Necrotizing bowel lesions complicated byPseudomonas septicaemia in previously healthy infants

Tsai, Ming‐Jer; Teng, Chen-Jui; Teng, Ru-Jeng; Lee, Ping–Ing; Chang, Mei–Hwei

doi:10.1007/bf01953941

Cited by 17 publications

(14 citation statements)

References 7 publications

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“…Twenty-three patients (85%) had severe necrotising enteritis, as defined and reported previously,11 and nine (33%) had bowel perforation requiring immediate surgical intervention. Intraoperative findings showed widespread patchy necrosis with fibrin coating of the small intestine or colon (figure 1A).…”

Section: Resultsmentioning

confidence: 55%

“…Although most patients have extensive necrotising enteritis, short bowel syndrome is rare, with only one reported case 9. Second, ecthyma gangrenosum occurs in more than 50% of the patients with Shanghai fever, as seen in this study 10 11. In contrast, this cutaneous manifestation occurs in only 1.3–2.8% of patients with Pseudomonas bacteraemia,24 many of whom are profoundly neutropenic.…”

Section: Discussionmentioning

confidence: 53%

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Shanghai fever: a distinctPseudomonas aeruginosaenteric disease

Chuang

Wang

Chang

et al. 2013

Gut

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BackgroundShanghai fever, a community-acquired enteric illness associated with sepsis caused by Pseudomonas aeruginosa, was first described in 1918. The understanding of Shanghai fever is incomplete.ObjectiveTo delineate the clinical features and to examine the host and microbial factors associated with Shanghai fever.MethodsWe prospectively enrolled 27 consecutive previously healthy children with community-acquired P aeruginosa enteritis and sepsis between July 2003 and June 2012. An immunological investigation, including measurement of serum immunoglobulin levels and lymphocyte subpopulations, was performed. The clonal relationship of bacterial isolates was determined by multilocus sequence typing (MLST) and the virulence of isolates was measured using cellular and animal models.ResultsThe median age of the patients was 7 months; 24 (89%) were aged <1 year. The most common clinical manifestations were fever (100%), diarrhoea (96%) and shock (81%). Leucopenia, thrombocytopenia, high C-reactive protein levels, coagulopathy and hypoalbuminaemia were the key laboratory findings. Necrotising enteritis with or without bowel perforation, ecthyma gangrenosum and seizures were main complications. The death rate was 15%. No common primary immune deficiency was identified. MLST genotypes indicated that isolates from Shanghai fever were non-clonal, but they shared similar phenotypes which were invariably cytotoxic, invasive and adhesive in cellular experiments and caused prolonged gut colonisation and more death than respiratory and laboratory control strains in mice.ConclusionsShanghai fever is a sporadic community-acquired disease of previously healthy infants that manifests as sepsis associated with P aeruginosa enteric disease. Both host and microbial factors play a role in pathogenesis.

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Section: Resultsmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 53%

Shanghai fever: a distinctPseudomonas aeruginosaenteric disease

Chuang

Wang

Chang

et al. 2013

Gut

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“…Even though P. aeruginosa is not generally considered as a cause of AAC, there are evidences that Pseudomonas can cause the infections of gastrointestinal tracts with diarrhea in infants. Pseudomonas septicemia in infants was manifested as necrotizing bowel lesions with a history of diarrhea (5). There have been some reports on community-acquired Pseudomonas infection of the gastrointestinal tract causing diarrhea in infants (6,7).…”

Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosaas a Potential Cause of Antibiotic-Associated Diarrhea

et al. 2001

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Although Pseudomonas aeruginosa is not generally considered as a cause of antibiotic-associated diarrhea, several cases of diarrhea caused by P. aeruginosa have been reported. We experienced seven cases of nosocomial diarrhea presumably caused by P. aeruginosa, which was the predominant organism isolated from stool cultures. Clostridium difficile toxin was also positive in one patient. No other potential or recognized enteropathogens were identified from stools. All patients had underlying diseases and had been receiving antibiotics before the diarrheal onset. All of the seven P. aeruginosa isolates were resistant to previously given antibiotics. Diarrhea stopped three days after withdrawal of probable offending antibiotics without specific treatment in two patients. The other five patients having continuous diarrhea despite withdrawal of probable offending antibiotics, were successfully treated with antipseudomonal agents. The median duration of diarrhea after the initiation of treatment was 6.3 days. These data suggest that P. aeruginosa can be a potential cause of antibiotic-associated diarrhea. Further investigations are warranted to evaluate the possible etiologic role of P. aeruginosa in antibiotic-associated diarrhea.

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“…1 Pseudomonas infection is rare in immunocompetent children. 2 However, when children develop an infection, it has a wide range of clinical features from mild cutaneous infections to life-threatening septicemia. Serious infections are usually hospital-acquired and occur typically in patients who are immunocompromised, have chronic diseases, are using therapeutic devices, or have been subject to invasive monitoring.…”

Section: Discussionmentioning

confidence: 99%

Multiple Ecthyma Gangrenosum in a Healthy Infant With Community-Acquired Pseudomonas aeruginosa Sepsis

Wu¹,

Huang²

2010

Pediatric Emergency Care

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We report the case of a previously healthy 8-month-old infant girl with Pseudomonas aeruginosa sepsis who presented to a pediatric emergency department with multiple ecthyma gangrenosum. Skin manifestations are uncommon in Pseudomonas infection. Ecthyma gangrenosum is a rare, distinct skin disorder associated with potentially fatal underlying Pseudomonas sepsis. Although typically occurring in immunocompromised or neutropenic patients, it can occasionally affect otherwise healthy children. This case demonstrates the critical importance of the pediatrician's identification of ecthyma gangrenosum to give directed antipseudomonal therapy.

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Necrotizing bowel lesions complicated byPseudomonas septicaemia in previously healthy infants

Abstract: The intestine should be considered a possible site of involvement in Pseudomonas sepsis and special attention should be paid to examination of the abdomen.

Cited by 17 publications

References 7 publications

Shanghai fever: a distinctPseudomonas aeruginosaenteric disease

Shanghai fever: a distinctPseudomonas aeruginosaenteric disease

Pseudomonas aeruginosaas a Potential Cause of Antibiotic-Associated Diarrhea

Multiple Ecthyma Gangrenosum in a Healthy Infant With Community-Acquired Pseudomonas aeruginosa Sepsis

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