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Kambhampati O, Scheiner A, Noor A, El-Chaar G, Canter M, Coren C. Rapidly Progressing Skin Lesion in Previously Healthy 5 Month Old. Clin Pediatr (Phila) 2024:99228231221889. [PMID: 38166408 DOI: 10.1177/00099228231221889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Affiliation(s)
| | - Alyssa Scheiner
- NYU Grossman Long Island School of Medicine, Mineola, NY, USA
| | - Asif Noor
- NYU Grossman Long Island School of Medicine, Mineola, NY, USA
| | - Gladys El-Chaar
- NYU Grossman Long Island School of Medicine, Mineola, NY, USA
| | | | - Charles Coren
- NYU Grossman Long Island School of Medicine, Mineola, NY, USA
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2
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Surukrattanaskul S, Pittayapongpat R, Wangtiraumnuay N. Periocular ecthyma gangrenosum with Pseudomonas septicemia in an infant: A case report. IDCases 2023; 34:e01894. [PMID: 37736020 PMCID: PMC10509654 DOI: 10.1016/j.idcr.2023.e01894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/23/2023] Open
Abstract
Ecthyma gangrenosum is a skin manifestation of fatal septicemia. We report a case of periocular ecthyma gangrenosum, which is an uncommonly infected area and rarely reported in infants. A 1-month-old female infant with periocular ecthyma gangrenosum presented with a high-grade fever and acute left medial canthus of the eyelid swelling and erythema. Hemoculture at 6 h confirmed Pseudomonas aeruginosa infection. Intravenous and topical antibiotics were administered. Daily dressing of the wound and noninvasive bedside escharectomy were performed. Cosmetically acceptable scar was achieved without additional surgery. The patient was considered to have congenital neutropenia due to persistent neutropenia and severe skin and mucosal infections in her first year of life. Noninvasive debridement of the wound reduces the risk of exposure keratitis, lacrimal drainage pathway damage, and the need for further surgical reconstruction. The cause of compromised immunity in infants with ecthyma gangrenosum should be investigated, and intensive follow-up is recommended.
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Affiliation(s)
- Supawan Surukrattanaskul
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | - Rosana Pittayapongpat
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
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3
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Colomba C, Scalisi M, Ciacio V, Albano C, Bagarello S, Billone S, Guida M, Giordano S, Canduscio LA, Milazzo M, Amoroso S, Cascio A. Shanghai Fever: Not Only an Asian Disease. Pathogens 2022; 11:pathogens11111306. [PMID: 36365057 PMCID: PMC9699416 DOI: 10.3390/pathogens11111306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: To describe a case of Shanghai fever disease and to analyze other published reports in non-Asiatic countries, defining clinical characteristics and highlighting that this is not only an Asian disease. Study design: A computerized search without language restriction was conducted using PubMed and Scopus; all references listed were hand-searched to identify any other relevant literature. An article was considered eligible for inclusion in the systematic review if it reported cases with Shanghai fever described in non-Asiatic countries. Our case was also included in the analysis. Results: Ten articles reporting 10 cases of Shanghai fever disease were considered. Fever, diarrhea and ecthyma gangrenosum were the most frequent symptoms observed. Blood was the most common site of isolation for Pseudomonas aeruginosa. Three patients underwent surgery due to necrotizing enteritis and intestinal perforation. Meningitis was documented in one case. None of the patients received antipseudomonal antibiotics within 24 h of admission. The outcome was good in nine cases; only one patient died due to multiple organ failure from Pseudomonas sepsis. No common primary immune deficiency was identified in these patients. Extremely young age (<1 year) was the only host factor predisposing to Shanghai fever. Conclusions: It is important to shed light on this disease in non-Asiatic countries and take into account that it can also affect healthy children. Pediatricians, therefore, should consider Shanghai fever among diagnoses in children with community-onset diarrhea, fever and skin lesions suggestive of ecthyma gangrenosum to start an appropriate treatment sooner and to reduce the mortality in these children.
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Affiliation(s)
- Claudia Colomba
- Division of Pediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Michela Scalisi
- Division of Pediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
- Correspondence:
| | - Valeria Ciacio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Chiara Albano
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Sara Bagarello
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Sebastiano Billone
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Marco Guida
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
| | - Salvatore Giordano
- Division of Pediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Laura A. Canduscio
- Division of Pediatric Infectious Diseases, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Mario Milazzo
- Pediatric Surgery Unit, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Salvatore Amoroso
- Pediatric Surgery Unit, “G. Di Cristina” Hospital, ARNAS Civico Di Cristina Benfratelli, 90100 Palermo, Italy
| | - Antonio Cascio
- Department of Health Promotion, Maternal and Infant Care, Internal Medicine and Medical Specialties, University of Palermo, 90100 Palermo, Italy
- Infectious and Tropical Diseases Unit, AOU Policlinico “P. Giaccone”, 90100 Palermo, Italy
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4
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Zhang X, Yu Y. Ecthyma gangrenosum and severe neutropenic sepsis caused by Staphylococcus aureus infection in a previously healthy child: a case report. J Int Med Res 2022; 50:3000605221126882. [PMID: 36168733 PMCID: PMC9523864 DOI: 10.1177/03000605221126882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Ecthyma gangrenosum (EG) is a potentially lethal skin infection mainly caused by Pseudomonas aeruginosa, but other causative pathogens have also been reported. EG usually occurs locally and often arises in immunocompromised patients. The fatality rate can be extremely high if a systemic infection leading to sepsis occurs. EG and severe sepsis caused by Staphylococcus aureus infection are extremely rare in healthy children. However, upon occurrence, disease progression can be rapid, and the mortality rate is high. This current case report describes a previously healthy child with no underlying diseases who developed EG in the facial and perianal regions following S. aureus infection. The infection rapidly progressed to sepsis, septic shock, and persistent severe neutropenia. The patient also developed drug-resistant bacterial infections that spread rapidly and resulted in multiorgan failure. The patient was treated with antibiotics, but she died of organ failure despite extracorporeal membrane oxygenation support. EG caused by S. aureus has the potential to progress rapidly, leading to septic shock and severe neutropenia. Patients should be identified at an early stage and promptly treated with antibiotics. However, the improvement of neutropenia and prevention of secondary infections remain the focus of our research.
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Affiliation(s)
- Xinjuan Zhang
- Department of Pediatric Intensive Care Unit, Affiliated to Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanping Yu
- Department of Pediatric Intensive Care Unit, Affiliated to Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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5
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Ecthyma gangrenosum as a serious complication of Pseudomonas aeruginosa infection in departments of paediatric oncology. Postepy Dermatol Alergol 2021; 38:537-543. [PMID: 34658690 PMCID: PMC8501443 DOI: 10.5114/ada.2020.100747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 04/11/2020] [Indexed: 11/17/2022] Open
Abstract
In most cases ecthyma gangrenosum is a consequence of Pseudomonas aeruginosa bloodstream infection in immunodeficient patients. This bacterium is characterized by multi-drug resistance and has a number of mechanisms that allow it to survive even in extreme conditions. The disease is characterized by an aggressive course involving the skin and mucous membranes, leading to ulceration with signs of necrosis within 12 to 24 h. Treatment includes targeted antibiotic therapy and surgical cleansing of the wound. If the perianal area is occupied, a colostomy may be performed. Prevention of bacterial infections involves taking special precautions when handling a patient with immunodeficiency.
