[Ecthyma vulgare, ecthyma gangrenosum, chancriform pyoderma].
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Diagnosis, Differential↗
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[Gangrenous ecthyma of the buttocks in the newborn infant (ecthyma vacciniforme syphiloide)].
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Animals↗
Perineal ecthyma gangrenosum in infancy and early childhood: septicemic and nonsepticemic forms.
BACKGROUND: Ecthyma gangrenosum is characterized by necrotic ulcerations surrounded by an erythematous halo. It is secondary to Pseudomonas aeruginosa infection. Most lesions are located in the anogenital and axillary areas, but the route of infection is generally difficult to establish. OBJECTIVE: We report six children with perineal ecthyma gangrenosum and discuss predisposing factors, origin, and route of infection. METHODS: This was a retrospective clinical study. RESULTS: Three children had blood cultures positive for P. aeruginosa, and one died. Predisposing factors were present in all cases; two had received chemotherapy (neuroblastoma, acute lymphoblastic leukemia), and two had idiopathic granulocytopenia. The last two patients previously had received treatment with systemic antibiotics and had abnormal granulocyte killing several months later. CONCLUSION: Septicemic ecthyma gangrenosum can be rapidly fatal in young children and requires aggressive antibiotic therapy. Benign ecthyma gangrenosum in healthy infants may result from a modification of bowel microflora after antibiotic therapy in conjunction with maceration in the diaper area. However, careful evaluation and long-term follow-up must be done to detect neutropenia, functional abnormalities of granulocytes, or a possible immune deficiency.
Child, Preschool↗
Ecthyma gangrenosum: report of clinical, histopathologic, and bacteriologic aspects of eight cases.
The records of eight patients with ecthyma gangrenosum who were treated at the Mayo Clinic between 1970 and 1982 were reviewed. All patients had hematologic disease and had received immunosuppressive drugs. Patients with neutropenia that did not resolve by the end of a course of appropriate antibiotic treatment usually died. Solitary lesions of ecthyma gangrenosum were associated with a better prognosis than were multiple lesions. The typical skin findings of ecthyma gangrenosum usually occurred early and were often incorrectly diagnosed, resulting in time lost during which antibiotic therapy could have been instituted. For patients with ecthyma gangrenosum, a systematic procedure is important to establish the diagnosis early, so that appropriate systemic antibiotic therapy can be initiated.
Adult↗
Ecthyma gangrenosum without bacteraemia in a leukaemic patient.
Ecthyma gangrenosum is a well recognized cutaneous manifestation of Pseudomonas aeruginosa infections in immunocompromised patients. Most cases of ecthyma gangrenosum have been associated with concomitant septicaemia. However, ecthyma gangrenosum rarely develops due to Ps. aeruginosa in the absence of bacteraemia. We report a rare case of a nonsepticaemic form of ecthyma gangrenosum presenting as a large solitary necrotic ulcer in a patient with acute myelogenous leukaemia. A culture from the lesion revealed the presence of Ps. aeruginosa, but the results of repeated blood cultures were negative. Histological examination revealed numerous tiny eosinophilic bacilli in the dermis and panniculus with Gram's stain.
Acute Disease↗
Ecthyma gangrenosum: considerations in a previously healthy child.
Ecthymagangrenosum is a skin lesion that is most commonly caused by. Although ecthyma gangrenosum usually develops in patients with underlying immunodeficiencies or chronic diseases, there have been reports of its appearance in previously healthy children. A review of such patients in the English literature showed that most of them had either previously undetected immunodeficiencies or transient risk factors that predisposed them to the development of ecthyma gangrenosum. We report a patient without apparent antecedent predisposing risk factors for ecthyma gangrenosum who developed chronic neutropenia 1 week after presentation. It is important for the primary care provider to recognize ecthyma gangrenosum, treat it with appropriate antimicrobial agents and investigate the patient for occult immunodeficiencies.
Administration, Oral↗
Ecthyma gangrenosum without bacteremia. Report of six cases and review of the literature.
We encountered six patients with ecthyma gangrenosum due to Pseudomonas aeruginosa who, uncharacteristically, had no evidence of bacteremia prior to the institution of antibiotic therapy. Seven similar cases have previously been reported in the English-language medical literature. These 13 patients resembled those with classic ecthyma gangrenosum accompanied by Pseudomonas septicemia in being immunocompromised and neutropenic and having skin lesions at similar sites. The most striking difference between these two groups of patients was a significantly lower mortality rate for the nonbacteremic patients. These findings suggest that ecthyma gangrenosum can occur as a primary skin lesion in the absence of bacteremia. Patients with this particular subtype of infection appear to have a better prognosis than those having a preceding bacteremia.
