Ecthyma Related terms: Ecthyma is often a deeper extension of untreated impetigo or folliculitis that Impetigo, Eschar, presents as 5- to 15-mm punched-out erosions with elevated, erythematous. Pseudomonas aeruginosa, borders. Venous Ulcer, Lesion, Cellulitis, Anthrax, From: The Travel and Tropical Medicine Manual (Fourth Edition), 2008 pranise oe View all Topics > ® Skin Infections Carlos N. Prieto-Granada, ... Martin C. Mihmyr., in Diagnostic Pathology of Infectious Disease (Second Edition), 2018 Etiology and Pathogenesis. Ecthyma has features similar to those of impetigo as far as the organisms and pathogenesis are concerned, However, one of the causative organisms is usually S. pyogenes. Often, culture reveals mixed staphylococcal and streptococcal infections. It is important to mention that the term “ecthyma,” from the Greek €x@Uw) “break out,” which literally means “break out in a rush’ and in this case will be of purulent material, is used in several other types of lesions produced from a variety of organisms, such as parapoxvirus in ecthyma contagiosum (also known as orf). Among bacterial-related ecthymas, there is significant overlap between ecthyma and ecthyma gangrenosum (discussed previously), both likely representing a cutaneous infection reaction pattern. Some authors propose unifying both concepts under the “ecthyrma gangrenosum” rubric.2® Nevertheless, the lesions referred to as ecthyma gangrenosum often reflect a more serious condition (see later). Purchase book Skin Infections Carlos Nicolas Prieto-Granada, ... Martin C. MihmJr., in Diagnostic Pathology of infectious Disease, 2010 Ecthyma Ecthyma, like impetigo, favors children and can similarly affect the occlusive areas of the body. It appears as a well- demarcated ulcer filled with purulent material. There is often a crust overlying the lesion. Ecthyma resembles any tune of inflamed. infected skin lesion with crusting. Culture is the best manner of diaenasine the exact cause afthe lesion. The lesion usually has a sharply demarcated border in which aggregates of neutrophils are present in the center of, the lesion and diffusely throughout the superficial dermis. There is frequently a neutrophil-impregnated crust (Fig. 19-3). Bacteria can often be visualized using tissue Gram stain. Ecthyma has features similar to those of impetigo as far as the organisms and pathogenesis are concerned. However, the causative organism is usually S. pyogenes. Often, culture reveals mixed staphylococcal and streptococcal infections. Purchase book Pseudomonas aeruginosa and Other Pseudomonas Species Erika D’Agata, in Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases (Eighth Edition), 2015 Ecthyma Gangrenosum Ecthyma gangrenosum is a characteristic manifestation of P. aeruginosa bacteremia among immunocompromised patients, especially those with neutropenia. Ecthyma gangrenosum, however, can also be caused by numerous other gram-negative bacteria fungi, and viruses and has also been documented to occur among, immunocompetent hosts, but with much lower incidence.11541# The characteristic lesions are usually due to hematogenous dissemination, but primary skin lesions, without bacteremia, can also occur. Lesions begin as single or multiple red macules progressing to vesicles and later bullous or pustular lesions. Hemorthage and necrosis in the central part ensues followed by the development of a ‘pray-black eschar with surrounding erythema (Fig, 221-5). All body parts can be involved, but ecthyma gangrenosum most commonly affects the perineal and gluteal regions and the extremities. On histology, there is epidermal and upper dermal necrosis with a mixed inflammatory cell infiltrate surrounding the infarcted area along with necrotizing vasculitis and vascular thrombosis. If bacteremia is present, P. aeruginosa is isolated from skin biopsy specimens as well as blood. Treatment of the bacteremia and local wound care are indicated. Bacterial Skin and Soft Tissue Infections in the Tropics Aisha Sethi, in Hunter's Tropical Medicine and Emerging Infectious Diseases (Tenth Edition), 2020 Ecthyma Ecthyma is considered the ulcerated form of bullous impetigo and is usually caused by S. pyogenes. It initiallypresents as a vesicle that develops into a shallow “punched-out” ulcer with a necrotic base, usually on the lower ‘extremities (Fig, 61.2). The ulcers are usually multiple and smaller in size than tropical ulcers. The most common locations are the backs of legs, thighs and buttocks, and, occasionally, on the trunk and arms. In the tropics, ‘ecthyma usually occurs in those working in damp, swampy, and humid environments, for example, rice paddy workers. Treatment includes systemic antibiotics in conjunction with topical antibiotics, such as fusidic acid or topical 0.5% GV ps application daily, along with leg elevation. Dermatologic manifestations of systemic infections Anthony C. Chu, Danielle T. Greenblatt, in Infectious Diseases (Third Edition), 2010 Ecthyma gangrenosum Eethyma gangrenosum is an uncommon cutaneous manifestation of Pseudomonas aeruginosa septicemia, usually ‘occurring in immunocompromised or debilitated patients. Erythematous or purple macules initially develop on extremities or the anogenital region. Lesions subsequently become bullous and hemorthagic, and rupture to leave ‘a gangrenous ulcer with central black eschar (Fig. 12.8). The surrounding tissue is painful and inflamed. Histologically, a necrotizing hemorrhagic vasculitis is present and the Gram-negative organism may be seen within the walls of deeper vessels. When the diagnosis