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6
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Kadden D, Fowler G, Engel E, Logan C, Marathe K, Gosdin C. Streptococcal pneumonia meningitis as an initial presentation of X-linked agammaglobulinemia: A case report and discussion. J Am Coll Emerg Physicians Open 2021; 2:e12553. [PMID: 34568871 PMCID: PMC8448482 DOI: 10.1002/emp2.12553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/16/2021] [Accepted: 08/19/2021] [Indexed: 11/10/2022] Open
Abstract
X-linked agammaglobulinemia (XLA) is a primary immunodeficiency caused by mutations in the gene for Bruton's tyrosine kinase (Btk), with affected males most commonly presenting with recurrent bacterial infections during the first few years of life. Here we present a 17-month-old male with a chief complaint of worsening rash and fever, whose history of streptococcal pneumonia meningitis at 5 months of age prompted suspicion for an underlying immunodeficiency and subsequent diagnosis of XLA. Bacterial meningitis is a rare initial presentation of XLA, and therefore physicians may easily overlook any underlying immunodeficiency. Prompt workup for immunodeficiency should be initiated in any vaccinated patient with a history of pneumococcal meningitis outside of the newborn period. Further discussion surrounding the various presentations of XLA, their related clinical manifestations and laboratory findings, and the importance of thorough chart review may encourage earlier diagnosis and initiation of treatment of this disease.
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Affiliation(s)
- Daniel Kadden
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Grace Fowler
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Elissa Engel
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Casey Logan
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Kalyani Marathe
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Craig Gosdin
- UC College of Medicine, Department of PediatricsCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
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7
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Ganesh N, Kasick R, Graham E. An Ulcerating Perineal Rash in an 8-month-old Girl. Pediatr Rev 2021; 42:155-159. [PMID: 34470898 DOI: 10.1542/pir.2020-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Nisha Ganesh
- The Ohio State University College of Medicine, Columbus, OH
| | - Rena Kasick
- The Ohio State University College of Medicine, Columbus, OH.,Nationwide Children's Hospital, Columbus, OH
| | - Emily Graham
- The Ohio State University College of Medicine, Columbus, OH.,Nationwide Children's Hospital, Columbus, OH.,The Ohio State University Wexner Medical Center, Columbus, OH
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8
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Abstract
PURPOSE OF REVIEW Pseudomonas aeruginosa is an opportunistic pathogen with considerable morbidity and mortality, particularly in vulnerable hosts. Skin manifestations are common, either representing local inoculation or secondary skin seeding following bloodstream infections. As patients with various predisposing conditions are expanding, we sought to review the most recent published evidence regarding epidemiology, risk factors and diagnosis of skin manifestations of P. aeruginosa. RECENT FINDINGS New data exist on epidemiology and diagnosis of skin infections; systemic infections are impacted by multidrug-resistance issues and host immune status. SUMMARY Green nail syndrome, toe web infection, hot tub folliculitis, hot hand-foot infection and external otitis are the most common infections originating from the skin per se. Local treatments are the cornerstone and prognosis is favorable in immunocompetent hosts. Ecthyma gangrenosum and P. aeruginosa subcutaneous nodules are usually associated with bloodstream infections and occur primarily in immunocompromised hosts. Necrotizing skin and soft tissue infections occur in diabetic, alcoholic and immunocompromised patients; management requires a multidisciplinary team with surgical approach. Burn wound infections may also be challenging, requiring a specialized team. In all the four latter types of P. aeruginosa skin infections portending significant morbidity and mortality, systemic antibiotics are an integral part of the treatment.
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9
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Goodarzi H, Wu TT, Wang J, Teng JM. Neonatal Dermatology: The Normal, the Common, and the Serious. Neoreviews 2021; 22:e40-e51. [PMID: 33386313 DOI: 10.1542/neo.22-1-e40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The objective of this review is to help practitioners of neonatal and pediatric medicine become more familiar with diagnosing and managing neonatal skin conditions. This article will discuss normal neonatal skin care and benign and common rashes, as well as some of the serious dermatologic conditions that require specialists for further evaluation and/or treatment.
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Affiliation(s)
- Heidi Goodarzi
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Tiffany T Wu
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Jami Wang
- Department of Dermatology, Stanford University, Palo Alto, CA
| | - Joyce M Teng
- Department of Dermatology, Stanford University, Palo Alto, CA
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10
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Vargas-Mora P, García S, Aranibar L, Valenzuela F. Ecthyma gangrenosum and severe transitory neutropenia in an immunocompetent girl. An Bras Dermatol 2020; 95:668-669. [PMID: 32727676 PMCID: PMC7562986 DOI: 10.1016/j.abd.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/05/2020] [Indexed: 11/26/2022] Open
Affiliation(s)
- Pablo Vargas-Mora
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile.
| | - Santiago García
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ligia Aranibar
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Fernando Valenzuela
- Department of Dermatology, Faculty of Medicine, University of Chile, Santiago, Chile
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11
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Lin SC, Chiang BL, Lee YJ, Chang YT, Fang SB. Pseudomonas aeruginosa sepsis presenting as oral ecthyma gangrenosum in identical twins with Bruton tyrosine kinase gene mutation: Two case reports and review of the literature. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2020; 53:1030-1034. [PMID: 32340921 DOI: 10.1016/j.jmii.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 10/24/2022]
Abstract
X-linked agammaglobulinemia (XLA) is a primary immunodeficiency disease. We reported two 7-month-old identical male twins with Pseudomonas aeruginosa sepsis who initially manifested as oral ecthyma gangrenosum and were finally diagnosed to have XLA. In both cases, we confirmed the c.862C > T BTK missense mutation in exon 10 at the SH2 domain.
