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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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Huang H, Bai K, Fu Y, Yan J, Li J. Ecthyma gangrenosum due to Pseudomonas aeruginosa sepsis as initial manifestation of X-linked agammaglobulinemia: a case report. BMC Pediatr 2020; 20:540. [PMID: 33261572 PMCID: PMC7704585 DOI: 10.1186/s12887-020-02436-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 11/19/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND X-linked agammaglobulinemia (XLA, OMIM#300,300), caused by mutations in the Bruton tyrosine kinase (BTK) gene, is a rare monogenic inheritable immunodeficiency disorder. Ecthyma gangrenosum is a cutaneous lesion caused by Pseudomonas aeruginosa that typically occurs in patients with XLA and other immunodeficiencies. CASE PRESENTATION We report the case of a 20-month-old boy who presented with fever, vomiting, diarrhea, and ecthyma gangrenosum. Blood, stool, and skin lesion culture samples were positive for P. aeruginosa. A diagnosis of XLA was established, and the c.262G > T mutation in exon 4 of BTK was identified with Sanger sequencing. Symptoms improved following treatment with antibiotics and immunoglobulin infusion. CONCLUSIONS Primary immunodeficiency (i.e., XLA) should be suspected in male infants with P. aeruginosa sepsis, highlighting the importance of genetic and immune testing in these patients.
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Affiliation(s)
- Haixia Huang
- Intensive Care Unit, Key Medical Laboratory of Pediatrics, Key Laboratory of Child Development and Disorders, Chongqing Health Bureau, Ministry of Education, Children's Hospital of Chongqing Medical University, 136#, Zhong Shan 2nd Rord, Yuzhong District, Chongqing, People's Republic of China
| | - Ke Bai
- Intensive Care Unit, Key Medical Laboratory of Pediatrics, Key Laboratory of Child Development and Disorders, Chongqing Health Bureau, Ministry of Education, Children's Hospital of Chongqing Medical University, 136#, Zhong Shan 2nd Rord, Yuzhong District, Chongqing, People's Republic of China
| | - Yueqiang Fu
- Intensive Care Unit, Key Medical Laboratory of Pediatrics, Key Laboratory of Child Development and Disorders, Chongqing Health Bureau, Ministry of Education, Children's Hospital of Chongqing Medical University, 136#, Zhong Shan 2nd Rord, Yuzhong District, Chongqing, People's Republic of China
| | - Jin Yan
- Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment, Chongqing University Cancer Hospital, Chongqing, People's Republic of China
| | - Jing Li
- Intensive Care Unit, Key Medical Laboratory of Pediatrics, Key Laboratory of Child Development and Disorders, Chongqing Health Bureau, Ministry of Education, Children's Hospital of Chongqing Medical University, 136#, Zhong Shan 2nd Rord, Yuzhong District, Chongqing, People's Republic of China.
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3
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Kung YH, Yeh YC, Kuo KC. Clinical characteristics and predictors of community-acquired pseudomonas aeruginosa sepsis and nontyphoidal salmonella sepsis in infants: A matched Case-Control study. Pediatr Neonatol 2020; 61:522-528. [PMID: 32571671 DOI: 10.1016/j.pedneo.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/20/2020] [Accepted: 05/26/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa and nontyphoidal Salmonella (NTS) species may cause enteric illness with sepsis in infancy. The clinical predictors distinguishing the two pathogens have not been comprehensively evaluated in this population in Taiwan. METHODS A retrospective matched case-control study was conducted in a teaching hospital in southern Taiwan from January 1, 2003 to January 30, 2019. The patients with community-acquired P. aeruginosa sepsis were matched at a ratio of 1:2 by age and gender with controls (who developed NTS sepsis). RESULTS A total of 21 infants with community-acquired P. aeruginosa sepsis were identified; of these, 12 (57.1%) were male, and the mean ± standard deviation of age was 6.95 ± 2.47 months. Two independent predictors indicative of P. aeruginosa sepsis, as identified by multivariate analysis using conditional logistic regression, were hemoglobin level (Hb) (matched odds ratio [mOR], 0.155; 95% confidence interval [CI], 0.027-0.900; p = 0.038) and platelet count (mOR, 0.988, 95% CI, 0.976-1.000; p = 0.049). The areas under the receiver operating characteristic (ROC) curves of Hb and platelet count for P. aeruginosa sepsis prediction were 0.855 and 0.803, respectively. With cut-off values for Hb of 10.7 g/dL and platelet count of 173,000/μL, the predictors had maximal diagnostic accuracy. CONCLUSION Most patients with P. aeruginosa sepsis are less than one year old. A lower hemoglobin level and a lower platelet count are significant predictors of P. aeruginosa sepsis. These findings should help to reshape the policy of empirical antibiotics in infants with sepsis.
