ABSTRACT
El ectima gangrenoso es un trastorno infeccioso infrecuente clásicamente relacionado a bacteriemia, descrito principalmente en poblaciones inmunodeprimidas. El agente más comúnmente relacionado es Pseudomonas aeruginosa, sin embargo, se han descrito otras etiologías bacterianas, hongos filamentosos y levaduras. Su patogénesis está dada por la invasión de la pared de los vasos sanguíneos, causando trombosis arterial y venosa, desencadenando necrosis de epidermis y tejidos subdérmicos. Clínicamente, se manifiesta como máculas, vesículas o pústulas hemorrágicas que evolucionan a úlceras de superficie necrótica rodeadas por un halo eritematoso característico, habitualmente en un contexto clínico de sepsis. El diagnóstico de este cuadro es clínico, sin embargo, el estudio microbiológico es clave en la identificación del agente etiológico y un posterior tratamiento dirigido. En su manejo es esencial una alta sospecha clínica y el inicio de tratamiento antibiótico en forma precoz. La duración del tratamiento es variable y en algunos casos debe asociarse a debridación quirúrgica. El pronóstico es variable dependiendo de múltiples factores: estado inmunológico, agente etiológico, presencia de sepsis y el tiempo de inicio de tratamiento.(AU)
Ecthyma gangrenosum is an infrequent infectious disorder classically related to bacteremia, described mainly in immunosuppressed populations. The most related agent is Pseudomonas aeruginosa, however other bacterial etiologies, filamentous fungi and yeasts have been described. Its pathogenesis is given by the invasion of the blood vessel wall, causing arterial and venous thrombosis, triggering necrosis of epidermis and subdermal tissues. Clinically, it manifests as hemorrhagic macules, vesicles or pustules that evolve into ulcers with a necrotic surface surrounded by a characteristic erythematous halo, usually in a clinical setting of sepsis. The diagnosis of this condition is clinical, however the microbiological study is key in the identification of the etiological agent and a subsequent directed treatment. In its management, a high clinical suspicion and an early start of antibiotic treatment are essential. The duration of treatment is variable and in some cases it must be associated with surgical debridement. The prognosis is variable depending on multiple factors: immunological status, etiological agent, presence of sepsis and time of initiation of treatment.(AU)
Subject(s)
Humans , Pseudomonas Infections/microbiology , Sepsis , Ecthyma/diagnosis , Prognosis , Ecthyma/etiology , Ecthyma/drug therapyABSTRACT
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.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Pseudomonas aeruginosa/isolation & purification , Pseudomonas Infections/complications , Ecthyma/microbiology , Gangrene/microbiology , Retrospective Studies , Ecthyma/drug therapy , Gangrene/drug therapyABSTRACT
El ectima gangrenoso es una vasculitis necrosante poco frecuente, en la mayoría de los casos secundaria a sepsis por Pseudomonas aeruginosa en pacientes inmunocomprometidos. Sin embargo, existen reportes de ectima gangrenoso secundarios a otras etiologías infecciosas. Presentamos un caso de ectima gangrenoso asociado a una infección por Staphylococcus aureus resistente a meticilina en una paciente sin los factores de riesgo clásicos de inmunosupresión que se describen en la literatura médica.
Ecthyma gangrenosum is an uncommon necrotizing vasculitis, in most cases secondary to sepsis by Pseudo-mona aeruginosa in immunocompromised patients. However, there have been several reports of ecthyma gangre-nosum caused by other infectious etiologies. We report an unusual case of ecthyma gangrenosum associated with methicillin-resistant Staphylococcus aureus infection in a patient without the classic immunological risk factors described in the literature.
Subject(s)
Humans , Female , Aged , Staphylococcal Infections/pathology , Ecthyma/microbiology , Ecthyma/pathology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/drug therapy , Biopsy , Risk Factors , Ecthyma/drug therapy , Epidermis/microbiology , Epidermis/pathology , Gangrene , ImmunocompetenceABSTRACT
Ecthyma gangrenosum [EG] is one of the most dangerous bacterial cutaneous infections in the infant. The Pseudomonas Aeruginosa is frequently responsible. The skin localization is often associated with a bacteriemia, rares cases of primitive cutaneous localisation were described. The evolution is often fatal in case of immunodeficiency situation. The authors report 3 observations of ecthyma gangrenosum 2 months, 7 months and 18 months old. They all presented localised cutaneous erythema followed one week later by oedematous plates. These lesions evolved to necrosis and ulceration. The fever was absent in all patients and only one had a deteriorated general state. A high lymphocyte count was found in all patients. The inflammatory syndrome was inconstant. There were not any other localizations of the infection. The 3 patients were treated with cephalosporin of 3rd generation, associated in 2 cases with the gentamycin. The evolution was favourable. The early recognition of the lesions of EG and the institution of an adequate treatment often allows a favourable result in this affection