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Affiliation(s)
- Sheng-Chieh Lin
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Bor-Luen Chiang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Yuarn-Jang Lee
- Division of Infectious Disease, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Ya-Ting Chang
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan; Department of Pediatrics, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Shiuh-Bin Fang
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan; Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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12
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Ecthyma gangraenosum – ein immundefektassoziiertes Ulkus. Rechtsmedizin (Berl) 2019. [DOI: 10.1007/s00194-019-00352-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Rodriguez JA, Eckardt PA, Lemos-Ramirez JC, Niu J. Ecthyma Gangrenosum of Scrotum in a Patient with Neutropenic Fever: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2019; 20:1369-1372. [PMID: 31523051 PMCID: PMC6767951 DOI: 10.12659/ajcr.917443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Ecthyma gangrenosum is an uncommon cutaneous infection commonly caused by Pseudomonas aeruginosa affecting typically immunocompromised patients. The presence of ecthyma gangrenosum can be associated with severe systemic infection often with a fatal prognosis. Most cases of ecthyma gangrenosum occur around the axilla, buttocks, and limbs; the scrotum is rarely affected. CASE REPORT A 68-year-old male with previously diagnosed acute myeloid leukemia, presented with left scrotal pain, fever, and rigors. Physical examination showed 2 ulcerating lesions with central black eschars surrounded by erythematous halos on the superior aspect of the left scrotum. Diagnosis of ecthyma gangrenosum was confirmed as both blood and lesion cultures showed growth of P. aeruginosa. After early empiric antibiotic treatment, the lesions significantly improved, and no sign of recurrence or new lesions was noticed. CONCLUSIONS Ecthyma gangrenosum should be considered in the differential diagnosis of ulcerating lesions of the scrotum. An early diagnosis and aggressive antibiotic treatment are imperative for resolution of this infection.
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Affiliation(s)
- Jose A Rodriguez
- Department of Internal Medicine, Memorial Hospital West, Memorial Healthcare System, Pembroke Pines, FL, USA
| | - Paula A Eckardt
- Division of Infectious Disease, Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL, USA
| | - Juan C Lemos-Ramirez
- Division of Infectious Disease, Memorial Regional Hospital, Memorial Healthcare System, Hollywood, FL, USA
| | - Jianli Niu
- Office of Human Research, Memorial Healthcare System, Hollywood, FL, USA
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14
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Isoherranen K, O'Brien JJ, Barker J, Dissemond J, Hafner J, Jemec GBE, Kamarachev J, Läuchli S, Montero EC, Nobbe S, Sunderkötter C, Velasco ML. Atypical wounds. Best clinical practice and challenges. J Wound Care 2019; 28:S1-S92. [DOI: 10.12968/jowc.2019.28.sup6.s1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Kirsi Isoherranen
- Helsinki University Central Hospital and Helsinki University, Wound Healing Centre and Dermatology Clinic, Helsinki, Finland
| | | | - Judith Barker
- Nurse Practitioner - Wound Management, Rehabilitation, Aged and Community Care., Adjunct Associate Professor, University of Canberra, Canberra, Australia
| | - Joachim Dissemond
- University Hospital of Essen, Department of Dermatology, Venerology and Allergology, Hufelandstraße 55, Essen, Germany
| | - Jürg Hafner
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Gregor B. E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde, Denmark
| | - Jivko Kamarachev
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | - Severin Läuchli
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland
| | | | - Stephan Nobbe
- Department of Dermatology, University Hospital of Zurich, Gloriastrasse 31, Zurich, Switzerland Department of Dermatology, Cantonal Hospital of Frauenfeld, Switzerland
| | - Cord Sunderkötter
- Chair, Department of Dermatology and Venerology, University and University Hospital of Halle, Ernst-Grube-Strasse 40, Halle, Germany
| | - Mar Llamas Velasco
- Department of Dermatology, Hospital Universitario De La Princesa, Madrid, Spain
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15
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Birlutiu V, Birlutiu RM, Baicu M, Iancu GM. A case report of double etiology of ecthyma gangrenosum: Pseudomonas aeruginosa and Enterococcus faecalis in an immunocompromised child occurred during influenza evolution. Medicine (Baltimore) 2019; 98:e15651. [PMID: 31096489 PMCID: PMC6531273 DOI: 10.1097/md.0000000000015651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Ecthyma gangrenosum is a cutaneous infection, most commonly occurring during sepsis evolution with Pseudomonas aeruginosa on an immunocompromised background. There have been rare case reports in previously healthy children and rarer are the cases with double etiology. PATIENT CONCERNS We present the case of a female Caucasian patient, aged 1 year and 8 months, who developed severe sepsis during flu evolution with predominant respiratory and cerebral manifestations. On admission, at skin level, there was noticed a necrotic coccygeal ulceration (with rapid increasing dimensions 0.5/0.5 cm in 24 hours), and with the transformation from a dry necrosis in a sphacelus at the periphery and progression of necrosis in depth. DIAGNOSES The patient was diagnosed with ecthyma gangrenosum from which Pseudomonsa aeruginosa and Enterococcus faecalis were isolated from the samples that were harvested intraoperatively, decision that was taken considering the appearance of CT scan and the extremely rapid expansion of necrosis. Excisional debridement with necrectomy, lavage, and dressing being performed. The invasion of the fascia was excluded intraoperatively. INTERVENTIONS Treatment with Meropenem for 14 days was initiated, as well as amikacin and linezolid, the latter being replaced with teicoplanin for 14 days. Red blood cells transfusion, intravenous immunoglobulins, anticonvulsants were also administered. OUTCOMES Under treatment the evolution was favorable. LESSONS This case brings into discussion a double etiology of ecthyma gangrenosum, in a previously healthy child that occurred in the evolution of influenza. The evolution was favorable under broad-spectrum antibiotic treatment and surgical excision.
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Affiliation(s)
- Victoria Birlutiu
- Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Academic Emergency Hospital Sibiu, Infectious Diseases Clinic
| | - Rares Mircea Birlutiu
- Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu; Spitalul Clinic de Ortopedie-Traumatologie si TBC osteoarticular “Foisor” Bucuresti
| | - Marius Baicu
- Pediatric Clinical Hospital Sibiu, Intensive Care Department
| | - Gabriela Mariana Iancu
- Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu; Academic Emergency Hospital Sibiu - Dermatology Clinic, Sibiu, Romania
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16
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Wuyts L, Wojciechowski M, Maes P, Matthieu L, Lambert J, Aerts O. Juvenile ecthyma gangrenosum caused by
Pseudomonas aeruginosa
revealing an underlying neutropenia: case report and review of the literature. J Eur Acad Dermatol Venereol 2019; 33:781-785. [DOI: 10.1111/jdv.15420] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 12/03/2018] [Indexed: 11/29/2022]
Affiliation(s)
- L. Wuyts
- Department of Dermatology University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
| | - M. Wojciechowski
- Department of Pediatrics University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
| | - P. Maes
- Department of Pediatrics University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
| | - L. Matthieu
- Department of Dermatology University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
| | - J. Lambert
- Department of Dermatology University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
| | - O. Aerts
- Department of Dermatology University Hospital Antwerp (UZA) University of Antwerp (UA) Antwerp Belgium
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17
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Isezuo KO, Sani UM, Waziri UM, Garba BI, Mohammed Y, Legbo JF, Aquil NP, Abubakar FI, Omar M. Ecthyma gangrenosum on the face of a malnourished child with Pseudomonas sepsis: Simulating Cancrum oris. Afr J Lab Med 2018; 7:756. [PMID: 30568894 PMCID: PMC6295829 DOI: 10.4102/ajlm.v7i1.756] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 09/19/2018] [Indexed: 11/21/2022] Open
Abstract
Introduction Ecthyma gangrenosum (EG) is a cutaneous lesion commonly caused by Pseudomonas aeruginosa that involves mainly the lower limbs and gluteal region, seen more in immunosuppressed patients with neutropenia. Cancrum oris (Noma) is a gangrenous necrosis of the face that begins as a gingival ulcer and progresses rapidly to destroy contiguous tissues in malnourished children. Case Presentation This article reports a case of facial EG which was similar to Noma in a malnourished child: a 16-month old girl with fever, cough, weight loss, watery stool and swelling on right cheek. She was febrile, pale, wasted with bilateral pitting pedal oedema. She had a solitary circumscribed round necrotic lesion, with surrounding hyperaemia on the right malar area which extended to destroy the right ala nasi. No intra-oral rashes but she had left ear discharge. She received blood transfusion, antibiotics, antiseptic wound care and nutritional rehabilitation. Management and Outcome Swabs of the lesion and ear discharge both revealed Gram-negative bacilli and culture yielded P. aeruginosa. Retroviral, Mantoux and Gene Xpert tests were negative. She had moderate anaemia, normal white blood cell count, and neutropaenia. Parenteral ceftriazone was changed to ciprofloxacin based on sensitivity results and lack of clinical response. The wound healed with residual scarring and partial destruction of right ala nasi. Discussion Although this patient had facial necrosis to suggest Noma, she did not have initial oral involvement, and clinical features such as Pseudomonas sepsis and neutropaenia suggested EG. Facial necrosis in malnourished children may be due to EG.