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Affiliation(s)
- Yin-Hsiang Kung
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Yi-Chun Yeh
- Department of Psychiatry, Kaohsiung Medical University Hospital, Department of Psychiatry, Faculty of Medicine, Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, 833, Taiwan
| | - Kuang-Che Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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4
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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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5
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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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6
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Ranjan R, Chowdhary P, Kamra A. Community Acquired Burkholderia cepacia Bacteraemia Presenting as MODS in an Immunocompetent Individual: An Unusual Case. J Clin Diagn Res 2017; 11:DD01-DD02. [PMID: 28511384 DOI: 10.7860/jcdr/2017/16285.9435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2015] [Accepted: 12/20/2016] [Indexed: 12/18/2022]
Abstract
Burkholderia cepacia has been recognized as a group of highly virulent organisms known as Burkholderia cepacia complex (Bcc). Bcc are ubiquitous in nature and most commonly found in moist environment, on plant roots and soil. Because of its high intrinsic antibiotic resistance, Bcc is a major cause of morbidity and mortality in hospitalized patients. It is reported most commonly in immunocompromised patients especially in patients with cystic fibrosis. Here, we report a rare case report of bacteraemia by Burkholderia cepacia in an immunocompetent male, who presented with fever and Multiple Organ Dysfunction Syndrome (MODS). Burkholderia cepacia was isolated from his blood culture, which he acquired from his work place. He was treated successfully and discharged after negative blood culture.
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Affiliation(s)
- Ritesh Ranjan
- Assistant Professor, Department of Surgery, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Priti Chowdhary
- Resident, Department of Microbiology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Aman Kamra
- Resident, Department of Surgery, Subharti Medical College, Meerut, Uttar Pradesh, India
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7
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Asgari S, McLaren PJ, Peake J, Wong M, Wong R, Bartha I, Francis JR, Abarca K, Gelderman KA, Agyeman P, Aebi C, Berger C, Fellay J, Schlapbach LJ. Exome Sequencing Reveals Primary Immunodeficiencies in Children with Community-Acquired Pseudomonas aeruginosa Sepsis. Front Immunol 2016; 7:357. [PMID: 27703454 PMCID: PMC5028722 DOI: 10.3389/fimmu.2016.00357] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 09/01/2016] [Indexed: 01/10/2023] Open
Abstract
One out of three pediatric sepsis deaths in high income countries occur in previously healthy children. Primary immunodeficiencies (PIDs) have been postulated to underlie fulminant sepsis, but this concept remains to be confirmed in clinical practice. Pseudomonas aeruginosa (P. aeruginosa) is a common bacterium mostly associated with health care-related infections in immunocompromised individuals. However, in rare cases, it can cause sepsis in previously healthy children. We used exome sequencing and bioinformatic analysis to systematically search for genetic factors underpinning severe P. aeruginosa infection in the pediatric population. We collected blood samples from 11 previously healthy children, with no family history of immunodeficiency, who presented with severe sepsis due to community-acquired P. aeruginosa bacteremia. Genomic DNA was extracted from blood or tissue samples obtained intravitam or postmortem. We obtained high-coverage exome sequencing data and searched for rare loss-of-function variants. After rigorous filtrations, 12 potentially causal variants were identified. Two out of eight (25%) fatal cases were found to carry novel pathogenic variants in PID genes, including BTK and DNMT3B. This study demonstrates that exome sequencing allows to identify rare, deleterious human genetic variants responsible for fulminant sepsis in apparently healthy children. Diagnosing PIDs in such patients is of high relevance to survivors and affected families. We propose that unusually severe and fatal sepsis cases in previously healthy children should be considered for exome/genome sequencing to search for underlying PIDs.
