Ecthyma gangrenosum is a characteristic skin lesion of systemic infection due to Pseudomonas aeruginosa. It has a high incidence in patients with chronic disease and impaired defense mechanisms. Early diagnosis and appropriate systemic antibiotic therapy is crucial since its mortality rate is very high. We report a case of ecthyma gangrenosum in aplastic anemia.
Adult ; Anemia, Aplastic/*complications/pathology ; Case Report ; Female ; Human ; Opportunistic Infections/microbiology/pathology ; Pseudomonas Infections/*complications/microbiology/pathology ; Skin Diseases, Bacterial/drug therapy/*etiology/pathology

OBJECTIVETo study the therapeutical effects of the Chinese medicinal herb, Sophora flavescens (SFA) on a rat model of chronic Pseudomonas aeruginosa (PA) biofilm pneumonia.

METHODRats were challenged intratracheally with alginate embedded PA strain PAO579 at the concentration of 1 x 10(9) colony-forming units per milliliter (CFU x mL(-1)). After challeng on the second day, three different doses SFA or sterile normal saline (NS) were administered by gastric intubation once a day for two weeks. Two weeks post intratracheal challenge with P. aeruginosa, parameters were evaluated.

RESULTTwo weeks after challenge, a remarkable serum antibody response and significant infiltration of numerous polymorphonuclear leukocytes (PMN) with lower IFN-gamma production in the lungs were found in the model group. However, milder macroscopic and lower incidence of lung abscesses were found in all the three groups received different doses of SFA treatment compared to the model group (P < 0.001). Meanwhile, the microscopic lung pathology in all SFA-treated groups were characterized by chronic inflammation dominated by mononuclear leukocytes (MN). The rat number with acute inflammation in group II, III was significantly lower than that in the model group (P < 0.05). Furthermore, the serum level of anti-PA IgG was down-regulated in group II and III (P < 0.05 or P < 0.001), and serum IgG level was negatively correlated with the SFA doses (r = -0.95, P < 0.01). In all the SFA-treated groups higher IFN-gamma production in the lung was found compared to the model group (P < 0.001), and the lung IFN-gamma level was positively correlated with the SFA doses (r = 0.9, P < 0.02). These findings indicate that SFA has an effect on inducing Thl type of immune response. The anti-PA activity test of SFA was weakly positive whereas NS was negative.

CONCLUSIONSFA treatment significantly reduced pathology, which might be associated with a shift of local immune responding type from a Th2 like to Thl like that might provide a better protection to the rats with chronic P. aeruginosa lung infection. And these results also showed that the SFA dose of 12 g x kg(-1) was the best dosage in this present study.

Animals ; Biofilms ; drug effects ; Drugs, Chinese Herbal ; chemistry ; pharmacology ; therapeutic use ; Female ; Male ; Pneumonia ; drug therapy ; microbiology ; pathology ; Pseudomonas Infections ; drug therapy ; microbiology ; pathology ; Pseudomonas aeruginosa ; pathogenicity ; Random Allocation ; Rats ; Rats, Wistar ; Sophora ; chemistry

To determine injection time and effective dose of ciprofloxacin in endophthalmitis and to evaluate the effectiveness of dexamethasone. In rabbits, Pseudomonas aeruginosa (2 x 10(4) CFU/0.1 ml) was inoculated intravitreally. At 6, 12, 18, 24 hours postinoculation, single intravitreal doses of ciprofloxacin (300 microgram/0.15 ml or 100 microgram/0.05 ml) alone or with dexamethasone (400 microgram) were given. Electrophysiological and histologic measures were utilized to rate drug effectiveness. 300 micrograms ciprofloxacin was effective in killing P. aeruginosa at 6 and 12 hours postinoculation, but one hundred ug ciprofloxacin was not effective. 300 ug ciprofloxacin had no significant effect in killing P. alphaeruginosa at 18 hrs and 24 hrs postinoculation. Eyes treated with dexamethasone (400 microgram) and ciprofloxacin (300 microgram) at 6 hours postinoculation did not differ from eyes treated with ciprofloxacin alone. Cultures from eyes treated with dexamethasone and ciprofloxacin at 12 hours postinoculation were positive. Cultures from eyes treated with ciprofloxacin alone were negative. The failure of treatment at 18 hrs and 24 hrs postinoculation may be due to either an increased rate of clearance of drugs from the eyes or a reduced bactericidal effect of ciprofloxacin which could be altered by acidic pH, degree of hypoxia or bacterial counts. Dexamethasone had no beneficial effect in the treatment of P. aeruginosa endophthalmitis in the early phase.
Animals ; Anti-Infective Agents/*administration & dosage ; Anti-Inflammatory Agents/*administration & dosage ; Ciprofloxacin/*administration & dosage ; Dexamethasone/*administration & dosage ; Disease Models, Animal ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Electroretinography ; Endophthalmitis/*drug therapy/microbiology/pathology ; Eye Infections, Bacterial/*drug therapy/microbiology/pathology ; Pseudomonas Infections/*drug therapy/microbiology/pathology ; Pseudomonas aeruginosa/drug effects/isolation & purification ; Rabbits ; Time Factors ; Vitreous Body/microbiology