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Affiliation(s)
- Khadijat O Isezuo
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Usman M Sani
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Usman M Waziri
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Bilkisu I Garba
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Yahaya Mohammed
- Department of Medical Microbiology and Parasitology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Joy F Legbo
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Nazish P Aquil
- Department of Surgery, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Fatima I Abubakar
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
| | - Memuna Omar
- Department of Paediatrics, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Ford A, Grim AW, Lee RU. Worsening Necrotic Skin Infection: What Lurks Below. Clin Pediatr (Phila) 2018; 57:749-750. [PMID: 28884586 DOI: 10.1177/0009922817730351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Alexandra Ford
- 1 Department of Pediatrics, Naval Medical Center San Diego, CA, USA
| | - Andrew W Grim
- 1 Department of Pediatrics, Naval Medical Center San Diego, CA, USA
| | - Rachel U Lee
- 2 Division of Allergy & Immunology, Department of Medicine, Naval Medical Center San Diego, CA, USA
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19
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Vide J, Moreira C, Nogueira A. Multiple anogenital hemorrhagic blisters in a 2-year-old girl. Pediatr Dermatol 2018; 35:413-414. [PMID: 29749120 DOI: 10.1111/pde.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Júlia Vide
- Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Catarina Moreira
- Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal
| | - Ana Nogueira
- Department of Dermatology and Venereology, Centro Hospitalar de São João EPE, Porto, Portugal
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20
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Martínez-Longoria CA, Rosales-Solis GM, Ocampo-Garza J, Guerrero-González GA, Ocampo-Candiani J. Ecthyma gangrenosum: a report of eight cases. An Bras Dermatol 2018; 92:698-700. [PMID: 29166510 PMCID: PMC5674706 DOI: 10.1590/abd1806-4841.20175580] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/09/2017] [Indexed: 11/21/2022] Open
Abstract
Ecthyma gangrenosum is a rare skin infection classically associated with Pseudomonas aeruginosa. We performed a retrospective study of all cases diagnosed with ecthyma gangrenosum from 2004-2010 in a university hospital in Mexico (8 cases, 5 female patients and 3 male patients, ages between 4 months and 2 years). The most common risk factor for ecthyma gangrenosum is neutropenia in immunocompromised patients. In previously healthy patients, immunological evaluation is important to rule out underlying immunodeficiency. Ecthyma gangrenosum in healthy patients has a high mortality rate and early diagnosis and aggressive antibiotic treatment is imperative as it can improve patients' prognosis.
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Affiliation(s)
| | - Gloria María Rosales-Solis
- Department of Pediatrics, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León - Monterrey, México
| | - Jorge Ocampo-Garza
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León - Monterrey, México
| | | | - Jorge Ocampo-Candiani
- Department of Dermatology, University Hospital "Dr. José Eleuterio González", Universidad Autónoma de Nuevo León - Monterrey, México
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21
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Impact of Type III Secretion Effectors and of Phenoxyacetamide Inhibitors of Type III Secretion on Abscess Formation in a Mouse Model of Pseudomonas aeruginosa Infection. Antimicrob Agents Chemother 2017; 61:AAC.01202-17. [PMID: 28807906 DOI: 10.1128/aac.01202-17] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 08/04/2017] [Indexed: 12/20/2022] Open
Abstract
Pseudomonas aeruginosa is a leading cause of intra-abdominal infections, wound infections, and community-acquired folliculitis, each of which may involve macro- or microabscess formation. The rising incidence of multidrug resistance among P. aeruginosa isolates has increased both the economic burden and the morbidity and mortality associated with P. aeruginosa disease and necessitates a search for novel therapeutics. Previous work from our group detailed novel phenoxyacetamide inhibitors that block type III secretion and injection into host cells in vitro In this study, we used a mouse model of P. aeruginosa abscess formation to test the in vivo efficacy of these compounds against the P. aeruginosa type III secretion system (T3SS). Bacteria used the T3SS to intoxicate infiltrating neutrophils to establish abscesses. Despite this antagonism, sufficient numbers of functioning neutrophils remained for proper containment of the abscesses, as neutrophil depletion resulted in an increased abscess size, the formation of dermonecrotic lesions on the skin, and the dissemination of P. aeruginosa to internal organs. Consistent with the specificity of the T3SS-neutrophil interaction, P. aeruginosa bacteria lacking a functional T3SS were fully capable of causing abscesses in a neutropenic host. Phenoxyacetamide inhibitors attenuated abscess formation and aided in the immune clearance of the bacteria. Finally, a P. aeruginosa strain resistant to the phenoxyacetamide compound was fully capable of causing abscess formation even in the presence of the T3SS inhibitors. Together, our results further define the role of type III secretion in murine abscess formation and demonstrate the in vivo efficacy of phenoxyacetamide inhibitors in P. aeruginosa infection.