Aged↗
Ecthyma gangrenosum in a patient with hypogammaglobulinemia.
Ecthyma gangrenosum is a characteristic skin lesion that is caused by Pseudomonas aeruginosa (P. aeruginosa) in the majority of cases. Systemic P. aeruginosa usually complicates debilitating conditions like leukaemia, burns and cystic fibrosis. We report a patient with underlying hypogammaglobulinemia who developed ecthyma gangrenosum secondary to P. aeruginosa septicaemia, which was potentially life-threatening. Recognition of the characteristic skin lesions with prompt initiation of appropriate antibiotics and intravenous immunoglobulins were life-saving. A review of the English literature reports three other cases of ecthyma gangrenosum in patients with underlying hypogammaglobulinemia.
Agammaglobulinemia↗
[Ecthyma gangrenosum caused by Pseudomonas aeruginosa without septicemia in a neutropenic patient].
INTRODUCTION: Ecthyma gangrenosum is a rare skin infection caused by gram negative bacteria. It involves immunocompromised patients, especially neutropenic patients, and can be easily diagnosed. EXEGESIS: We report a case of ecthyma gangrenosum without septicemia due to Pseudomonas aeruginosa in a myelodysplastic patient with severe neutropenia. Granulocyte growth factors adjunction was necessary in combination to antibiotics to obtain complete healing. CONCLUSION: In neutropenic patient, ecthyma gangrenosum due to Pseudomonas aeruginosa should be rapidly diagnosed to avoid septicemic complications. In the case of antibiotic treatment failure, granulocyte growth factors may be added. Frequent Pseudomonas aeruginosa infections justify bacteriologic survey to look for hospital contamination.
Aged↗
Ecthyma gangrenosum-like eruption associated with Morganella morganii infection.
Ecthyma gangrenosum is considered as a pathognomonic sign of Pseudomonas aeruginosa sepsis. Lesions similar to ecthyma gangrenosum may be caused by other organisms. We report a case of an ecthyma gangrenosum-like eruption caused by Morganella morganii, a Gram-negative bacillus.
Aged↗
Spontaneous bacterial peritonitis with ecthyma gangrenosum due to Escherichia coli.
Ecthyma gangrenosum caused by Escherichia coli (E. coli) occurred in a decompensated alcoholic cirrhotic patient with spontaneous bacterial peritonitis due to the same organism. Ecthyma is usually associated with systemic sepsis from Pseudomonas aeruginosa. Isolated instances due to other bacteria have been reported, but its occurrence in spontaneous bacterial peritonitis, of which the predominant causative organism is E. coli, is unique. The frequency, varied etiology, and pathogenesis of ecthyma are briefly reviewed.
Alcoholism↗
Experimental contagious ecthyma in mule deer, white-tailed deer, pronghorn and wapiti.
Hand-reared mule deer fawns (Odocoileus hemionus), white-tailed deer fawns (Odocoileus virginianus), pronghorn fawns (Antilocapra americana) and wapiti calves (Cervus elaphus nelsoni) were exposed to contagious ecthyma lesion material obtained from Rocky Mountain bighorn sheep (Ovis canadensis canadensis) to determine the susceptibility and pathogenesis in these species. All four species developed mucocutaneous proliferative lesions of the oral cavity, grossly and histologically compatible with contagious ecthyma. The limited clinical responses to the virus indicated that contagious ecthyma would not seriously impact free-ranging individuals.
Animals↗
Contagious ecthyma in Alaskan musk-oxen and Dall sheep.
In 1976 and 1977, a disease resembling contagious ecthyma was seen in captive musk-oxen (Ovibos moschatus) in Alaska. A similar disease occurred in 1977 in captive Dall sheep (Ovis dalli). Paravaccinia viruses were detected by electron microscopy and isolated in cell cultures from both species. Experimental inoculation in susceptible and immune domestic sheep (Ovis aries) plus fluorescent antibody tests with ecthyma-immune conjugate indicated that the isolate was contagious ecthyma virus.
Alaska↗
Ecthyma gangrenosum: survival with individualized antibiotic therapy.
