Ecthyma gangrenosum and septic shock syndrome secondary to Chromobacterium violaceum

Brown, Katherine L.; Stein, Amy; Morrell, Dean S.

doi:10.1016/j.jaad.2005.07.016

Cited by 30 publications

(15 citation statements)

References 36 publications

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“…Workup for CGD should particularly be considered in patients who have a previous history of unusual infection of the skin or lymph node with other catalase positive organism such as staphylococcus aureus , Nocardia or Aspergillu s. Seigel et al reported a 14-year old teenager who developed necrotizing fasciitis secondary to C. violaceum , who was subsequently found to have CGD [ 23 ]. In many cases, as in our patient, C. violaceum can be the first infectious disease that leads to the diagnosis of CGD [ 23 , 24 ].…”

Section: Discussionmentioning

confidence: 97%

Chromobacterium Violaceum Sepsis: Rethinking Conventional Therapy to Improve Outcome

et al. 2015

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Patient: Male, 11Final Diagnosis: Chromobacterium violaceum infectionSymptoms: Abscess • fever • rashMedication: —Clinical Procedure: ECMOSpecialty: Critical Care MedicineObjective:Rare diseaseBackground:Chromobacterium violaceum (C. violaceum) is a facultative anaerobic gram-negative bacterium found in soil and water, especially in tropical and subtropical areas. Although infection in humans is rare, it is associated with significant morbidity. The bacterium is known for its resistance to multiple antimicrobials, and the possibility of relapse and reinfection. Presence of bacteremia, disseminated infection, and ineffective antimicrobial agents are predictors of mortality.Case Report:We report the case of a previously healthy 11-year-old male with C. violaceum sepsis who was exposed to stagnant water. He presented with severe septic shock and developed multi-organ system failure. Initial presumptive diagnosis was staphylococcal infection secondary to presence of skin abscesses resulting in antibiotic coverage with vancomycin, clindamycin, nafcillin and ceftriaxone. He also had multiple lung and liver abscesses. Once C. violaceum was identified, he received meropenem and ciprofloxacin, and was later discharged on ertapenem and trimethoprim-sulfamethoxazole (TMP-SMX) to complete a total of six months of antibiotics. He was diagnosed with chronic granulomatous disease (CGD) and is currently on prophylactic TMP-SMX and itraconazole. He has not had any relapses since his initial presentation.Conclusions:This case highlights the importance of considering C. violaceum as a relevant human pathogen, and considering it early in temperate regions, particularly in cases of fulminant sepsis associated with multi-organ abscesses. Once C. violaceum is identified, appropriate antimicrobial therapy should be started promptly, and sufficient duration of treatment is necessary for successful therapy.

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Section: Discussionmentioning

confidence: 97%

Chromobacterium Violaceum Sepsis: Rethinking Conventional Therapy to Improve Outcome

et al. 2015

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“…Ecthyma gangrenosum (EG) is a cutaneous infection most commonly associated with sepsis with Pseudomonas aeruginosa due to the subcutaneous thrombotic vascular lesions. In the etiology of EG, other types of bacteria may also be involved: Gram-positive and Gram-negativ cocci, [1–4] Gram-negative bacteria, [2,5–12] and 3 were also described cases of EG caused by fungi. [13–15] The lesions of EG are caused by necrotizing vasculitis produced by the perivascular bacterial invasion in the dermis and subcutaneous tissues.…”

