Then, it develops into a pustule, and then a bulla with central hemorrhagic focus. The bulla progresses into an ulcer which extends laterally. Finally it becomes a gangrenous ulcer with a central black eschar surrounded by an erythematous halo. They are most commonly seen in perineum and under arm pit. However, they can occur in any part of the body. Conditions which lead to the development of an immunocompromised state make the patient more susceptible to ecthyma gangrenosum and sepsis.
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The following tests are performed to identify the exact cause of the infection. Gram stain A Gram stain of fluid from the central haemorrhagic pustule or blister can rapidly indicate the diagnosis. If no fluid is present, the scab should be lifted and a swab taken from underneath. Blood cultures Two specimens are normally taken prior to starting antibiotic therapy. The optimum time for collection is during a temperature spike.
Sensitivity studies are done on any isolated organisms. Skin biopsy A skin biopsy is taken for routine histology and special stains may also be done to to rule out other organisms that may cause ecthyma gangrenosum-like lesions.
Histopathology of ecthyma gangrenosum lesions shows vascular necrosis with few inflammatory cells but many surrounding bacteria. In sections stained with Gram stain, gram-negative rods are numerous surrounding necrotic vessels. Haemorrhage, oedema and necrosis are seen in and around the involved vessels.
Tissue cultures A second skin biopsy is usually sent for tissue culture for bacteria, fungi, yeasts and mycobacteria. Sensitivity tests are done on any isolated organisms.
What is the management of ecthyma gangrenosum? Ecthyma gangrenosum requires prompt diagnosis and treatment with appropriate antibiotics for the underlying cause. The presence of ecthyma gangrenosum should alert the physician to the likelihood of an accompanying Pseudomonas septicaemia. Antibiotics which may be used include Antipseudomonal penicillin such as piperacillin Aminoglycosides Third-generation cephalosporins Aztreonam While awaiting culture results, piperacillin is usually given in combination with an aminoglycoside.
Antibiotic choice may require adjustment once antibiotic sensitivity results are known.
Ectima: cause, sintomi e cura