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22
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Kuan EC, Tajudeen BA, Welch KC, Chandra RK, Glasgow BJ, Suh JD. Aggressive necrotizing pseudomonal sinonasal infections. Int Forum Allergy Rhinol 2017; 7:910-915. [PMID: 28707783 DOI: 10.1002/alr.21981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 05/16/2017] [Accepted: 06/06/2017] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is a gram-negative bacterium frequently implicated in recalcitrant sinonasal infections, especially in immunocompromised hosts. We report 6 cases of rapidly progressive pseudomonal acute rhinosinusitis producing tissue necrosis and, in certain cases, cranial nerve palsies. METHODS Retrospective review of 6 patients with aggressive necrotizing sinonasal infections treated at 4 tertiary academic medical centers with sinonasal cultures growing P. aeruginosa in the absence of other pathology. RESULTS A total of 6 patients were identified. In all cases, there was tissue necrosis that appeared to mimic an invasive process such as mucormycosis, prompting urgent surgical intervention. Pathologic analysis revealed fibropurulent exudates in backgrounds of positive P. aeruginosa cultures without evidence of invasive fungal organisms or malignancy. Four of the 6 patients presented with cranial nerve palsies, with 3 patients having vision changes and 3 complaining of trigeminal neuropathy. Four of 6 patients improved clinically over time after surgery and antibiotic therapy; 1 remains in follow-up without complete improvement and 1 has succumbed to other causes. CONCLUSION P. aeruginosa is a tenacious organism that is frequently associated with severe, recalcitrant sinonasal infections. We report the first case series of necrotizing sinonasal infections caused by this organism, and illustrate that, in rare cases, P. aeruginosa may mimic and behave like life-threatening conditions such as fulminant invasive fungal sinusitis or malignancy.
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Affiliation(s)
- Edward C Kuan
- Department of Head and Neck Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Bobby A Tajudeen
- Department of Otolaryngology-Head and Neck Surgery, Rush University Medical Center, Chicago, IL
| | - Kevin C Welch
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Medical Center, Chicago, IL
| | - Rakesh K Chandra
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Ben J Glasgow
- Department of Pathology and Laboratory Medicine, University of California, Los Angeles (UCLA), Los Angeles, CA.,Department of Ophthalmology, University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Jeffrey D Suh
- Department of Head and Neck Surgery, University of California, Los Angeles (UCLA), Los Angeles, CA
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Abstract
RATIONALE Ecthyma gangrenosum (EG) is an aggressive cutaneous disease caused by local or systemic infection with Pseudomonas aeruginosa. EG is characterized by cutaneous manifestations ranging from nodule and papule, to necrotic ulceration with surrounding erythema, especially with black eschar or central crust. EG presents with characteristic skin lesions which is important to establish diagnosis of sepsis caused by P aeruginosa, a serious condition that can be treated efficiently if diagnosed early. PATIENT CONCERNS A 3-month-old female infant was presented with characteristic skin lesions of EG and developed sepsis 3 days later. DIAGNOSES Ecthyma gangrenosum and sepsis caused by Pseudomonas aeruginosa. INTERVENTIONS Meropenem was used in combination with ceftazidime at first and excision of necrotic skin lesions was performed later. OUTCOMES Cure. LESSONS Early recognition of EG plays an important role in providing appropriate empiric antibiotic treatment at early stage of sepsis, and improves the prognosis. Surgical excision may be helpful if no improvement was achieved via antibiotic treatment.
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Affiliation(s)
| | | | | | - Hai-feng Yu
- Department of Urology, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang
| | - Xu-hua Tang
- Department of Dermatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China
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24
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Biscaye S, Demonchy D, Afanetti M, Dupont A, Haas H, Tran A. Ecthyma gangrenosum, a skin manifestation of Pseudomonas aeruginosa sepsis in a previously healthy child: A case report. Medicine (Baltimore) 2017; 96:e5507. [PMID: 28079790 PMCID: PMC5266152 DOI: 10.1097/md.0000000000005507] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Ecthyma gangrenosum (Eg) is a necrotic lesion that is mostly seen in immunocompromised patients. It reflects a severe sepsis, possibly caused by Pseudomonas aeruginosa (Pa). PATIENT CONCERNS A healthy 3-year-old girl admitted to the Pediatric Emergency Department presented a sepsis-associated purpura with neurological and respiratory distress. INTERVENTIONS An empiric antibiotherapy (anti-meningococcal) was prescribed. DIAGNOSES Forty-eight hours after admission, blood and wound cultures were positive for Pa. As a result, the decision was made to change the antibiotic therapy.Unfortunately, on day 3, the patient died. Exhaustive immunologic tests are presently being carried out. OUTCOMES Eg caused by Pa is uncommon in healthy children, and purpura sepsis is usually caused by Neisseria meningitides infection. LESSONS Eg should be recognized rapidly so that the appropriate treatment can be prescribed as quickly as possible.
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25
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Hizli Ş, Işikay S, Arikan Ç. Ecthyma gangrenosum in an infant after liver transplantation. Pediatr Int 2016; 58:950-2. [PMID: 27682614 DOI: 10.1111/ped.13066] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 06/01/2016] [Indexed: 11/28/2022]
Abstract
Ecthyma gangrenosum is a rare, necrotizing, bacterial infection of the skin most commonly caused by Pseudomonas aeruginosa. It has a characteristic clinical picture starting with maculopapular eruption followed by hemorrhagic vesicle and evolving into gangrenous ulcer. Although direct skin inoculation without septicemia is also probable, usually ecthyma gangrenosum is pathognomonic for Pseudomonas septicemia, which has a mortality rate of 38-96%. Herein, we report on the case of a 9-month-old male infant diagnosed with ecthyma gangrenosum who had undergone liver transplantation approximately 6 months previously and who was under immunosuppressive treatment, in order to highlight the importance of the early diagnosis and treatment of this disease.
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Affiliation(s)
- Şamil Hizli
- Department of Pediatric Gastroenterology, Yıldırım Beyazıt University, Ankara, Turkey
| | - Sedat Işikay
- Department of Pediatrics, Kahramanmaraş Sütçü İmam University, Kahramanmaraş, Turkey.
| | - Çiğdem Arikan
- Department of Pediatric Gastroenterology, Kent Hospital, İzmir, Turkey
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26
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Ecthyma gangrenosum of the scrotum: a case report. Front Med 2016; 10:101-3. [PMID: 26941196 DOI: 10.1007/s11684-016-0437-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/15/2016] [Indexed: 10/22/2022]
Abstract
A 43-year-old man with pancytopenia from chemotherapy for acute myeloid leukemia developed left scrotal pain, fever, and rigors. Physical exam revealed an ulcerating lesion with central necrosis and eschar surrounded by a halo of erythema on the inferior aspect of the left scrotum. The condition indicated an early necrotizing soft tissue infection. The patient was started on broad-spectrum antibiotics and taken to the operating room for a wound debridement. Blood and tissue cultures grew Pseudomonas aeruginosa, which confirmed the diagnosis of ecthyma gangrenosum of the scrotum. The fever resolved, and the wound healed without further progression after wet to dry dressing changes.
