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Restriction enzyme analysis with KpnI revealed heterogeneity among 10 different strains of contagious ecthyma virus from sheep, musk ox, Dall sheep and humans. Hybridization of electroblots indicated deletion of DNA segments and changes in nucleotide sequences.
Cutaneous nodules are recognized as a manifestation of disseminated candidiasis. We describe skin lesions clinically identical to ecthyma gangrenosum that, on microscopic examination, were due to Candida emboli rather than Pseudomonas sepsis. Thus, the appearance of necrotic pustules and ulcerative plaques in the immunocompromised patient would raise the possibility of Candida as well as Pseudomonas sepsis, and illustrates the diagnostic importance of skin biopsy in such cases.
We present a case of ecthyma gangrenosum involving the penis in an IV drug abuser probably resulting from direct arterial septic embolization from a femoral injection site. An increased awareness of this condition is essential because misdiagnosis has been reported in up to 100 percent of cases. Prompt diagnosis is essential to begin appropriate therapy.
Lambs which received colostrum from ewes vaccinated with contagious ecthyma (CE) virus and other lambs vaccinated with CE virus were compared for serum anti-CE immunoglobulin (Ig)G levels, delayed-type hypersensitivity (DTH) responses to CE viral antigen, and protective immunity to challenge with CE virus. Ewes vaccinated 3-4 weeks prior to parturition transferred CE antibody to lambs via colostrum. Although these lambs had higher levels of antibody at challenge than lambs vaccinated when 1-4 days old, only the vaccinated lambs were protected against challenge with CE virus at 1 month of age. Furthermore, the presence of colostrum-derived maternal antibody prevented an active antibody response in lambs to vaccination and/or challenge with CE virus, except where pre-inoculation titres were low. In contrast, the DTH response to CE viral antigen and induction of protective immunity by CE vaccination were not impaired by passively-acquired antibody. Actively immunised lambs could be distinguished from those only receiving passively-acquired antibody by the DTH response to heat-killed CE viral antigen.
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.
A new polymerase chain reaction (PCR) assay for rapid diagnosis of contagious ecthyma was designed and applied to 21 clinical samples from Greece. This assay, which detects a highly conserved gene from the parapox genome, was evaluated for its sensitivity and specificity in order to be considered as a useful diagnostic tool. A comparative study with two published PCR protocols one using primers PPP1-PPP3, PPP1-PPP4 which targets putative virion envelope gene B2L and the other using VIR1-VIR2 primers which amplifies ORF virus interferon resistant (VIR) gene, as well as cell culture virus neutralization assay was carried out. All samples tested were amplified successfully with the PCR protocol established in the laboratory. The combination of primers PPP1-PPP3 and PPP1-PPP4 in a semi-nested PCR gave a positive result in 20 of 21 samples while primers VIR1-VIR2 failed to amplify successfully 7 of 21 samples. The diagnostic value of parapox viral DNA amplification was also compared with the results of virus isolation by cell culture and was positive in three samples that the virus isolation was obtained.
Ecthyma is a deep ulcerative pyoderma usually caused by group A beta-hemolytic streptococcus (Streptococcus pyogenes). It usually presents in areas of damaged skin and in immunocompromised patients, and very infrequently is accompanied by general symptoms and bacteremia. We describe the case of a 41-year-old female patient with HIV infection who presented with fever and ulcerated lesions on the right ankle and left foot which had been developing for three weeks. Streptococcus pyogenes and Escherichia coli were simultaneously isolated from a culture of the skin biopsy sample and from blood cultures. Escherichia coli is of dubious pathogenic significance in this case.
Growth of Aspergillus niger on a burn wound clinically simulated the early (hemorrhagic) phase of an invasive infection by Pseudomonas aeruginosa or ecthyma gangrenosa. Wound biopsy for histologic examination and culture readily yielded a definitive diagnosis of noninvasive mycotic infection of the burn wound. Pigmentation surrounding mycotic hyphae (otherwise typical for Aspergillus spp.) strongly suggested Aspergillus niger. Cultural data confirmed the diagnosis.
