Ectima gangrenoso, manifestación cutánea infrecuente de una infección por diversos agentes / Ecthyma gangrenosum, a rare cutaneous manifestation of infection by various agents

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)

Severe bacterial skin infections

Abstract The severe bacterial diseases discussed herein are those that present dermatological lesions as their initial manifestations, for which the dermatologist is often called upon to give an opinion or is even the first to examine the patient. This review focuses on those that evolve with skin necrosis during their natural history, that is, necrotizing fasciitis, Fournier gangrene, and ecthyma gangrenosum. Notice that the more descriptive terminology was adopted; each disease was individualized, rather than being referred by the generic term "necrotizing soft tissue infections". Due to their relevance and increasing frequency, infections by methicillin-resistant Staphylococcus aureus (MRSA) were also included, more specifically abscesses, furuncle, and carbuncle, and their potential etiologies by MRSA. This article focuses on the epidemiology, clinical dermatological manifestations, methods of diagnosis, and treatment of each of the diseases mentioned.

Ecthyma gangrenosum and agranulocytosis in a previously healthy 12-month-old girl: Report of 1 case with a literature review

Ecthyma gangrenosum (EG) is a rare skin manifestation which starts with a maculopapular eruption and followed by a necrotic ulcer covered with black eschar. EG usually occurs in immunosuppressed patients with Pseudomonas aeruginosa sepsis. We present a previously healthy 12-month-old girl with EG by P. aeruginosa and agranulocytosis due to influenza A and then rhinovirus infection, without bacteremia. It is important for allergists to culture wound and differentiate EG from other skin disorders including Tsutsugamushi disease and initiate appropriate empiric antipseudomonal antibiotic treatment, and to evaluate for possible immunodeficiency, even in a healthy child.

Ecthyma gangrenosum: a report of eight cases

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.

Ecthyma Gangrenosum in a Previously Healthy Adolescent / 대한피부과학회지

No abstract available.

A single black ulcer in a child with acute lymphocytic leukemia

Abstract Ecthyma gangrenosum is an uncommon dermatological manifestation characterized by round, indurated ulcers with a central necrotic black eschar and surrounding erythema. This report describes the case of a 5-year-old girl, affected by acute lymphocytic leukemia, presenting with a black eschar on her right thigh. Such lesions should always be correctly identified to avoid potentially fatal bacteraemia. Furthermore, because of its similar clinical presentation, cutaneous anthrax must be ruled out.

Ectima gangrenoso secundario a Staphylococcus aureus / Ecthyma gangrenosum caused by Staphylococcus aureus

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.

Otitis externa maligna con ectima gangrenoso en un paciente con infección por VIH / Malignant otitis externa with ecthyma gangrenosum in an hiv-positive patient

La otitis externa maligna es considerada una infección invasiva del conducto auditivo externo, infrecuente y sumamente agresiva, que llega, en ocasiones, a comprometer la base del cráneo. Se presenta habitualmente en inmunocomprometidos, incluidos aquellos con infección por VIH. El ectima gangrenoso es una infección cutánea localizada, inusual, causada, en la mayoría de los casos por Pseudomonas aeruginosa, con compromiso multisistémico y evolución tórpida. La asociación entre ambas entidades es aún más rara. A continuación, presentamos el caso de una mujer de 37 años, con el antecedente principal de infección por VIH desde hace 10 años, adherente al tratamiento antirretroviral y, a pesar de mantener una adecuada respuesta inmunológica y virológica, se presenta a la urgencia de nuestro hospital en shock séptico por otitis externa maligna, con ectima gangrenoso y posible síndrome hemofagocítico como complicación, aislándose Pseudomonas aeruginosa como agente causal.

Malignant otitis externa is an aggressive, infrequent and invasive infection of the external auditory canal. In some cases it leads to skull base compromise, particularly in immunocompromised individuals, including HIV-positive patients. Ecthyma gangrenosum is an unusual, localized cutaneous infection, caused mostly by Pseudomonas aeruginosa, with systemic compromise and a torpid evolution. An association between these 2 entities is even more rare. We present the case of a 37-year old woman with a history of 10 years’ HIV infection and good adherence to antiretroviral therapy. Although she had an adequate immunological and virological response, she presented at our emergency department in septic shock due to malignant otitis externa with ecthyma gangrenosum and possible haemophagocytic syndrome as a complication, with Pseudomonas aeruginosa determined to be the causative agent.

A Rare Case of Ecthyma Gangrenosum Caused by Proteus vulgaris and Candida albicans in a Patient with Castleman Disease

No abstract available.