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27
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Abstract
We present the case of a 1-year-old healthy boy who was taking oral antibiotics for an otitis media and then developed an erythematous penile lesion that rapidly became ulcerated. He was admitted to the hospital for further diagnostic studies and intravenous therapy, and his wound culture grew Pseudomonas aeruginosa, consistent with the diagnosis of ecthyma gangrenosum. Serial blood counts also demonstrated a progressive neutropenia, and an immunodeficiency evaluation resulted in the diagnosis of autoimmune neutropenia of childhood. This case illustrates the importance of culturing wounds and the need for clinicians to recognize the characteristic features of ecthyma gangrenosum, to initiate appropriate antipseudomonal antibiotic therapy empirically, and to evaluate for a possible immunodeficiency, even in the apparently healthy child.
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28
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Song SS, Matiz C, Tom WL, Calame A, Krakowski AC, Friedlander SF. Ecthyma Gangrenosum-Like Lesions Secondary to Methicillin-Sensitive Staphylococcus aureus in an Immunocompetent Child. Pediatr Dermatol 2015; 32:e259-62. [PMID: 26459977 DOI: 10.1111/pde.12699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We describe a previously healthy 15-month-old girl who developed ecthyma gangrenosum (EG)-like lesions secondary to methicillin-sensitive Staphylococcus aureus (MSSA). Her systemic symptoms and negative blood cultures suggested MSSA toxin-mediated effects. When toxin-mediated systemic symptoms accompany such lesions, pathogens other than Pseudomonas aeruginosa should be considered.
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Affiliation(s)
- Silvia S Song
- Department of Dermatology, University of California at San Diego, San Diego, California.,Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Catalina Matiz
- Department of Dermatology, University of California at San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - Wynnis L Tom
- Department of Dermatology, University of California at San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - Antoanella Calame
- Rady Children's Hospital, San Diego, California.,Compass Dermatopathology, La Jolla, California
| | - Andrew C Krakowski
- Department of Dermatology, University of California at San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
| | - Sheila F Friedlander
- Department of Dermatology, University of California at San Diego, San Diego, California.,Rady Children's Hospital, San Diego, California
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29
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Mouna K, Akkari H, Faten H, Yosra K, Hichem B, Maha M, Abdelfatteh Z, Jamelledine Z. Ecthyma Gangrenosum Caused by Escherichia coli in a Previously Healthy Girl. Pediatr Dermatol 2015; 32:e179-80. [PMID: 25940214 DOI: 10.1111/pde.12595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Ecthyma gangrenosum is a characteristic lesion of Pseudomonas aeruginosa sepsis in immunocompromised patients. Only eight cases of ecthyma gangrenosum caused by Escherichia coli have been reported. We report a case of ecthyma gangrenosum due to E. coli without bacteremia in a previously healthy girl.
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Affiliation(s)
- Korbi Mouna
- Department of Dermatology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Hayet Akkari
- Department of Dermatology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Hammedi Faten
- Department of Anatomopathology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Kadri Yosra
- Department of Microbiology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Belhadjali Hichem
- Department of Dermatology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Mastouri Maha
- Department of Microbiology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Zakhama Abdelfatteh
- Department of Anatomopathology, Fattouma Bourguiba Hospital, Monastir, Tunisia
| | - Zili Jamelledine
- Department of Dermatology, Fattouma Bourguiba Hospital, Monastir, Tunisia
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30
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Cohen N, Capua T, Bilavsky E, Dias-Polak H, Levin D, Grisaru-Soen G. Ecthyma gangrenosum skin lesions in previously healthy children. Acta Paediatr 2015; 104:e134-8. [PMID: 25469722 DOI: 10.1111/apa.12889] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 11/13/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022]
Abstract
UNLABELLED Ecthyma gangrenosum (EG) is an uncommon skin lesion that usually develops in patients with known immune deficiency or who are on immunosuppressive treatment. We report on five previously healthy children presenting with EG. Three of them developed severe neutropaenia. Immunologic work-up revealed chronic neutropaenia in two. CONCLUSION Recognition of EG is essential for providing early appropriate empiric antibiotic treatment. An immunologic work-up should be done, although a concomitant viral infection can be the predisposing factor.
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Affiliation(s)
- Neta Cohen
- Department of Pediatrics; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Tali Capua
- Department of Pediatrics; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
| | - Efraim Bilavsky
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Pediatrics C; Schneider Children's Medical Center; Petah Tiqva Israel
| | - Hila Dias-Polak
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Pediatrics C; Schneider Children's Medical Center; Petah Tiqva Israel
| | - Dror Levin
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Department of Hematology; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
| | - Galia Grisaru-Soen
- Sackler Faculty of Medicine; Tel Aviv University; Tel Aviv Israel
- Pediatric Infectious Disease Unit; Dana-Dwek Children's Hospital; Tel Aviv Sourasky Medical Center; Tel Aviv Israel
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31
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Yin J, Li CW, Luo N, Ma JJ, Liu L, Li XJ, Du XJ, Hu J. Pseudomonas aeruginosa Sepsis Associated With Ecthyma Gangrenosum in a Previously Healthy Infant: A Case Report and Literature Review. Glob Pediatr Health 2015; 2:2333794X15591566. [PMID: 27335965 PMCID: PMC4900116 DOI: 10.1177/2333794x15591566] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jing Yin
- Tianjin Children's Hospital, Tianjin, China
| | | | - Na Luo
- Nankai University, Tianjin, China
| | - Ji-Jun Ma
- Tianjin Children's Hospital, Tianjin, China
| | - Li Liu
- Tianjin Children's Hospital, Tianjin, China
| | | | | | - Jian Hu
- Tianjin Children's Hospital, Tianjin, China
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32
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Ecthyma gangrenosum and ecthyma-like lesions: review article. Eur J Clin Microbiol Infect Dis 2014; 34:633-9. [DOI: 10.1007/s10096-014-2277-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
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33
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Chuang CH, Wang YH, Chang HJ, Chen HL, Huang YC, Lin TY, Ozer EA, Allen JP, Hauser AR, Chiu CH. Shanghai fever: a distinct Pseudomonas aeruginosa enteric disease. Gut 2014; 63:736-43. [PMID: 23943780 PMCID: PMC3995289 DOI: 10.1136/gutjnl-2013-304786] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Shanghai fever, a community-acquired enteric illness associated with sepsis caused by Pseudomonas aeruginosa, was first described in 1918. The understanding of Shanghai fever is incomplete. OBJECTIVE To delineate the clinical features and to examine the host and microbial factors associated with Shanghai fever. METHODS We prospectively enrolled 27 consecutive previously healthy children with community-acquired P aeruginosa enteritis and sepsis between July 2003 and June 2012. An immunological investigation, including measurement of serum immunoglobulin levels and lymphocyte subpopulations, was performed. The clonal relationship of bacterial isolates was determined by multilocus sequence typing (MLST) and the virulence of isolates was measured using cellular and animal models. RESULTS The median age of the patients was 7 months; 24 (89%) were aged <1 year. The most common clinical manifestations were fever (100%), diarrhoea (96%) and shock (81%). Leucopenia, thrombocytopenia, high C-reactive protein levels, coagulopathy and hypoalbuminaemia were the key laboratory findings. Necrotising enteritis with or without bowel perforation, ecthyma gangrenosum and seizures were main complications. The death rate was 15%. No common primary immune deficiency was identified. MLST genotypes indicated that isolates from Shanghai fever were non-clonal, but they shared similar phenotypes which were invariably cytotoxic, invasive and adhesive in cellular experiments and caused prolonged gut colonisation and more death than respiratory and laboratory control strains in mice. CONCLUSIONS Shanghai fever is a sporadic community-acquired disease of previously healthy infants that manifests as sepsis associated with P aeruginosa enteric disease. Both host and microbial factors play a role in pathogenesis.
