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4.
Pediatr Dermatol ; 41(3): 501-503, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38151231

RESUMO

Leukocyte adhesion deficiency (LAD), a disorder of neutrophil function, is characterized by a defect in leukocyte adhesion to the endothelium. Recurrent infections in the skin, soft tissue, gingiva, and lungs due to Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella sp. are common in these patients. Ecthyma gangrenosum (EG) is an ulcer of skin and subcutaneous tissue with a black eschar and surrounding erythematous halo secondary to a bacterial infection. Here, we report an unusual presentation of LAD type-1 with extensive EG of perineum secondary to Staphylococcus hominis bacteremia treated successfully with combination of granulocyte transfusion and diversion colostomy.


Assuntos
Bacteriemia , Ectima , Síndrome da Aderência Leucocítica Deficitária , Staphylococcus hominis , Humanos , Bacteriemia/microbiologia , Síndrome da Aderência Leucocítica Deficitária/complicações , Ectima/microbiologia , Ectima/diagnóstico , Staphylococcus hominis/isolamento & purificação , Períneo , Infecções Estafilocócicas/complicações , Masculino , Colostomia , Feminino , Lactente
5.
J Infect Dev Ctries ; 17(11): 1654-1657, 2023 11 30.
Artigo em Inglês | MEDLINE | ID: mdl-38064400

RESUMO

INTRODUCTION: This brief picture-oriented case report focuses on typical skin lesions in a patient who developed Ecthyma gangrenosum and pseudomonal sepsis after extensive immunosuppressive therapy for Pemphigus vulgaris. CASE PRESENTATION: The patient was immunosuppressed with high doses of glucocorticoids and azathioprine; the follow-up after the treatment was not carried out well due to the pandemic conditions and because the patient herself got a Covid infection, which resulted in the development of pseudomonal sepsis and Ecthyma gangrenosum. The outcome was fatal despite extensive broad-spectrum antibiotic therapy, plasmapheresis, and intravenous immunoglobulins. CONCLUSIONS: Infections with Pseudomonas aeruginosa have become a real concern in hospital-acquired infections, especially in critically ill and immunocompromised patients, because of multi-drug resistance in the first place.


Assuntos
Ectima , Infecções por Pseudomonas , Sepse , Humanos , Ectima/diagnóstico , Ectima/tratamento farmacológico , Ectima/etiologia , Estado Terminal , Antibacterianos/uso terapêutico , Sepse/tratamento farmacológico , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa , Hospedeiro Imunocomprometido
7.
Arch Dermatol Res ; 315(9): 2717-2719, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-37432465

RESUMO

Ecthyma gangrenosum is an uncommon cutaneous eruption that can initially present with painless macules, which rapidly evolve into necrotic ulcers. This study sought to characterize clinicopathologic features of ecthyma gangrenosum from a single integrated health system. Our cohort consisted of 82 individuals diagnosed with ecthyma gangrenosum. Lesions were most commonly found in the lower extremities (55%) and the truncal region (20%). A wide variety of fungal and bacterial etiologies were found among our cohort. The majority of patients with EG were immunocompromised (79%) and 38% of patients also experienced sepsis. The mortality rate seen in our cohort was approximately 34%. No statistical differences in mortality outcome due to EG related complications were seen between pathogen etiology, and distribution or location of lesions. Patients who were septic or immunocompromised died more frequently than non-septic or immunocompetent patients, suggesting poorer prognosis.


Assuntos
Prestação Integrada de Cuidados de Saúde , Ectima , Infecções por Pseudomonas , Sepse , Humanos , Ectima/etiologia , Ectima/microbiologia , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/patologia , Hospedeiro Imunocomprometido , Pseudomonas aeruginosa
8.
Am J Case Rep ; 24: e939905, 2023 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-37518986

RESUMO

BACKGROUND Ecthyma gangrenosum is a rare skin lesion associated with Pseudomonas aeruginosa, an aerobic gram-negative opportunistic bacterial pathogen. In non-bacteremia patients, sepsis is not a common complication. Immunocompromised patients are more commonly affected. If diagnosis and therapy are delayed, the mortality rate is 18-96%. This report is of a 52-year-old man with diabetes mellitus and myelofibrosis presenting with hemorrhagic vesiculobullous lesions of ecthyma gangrenosum on the upper and lower extremities, oral mucosa, and anogenital area with, interestingly, no associated Pseudomonas aeruginosa bacteremia. CASE REPORT A 52-year-old diabetes patient with myelofibrosis presented with hemorrhagic vesiculobullous and necrotic eschar-covered erosions over the upper and lower extremities, oral mucosa, and anogenital area. Although he appeared septic looking initially, with signs of end-stage organ failure, and he was later determined to have septic shock, the clinical diagnosis was not possible without a positive culture swab of the cutaneous lesions showing growth of Pseudomonas aeruginosa. The diagnosis of cutaneous ecthyma gangrenosum-induced septic shock was confirmed, though bacteremia was not detected. This patient was successfully managed with the early initiation of proper antibiotics. CONCLUSIONS Early detection and vigilance when confronted with the clinical presentation of ecthyma gangrenosum are a vital part of patient management to reduce the high mortality risk of the disease. Although bacteremia is associated with a high risk for fatalities, cutaneous ecthyma gangrenosum can be complicated by septic shock and serious adverse events. The involvement of multidisciplinary teams in patient management is an essential aspect of ecthyma gangrenosum disease management.