is suspected, culture and biopsy of skin lesions is essential, together with blood and urine cultures, Immediate treatment directed towards P. aeruginosa is indicated. Dermatologic Manifestations of Systemic Infections Chantal P. Bleeker-Rovers, Henry J.C. De Vries, in Infectious Diseases (Fourth Edition), 2017 Pseudomonas aeruginosa Ecthyma gangrenosum is classically associated with P. aeruginosa bacteremia in immunocompromised patients. Most infections occur via contact with contaminated water (hot tubs, saunas, tropical swimming pools). The lesions of ecthyma gangrenosum commonly begin as painless red macules, which rapidly evolve into areas of induration that develop into pustules and/or bullae (Figure 13-2). Ultimately, these become gangrenous ulcers. Ecthyma lesions typically progress rapidly within 12-18 hours. The lesions may involve the skin or mucous membranes and may be single or multiple. Most patients have fever, but ecthyma gangrenosum can occur in the absence of constitutional signs. RE on ehace hanknae | Superficial Bacterial Skin Infections and Cellulitis Hillary S. Lawrence, Amy Jo Nopper, in Principles and Practice of Pediatric Infectious Diseases (Fifth Edition), 2018 Ecthyma Gangrenosum Ecthyma gangrenosum is the characteristic skin lesion associated with gram-negative organisms, especially Pseudomonas aeruginosa. Pseudomonas septicemia usually occurs in the setting of neutropenia or congenital neutrophil dysfunction, but it also has been described in healthy children, often younger than 1 year of age.”? Cutaneous findings are the result of a necrotizing bacterial vasculitis affecting small veins in the skin. Lesions begin as erythematous, indurated papules, vesicles, and nodules that progress over hours to days into a necrotic ulcer with a black eschar and an erythematous rim (Figs. 68.8 and 68.9). Lesions are most common on the gluteal and perineal areas, but they can occur anywhere.”®”* Ecthyma gangrenosum also can manifest in a localized form, usually on the buttocks and legs, after inoculation of the organism into the skin. The localized form of ecthyma gangrenosum usually is not associated with bacteremia!” and can occur in healthy children or those with occult immunodeficiency® Culture of the lesions and blood cultures confirm the diagnosis. Ecthyma gangrenosum-like lesions can develop as a result of infection with other agents, usually in the setting of immunosuppression. Etiologic agents include gram-negative bacteria other than P. aeruginoso,!27" MSSA, MRSA” Streptococcus species,” Candida species, fungi (ve., Aspergillus, Mucor, and Fusarium species)? and herpesviruses.” Effective treatment requires prompt initiation of an antibiotic effective against P. aeruginosa or other likely causative organisms. Purchase book Bacterial and rickettsial infections David Weedon AO MD FRCPA FCAP(HON), in Weedon's Skin Pathology (Third Edition), 2010 ECTHYMA Ecthyma is a deeper pyoderma than impetigo and much less frequent. It has a predilection for the extremities of children, often at sites of minor trauma, which allow entry of the causative bacteria. Group A streptococci, particularly Streptococcus pyogenes, are usually implicated, although coagulase-positive staphylococci are sometimes isolated as well.!®”2 The lesions, which are sometimes multiple, consist of a dark crust adherent to a shallow ulcer and surrounded by a rim of erythema. Scarring usually results when the lesions heal.!? Ecthyma gangrenosum is a severe variant of ecthyma seen in 59% or more of immunosuppressed individuals who develop a septicemia with Pseudomonas aeruginosa.”*-78 & septicemia is not invariable.” It has also been seen in a harlequin baby, and in previously healthy individuals.*" It commences as an erythematous macule on the trunk or limbs: the lesion rapidly becomes vesicular. then pustular. and finally develops into a gangrenous ulcer with adark eschar and an erythematous halo.‘ Annular lesions are rare.*® Periocular lesions have been reported in a diabetic patient.®7 Constitutional symptoms are usually present. Patients with solitary lesions have a better prognosis than those with multiple lesions. Similar necrotic ulcers have been reported in association with Aspergillus, Candida,*® and Exserohilum?®? infection, Morganella morganii,? Citrobacter freundii?* Chromobacterium violaceum,.? candidosis, and following pseudomonas folliculitis (but usually without septicemia),7? and cutaneous infections treated with antibiotics.® Pseudomonas aeruginosa septicemia may result in the development of pustules, bullae,% intertrigo,% or of a nodular cellulitis” rather than ecthyma gangrenosum.% It needs to be distinguished from purpura fulminans in which disseminated intravascular coagulation (DIC) accompanies the infection (see p. 199)! Histopathology In ecthyma there is ulceration of the skin with an inflammatory crust on the surface. There is a heavy infiltrate of neutrophils in the reticular dermis, which forms the base of the ulcer. Gram-positive cocci may be seen within the inflammatory crust. Ecthyma gangrenosum shows necrosis of the epidermis and the upper dermis, with some hemorrhage into the dermis.®2 The epidermis may separate from the dermis. A mixed inflammatory-cell infiltrate surrounds the infarcted region. In some cases there is a paucity of inflammation.*#? necrotizing vasculitis with vascular thrombosis is present in the margins.%” Numerous Gram-negative bacteria are usually present between the collagen bundles, and sometimes in the media and adventitia of small blood vessels Purchase book