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Affiliation(s)
- Samira Asgari
- Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Paul J McLaren
- National HIV and Retrovirology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada; Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB, Canada
| | - Jane Peake
- Lady Cilento Children's Hospital , Brisbane, QLD , Australia
| | - Melanie Wong
- Children's Hospital Westmead , Sydney, NSW , Australia
| | - Richard Wong
- Pathology Queensland Central Laboratory, Royal Brisbane and Women's Hospital , Brisbane, QLD , Australia
| | - Istvan Bartha
- Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Joshua R Francis
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia; Royal Darwin Hospital, Darwin, NT, Australia
| | - Katia Abarca
- Departamento de Enfermedades Infecciosas e Inmunología Pediátrica, Escuela de Medicina, Pontificia Universidad Católica de Chile , Santiago , Chile
| | | | - Philipp Agyeman
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | - Christoph Aebi
- Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern , Bern , Switzerland
| | | | - Jacques Fellay
- Global Health Institute, School of Life Sciences, École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland; Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Luregn J Schlapbach
- Lady Cilento Children's Hospital, Brisbane, QLD, Australia; Department of Pediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Paediatric Critical Care Research Group (PCCRG), Mater Research, University of Queensland, Brisbane, QLD, Australia
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Paul LM, Hegde A, Pai T, Shetty S, Baliga S, Shenoy S. An Outbreak of Burkholderia cepacia Bacteremia in a Neonatal Intensive Care Unit. Indian J Pediatr 2016; 83:285-8. [PMID: 26264633 DOI: 10.1007/s12098-015-1855-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To identify the source of infection, to study the clinical profile and outcomes of neonates with Burkholderia septicemia and to determine the antimicrobial susceptibility patterns of the isolates. METHODS The authors describe a 3 mo outbreak of nosocomial Burkholderia cepacia bacteremia involving 12 neonates. During the outbreak, ventilator humidifier water, intravenous solutions and other possible sources were taken from the concerned neonatal intensive care units (NICUs); cultured and isolates identified by standard microbiological techniques and VITEK system. Clinical details of affected babies were also obtained to ascertain the clinical significance of the isolates. RESULTS All neonates had clinical and biochemical evidence of sepsis and the source could be tracked to intravenous solutions of 5% dextrose, normal saline (opened bottles) and continuous positive airway pressure humidifier water. Strain relatedness of the environmental isolates with the clinical isolates is likely as antibiotic susceptibility patterns were similar. CONCLUSIONS The investigations revealed the source of the nosocomial outbreak which is crucial for initiating appropriate control measures.
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Affiliation(s)
- Liz Mary Paul
- Department of Microbiology, Kasturba Medical College, Manipal University, Mangalore, India
| | - Ashwini Hegde
- Department of Microbiology, Kasturba Medical College, Manipal University, Mangalore, India.
| | - Tanvi Pai
- Department of Pediatrics, Kasturba Medical College, Manipal University, Mangalore, India
| | - Subodh Shetty
- Department of Pediatrics, Kasturba Medical College, Manipal University, Mangalore, India
| | - Shrikala Baliga
- Department of Microbiology, Kasturba Medical College, Manipal University, Mangalore, India
| | - Suchitra Shenoy
- Department of Microbiology, Kasturba Medical College, Manipal University, Mangalore, India
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9
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Abstract
Ecthyma gangrenosum is the cutaneous manifestation of pseudomonas infection in patients with sepsis. A previously healthy 7-month-old girl who developed ecthyma gangrenosum without apparent inciting factors became neutropenic secondary to autoimmune neutropenia 2 months after initial presentation. She was treated with appropriate surgical and medical intervention and was discharged in stable condition only to die suddenly 2 days after discharge.
