients. Of the total population, 31 patients (55.4%) had sterile cultures or cultures growing only contaminants; 25 patients (44.6%) had bacterial pathogens present. No demographics, inflammatory markers, or differences in hospital length of stay were present between the culture-negative and culture-positive groups.

• In this population, many cases (55%) of suspected secondarily infected molluscum contagiosum could be attributed to inflammation rather than true infection. In cases of severe inflammation, a bacterial culture should be obtained, although additional studies are required to determine the specifics of cases which require empiric antibiotics.

– Margaret Hammond, MD

Abstract

BACKGROUND

Molluscum contagiosum (MC) is a common skin infection in the pediatric age group. The infection is self-limited and manifests as discrete, umbilicated skin-colored papules on any skin surface of the body. At times, complications such as local dermatitis and swelling, erythema, and pus formation may appear. These signs of inflammation are commonly presumed to represent bacterial infection.

METHODS

This multicenter study was a retrospective analysis of data collected on all patients diagnosed with inflamed lesions secondary to MC and treated at the Hadassah Medical Centers and Shaare Zedek Medical Center in Jerusalem, Israel, from 1/1/2008 to 1/07/2018. Characteristics of children with positive cultures were compared to those with negative cultures and those with contaminants.

RESULTS

A total of 56 cases were reviewed; the mean age at presentation was 4.6 years. Fever was reported in 12.5%, and 62.5% received systemic antibiotics because of their inflamed MC prior to admission. Fifty-five percent had sterile cultures or cultures growing only contaminants. Only seven had positive cultures with the common cutaneous pathogens. No statistical difference was observed between the patients with pathogenic isolates and patients with sterile or non-pathogenic cultures in terms of demographics, lesion characteristics, inflammatory markers, or length of hospitalization.

CONCLUSION

The findings suggest that most cases of suspected MC-related secondary infection can be attributed to inflammation rather than to bacterial infection. However, in some cases, true bacterial infection should be suspected and treated accordingly.

Pediatric Dermatology

The Molluscum Contagiosum BOTE Sign — Infected or Inflamed?

Pediatr Dermatol 2020 Mar 01;[EPub Ahead of Print], I Gross, N Ben Nachum, V Molho-Pessach, G Weiser, Y Oster, D Engelhard, O Megged, S Hashavya