What are the dermatologic manifestations of P aeruginosa infection?

Updated: Dec 17, 2018
  • Author: Selina SP Chen, MD, MPH; Chief Editor: Russell W Steele, MD  more...
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Skin and soft tissue infections (eg, burn wound sepsis, dermatitis, ecthyma gangrenosum [EG], pyoderma, cellulitis, hot tub folliculitis, necrotizing fasciitis, chronic paronychia)

  • Do not confuse EG with pyoderma gangrenosum or streptococcal ecthyma; EG is a rare but pathognomonic form of pseudomonal infection. Although EG is often due to Pseudomonas, case reports indicate that the same frequency is associated with non-Pseudomonas EG (ie, Fusarium, Klebsiella).

  • EG in patients without neutropenia is very rare, as is nonbacteremic EG cases. However, nonsepticemic cases occur in patients without immunosuppression or neutropenia or following antibiotic therapy.

  • Pseudomonal burn wound infections occur with systemic involvement (eg, bacteremia, fever, hypothermia, disorientation, obtundation, hypotension, oliguria, ileus, leukopenia).

  • Chronic paronychia slowly evolves and initially presents with tenderness and mild swelling about the proximal and lateral nail folds.

  • Pseudomonal toe web infections are distinctive clinical entities often misdiagnosed as tinea pedis. Dried exudate or a green stain (caused by pyoverdin) may be found on socks or toenails.

  • Pseudomonal folliculitis presents as cutaneous lesions any time from 8 hours to 5 days or more (mean incubation period is 48 h) after using a contaminated whirlpool, home hot tub, water slide, physiotherapy pool, or contaminated loofah sponge. Malaise and fatigue may occur during initial days of the eruption. Fever (uncommon) is low grade when present.

  • Localized cellulitis can occur as a secondary infection of tinea of the toe webs or groin; from bedsores, stasis ulcers, or burns; in grafted areas; or under the foreskin of the penis. Maceration or occlusion of these skin lesions leads to secondary infection. Deep erosions and tissue necrosis may occur before the condition is diagnosed correctly. Severe pain is highly characteristic of an evolving infection.

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