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Affiliation(s)
- Omar Pacha
- Department of Dermatology, University of Texas Health Science Center, Houston, Texas
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10
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Kuo KC, Kuo HC, Huang LT, Lin CS, Yang SN. The clinical implications of ABO blood groups in Pseudomonas aeruginosa sepsis in children. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 46:109-14. [DOI: 10.1016/j.jmii.2012.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 10/27/2011] [Accepted: 01/02/2012] [Indexed: 10/28/2022]
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11
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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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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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13
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Viola L, Langer A, Pulitanò S, Chiaretti A, Piastra M, Polidori G. Serious Pseudomonas aeruginosa infection in healthy children: case report and review of the literature. Pediatr Int 2006; 48:330-3. [PMID: 16732805 DOI: 10.1111/j.1442-200x.2006.02214.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Luigi Viola
- Pediatric Intensive Care Unit, Institute of Pediatrics, Catholic University of Rome, Rome, Italy.
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14
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Ishizuka T, Oyama T, Sato M, Hisada T, Takagi H, Hamada T, Kimura T, Kashiwabara K, Mori M. Fatal pneumonia caused by Burkholderia cepacia 9 months after resection of aspergilloma. Respirology 2004; 8:401-3. [PMID: 14528890 DOI: 10.1046/j.1440-1843.2003.00476.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A 69-year-old man developed an episode of severe community-acquired pneumonia 9 months after resection of aspergilloma. Although Aspergillus fumigatus was also isolated in the pleural cavity, it did not invade the remaining lung parenchyma. The patient developed progressive bilateral pneumonia leading to death from respiratory failure. Burkholderia cepacia was considered as prime pathogen, as it was repeatedly cultured from sputum and tracheal secretions, as well as the autopsy lung. B. cepacia is resistant to most antibiotics, and seldom causes pneumonia in patients without cystic fibrosis or chronic granulomatous disease. The precise reason that this apparently immunocompetent patient developed B. cepacia pneumonia remains unknown.
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Affiliation(s)
- Tamotsu Ishizuka
- First Department of Internal Medicine, Gunma University School of Medicine, Showa-machi, Maebashi, Japan.
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15
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Abstract
Ecthymagangrenosum is a skin lesion that is most commonly caused by. Although ecthyma gangrenosum usually develops in patients with underlying immunodeficiencies or chronic diseases, there have been reports of its appearance in previously healthy children. A review of such patients in the English literature showed that most of them had either previously undetected immunodeficiencies or transient risk factors that predisposed them to the development of ecthyma gangrenosum. We report a patient without apparent antecedent predisposing risk factors for ecthyma gangrenosum who developed chronic neutropenia 1 week after presentation. It is important for the primary care provider to recognize ecthyma gangrenosum, treat it with appropriate antimicrobial agents and investigate the patient for occult immunodeficiencies.