Assuntos
Bacteriemia , Diabetes Mellitus , Ectima , Mielofibrose Primária , Infecções por Pseudomonas , Choque Séptico , Masculino , Humanos , Pessoa de Meia-Idade , Ectima/diagnóstico , Ectima/microbiologia , Pseudomonas aeruginosa , Choque Séptico/complicações , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico , Bacteriemia/complicações , Bacteriemia/diagnóstico
10.
Rev Fac Cien Med Univ Nac Cordoba ; 80(2): 158-159, 2023 06 30.
Artigo em Espanhol | MEDLINE | ID: mdl-37402301

RESUMO

A 51-year-old male with profound and prolonged neutropenia 12 days after receiving chemotherapy for an acute myeloid leukemia developed a nodular, erythematous lesion with a necrotic center on the base of the neck, associated with fever, chills, and myalgia. An invasive fungal infection was diagnosed after growth of Candia tropicalis in blood cultures. He evolved with multiple reddish papular lesions concentrated mainly on the trunk, although they also spread to the extremities. The most common skin lesions of disseminated candidiasis are erythematous-violaceous papules with vesicular centers, which, in some cases, can progress to necrosis. Other forms of cutaneous presentation of invasive candidiasis are ecthyma gangrenosum-like lesions, hemorrhagic plaques or bullae, rash resembling folliculitis, and subcutaneous nodules.


Un varón de 51 años que se encontraba con neutropenia profunda y prolongada luego de 12 días del inicio de su quimioterapia por una leucemia mieloide aguda desarrolló una lesión nodular, eritematosa y con centro necrótico en la base del cuello, asociada a fiebre, escalofríos y mialgias. Se diagnosticó infección fúngica invasiva luego del desarrollo de Candia tropicalis en los hemocultivos. Evolucionó con múltiples lesiones papulares rojizas concentradas principalmente en el tronco, aunque también extendidas a las extremidades. Las lesiones cutáneas más frecuentes de la candidiasis diseminada son pápulas eritematosas-violáceas con centros vesiculares, que, en algunos casos, pueden evolucionar a necrosis. Otras formas de presentación cutánea de la candidiasis invasiva son lesiones similares a ectima gangrenoso, placas o bullas hemorrágicas, erupción que resembla foliculitis, y nódulos subcutáneos.


Assuntos
Candidíase Invasiva , Ectima , Leucemia Mieloide Aguda , Masculino , Humanos , Pessoa de Meia-Idade , Pele/patologia , Candidíase Invasiva/complicações , Candidíase Invasiva/patologia , Ectima/complicações , Ectima/patologia , Leucemia Mieloide Aguda/complicações , Leucemia Mieloide Aguda/tratamento farmacológico
14.
BMC Infect Dis ; 22(1): 797, 2022 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-36274136

RESUMO

BACKGROUND: Exophiala dermatitidis is a dematiaceous fungus isolated from various environmental sources. Systemic E. dermatitidis infections can lead to fatal outcomes, and treatment has not yet been standardized. Although E. dermatitidis is also known to cause cutaneous infection, it has not been previously reported to appear as ecthyma gangrenosum (EG), an uncommon cutaneous lesion in neutropenic patients that is mainly caused by Pseudomonas aeruginosa. CASE PRESENTATION: A 2-month-old male infant with mixed-phenotype acute leukemia presented with prolonged fever unresponsive to antibacterial and antifungal agents during myelosuppression due to remission induction therapy. He also presented with skin lesions on the left wrist and left lower quadrant of the abdomen. The abdominal lesion gradually turned black and necrotic, which was consistent with the findings of the EG. E. dermatitidis was isolated from the blood, stool, wrist skin, and endotracheal aspirate. During hematopoietic recovery, consolidation in both lungs was evident. Multiagent antifungal treatment failed to eliminate E. dermatitidis from blood. In order to salvage the central venous catheter, ethanol lock therapy (ELT) was adopted, following which the blood culture became negative. The abdominal lesion that evolved as a necrotic mass connecting the small intestine and subcutaneous tissue adjacent to the skin was surgically resected. After these interventions, the general condition improved. CONCLUSION: Disseminated E. dermatitidis mycosis in the neutropenic infant was successfully managed with a multidisciplinary treatment consisting of multiagent antifungal treatment, ELT, and surgery.


