Epidemiology
Microbiology
- Member of Pseudomonas Genus (see Pseudomonas, [[Pseudomonas]])
- Non-Fermenting Gram-negative Rod
Clinical
Cardiac Manifestations
Endocarditis (see Endocarditis, [[Endocarditis]])
Ear Manifestations
Otitis Externa
Otitis Media
Dermatologic Manifestations
Ecthyma Gangrenosum (see Ecthyma Gangrenosum, [[Ecthyma Gangrenosum]])
- Etiology
- In addition to Pseudomonas aeruginosa, can also be caused less commonly by Staph, Mucor, Candida, and Herpes
- Diagnosis
- Skin Biopsy: quite characteristic, showing bacterial invasion of the media and adventitia of veins deep in the dermis (intima and lumen of the vein are spared)
- Clinical
- Begins as red/purpuric macular rash -> progresses to indurated vesicles -> progresses to bullous, pustular, or hemorrhagic lesions -> gangrenous ulcers with surrounding erythema (may occur within 12-24 hrs)
- Usually less than 10 lesions are present, most often found in the gluteal or perineal regions, but also appearing on the extremities, trunk, and face in descending order, respectively
- Treatment
- Aminoglycoside + Antipseudomonal PCN:
- Ceftazidime:
- Imipenem:
- Surgical Debridement: often required
- Prognosis
- The lower the absolute neutrophil count (ANC), the poorer the prognosis
- Patients with an ANC < 500 cells/mm3 (0.5 x 109/L) rarely survive
Gastroenterologic Manifestations
Diarrhea
Enterocolitis
Neurologic Manifestations
Brain Abscess (see xxxx, [[]])
Meningitis (see xxxx, [[]])
Opthalmologic Manifestations
Bacterial Keratitis
Endophthalmitis
Pulmonary Manifestations
Necrotizing Pneumonia (see Necrotizing Pneumonia, [[Necrotizing Pneumonia]])
Pneumonia (see Pneumonia, [[Pneumonia]])
Ventilator-Associated Pneumonia (see Ventilator-Associated Pneumonia, [[Ventilator-Associated Pneumonia]])
- Epidemiology
- Risk Factors: prior antibiotic use
- Prognosis
- Isolation of Pseudomonas aeruginosa from the lungs of mechanically ventilated patient with VAP indicates a worse prognosis
Renal Manifestations
Urinary Tract Infection (UTI) (see Urinary Tract Infection, [[Urinary Tract Infection]])
Rheumatologic/Orthopedic Manifestations
Osteomyelitis
Other Manifestations
Bacteremia
Treatment
- Aminoglycosides (see Aminoglycosides, [[Aminoglycosides]])
- Anti-Pseudomonal Penicillins
- Fluoroquinolones (see Fluoroquinolones, [[Fluoroquinolones]])
- Cefepime (Maxipime) (see Cefepime, [[Cefepime]])
References
- Lopez FA. Bacterial skin infections. Infect Dis Clin North Am 2001; 15:671-690
- xxx