0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:19
1232 Pseudomonas Infections■Bacteremia – can be primary without source (neutropenic patients
with presumed source the gastrointestinal tract) or secondary to
pneumonia, genitourinary infection, intravascular devices or rarely
endocarditis; manifestations similar to other causes of bacteremia;
characteristic skin lesion, ecthyma gangrenosum, may be early clue
to diagnosis – vesicular lesion that ulcerates, becomes necrotic and is
surrounded by erythema; Gram stain of lesion reveals Gram-negative
rods
■Bone and Joint Infections – secondary to hematogenous seeding or
direct contiguous spread; predilection for fibrocartilaginous joints
including the vertebrae, and in IV drug users the sternoclavicular
joint and the symphysis pubis; osteochondritis of the foot following
nail puncture wound common in children
■Ear Infections – otitis externa presents with pain, swelling, and
marked tenderness with a waxy exudate in the ear canal; inva-
sive disease (malignant otitis externa or basilar skull osteomyelitis)
with involvement of bone seen almost exclusively in diabetics with
microvascular disease
■Eye Disease – keratitis and ulcer from trauma or extended-wear
contact lenses; ulcer that expands to include the sclera, associated
with pain, decreased vision and purulent discharge; can be rapidly
progressive and sight-threatening; Gram stain reveals characteris-
tic organisms; endophthalmitis involving the anterior and/or pos-
terior chamber with pain and decreased vision results from trauma
or hematogenous seeding and is uncommon
■Skin Infections – ecthyma gangrenosum (see above), postoperative
wound infection and infection of burns most common; burn wound
infection presents with separation of eschar, black discoloration of
wound, spread of cellulitis to adjacent normal skin with necrosis
and bleeding; frequently associated with bacteremia and sepsis; hot
tub dermatitis is a maculopapular or vesicular, erythematous rash
involving swimming suit-covered areas (can be more diffuse) result-
ing from exposure to hot tubs, spas or swimming pools improperly
maintained
■Meningitis, Endocarditis and Neutropenic Enterocolitis (typhlitis) –
unusual manifestations of Pseudomonas infectiontests
■Culture of blood or specimen from suspected site of infection (spu-
tum, urine, joint fluid, etc) confirms diagnosis in most cases.