Scleral necrosis and infection are serious late complications of pterygium treatment and are difficult to manage. We describe a 70-year-old Chinese male who presented with scleral necrosis and Pseudomonas aeruginosa infection 15 years after the excision of a pterygium. The infection was treated early and aggressively with intensive topical and intravenous antibiotics and the thin necrotic sclera was reinforced with a donor scleral patch graft when the scleral infection was clinically controlled. The integrity of the globe was maintained by a thin layer of sclera anterior to the graft after the graft gradually shrunk in size and retracted posteriorly. The eye was saved from possible scleral perforation and endophthalmitis. This case is reported to highlight the importance of early aggressive treatment of infection and the value of prophylactic repair of scleral necrosis in the management of these late complications of pterygium treatment.
Administration, Topical ; Aged ; Anti-Bacterial Agents ; Drug Therapy, Combination ; administration & dosage ; therapeutic use ; Humans ; Injections, Intravenous ; Male ; Necrosis ; Pseudomonas Infections ; drug therapy ; Pseudomonas aeruginosa ; Pterygium ; surgery ; Sclera ; pathology ; transplantation ; Scleral Diseases ; drug therapy ; microbiology ; Surgical Wound Infection ; drug therapy ; etiology

BACKGROUNDHealthcare-associated pneumonia (HCAP) is associated with drug-resistant pathogens and high mortality, and there is no clear evidence that this is due to inappropriate antibiotic therapy. This study was to elucidate the clinical features, pathogens, therapy, and outcomes of HCAP, and to clarify the risk factors for drug-resistant pathogens and prognosis.

METHODSRetrospective observational study among hospitalized patients with HCAP over 10 years. The primary outcome was 30-day all-cause hospital mortality after admission. Demographics (age, gender, clinical features, and comorbidities), dates of admission, discharge and/or death, hospitalization costs, microbiological results, chest imaging studies, and CURB-65 were analyzed. Antibiotics, admission to Intensive Care Unit (ICU), mechanical ventilation, and pneumonia prognosis were recorded. Patients were dichotomized based on CURB-65 (low- vs. high-risk).

RESULTSAmong 612 patients (mean age of 70.7 years), 88.4% had at least one comorbidity. Commonly detected pathogens were Acinetobacter baumannii, Pseudomonas aeruginosa, and coagulase-negative staphylococci. Initial monotherapy with β-lactam antibiotics was the most common initial therapy (50%). Mean age, length of stay, hospitalization expenses, ICU admission, mechanical ventilation use, malignancies, and detection rate for P. aeruginosa, and Staphylococcus aureus were higher in the high-risk group compared with the low-risk group. CURB-65 ≥3, malignancies, and mechanical ventilation were associated with an increased mortality. Logistic regression analysis showed that cerebrovascular diseases and being bedridden were independent risk factors for HCAP.

CONCLUSIONInitial treatment of HCAP with broad-spectrum antibiotics could be an appropriate approach. CURB-65 ≥3, malignancies, and mechanical ventilation may result in an increased mortality.

Acinetobacter baumannii ; pathogenicity ; Aged ; Anti-Bacterial Agents ; therapeutic use ; Community-Acquired Infections ; drug therapy ; microbiology ; pathology ; Female ; Hospital Mortality ; Hospitalization ; Humans ; Male ; Middle Aged ; Pneumonia ; drug therapy ; microbiology ; pathology ; Pseudomonas aeruginosa ; pathogenicity ; Retrospective Studies ; Staphylococcus aureus ; pathogenicity