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A 30-year-old white woman with diabetes was seen with a Pseudomonas corneal ulcer. The ulcer progressed despite appropriate antibiotics, and the patient was treated with surgical debridement. Pseudomonas infections in a compromised host are discussed.
Of the pathogens causing septicaemia due to Gram-negative bacteria at Zentrum der Inneren Medizin, Frankfurt, over a 7-year period (1974-80), 16.8 per cent were due to P. aeruginosa. Analysis of all septicaemias over this period, however, shows a decrease from 13 per cent in the 3-year period 1974-76 to 8 per cent in 1977-79 and 5 per cent P. aeruginosa septicaemia in 1980. The overall mortality rate was 66 per cent, most of the patients dying within 24 hours. Azlocillin and Piperacillin are at present the drugs of choice for systemic therapy of pseudomonas infections, preferably in combination with an aminoglycoside.
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In artificial pseudomonas infections undertaken on white mice the effectiveness of the aminoglycosides (gentamicin, tobramycin, netilmicin, amikacin) was compared. The most effective drugs on highly susceptible Ps. aeruginosa were amikacin and netilmicin. Moreover amikacin is probably capable of inhibiting pseudomonas toxin production. Therefore this preparation should be left in reserve for the treatment of serious pseudomonas processes.
An experimental Pseudomonas aeruginosa lung infection was induced by aerosol exposure in mice which had been pretreated with cyclophosphamide. A single dose of 200 mg/kg cyclophosphamide resulted in leukopenia which lasted for three days. At the lowest PMN levels, the mice were exposed to aerosols containing varying doses of bacteria. The survival time of the mice and the number of viable bacteria in their lungs were determined. A dramatic rise in the viable counts of Pseudomonas organisms was found between 18 and 24 hours after infection. Mice which had not been pretreated with cyclophosphamide remained healthy and did not show any lung lesions. The number and phagocytic function of the alveolar macrophages remained unaltered after cyclophosphamide treatment. Thus, PMNs seem to play an important role in the lung's early defence mechanisms against Pseudomonas aeruginosa. This animal model could be of use in evaluating additional therapies for lung infections caused by Pseudomonas aeruginosa.
A 59-year-old man developed bilateral keratitis several weeks after the initiation of mechanical ventilation because of respiratory failure and sepsis following abdominal surgery. Colonisation of the upper airways by P. aeruginosa had been established before. Invasion through corneal epithelial defects based on dehydration keratitis was the presumed route of infection. Despite aggressive treatment, including antibiotics, the infection was rapidly progressive in both eyes. The patient died of deterioration of his general condition. In order to prevent such eye infections in a patient on mechanical ventilation, there is a need of good eye care, prevention of corneal lesions and alertness, especially when the patient is colonised by virulent micro-organisms like P. aeruginosa.
BACKGROUND: Pulmonary inflammation in bronchiectasis, pneumonia and idiopathic pulmonary fibrosis (IPF) is dominated by neutrophils. Pathophysiologic differences are seen in the degree of airway and tissue destruction. Neutrophil activation and neutrophil proteolytic activity might differ between bronchiectasis, pneumonia and IPF. OBJECTIVE: The aim of this study was to determine whether levels of inflammatory and protective markers in bronchoalveolar lavage (BAL) differed among cases of bronchiectasis, pneumonia and IPF. METHODS: We studied 11 bronchiectasis patients (group 1), 30 pneumonia patients (group 2), 15 IPF patients (group 3) and 12 healthy volunteers (group 4). In the bronchoalveolar lavage fluid, concentrations of alpha(1)-proteinase inhibitor, myeloperoxidase (MPO) and elastase-alpha(1)PI complex were determined using immunoluminometric assays. Elastase inhibition capacity (EIC) and elastase activity were determined using a colorimetric assay. RESULTS: No EIC, but free elastase activity, was found in 82% of group 1, 20% of group 2, 20% of group 3 and 0% of group 4. Median MPO concentration was highest in group 1: 7,951 ng/ml (16th-84th percentile [16-84%]: 256-36,342) vs. 692 ng/ml (106-2,279; group 2), 332 ng/ml (98-1,657; group 3), and 0.12 ng/ml (0.08-0.26; group 4). Bronchiectasis patients with bronchial Pseudomonas infection showed higher amounts of neutrophils (p < 0.01) and higher elastase activity (p < 0.05) than patients with sterile lavage. CONCLUSION: Bronchiectasis patients show a severe imbalance between neutrophil activity and protective molecules leading to possible lung destruction. Chronic Pseudomonas infection might trigger neutrophil activation. Future research and treatment strategies should focus on increased bacterial clearance and inhibition of neutrophil toxicity.
Antisera to extracellular slime glycolipoprotein of Pseudomonas aeruginosa of different O serogroups (immunotypes) show cross reactivity in passive haemagglutination (PHA) and agar gel immunoprecipitation test; cross reactivity is more distinct in PHA. Antisera to glycolipoprotein also have marked cross activity in mouse passive protection test against intraperitoneal challenge with 24 P. aeruginosa strains of different O groups including the toxigenic strain PA-103. On the basis of the results, glycolipoprotein producer P. aeruginosa strains may be selected in order to make a preparation for active and passive immunization against pseudomonas infection.