Noma neonatorum was suggested as a distinct entity characterized by a gangrenous process of the nose, oral cavity, eyelids and perineum that was almost universally fatal in premature infants with Pseudomonas sepsis. We report the first case of noma neonatorum in a 26-week-gestation twin born in the United States. Our case is consistent with previous descriptions of noma neonatorum; however, we question the distinction between noma neonatorum and a neonatal presentation of ecthyma gangrenosum.
We have reported the case of an immunocompromised patient with a K pneumoniae bacteremia admitted with endophthalmitis. The source of the infection was an asymptomatic left renal calculus associated with a perinephric abscess. Persistent bacteremia resulted in the development of ecthyma gangrenosum, which has not previously been associated with Klebsiella spp infection.
Pseudomonas aeruginosa septicemia is rare in healthy infants and children. Also not common, dermatologic manifestations such as ecthyma gangrenosum and indurated erythematous nodular lesions may be the first signs of pseudomonas infection, or may appear later in the course of the disease. Peripheral facial paralysis and mastoiditis are also rare and serious complications of acute otitis media caused by P. aeruginosa. We report a previously healthy 6-month-old boy who had an uncommon presentation and rare complications during the course of P. aeruginosa sepsis.
Two males with presumed X-linked agammaglobulinemia (X-LA) presented with ecthyma gangrenosum. This is an unusual presentation of this syndrome. Possible causes are discussed.
OBJECTIVE: To investigate control options for contagious ecthyma (scabby mouth) in Australian sheep exported live to the Middle East. DESIGN: Prevalence, vaccination and modelling studies. PROCEDURE: One hundred and forty weaner sheep (less than 1 year old) on each of 106 farms in Western Australia (WA) and 18 farm groups of adult wethers received at a WA commercial feedlot were examined for lesions of scabby mouth. Sheep on a total of 26 farms in 3 States were divided into treatment and control groups for the vaccination study. A simple deterministic compartmental model was developed to establish which parameters had the greater effect on disease prevalence. RESULTS: The proportion of farms with evidence of scabby mouth in weaner sheep was 23.6% and, on those farms with the disease, the overall prevalence was 6.1%. At the feedlot, 4 out of 18 farm groups had 5 or more sheep with lesions on arrival. The overall prevalence in the 4 diseased groups was 5.2%. Sheep vaccinated on farm before trucking to the feedlot had a lower prevalence of scabby mouth at the end of simulated shipping than controls. The main determinant of scabby mouth prevalence was the proportion of sheep immune to the disease. CONCLUSION: A program of vaccination for scabby mouth will reduce the prevalence of disease during live export. However, using current technology it is not possible to deliver shipments of sheep to the Middle East that are guaranteed completely free of scabby mouth.
A 48-year-old patient under immunosuppressive therapy for renal transplantation had contagious ecthyma which relapsed after excision. Stable healing was obtained by cryotherapy.
We report on three HIV-infected homosexual male patients with atypical manifestations of mollusca contagiosa (MC). Their clinical presentation mimicked sebaceous nevus of Jadassohn, ecthyma and giant condylomata acuminata. HIV-infected patients feature MC with atypical morphology in about two thirds of the cases. The atypical aspects of MC concern the localization, morphology, growth pattern and size of the lesions. MC is a late manifestation of HIV infection and mirrors marked cellular immune deficiency. We conclude that in HIV-infected patients all tumorous lesions should be biopsied because the clinical characteristics are often not specific enough for a definite diagnosis.
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.
A severe outbreak of contagious ecthyma (orf) is described in sheep in Saudi Arabia. In some of the affected sheep, the condition was highly aggravated by myiasis which appeared to have been favoured by the abundance of flies during the hot season. The outbreak is discussed in relation to the epidemiology of the disease in Saudi Arabia.
A 6-month-old boy with methylmalonic acidemia died of ecthyma gangrenosum caused by systemic Pseudomonas aeruginosa infection. Subtle malnutrition accompanied by the occasional protein restriction treatment may have underlain the development of serious infection in this case.