|
|
|
Excerpt from Ecthyma GangrenosumSynonyms, Key Words, and Related Terms: EG Pseudomonas aeruginosa, P aeruginosa, gram-negative infection, gram-negative bacteremia, immunosuppression, pseudomonal infection Please click here to view the full topic text: Ecthyma GangrenosumBackgroundEcthyma gangrenosum (EG) is a well-recognized but uncommon cutaneous infection most often associated with a Pseudomonas aeruginosa bacteremia. EG usually occurs in patients who are critically ill and immunocompromised and is almost always a sign of pseudomonal sepsis. The characteristic lesions of EG are hemorrhagic pustules or infracted-appearing areas with surrounding erythema that evolve into necrotic ulcers surrounded by erythema. These were first described in association with Pseudomonas septicemia by Barker in 1897 and were later given the name "ecthyma gangrenosum" by Hitschmann and Kreibich.
Additionally, related eMedicine articles include the following: PathophysiologyImpaired humoral or cellular immunity leads to increased susceptibility to infections with P aeruginosa or other pathogens. In addition, breakdown of mechanical defensive barriers, such as the skin and mucosa, may allow infectious organisms to disseminate. The lesions of EG result from perivascular bacterial invasion of arteries and veins in the dermis and subcutaneous tissues, producing a necrotizing vasculitis. Perivascular involvement can occur by hematogenous seeding of the skin in bacteremic patients or by direct inoculation through the skin in nonbacteremic patients. Extravasation, edema, and necrosis around the vessel interrupt the blood supply to these tissues, resulting in secondary ischemic necrosis of the epidermis and dermis, which manifests as nodular lesions that rapidly evolve through stages of central hemorrhage, ulceration, and necrosis. FrequencyUnited StatesEG develops in 1.3-13% patients with P aeruginosa sepsis and, to a lesser extent, in patients who are not bacteremic. Mortality/MorbidityA high mortality rate is reported with delayed diagnosis and therapy. Mortality rates of Pseudomonas sepsis in immunocompromised persons range from 18-96%, whereas the mortality rate of EG in nonbacteremic patients is 15.4%. Coexisting conditions in patients prone to Pseudomonas sepsis may contribute to the morbidity and mortality rates. SexNo sexual predilection is evident in the overall prevalence of EG; however, a slight predominance of bacteremic EG in males (male-to-female ratio, 1.3-5:1) and nonbacteremic EG in females (female-to-male ratio, 2.3:1) has been observed. AgeEG may affect patients of any age, although it is commonly reported in infants and elderly patients due to underdeveloped and/or compromised immune systems. Please click here to view the full topic text: Ecthyma Gangrenosum |
 |
| About Us | Privacy | Code of Ethics | Terms of Use | Contact Us | Advertising | Institutional Subscribers |
|
|||
|
| Medicine is a constantly changing science and not all therapies are clearly established. New research changes drug and treatment therapies daily. The authors, editors, and publisher of this journal have used their best efforts to provide information that is up-to-date and accurate and is generally accepted within medical standards at the time of publication. However, as medical science is constantly changing and human error is always possible, the authors, editors, and publisher or any other party involved with the publication of this article do not warrant the information in this article is accurate or complete, nor are they responsible for omissions or errors in the article or for the results of using this information. The reader should confirm the information in this article from other sources prior to use. In particular, all drug doses, indications, and contraindications should be confirmed in the package insert. FULL DISCLAIMER |