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Affiliation(s)
- Arezoo Zomorrodi
- Department of Pediatrics, University of Pittsburgh School of Medicine, PA, USA
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16
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Huang YC, Lin TY, Wang CH. Community-acquired Pseudomonas aeruginosa sepsis in previously healthy infants and children: analysis of forty-three episodes. Pediatr Infect Dis J 2002; 21:1049-52. [PMID: 12442028 DOI: 10.1097/00006454-200211000-00015] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa sepsis is often considered to be hospital-acquired and to affect mainly children with underlying problems. Fewer than 50 cases of community-acquired sepsis associated with P. aeruginosa in previously healthy infants and children have been reported in English language literature. METHODS We retrospectively reviewed the medical records of 121 infants and children younger than 15 years of age who had 124 episodes of P. aeruginosa sepsis and were hospitalized at Chang Gung Memorial Hospital and Chang Gung Children's Hospital during 1983 and 1998. Forty-three episodes of community-acquired infection occurring in previously healthy children were evaluable for this study. RESULTS Thirty-two children (74%) were male and 36 (84%) were <1 year of age. Ten patients (23%) died. The onset of P. aeruginosa sepsis occurred during May to October in 34 cases (79%). Fever (91%) and diarrhea (72%) were the 2 most common initial symptoms. On admission leukopenia (leukocyte count <5,000/mm ) was present in 24 cases (57%) and in 9 of 10 fatal cases. P. aeruginosa was also isolated from other sites than bloodstream in 25 cases (58%), including 10 (43%) of 23 fecal specimens. The initial antibiotic regimen was inappropriate in 16 cases (38%), and the rate of inappropriate initial antibiotic regimen was significantly higher (P = 0.002) in fatal cases (90%) than that in nonfatal cases (24%). CONCLUSION Community-acquired P. aeruginosa sepsis in previously healthy infants is not rare in Taiwan. During warm weather seasons, in infants with fever and diarrhea who suddenly develop a septic appearance, it is advisable to cover for P. aeruginosa sepsis with aminoglycosides and/or anti-Pseudomonas beta-lactam antibiotics.
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Affiliation(s)
- Yhu-Chering Huang
- Divisions of Pediatric Infectious Diseases, Chang Gung Children's Hospital, School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Almeida JFLD, Sztajnbok J, Troster EJ, Vaz FAC. Pseudomonas aeruginosa septic shock associated with ecthyma gangrenosum in an infant with agammaglobulinemia. Rev Inst Med Trop Sao Paulo 2002; 44:167-9. [PMID: 12163911 DOI: 10.1590/s0036-46652002000300010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ecthyma gangrenosum (EG) due to Pseudomonas aeruginosa is a rare and invasive infection that can be associated with agammaglobulinemia. The cornerstone of the treatment is based on prompt recognition with appropriate antibiotic coverage and intravenous immunoglobulin. The authors report a case of EG emphasizing the clinical and therapeutic aspects of this condition.
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18
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Jones AM, Dodd ME, Webb AK. Burkholderia cepacia: current clinical issues, environmental controversies and ethical dilemmas. Eur Respir J 2001; 17:295-301. [PMID: 11334134 DOI: 10.1183/09031936.01.17202950] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Burkholderia cepacia is a plant phytogen and is known as a hardy and versatile organism. Over the past two decades it has emerged as a pathogen in the cystic fibrosis (CF) community, with devastating effects. Pulmonary colonisation can lead to an accelerated decline in lung function. In some cases, it causes a rapid and progressive pneumonic illness termed "cepacia syndrome", which is untreatable and fatal. B. cepacia is inherently resistant to multiple antibiotics and highly transmissible and virulent strains have been identified. CF patients colonised with the organism have to be segregated from their peers to try to prevent cross-infection. However, the pathogenicity of B. cepacia is not limited to CF. Other groups, such as individuals with chronic granulomatous disease and immunocompromised patients are vulnerable and it has caused disease in healthy individuals. However, the agricultural and petrochemical industries are attempting to exploit properties of B. cepacia for use as a biopesticide and biodegradation agent. This article provides an up to date review of clinically based literature on the Burkholderia cepacia complex, highlighting clinical management issues for both cystic fibrosis and non-cystic fibrosis patients. The article also addresses the potential conflict between medicine and agriculture on plans to reintroduce strains of Burkholderia cepacia back into the environment.