Assuntos
Ectima , Leucemia , Micoses , Masculino , Humanos , Antifúngicos/uso terapêutico , Micoses/tratamento farmacológico , Ectima/tratamento farmacológico , Leucemia/tratamento farmacológico , Doença Aguda , Antibacterianos , Etanol , Fenótipo
16.
J Int Med Res ; 50(9): 3000605221126882, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36168733

RESUMO

Ecthyma gangrenosum (EG) is a potentially lethal skin infection mainly caused by Pseudomonas aeruginosa, but other causative pathogens have also been reported. EG usually occurs locally and often arises in immunocompromised patients. The fatality rate can be extremely high if a systemic infection leading to sepsis occurs. EG and severe sepsis caused by Staphylococcus aureus infection are extremely rare in healthy children. However, upon occurrence, disease progression can be rapid, and the mortality rate is high. This current case report describes a previously healthy child with no underlying diseases who developed EG in the facial and perianal regions following S. aureus infection. The infection rapidly progressed to sepsis, septic shock, and persistent severe neutropenia. The patient also developed drug-resistant bacterial infections that spread rapidly and resulted in multiorgan failure. The patient was treated with antibiotics, but she died of organ failure despite extracorporeal membrane oxygenation support. EG caused by S. aureus has the potential to progress rapidly, leading to septic shock and severe neutropenia. Patients should be identified at an early stage and promptly treated with antibiotics. However, the improvement of neutropenia and prevention of secondary infections remain the focus of our research.


Assuntos
Ectima , Neutropenia , Infecções por Pseudomonas , Sepse , Choque Séptico , Infecções Estafilocócicas , Antibacterianos/uso terapêutico , Criança , Ectima/etiologia , Ectima/microbiologia , Feminino , Humanos , Neutropenia/complicações , Infecções por Pseudomonas/complicações , Infecções por Pseudomonas/diagnóstico , Infecções por Pseudomonas/tratamento farmacológico , Pseudomonas aeruginosa , Sepse/complicações , Sepse/tratamento farmacológico , Choque Séptico/complicações , Choque Séptico/tratamento farmacológico , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus
17.
Medicine (Baltimore) ; 101(33): e30070, 2022 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-35984202

RESUMO

RATIONALE: Ecthyma gangrenosum (EG) is a potentially life-threatening, systemic infection generally caused by Pseudomonas aeruginosa. Data on EG caused by Staphylococcus aureus in patients with hematological malignancies are scarce. The present case report aimed to describe the clinical features of EG caused by S. aureus in patients with hematological malignancies and to provide a comprehensive review of previous studies on the topic. PATIENT CONCERNS: The first patient was a 61-year-old man with acute myeloid leukemia who presented fever and multiple lesions during chemotherapy. The second patient was a 47-year-old man with myelodysplastic syndrome who developed progressive erythematous necrotic plaques on his extremities and face. DIAGNOSIS: Both cases were diagnosed as EG caused by S. aureus. While the first patient had concurrent methicillin-resistant S. aureus (MRSA) bacteremia, the second patient had positive results only for tissue culture of the skin lesion isolated methicillin-sensitive S. aureus. INTERVENTIONS: Vancomycin was initiated with critical care to the first patient. Cefazolin was administered to the second patient for 3 weeks, followed by cephalexin for 1 week. OUTCOMES: The first patient died of a brain hemorrhage and multiple organ failure. The second patient was cured without relapse. LESSONS: Of 18 patients in the previous and current studies with EG caused by S. aureus, 6 (33%) had an underlying hematological malignancy, and 10 (56%) had EG caused by MRSA. While 28% of the patients had positive blood cultures, all tissue cultures were positive. All 3 fatalities had concurrent bacteremia (MRSA caused two). EG caused by MRSA with concurrent bacteremia can be fatal, especially in patients with hematological malignancies. Although S. aureus-associated EG in patients with hematological malignancies is relatively uncommon, tissue cultures with an initial gram stain smear are essential for selecting appropriate empirical antimicrobials, including the coverage of S. aureus.


Assuntos
Bacteriemia , Ectima , Neoplasias Hematológicas , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Ectima/tratamento farmacológico , Ectima/microbiologia , Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/complicações , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/patologia , Staphylococcus aureus
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