CUTANEOUS PSEUDOMONAS INFECTIONS

BY JOE P JOHN

PSEUDOMONAS

STRICT AEROBE GRAM NEGATIVE ROD

MAJORITY OF HUMAN INFECTIONS -

PSEUDOMONAS AEROGINOSA o p.aeruginosa widely distributed especially in moist environments

PSEUDOMONAS AERUGINOSA INFECTIONS OF INTACT SKIN

p.Aeruginosa Infections of healthy skin uncommon Infections occur when (1) normal cutaneous or mucosal barriers have bypassed or breached E.g.: BURN injury , penetrating trauma , surgery, Endotracheal intubation, UB catheterization, IV drug abuse (2) immunologic defense mechanisms compromised e.g.: chemotherapy induced neutropenia, hypogammaglobulinemia, extremes of age, diabetes mellitus , cystic fibrosis, cancer, HIV disease

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Protective function of normal bacterial flora disrupted by broad spectrum antimicrobial therapy Patient exposed to reservoirs associated with hospital environments It causes following types of cutaneous infections Localized Mild epidermal infections (the green nail syndrome, webbed space infections) Moderately serious infections(cutaneous folliculitis) In immunocompromised patients, extremely serious infections(ecthyma gangrenosum)

Nodules from aeruginosa infections

Developed condition of aeruginosa infections

Pseudomonas does not grow on dry skin, but it flourishes on moist skin Green nail syndrome is a paronychial infection that can develop in individuals whose hands are frequently submerged in water Pseudomonas is an important source of burn wound sepsis. Invasive burn wound sepsis shows bacterial proliferation of 100,000 organisms per gram of tissue, with subjacent involvement of subjacent unburned tissue

PSEUDOMONAL FOLLICULITIS

Folliculitis is a primary inflammation of hair follicle Hot tub folliculitis and wet suit folliculitis Appears 8-48 hrs after exposure to contaminated water or wet suits Occurs as erythematous follicular-based papules and pustules most concentrated in areas occluded by swim wear May be associated with systemic findings such as fever , headache, sore throat , malaise ,or gastrointestinal abscess Self-limiting condition that resolves in 7-14 days

ECTHYMA GANGRENOSUM
Violaceous plaques and necrotic ulcers on the abdomen of a renal transplant patient. Tissue cultures were positive for p.aeruginosa

Most often associated with a p. aeruginosa infections Occurs in critically ill and immunocompromised patients Almost always a sign of pseudomonal sepsis It is a necrotizing soft tissue infection that occurs after local tissue invasion or bacteremic seeding; Associated with blood vessel invasion, septic vasculitis , vascular occlusion and infarction of tissue Characteristic lesions are hemorrhagic pustules Or infracted-appearing areas with surrounding erythema that evolve into necrotic ulcers

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