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Affiliation(s)
- A M Jones
- Manchester Adult Cystic Fibrosis Unit, Wythenshawe Hospital, UK
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19
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Mull CC, Scarfone RJ, Conway D. Ecthyma gangrenosum as a manifestation of Pseudomonas sepsis in a previously healthy child. Ann Emerg Med 2000; 36:383-7. [PMID: 11020689 DOI: 10.1067/mem.2000.110013] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We present a case of Pseudomonas aeruginosa sepsis heralded by ecthyma gangrenosum in a previously healthy 15-month-old child. Pseudomonas infection and its uncommon skin manifestation are rarely encountered in an immunocompetent child. This case highlights the critical importance of identifying ecthyma gangrenosum to institute optimal antimicrobial therapy.
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Affiliation(s)
- C C Mull
- Department of Emergency Medicine, and the Sections of Immunology and Neonatal Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA.
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20
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Belchis DA, Simpson E, Colby T. Histopathologic features of Burkholderia cepacia pneumonia in patients without cystic fibrosis. Mod Pathol 2000; 13:369-72. [PMID: 10786801 DOI: 10.1038/modpathol.3880060] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We present the histopathologic features of fatal Burkholderia cepacia pneumonia in three adults (one man [age 44 years] and two women [aged 40 and 43 years]). In all patients, the pulmonary infiltrates initially were localized (right middle lobe, left upper lobe, and right middle lobe) but rapidly progressed. Two open-lung biopsies and one pneumonectomy specimen showed necrotizing granulomatous inflammation merging with areas of more conventional necrotizing bronchopneumonia In one patient, a mediastinal lymph node also showed stellate necrotizing granulomas. Vasculitis was absent. B. cepacia was cultured from the open-lung biopsies and bronchial wash specimens in two patients and from postmortem cultures of lung, subcarinal lymph nodes, and blood in the third. The histopathology in these patients resembles that of melioidosis, which is caused by a related organism, Burkholderia pseudomallei. B. cepacia needs to be considered in the differential diagnosis of necrotizing granulomatous inflammation. In addition, given the rarity with which B. cepacia is identified as a cause of pneumonia in the immunocompetent host, isolation of B. cepacia should trigger a workup for underlying immunodeficiency or lead to an investigation to exclude the possibility of a nosocomial infection.
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Affiliation(s)
- D A Belchis
- Department of Pathology, Penn State Geisinger Health System, Hershey Medical Center, Pennsylvania 17033, USA.
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21
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Septicémie communautaire à Pseudomonas aeruginosa chez le nourrisson. À propos de cinq observations. Med Mal Infect 1999. [DOI: 10.1016/s0399-077x(99)80008-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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22
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Yeung CK, Lee KH. Community acquired fulminant Pseudomonas infection of the gastrointestinal tract in previously healthy infants. J Paediatr Child Health 1998; 34:584-7. [PMID: 9928656 DOI: 10.1046/j.1440-1754.1998.00290.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Three previously healthy infants presented with diarrhoea and pyrexia and deteriorated rapidly. Two patients had necrotizing bowel disease requiring aggressive surgical intervention. All survived. P. aeruginosa gastrointestinal infection in previously healthy children is an extremely rare condition with a high mortality. Ecthyma gangrenosum was present in over 60% of reported cases although often not recognized initially. A high index of clinical suspicion, including prompt recognition of ecthyma gangrenosum, is mandatory for an early diagnosis of P. aeruginosa gastrointestinal infection. Early diagnosis and treatment may improve the prognosis.
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Affiliation(s)
- C K Yeung
- Department of Surgery, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, China.
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23
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Hendricks MK, Senekal M. Community-acquired Pseudomonas aeruginosa infection in an infant. ANNALS OF TROPICAL PAEDIATRICS 1996; 16:203-6. [PMID: 8893949 DOI: 10.1080/02724936.1996.11747827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A 7-month-old infant presented at a tertiary centre with a 6-day history of a skin rash, fever and diarrhoea. Clinical features included pyrexia, kwashiorkor, extensive ulcerating skin lesions suggestive of ecthyma gangrenosum, hepatomegaly, meningismus, neutropenia and iron deficiency anaemia. Blood and skin aspirate cultures yielded a positive growth of Pseudomonas aeruginosa. Apart from severe protein energy malnutrition, no other causes of immunodeficiency were found. He responded well to parenteral antibiotic therapy with gentamicin and piperacillin.