Diagnosis and Management of Ecthyma Gangrenosum in Chronic Renal Failure Patient

No abstract available.

Ectima gangrenoso en pediatría / Ecthyma gangrenosum in pediatrics

Resumen El ectima gangrenoso es una infección poco frecuente de la piel, conocida con una característica lesión causada principalmente por la Pseudomoma aeruginosa, pero que también se puede presentar por otro tipo de bacterias del tipo Staphylococcus aureus o el Streptococcus beta hemolítico del grupo A ( S. beta hemolítico del grupo A), entre otros. Esta entidad se asocia frecuentemente con inmunodeficiencias primarias y secundarias. Las lesiones, clínicamente, se presentan como máculas eritematovioláceas, descamativas que rápidamente evolucionan a papulovesículas, ampollas hemorrágicas y costrosas que dejan unas úlceras profundas en sacabocado con fondo necrótico. La mortalidad es alta, entre 40 y 75% de los individuos inmunológicamente comprometidos. Se describe el caso de una niña de 5 años que inicialmente presentó varicela y luego una sobreinfección por S. aureus ocasionando un cuadro clínico de un ectima gangrenoso; al diagnóstico se llega por la clínica, cultivos y biopsias de piel. Se realizó manejo con aciclovir, clindamicina y cefepime endovenoso, con buena y rápida respuesta de la paciente.

Abstract Ecthyma gangrenosum (EG) is a rare infection of the skin, known as a characteristic lesion caused by Pseudomoma aeruginosa , but also can occur from other types of bacteria like Staphylococcus aureus or beta hemolytic group, among others. This condition is often associated with primary and secondary immunodeficiencies. The lesions present clinically as scaly, erythematous violacious macules that rapidly evolve into papule-vesicles, bleeding and crusty blisters leaving a deep punch ulcer with a necrotic base. Mortality is high, between 40% and 75% of immunologically compromised individuals. We describe the case of a girl of 5 years of age who initially presented chickenpox and then superinfection with Staphylococcus aureus, causing a clinical picture of EG. The diagnosis was reached based on symptoms, cultures and skin biopsies. Management was achieved with acyclovir, intravenous clindamycin and cefepime, with a good and quick response by the patient.

Ectima gangrenoso y osteoartritis por pseudomonas aeruginosa en un paciente previamente sano / Ecthyma gangrenosum and osteoarthritis by pseudomonas aeruginosa in a previously healthy patient

Las infecciones por pseudomonas aeruginosa se presentan habitualmente en individuos con factores predisponentes, siendo excepcional su ocurrencia en los previamente sanos. Se describe el caso de un lactante de 2 meses sin antecedentes patológicos a destacar que presentó una infección grave por pseudomonas aeruginosa, presentando al momentode la consulta en emergencia lesiones en piel características de ectima gangrenoso. El reconocimiento de estas lesiones permite adecuar el tratamiento antibiótico empírico a la susceptibilidad antimicrobiana de este germen. La presencia de una infección por esta bacteria obliga al clínico a la búsqueda de inmunodeficiencias no diagnosticadas previamente...

Ecthyma Gangrenosum Caused by Klebsiella Pneumoniae in Immunocompromised Patient Associated with Severe Aplastic Anemia / 임상소아혈액종양

Ecthyma gangrenosum (EG) is a skin infection that is classically associated with Pseudomonas aeruginosa septicemia in immunocompromised patients with severe neutropenia. Other bacterial, viral, and fungal pathogens also have been implicated in EG. EG is rare condition with characteristic clinical appearance of red macule that progresses to a central area presenting a necrotic black or gray-black eschar with surrounding erythema. The skin lesions usually occur in the gluteal and perineal regions or extremities and widespread over the body. Although the usual outcome is poor, early recognition and appropriate systemic antibiotic treatment can lead to successful outcome. Therefore, we describe a case of EG associated with Klebsiella pneimoniae in a 15-year-old patient with severe aplastic anemia and review the literature.

Multiple Ecthyma Gangrenosum in a Hemophagocytic Lymphohistiocytosis Patient / 대한피부과학회지

No abstract available.

Ecthyma Gangrenosum Caused by Klebsiella Pneumoniae in Immunocompromised Patient Associated with Severe Aplastic Anemia / 임상소아혈액종양

Ecthyma gangrenosum (EG) is a skin infection that is classically associated with Pseudomonas aeruginosa septicemia in immunocompromised patients with severe neutropenia. Other bacterial, viral, and fungal pathogens also have been implicated in EG. EG is rare condition with characteristic clinical appearance of red macule that progresses to a central area presenting a necrotic black or gray-black eschar with surrounding erythema. The skin lesions usually occur in the gluteal and perineal regions or extremities and widespread over the body. Although the usual outcome is poor, early recognition and appropriate systemic antibiotic treatment can lead to successful outcome. Therefore, we describe a case of EG associated with Klebsiella pneimoniae in a 15-year-old patient with severe aplastic anemia and review the literature.

