Ecthyma Gangrenosum - Symptoms & Treatment

Ecthyma gangrenosum (EG) is a well-recognized cutaneous infection most commonly associated with a Pseudomonas aeruginosa bacteremia. It usually occurs in people with reduced immune function (immunocompromised). Ecthyma gangrenosum is characterized by single or multiple, cutaneous or mucous membrane ulcers that are most often associated with prolonged neutropenia, Pseudomonas aeruginosa bacteremia , and other serious bacterial infections. Mortality rates of patients affected by ecthyma gangrenosum depends on the severity of the underlying sepsis, with mortality ranging from 38% to 96%. Patients are likely to have an underlying condition, such as cancer, immunodeficiency syndrome, extensive burns, and malnutrition. It typically involves the extremities, gluteal and perineal regions. The predisposing factor that can lead to ecthyma gangrenosum is the presence of any kind of immunodeficiency associated with severe neutropenia. An ecthyma may begin with a pus-filled blister, similar to that seen in impetigo. However, the infection goes through the outer layer of skin and into the deeper layer.

Children with Ecthyma gangrenosum may develop diarrhea before the onset of cutaneous lesions. This disease is a life-threatening septicaemic infection and has a high mortality. The infection may start at the site of an injury, such as a scratch or insect bite, and is often found on the legs. The underlying pathogenic mechanism of ecthyma gangrenosum is thought to be a vasculitis caused directly by enzymes and toxins elaborated by the bacteria present. Untreated ecthymatous lesions can enlarge over the course of weeks or months to a diameter of 2 to 3 cm. While a few case reports describe the development of EG in previously healthy children, most of these patients had previously unrecognized risk factors for the development of EG, including intra-abdominal or appendiceal abscesses, recent viral illness, or antibiotic treatment for underlying medical conditions such as hypogammaglobulinemia and neutropenia. Treatment should include prompt recognition of the skin lesion, appropriate antibiotic therapy for Pseudomonas aeruginosa, and surgical debridement.

Causes of Ecthyma gangrenosum

The common causes and risk factor's of Ecthyma gangrenosum include the following:

• Pseudomonas aeruginosa bacteremia.
• Staphylococcus bacteria.
• The presence of any kind of immunodeficiency associated with severe neutropenia.
• Xanthomonas maltophilia.
• Other serious bacterial infections.
• Herpes simplex virus.

Symptoms of Ecthyma gangrenosum

Some sign and symptoms related to Ecthyma gangrenosum are as follows:

• A small blister that may be pus-filled and has a reddish border.
• Shortness of breath.
• Fever.
• Children with EG may develop diarrhea.
• A crusted ulcer that follows the appearance of the blister.

Treatment of Ecthyma gangrenosum

Here is list of the methods for treating Ecthyma gangrenosum:

• Treatment of EG requires the use of antipseudomonal penicillins, aminoglycosides, fluoroquinolones, third-generation cephalosporins, or aztreonam.
• Antiseptic soap or peroxide washes of the lesion may be helpful in speeding recovery.
• Other combinations with a similar therapeutic spectrum, such as double beta-lactams or a beta-lactam plus a quinolone, have been used by some investigators.
• Other treatment of Ecthyma gangrenosum: Prompt recognition of the skin lesion, appropriate antibiotic therapy for Pseudomonas aeruginosa.
• Surgical interventions may be needed if ecthyma gangrenosum manifests as a necrotizing soft-tissue infection.

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