Portal de Periódicos da CAPES

Presence and persistence of human papillomavirus types 1, 2, 3, 4, 27, and 57 on dermoscope before and after examination of plantar warts and after cleaning

2012; Elsevier BV; Volume: 68; Issue: 1 Linguagem: Inglês

10.1016/j.jaad.2012.07.011

1097-6787

D. Penso-Assathiany, Tarik Gheit, Jean‐Luc Prétet, Agnès Aubin, Massimo Tommasino, Christiane Mougin, Ralph P. Braun, O. Chosidow, F. Aubin,

Cutaneous Melanoma Detection and Management

To the Editor: Surface-mediated infectious disease transmission is a major concern in various settings including the use of emery cardboard for scraping off the warts1Aubin F. Gheit T. Prétet J.L. Tommasino M. Mougin C. Chosidow O. Presence and persistence of human papillomavirus types 1, 2, and 4 on emery boards after scraping off plantar warts.J Am Acad Dermatol. 2010; 62: 151-153Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar and the dermoscopic examination of patients with common warts. We wished to investigate the contamination of dermoscope lens by human papillomavirus (HPV) DNA. Indeed, dermoscopes harbor potential pathogens and may be a source of microbial transmission.2Stauffer F. Kittler H. Forstinger C. Binder M. The dermatoscope: a potential source of nosocomial infection?.Melanoma Res. 2001; 11: 153-156Crossref PubMed Scopus (21) Google Scholar Twenty-three plantar warts from different patients were examined with 3 different dermoscopes (Heine Delta 20, Herrsching, Germany) using sterile gloves. The lens of the dermoscope was swabbed using cotton-tipped swabs before examination, after dermoscopic examination with hydroalcoholic gel and after cleaning (approximately 15 seconds) of the lens with antiseptic cleansing wipe (Wip'Anios Premium, Anios, France). The antiseptic cleansing wipe contained bactericidal and virucidal agents including didecyldimethylammonium chloride, polyhexamethylene biguanide, cationic and amphoteric surfactants, and scavenger agents. DNA extraction was performed using the Qiagen BioRobot EZ1 with the EZ1 DNA tissue kit according to the manufacturer's instructions (Qiagen, Hilden, Germany). In addition, 33 swabs collected from 11 different lenses (before, after dermoscopic examination, and after cleaning) were treated with DNase (New England Biolabs, Ipswich, MA) before DNA extraction using the MagNA Pure Compact robot (Roche Diagnostics GmbH, Mannheim, Germany) according to the manufacturer's instructions.3Foulongne V. Courgnaud V. Champeau W. Segondy M. Detection of Merkel cell polyomavirus on environmental surfaces.J Med Virol. 2011; 83: 1435-1439Crossref PubMed Scopus (43) Google Scholar Purified DNA were analyzed for HPV-1, -2, -3, -4, -27, and -57 by multiplex polymerase chain reaction using the Multiplex kit (Qiagen) as previously described.4Gheit T. Billoud G. de Koning M.N. Gemignani F. Forslund O. Sylla B.S. et al.Development of a sensitive and specific multiplex PCR method combined with DNA microarray primer extension to detect betapapillomavirus type.J Clin Microbiol. 2007; 45: 2537-2544Crossref PubMed Scopus (85) Google Scholar Typing of the specific HPVs was carried out by hybridization of the polymerase chain reaction products to type-specific Luminex bead–coupled HPV probes as described by Steinbeis Transfer Centre Multiplexion and Luminex Corp.5Schmitt M. Bravo I.G. Snijders P.J. Gissmann L. Pawlita M. Waterboer T. Bead-based multiplex genotyping of human papillomaviruses.J Clin Microbiol. 2006; 44: 504-512Crossref PubMed Scopus (414) Google Scholar After DNA extraction, 23 (34%) swabs tested positive for β-globin and DNA from HPV was detected on 46 swabs (67%) as single or multiple infection (Table I). HPV DNA was detected in 43% of swabs collected before dermoscopic examination, in 82% of swabs collected after dermoscopic examination, and in 74% of swabs collected after lens cleaning. In addition, a set of 33 swabs was processed in parallel with DNase treatment (New England Biolabs) before DNA extraction (Table II). HPV DNA was still detectable in 45.5% of swabs and 15% of swabs were still positive for β -globin. Among them, 9% were positive before dermoscopic examination, 64% after wart examination, and 64% after lens cleaning.Table IDetection of human papillomavirus DNA on dermoscopeSwabsTotalβ-globin+HPV DNA+Before dermoscopic examination2310 (43%)After dermoscopic examination2319 (82%)After cleaning2317 (74%)Total6923 (34%)46 (67%)HPV, Human papillomavirus. Open table in a new tab Table IIDetection of human papillomavirus DNA types 1, 2, 3, 4, 27, and 57 on dermoscope after DNAse∗New England Biolabs, Ipswich, MA. treatmentSwabsTotalβ-globin+HPV DNA+Before dermoscopic examination111 (9%)After dermoscopic examination117 (64%)After cleaning117 (64%)Total335 (15%)15 (45.5%)HPV, Human papillomavirus.∗ New England Biolabs, Ipswich, MA. Open table in a new tab HPV, Human papillomavirus. HPV, Human papillomavirus. Results from this study indicate that wart-specific HPV DNA is detected with a high frequency (43%) on the lens before dermoscopic examination suggesting a previous HPV contamination of dermoscope. Although strict measures were taken to prevent and monitor cross-contamination during the DNA extraction, we cannot exclude the possibility of a previous contamination of dermoscopes, which may have contaminated the different samples through gloves, or contact with skin (healthy or not) or contaminated surfaces in the clinic. However, the number of co-infections was low and the distribution of HPV genotypes revealed the same genotype in only 4 specimens. Furthermore, the cleaning of the dermoscope using an antiseptic cleansing wipe was not efficient in terms of removing HPV DNA because 74% of swabs were still positive. Infectivity of the viruses detected on dermoscopic lens could not be investigated because neither animal nor cellular models are available. However, viral HPV DNA remained detectable after DNase treatment (New England Biolabs) before nucleic acid extraction in 45.5% of swabs suggesting that this viral DNA is protected by an entire viral capsid belonging to potentially infectious virions. In conclusion, our data demonstrate the contamination of dermoscope lens by HPV. In addition, the persistence of viral DNA after DNAse treatment (New England Biolabs) might reflect the presence of infectious viral particles, and transmission from dermoscope to human beings cannot be ruled out.