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Affiliation(s)
- Chih-Hsien Chuang
- Graduate Institute of Clinical Medical Sciences, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Hsin Wang
- Molecular Infectious Diseases Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Ju Chang
- Molecular Infectious Diseases Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsiu-Ling Chen
- Molecular Infectious Diseases Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yhu-Chering Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Tzou-Yien Lin
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Egon A Ozer
- Division of Infectious Diseases, Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Jonathan P Allen
- Department of Microbiology and Immunology, Northwestern University, Chicago, Illinois, USA
| | - Alan R Hauser
- Department of Microbiology and Immunology, Northwestern University, Chicago, Illinois, USA
| | - Cheng-Hsun Chiu
- Molecular Infectious Diseases Research Center, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan
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34
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A healthy 2-year-old child with a round black skin lesion. J Pediatr 2013; 163:1225-1225.e1. [PMID: 23721912 DOI: 10.1016/j.jpeds.2013.04.038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/15/2013] [Accepted: 04/22/2013] [Indexed: 11/22/2022]
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35
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Ecthyma gangrenosum in a previously healthy infant. Arch Plast Surg 2012; 39:673-5. [PMID: 23233899 PMCID: PMC3518017 DOI: 10.5999/aps.2012.39.6.673] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 09/26/2012] [Accepted: 09/26/2012] [Indexed: 11/08/2022] Open
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36
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Zhang Q, Smith JC, Zhu Q, Guo Z, MacDonald NE. A five-year review of Pseudomonas aeruginosa bacteremia in children hospitalized at a single center in southern China. Int J Infect Dis 2012; 16:e628-32. [DOI: 10.1016/j.ijid.2012.03.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2011] [Accepted: 03/28/2012] [Indexed: 12/01/2022] Open
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37
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Ecthyma Gangrenosum Due to Streptococcus pyogenes Infection in a Previously Healthy Child. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2012. [DOI: 10.1097/ipc.0b013e318248f10e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Pseudomonas aeruginosa sepsis with ecthyma gangrenosum and pseudomembranous pharyngolaryngitis in a 5-month-old boy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 47:158-61. [PMID: 22727891 DOI: 10.1016/j.jmii.2012.05.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 04/12/2012] [Accepted: 05/15/2012] [Indexed: 11/20/2022]
Abstract
Pseudomonas aeruginosa infection that induced pseudomembranous laryngopharyngitis and ecthyma gangrenosum simultaneously in a healthy infant is rare. We reported on a previously healthy 5-month-old boy with initial presentation of fever and diarrhea followed by stridor and progressive respiratory distress. P. aeruginosa sepsis was suspected because ecthyma gangrenosum over the right leg was found at the emergency department, and the diagnosis was confirmed by the blood culture. Fiberscope revealed bacterial pharyngolaryngitis without involvement of the trachea. Because of early recognition and adequate treatment, including antimicrobial therapy, noninvasive ventilation, incision, and drainage, he recovered completely without any complications.
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39
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Reconstructive Procedure of Lower Lip Defect Due to Ecthyma Gangrenosum—A Rare Complication of Acute Lymphoblastic Leukemia. J Craniofac Surg 2012; 23:e182-4. [DOI: 10.1097/scs.0b013e31824de403] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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40
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Gomes J, Vilarinho C, Ventura F, Vieira AP, Brito C. Ecthyma gangrenosum secondary to severe invasive infection caused by Escherichia coli. Int J Dermatol 2012; 51:356-7. [DOI: 10.1111/j.1365-4632.2010.04527.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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41
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Abstract
Ecthyma gangrenosum is a well-recognised cutaneous infection in critically ill and immunocompromised patients. It is commonly associated with Pseudomonas aeruginosa septicaemia. Classic lesions of ecthyma gangrenosum comprise deep ulcers with ecchymotic, gangrenous centres, bright red areolae and typical raised, purplish, indurated, rolled-out edges. We report ecthyma gangrenosum in a premature low-birth-weight neonate, delivered at home to a third gravida mother with history of chorioamnionitis. He was admitted to a private hospital on third day of life, with a diagnosis of early-onset neonatal sepsis and received multiple antibiotics over next 22 days. The infant was referred to the paediatrics emergency department of Sir Sunderlal Hospital, Banaras Hindu University in a condition of shock, pneumonitis and generalised sepsis. Two gangrenous ulcers with gray-black eschar were present, one over the neck and another over the back. He was diagnosed as a case of neonatal sepsis with ecthyma gangrenosum. Blood culture revealed growth of Pseudomonas aeruginosa, sensitive only to imipenem. The infant died the day following admission.
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Affiliation(s)
- S Basu
- Banaras Hindu University, Varanasi, India.
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42
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Bucak IH, Tümgör G, Mengen E, Temiz F, Turgut M. Ecthyma gangrenosum in a previously healthy pediatric patient and associated facial paralysis and persistent hyperplastic primary vitreous. AMERICAN JOURNAL OF CASE REPORTS 2012; 13:250-3. [PMID: 23569541 PMCID: PMC3615913 DOI: 10.12659/ajcr.883503] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2012] [Accepted: 07/20/2012] [Indexed: 11/09/2022]
Abstract
Background: Ecthyma gangrenosum is an infective lesion of the skin and mucosal membranes. It is most commonly caused by Pseudomonas aeruginosa, and the most important risk factors are malignancy and neutropenia. However, it has rarely been reported in children who were previously healthy. Persistent hyperplastic primary vitreous has been described as the persistence of the fetal hyaloid vascular system. Acute otitis media with facial paralysis is an infrequent association. Case Report: We report the case of a 5-month-old boy hospitalized because of fever, otorrhea and necrosis on his body. He had peripheral facial paralysis on the same side as otorrhea. Leukocoria was determined in the right eye. He had many gangrenous ulcers on the extremities and body. Conclusions: We present a previously healthy pediatric patient diagnosed with persistent hyperplastic primary vitreous, ecthyma gangrenosum (by the septicemia of P. aeruginosa), and peripheric facial paralysis (a complication of acute otitis media), admitted to hospital.
