Ecthyma gangrenosum and ecthyma-like lesions: review article

The generally accepted definition of ecthyma gangrenosum (EG) states that this condition is pathognomonic of Pseudomonas septicemia ( Pseudomonas aeruginosa ) and that it should usually be seen in immunocompromised patients, particularly those with underlying malignant disease. The cases described i...

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Bibliographic Details
Published in:European journal of clinical microbiology & infectious diseases 2015-04, Vol.34 (4), p.633-639
Main Authors: Vaiman, M., Lazarovitch, T., Heller, L., Lotan, G.
Format: Article
Language:English
Subjects:
Bacteria - classification
Bacteria - isolation & purification
Bacterial Infections - epidemiology
Bacterial Infections - microbiology
Bacterial Infections - pathology
Biomedical and Life Sciences
Biomedicine
E coli
Ecthyma - epidemiology
Ecthyma - pathology
Etiology
Fungi
Fungi - classification
Fungi - isolation & purification
Humans
Immunocompetence
Infections
Internal Medicine
Lesions
Medical Microbiology
Mycoses - epidemiology
Mycoses - microbiology
Mycoses - pathology
Review
Sepsis
Skin
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Summary:The generally accepted definition of ecthyma gangrenosum (EG) states that this condition is pathognomonic of Pseudomonas septicemia ( Pseudomonas aeruginosa ) and that it should usually be seen in immunocompromised patients, particularly those with underlying malignant disease. The cases described in the literature present a somewhat different picture. Our objective was to analyze this controversy. The review analyzes 167 cases of EG that were described in the literature from 1975 to 2014. All articles on EG cases with EG-specific tissue defect that had signs of general and/or local infection and skin necrosis were included and analyzed, whatever the etiology detected. Necrotic lesions of the skin diagnosed as EG have various microbiological etiology, can occur in immunocompetent or even healthy persons, and are not necessarily connected with septicemia. In published cases, P. aeruginosa was detected in 123 cases (73.65 %); of them, there were only 72 cases (58.5 %) with sepsis. Other bacterial etiology was detected in 29 cases (17.35 %) and fungi were detected in 15 cases (9 %). While the clinical picture of the disease and the treatment strategy remain the same, there is no need to invent two separate definitions for Pseudomonas and non- Pseudomonas cases. We suggest accepting a broader definition of EG.
ISSN:0934-9723
1435-4373
DOI:10.1007/s10096-014-2277-6