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Affiliation(s)
- M K Hendricks
- Department of Paediatrics & Child Health, Tygerberg Hospital, Parow, South Africa
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24
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Reymond D, Frey B, Birrer P. [Invasive Pseudomonas aeruginosa and Ecthyma gangrenosum infection in a child without risk factors]. Arch Pediatr 1996; 3:569-72. [PMID: 8881303 DOI: 10.1016/0929-693x(96)83229-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pseudomonas aeruginosa sepsis, well known in immunocompromised patients, is rare in previously healthy children. CASE REPORT A previously healthy 4 month-old boy was admitted with the suspicion of meningococcal septicemia. Three days prior to admission, he had developed high fever and two 4 cm-diameter skin lesions on his right leg, with dark red colour and a central haemorrhagic blister. He subsequently developed generalized seizures; meningitis and urinary tract infection were excluded. Despite topical therapy with an antistaphylococcal drug skin lesions extended, particularly at the level of the head. The patient was given oral amoxicillin-clavulanate, but his condition worsened; he was transferred to our intensive care unit with septic shock and a diagnosis of meningococcemia. Blood cultures grew Pseudomonas aeruginosa. Despite intensive therapy and appropriate antibiotic therapy, the patient died. CONCLUSION To allow early diagnosis and adequate treatment, it is mandatory to diagnose Ecthyma gangrenosum as the most frequent manifestation of invasive infection with Pseudomonas aeruginosa.
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Affiliation(s)
- D Reymond
- Clinique pédiatrique, hôpital universitaire de l'Ile, Berne, Suisse
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25
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Alsaeid K, Alshabany E, Alharshany F, Aleker N, Alsaeid M. Case of the month: a 20-month-old boy with fever, respiratory distress and necrotizing skin lesions. Eur J Pediatr 1996; 155:341-2. [PMID: 8777932 DOI: 10.1007/bf02002725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- K Alsaeid
- Department of Paediatrics, Faculty of Medicine, Kuwait University, Safat, Kuwait
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26
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Hobson R, Gould I, Govan J. Burkholderia (Pseudomonas) cepacia as a cause of brain abscesses secondary to chronic suppurative otitis media. Eur J Clin Microbiol Infect Dis 1995; 14:908-11. [PMID: 8605906 DOI: 10.1007/bf01691499] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A patient with a cholesteatoma secondary to chronic suppurative otitis media developed infective complications including cerebellar and cerebello-pontine abscesses. Burkholderia cepacia was isolated from ear swabs, infected tissue and surgical pus on five occasions over a six-month period. Despite exhibiting three different antibiotic susceptibility profiles, all five isolates were confirmed as clonally indistinguishable by pulsed-field gel electrophoresis. To the best of the authors' knowledge there are no previous reports of Burkholderia cepacia causing infection of the adult central nervous system.
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Affiliation(s)
- R Hobson
- Department of Medical Microbiology, Aberdeen Royal Infirmary, Aberdeen Royal Hospitals NHS Trust, Foresterhill, UK
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27
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Lacy DE, Spencer DA, Goldstein A, Weller PH, Darbyshire P. Chronic granulomatous disease presenting in childhood with Pseudomonas cepacia septicaemia. J Infect 1993; 27:301-4. [PMID: 7508484 DOI: 10.1016/0163-4453(93)92271-w] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Two children who presented with fever, enlarged liver and spleen and ascites were found to have Pseudomonas cepacia septicaemia which proved fatal despite appropriate antibiotics and maximum supportive care. Chronic granulomatous disease of childhood (CGD) was subsequently diagnosed in both children. The possibility of CGD needs to be considered in any child with unexplained P. cepacia infection.
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Affiliation(s)
- D E Lacy
- Children's Hospital, Middleway, Birmingham, U.K
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