Five burn patients with ecthyma gangrenosum were treated with gentamicin sulfate in an individualized aminoglycoside regimen. Dosages greater than the currently recommended 3 to 5 mg/kg/day were necessary and ranged from 15 to 30 mg/kg/day. These increased dosages cannot be used routinely but only as serum level data indicate the need. Four of the five patients survived their course of ecthyma gangrenosum. The single fatality received a much smaller dosage of gentamicin as compared with the other four patients. No ototoxic or nephrotoxic reactions were noted in any of the patients.
Adolescent↗
Serologic and cross-immunity studies with contagious ecthyma and goat pox virus isolates from the western United States.
Contagious ecthyma and goat pox viruses were isolated from goats affected with papulopustular epidermal lesions. Results of in vitro serum neutralization and in vivo cross-immunity studies indicate that these contagious ecthyma and goat pox isolates from the western United States are antigenically dissimilar and that exposure or vaccination with one isolate could not be used as a method of inducing immunity to the other. Exposure to each isolate conferred immunity to re-exposure with the same agent. The serum neutralization test indicates that the severity and persistance of lesions to goat pox infection influences the nature of the antibody response to an initial exposure.
Animals↗
Perineal reconstruction for severe sequela of ecthyma gangrenosum: report of a case.
Ecthyma gangrenosum is a cutaneous gangrenous disorder which usually follows Pseudomona aeruginosa infection and is found mainly in immunosuppressed children. We describe a case of a five-year-old female with leukemia with a severe perineal ecthyma gangrenosum resulting in a cloaca-like deformity. One year later a perineoplasty with puborectalis interposition and overlapping external anal sphincteroplasty was successfully performed, achieving satisfactory continence.
Child, Preschool↗
Ecthyma gangrenosum in a kidney transplant recipient with Pseudomonas septicemia.
This report describes a renal transplant recipient in whom Pseudomonas septicemia and ecthyma gangrenosum developed within days of renal transplantation. Microscopic skin sections showed perivascular bacillary invasion. Pseudomonas organisms were cultured and microscopically visualized in sections from the transplanted kidney. Although cultures from the donor kidney preservation perfusate fluid showed no growth, Pseudomonas aeruginosa was found in the recipient's urine, blood, and peritoneal fluid. The recipient's course was complicated by septic shock, cardiopulmonary arrest, coma, and extensive skin lesions; but his condition improved with appropriate antibiotic therapy, wound debridement, and an aggressive rehabilitative program. He is now a candidate for retransplantation. This is the first known case of ecthyma gangrenosum in a renal transplant recipient.
Adult↗
In vivo and in vitro characteristics of contagious ecthyma virus isolates: host response mechanism.
Three Vero cell culture-adapted contagious ecthyma virus (CEV) isolates were compared by plaque morphology, ability to induce vesicles in skin and in vivo growth curve characteristics by sampling sequentially experimental skin lesions produced in four sheep and one goat. Two of the isolates (CEV-29A and CEV-378) were from outbreaks of ecthyma in sheep and one (CEV-102) from a human case of orf. When replicating in Vero cells, the viruses exhibited similar growth parameters, but were distinguishable from each other on the basis of plaque morphology. In vivo latent periods for these isolates were 48 h (CEV-29A), 96 h (CEV-102), and 120 h (CEV-378). When isolates CEV-102 and CEV-29A were passaged into another sheep, they produced similar patterns of growth. Isolate CEV-102 produced the highest infectivity titer [1.4 X 10(9) plaque forming units (PFU) g-1], followed by CEV-29A (6.8 X 10(7) PFU g-1) and CEV-378 (2.5 X 10(7) PFU g-1). In addition, these viruses varied in their ability to induce vesicle formation. Virus was no longer detectable at the inoculation sites at 288 h post-infection (PI). We conclude that plaque morphology, ability to induce vesicle formation in the skin and growth curves in the skin can be considered as important criteria to differentiate CEV isolates. A comparison of the growth curves of CEV-378 in the skin of sheep and goats suggested differences in virus-host interaction between the two animal species. Since intravenous injection of 1 X 10(9) PFU of CEV failed to produce lesions in the sham-scarified skin of sheep, virus spread via the hematogenous route from one site to another appears unlikely. No virus-neutralizing antibody or interferons were found in serum samples or in skin homogenates collected between 0 and 24 days PI. Virus-neutralizing antibody was present in the circulation as late as 24 days PI. Lymphocytes collected from CEV-exposed sheep as early as 12 days PI responded specifically to stimulation with CEV antigen. As this was about the time when infectious virus disappeared from the sites, we assume that cell-associated immune mechanisms may play a larger role in virus clearance from skin lesions than virus-neutralizing antibody.
Animals↗