Cutaneous Infection Caused by Klebsiella pneumonia in a Patient with Aplastic Anemia / 대한피부과학회지

Klebsiella pneumonia is an opportunistic pathogen that can lead to severe diseases such as septicemia, pneumonia, urinary and hepatobiliary track infection, in mainly hospitalized, immunocompromised patients. It has been reported to produce cellulitis, ecthyma gangrenosum in cutaneous manifestions, which are more commonly induced by bacteremia and spreading from other internal organs than primary inoculation. Herein, we present a case of a 75-year-old man with aplastic anemia, which progressed to septic shock and secondary cutaneous infection caused by Klebsiella pneumonia, but showed similar skin lesions to systemic fungal infection with dispersed erythematous macules and vesicular change on the center of his erythema.

Acute Ecthyma Caused by Serratia marcescens in a Patient with Diabetes Mellitus / 대한피부과학회지

Despite their existence all around, primary cutaneous infections caused by Serratia marcescens are still fairly rare. In many cases, symptoms caused by S. marcescens usually manifest as opportunistic infections in pulmonary, urinary and digestive organs of immunocompromised patients. It is unusual to find manifestations as "primary" cutaneous infection. A 56-year-old woman presented to our hospital with ulcerative skin lesions. She had a medical history of poorly controlled diabetes mellitus for 5 years. Multiple nodules and ulcerative lesions of various sizes were distributed on the abdomen, both buttocks and thighs. Two biopsy samples revealed deep dermal and subcutaneous suppurative inflammation. Two culture samples from the skin biopsy sites demonstrated S. marcescens. Small-to-medium sized lesions showed improvements with antibiotic treatment for 14 days. However, for large sized lesions, partial-thickness skin grafts were done.

Ecthyma Gangrenosum in a Previously Healthy Infant

No abstract available.

Comparison of isolation and conventional and developed indoor new sybr green real-time PCR assay for diagnosis of sheep/goat pox and contagious ecthyma viruses

Outbreaks of pox among animals have been reported from different parts of the world regularly. Differential diagnosis of Sheep/Goat Pox virus [SGPV], and Contagious ecthyma [Orf] virus [ORFV] by host species and clinical signs is not always exact, hence; laboratory confirmation is necessary to establish the cause of the disease and to distinguish these two viruses. During summer 2009, Pox infection among sheep and goat flocks were suspected. Based on clinical examinations sheep/goat Pox, and contagious ecthyma were suspected; samples of the skin biopsy of affected sheep and goats were sent to the Lab for more exact diagnosis. The etiological viruses were fruitfully isolated on the chorio-aliantoic membranes [CAMs] of embryonated chicken eggs indicated by expressing the characteristic pock lesions Poxfiridae family and confirmed to be a SGPV, and ORFV on the basis of conventional polymerase chain reaction assay [PCR] in sample and CAMs harvests. The primer used for diagnosis of SGPV was Capripoxvirus [KS-15 and KS-1.6], while the primer used for ORFV were 045Orf coding for the later transcription factor [VLTF-1]. A Real-Time polymerase chain reaction assay [RT-PCR], based on SYBR green I technology was subsequently developed for DNA qualitative in sample and CAM harvests for SGPV and ORFV based on the same mentioned primers. The assay was specific as only SGPV or ORFV suspected samples and their reference strains reacted and their reference strains reacted with the corresponding primer only. With melting curve analysis; temperature of melting [T[m]] scored by SGPV were relatively identical between 81.24 [degree sign] C [tilde] 81.49 [degree sign] C while; T[m] scored by ORFV were 92.62[degree sign] C [tilde] 93.08 [degree sign] C. The sensitivity of the RT-PCR with each of the 2 primers used for SGPV or ORFV was equivalent for the PCR. In addition; no amplification was detected from DNAs of SGPV tested by the primer used for ORFV and veers versa in current applied assays. The results of the study suggest that; the presented RT-PCR provides a highly robust and sensitive method to detect SGPV and ORFV directly from clinical samples. The method can be used for viral identification and monitoring, especially in areas where the two viruses co-circulate. To our knowledge, this is the first study to used the developed indoor new SYBR green IRT-PCR assay to identify of SGPV and ORFV and strong association between the PCR and RT-PCR using the same explicit primer set for each virus