Section: Introductionmentioning

confidence: 99%

A case report of double etiology of ecthyma gangrenosum

Bîrluțiu

Bîrluţiu

Baicu³

et al. 2019

Medicine

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Rationale: Ecthyma gangrenosum is a cutaneous infection, most commonly occurring during sepsis evolution with Pseudomonas aeruginosa on an immunocompromised background. There have been rare case reports in previously healthy children and rarer are the cases with double etiology. Patient concerns: We present the case of a female Caucasian patient, aged 1 year and 8 months, who developed severe sepsis during flu evolution with predominant respiratory and cerebral manifestations. On admission, at skin level, there was noticed a necrotic coccygeal ulceration (with rapid increasing dimensions 0.5/0.5 cm in 24 hours), and with the transformation from a dry necrosis in a sphacelus at the periphery and progression of necrosis in depth. Diagnoses: The patient was diagnosed with ecthyma gangrenosum from which Pseudomonsa aeruginosa and Enterococcus faecalis were isolated from the samples that were harvested intraoperatively, decision that was taken considering the appearance of CT scan and the extremely rapid expansion of necrosis. Excisional debridement with necrectomy, lavage, and dressing being performed. The invasion of the fascia was excluded intraoperatively. Interventions: Treatment with Meropenem for 14 days was initiated, as well as amikacin and linezolid, the latter being replaced with teicoplanin for 14 days. Red blood cells transfusion, intravenous immunoglobulins, anticonvulsants were also administered. Outcomes: Under treatment the evolution was favorable. Lessons: This case brings into discussion a double etiology of ecthyma gangrenosum, in a previously healthy child that occurred in the evolution of influenza. The evolution was favorable under broad-spectrum antibiotic treatment and surgical excision.

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“…16 Most infections are reported from temperate and tropical regions with high case fatality rates (CFRs), especially in immunocompromised patients. 17,18 In 1982, Macher and colleagues reported 12 cases of C. violaceum infections in the United States in patients with chronic granulomatous disease, 7 of whom died of invasive septicemia 7 days to 15 months after initial infections. 17 The portal of entry for C. violaceum is usually a skin injury from a laceration or fish bite followed by exposure to brackish or stagnant water.…”

Section: Aeromonas Speciesmentioning

confidence: 99%

“…15 Within days, invasive septicemia may occur, especially in the immunocompromised, with high fevers and disseminated macular skin lesions that progress to abscesses. 18 Abscesses may also occur in bone and in the liver. 14,18 The organism is susceptible to aminoglycosides, fluoroquinolones, tetracyclines, imipenem, and trimethoprim-sulfamethoxazole, but resistant to penicillins and cephalosporins.…”

Section: Aeromonas Speciesmentioning

confidence: 99%

“…18 Abscesses may also occur in bone and in the liver. 14,18 The organism is susceptible to aminoglycosides, fluoroquinolones, tetracyclines, imipenem, and trimethoprim-sulfamethoxazole, but resistant to penicillins and cephalosporins. 15,16 Because of high CFRs, treatment of suspected C. violaceum infections should begin immediately with drainage of all purulent abscess collections and combined intravenous antibiotic therapy.…”

Section: Aeromonas Speciesmentioning

confidence: 99%

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Skin and Soft Tissue Infections Following Marine Injuries and Exposures in Travelers

Diaz

2014

J Travel Med

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Travelers with well-known risk factors for the increasing severity of marine infections, including those with open wounds, suppressed immune systems, liver disease, alcoholism, hemochromatosis, hematological disease, diabetes, chronic renal disease, acquired immunodeficiency syndrome, and cancer, should be cautioned about the risks of marine infections through exposures to marine animals, seawater, the preparation of live or freshly killed seafood, and the accidental ingestion of seawater or consumption of raw or undercooked seafood, especially shellfish. With the exception of minor marine wounds demonstrating localized cellulitis or spreading erysipeloid-type reactions, most other marine infections and all Gram-negative and mycobacterial marine infections will require therapy with antibiotic combinations.

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Ecthyma gangrenosum and septic shock syndrome secondary to Chromobacterium violaceum

Cited by 30 publications

References 36 publications

Chromobacterium Violaceum Sepsis: Rethinking Conventional Therapy to Improve Outcome

Chromobacterium Violaceum Sepsis: Rethinking Conventional Therapy to Improve Outcome

A case report of double etiology of ecthyma gangrenosum

Skin and Soft Tissue Infections Following Marine Injuries and Exposures in Travelers

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