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Affiliation(s)
- Ibrahim Hakan Bucak
- Department of Pediatrics, Faculty of Medicine, Adýyaman University, Adýyaman, Turkey
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43
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Abstract
Ecthyma gangrenosum is a skin manifestation of systemic sepsis commonly caused by Pseudomonas aeruginosa in patients with neutropenia or underlying immune deficiency. Although the usual outcome is poor, early recognition and appropriate systemic antibiotic treatment can lead to successful outcome. We report a case of a previously healthy lady with no apparent immune deficiency or neutropenia who had ecthyma gangrenosum of left lower limb in which the arterial line was placed.
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Affiliation(s)
- George M Varghese
- Department of Medicine and Infectious Diseases, Christian Medical College, Vellore, India
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44
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Kim JS, Ricafort R, Garfein ES, Levin TL. Imaging findings of ecthyma gangrenosum, an unusual complication of pseudomonas sepsis. HSS J 2011; 7:279-81. [PMID: 23024626 PMCID: PMC3192886 DOI: 10.1007/s11420-011-9216-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 07/29/2011] [Indexed: 02/07/2023]
Abstract
A child with acute lymphoblastic leukemia and pseudomonas sepsis rapidly developed left foot pain and swelling. A diagnosis of ecthyma gangrenosum was made. The clinical and imaging features of this unusual entity are discussed. To our knowledge, this is the first description of the MR imaging findings of ecthyma gangrenosum.
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Affiliation(s)
- Jane S. Kim
- grid.240283.f0000 0001 2152 0791Department of Radiology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10467 USA
| | - Rosanna Ricafort
- grid.240283.f0000 0001 2152 0791Department of Hematology/Oncology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10467 USA
| | - Evan S. Garfein
- grid.240283.f0000 0001 2152 0791Division of Plastic and Reconstructive Surgery, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10467 USA
| | - Terry L. Levin
- grid.240283.f0000 0001 2152 0791Department of Radiology, Montefiore Medical Center, 111 East 210th St., Bronx, NY 10467 USA
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45
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Wu DC, Chan WW, Metelitsa AI, Fiorillo L, Lin AN. Pseudomonas skin infection: clinical features, epidemiology, and management. Am J Clin Dermatol 2011; 12:157-69. [PMID: 21469761 DOI: 10.2165/11539770-000000000-00000] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Pseudomonas aeruginosa is a Gram-negative bacillus that is most frequently associated with opportunistic infection, but which can also present in the otherwise healthy patient. The range of P. aeruginosa infections varies from localized infections of the skin to life-threatening systemic disease. Many P. aeruginosa infections are marked by characteristic cutaneous manifestations. The aim of this article is to provide a comprehensive synthesis of the current knowledge of cutaneous manifestations of P. aeruginosa infection with specific emphasis on clinical features and management. The ability of P. aeruginosa to rapidly acquire antibacterial resistance is an increasingly well recognized phenomenon, and the correct application of antipseudomonal therapy is therefore of the utmost importance. A detailed discussion of currently available anti-pseudomonal agents is included, and the benefits of antimicrobial combination therapy versus monotherapy are explored. Rapid clinical recognition of P. aeruginosa infection aided by the identification of characteristic cutaneous manifestations can play a critical role in the successful management of potentially life-threatening disease.
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Affiliation(s)
- Douglas C Wu
- Division of Dermatology, University of Alberta, Edmonton, Alberta, Canada
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46
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Tofteland ND, Wittler RR. Visual diagnosis: fever and multiple ruptured bullae in a 6-year-old boy. Pediatr Rev 2010; 31:472-6. [PMID: 21041425 DOI: 10.1542/pir.31-11-472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Nathan D Tofteland
- Department of Pediatrics, Pediatric Infectious Disease, University of Kansas School of Medicine-Wichita, Wichita, KS, USA
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47
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Multiple ecthyma gangrenosum in a healthy infant with community-acquired Pseudomonas aeruginosa sepsis. Pediatr Emerg Care 2010; 26:750-1. [PMID: 20930597 DOI: 10.1097/pec.0b013e3181f39b5e] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report the case of a previously healthy 8-month-old infant girl with Pseudomonas aeruginosa sepsis who presented to a pediatric emergency department with multiple ecthyma gangrenosum. Skin manifestations are uncommon in Pseudomonas infection. Ecthyma gangrenosum is a rare, distinct skin disorder associated with potentially fatal underlying Pseudomonas sepsis. Although typically occurring in immunocompromised or neutropenic patients, it can occasionally affect otherwise healthy children. This case demonstrates the critical importance of the pediatrician's identification of ecthyma gangrenosum to give directed antipseudomonal therapy.
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48
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Hekiert AM, Cohen MB, Montone KT, Palmer JN, Govindaraj S. Ecthyma Gangrenosum Mimicking Acute Invasive Fungal Sinusitis in an Immunocompromised Patient. EAR, NOSE & THROAT JOURNAL 2010. [DOI: 10.1177/014556131008900608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Ecthyma gangrenosum is a rare necrotizing cutaneous infection usually caused by Pseudomonas aeruginosa. We report a case of ecthyma gangrenosum presenting as a sinonasal eschar and mimicking acute invasive fungal sinusitis in an immunocompromised 39-year-old man with a hematologic malignancy To the best of our knowledge, this represents the first case of ecthyma gangrenosum affecting the sinonasal mucosa to he reported in the literature.
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Affiliation(s)
| | - Michael B. Cohen
- University of Pennsylvania School of Medicine, Philadelphia; the Department of Otolaryngology-Head & Neck Surgery, Boston University School of Medicine
| | | | - James N. Palmer
- From the Department of Otorhinolaryngology-Head and Neck Surgery
| | - Satish Govindaraj
- Department of Otolaryngology, Mount Sinai Medical Center, New York City
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49
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Kuo CH, Lee MS, Yang RC, Chen BH, Lin JY, Hung CH. Cerebral venous sinus thrombosis in an infant with Pseudomonas aeruginosa sepsis. Pediatr Int 2010; 52:314-6. [PMID: 20500483 DOI: 10.1111/j.1442-200x.2010.03026.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Chang-Hung Kuo
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
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50
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Yuen ACL, Ng DK, Chow PY. Pseudomembranous necrotising pharyngitis in a child with Pseudomonas aeruginosa bacteraemia. ACTA ACUST UNITED AC 2009; 29:239-42. [PMID: 19689869 DOI: 10.1179/027249309x12467994694175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Pseudomonas aeruginosa is a common infection in immunocompromised patients. However, it can also cause severe infections in otherwise healthy individuals. We describe pseudomonal bacteraemia in a 6-month-old boy with significant obstruction of the nasopharynx by pseudomonal debris, which we termed pseudomembranous nectrotising pharyngitis. To prevent aspiration and suffocation, early recognition and removal of the obstruction by endoscopy is recommended.
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Affiliation(s)
- A C L Yuen
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong
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