Some lots of commercial normal human immunoglobulin have been found to contain antibodies neutralizing the action of P. aeruginosa exotoxin. The content of antibodies in human immunoglobulin preparations correlates to a certain degree with their protective activity determined in the passive protection test in white mice. Certain lots of normal human immunoglobulin have been found to possess protective activity, but contain no specific antitoxins. The clinical testing of these immunoglobulin preparations used for treating patients with Pseudomonas infections has yielded promising results.
INTRODUCTION: Ecthyma gangrenosum is a cutaneous manifestation of Pseudomonas infections. This condition may be associated with bacteraemia but can also occur in the absence of bacteraemia. EXEGESIS: The authors report the case of a 66-year-old woman presented with necrotic ulcerations on the face associated with fever, arthralgia, myalgia, fatigue and neutropenia. Blood cultures and skin cultures were positive for Pseudomonas stutzeri. Her condition improved under appropriate antibiotic therapy. However, the patient further developed clinical and biological symptoms of systemic vasculitis and mixed cryoglubulinemia. Complete healing was finally obtained after a course of corticosteroids. CONCLUSION: Ecthyma gangrenosum should be suspected in people who have typical clinical presentation. This disease could sometimes be associated with systemic vasculitis.
Pseudomonas aeruginosa causes a variety of cutaneous infections. Pseudomonas folliculitis has been associated with a number of activities, particularly bathing in contaminated water and the use of contaminated objects while bathing. We present two unique cases in which the subjects noted Pseudomonas folliculitis after recreational use of diving suits.
When Pseudomonas aeruginosa was injected through a catheter into the bladder. Hemorrhage, edema, and vessel engorgement were seen 1 h after challenge. At 3 hours we observed microulceration of the bladder, which rapidly healed and was rarely present after 24 h. Pseudomonas was cultured from 50% of the kidneys at 1 week, and the number of kidneys infected decreased over 4 weeks.
OBJECTIVE: This study was pursued as an extension of a randomized clinical investigation of neonatal screening for cystic fibrosis (CF). The project included assessment of respiratory secretion cultures for pathogens associated with CF. The objective was to determine whether patients diagnosed through neonatal screening and treated in early infancy were more likely to become colonized with Pseudomonas aeruginosa compared with those identified by standard diagnostic methods. METHODOLOGY: The design involved prospective cultures of respiratory secretions obtained generally by oropharyngeal swabs at least every 6 months and more often if clinically indicated. Patients were managed with a standardized evaluation and treatment protocol at the two Wisconsin certified CF centers; however, there were community and environmental variations associated with the follow-up period as described below. RESULTS: Overall, there were no differences in acquisition of respiratory pathogens between the screened and the control (standard diagnosis) groups. Evaluation of the data between and within the two centers, however, revealed significant differences with earlier acquisition of P aeruginosa in the center with the following distinguishing characteristics: urban location; following patients with the standard US approach in which newly diagnosed, young children were interspersed with older CF patients; and where there were more opportunities for social interactions with other CF patients. The differences were confined to the screened group followed in the urban center in which the median pseudomonas-free survival period was 52 weeks contrasted with 289 weeks in the other center. In addition, assessment of data for the entire CF populations followed at the two centers revealed that the urban center showed a significantly higher prevalence of P aeruginosa colonization in patients between the ages of 3 and 9 years. CONCLUSIONS: These results present questions and generate hypotheses on risk factors for acquisition of P aeruginosa in CF and suggest that clinic exposures and/or social interactions may predispose such patients to pseudomonas infections.
Exchange operation is recommended as the treatment of choice for most deep infections involving a total hip replacement. This revision arthroplasty comprises, in one stage, excision of soft tissue, removal of implant and cement, replacement with an appropriate implant using Palacos R acrylic cement loaded with an appropriate antibiotic and, more recently, systemic antibiotics. During our first 10 years without systemic antibiotics we have achieved an overall 77 per cent success rate from a first attempt in 583 patients and a 90 per cent success rate after subsequent exchange procedures. Morbidity is significant but acceptable. Success is defined as control of infection, no loosening, and useful function. The factors associated with failures include, in particular, specific infections (Pseudomonas group, Streptococcus group D, Proteus group, and Escherichia coli), delay in operation and inadequate antibiotic dosage in the cement.
Intravenous inoculation of 3.4 x 10(10) to 7.4 x 10(10)Pseudomonas aeruginosa organisms into rhesus monkeys 4 days after intravenous or intratracheal inoculation of 2.0 to 2.5 mg of vincristine sulfate resulted in fatal sepsis in eight of nine monkeys. After intramuscular administration, in two equal doses, of 5 mg of tobramycin, gentamicin, and colistin per kg per day beginning 16 hr after challenge, 4 of 11, 4 of 11, and 3 of 10 monkeys died, respectively. Administration of daily doses of 100 to 400 mg of carbenicillin per kg was followed by death in 5 of 12. Duration of illness in the surviving monkeys in each therapy group was similar. Under the conditions of this study, prior administration of vincristine sulfate resulted in a decrease in leukocytes and enhanced susceptibility to Pseudomonas infection. Using this model for studies of comparative efficacy of antibiotics, we observed comparable results after treatment with tobramycin, gentamicin, colistin, and carbenicillin.