Pseudomonas aeruginosa cellulitis and ecthyma gangrenosum in immunocompromised children

Area of Science:

• Pediatric Infectious Diseases
• Dermatology
• Hematology/Oncology

Background:

• Pseudomonas aeruginosa skin infections are typically secondary to disseminated disease.
• Ecthyma gangrenosum and cellulitis are common presentations.
• Bacteremia is often associated with these infections.

Purpose of the Study:

• To analyze Pseudomonas aeruginosa skin infections in immunocompromised children.
• To determine if these infections occur without bacteremia.
• To evaluate treatment outcomes and duration.

Main Methods:

• Retrospective analysis of P. aeruginosa skin infection cases since 1962.
• Inclusion criteria: P. aeruginosa skin infection with negative blood cultures.
• Patient data: diagnosis, neutrophil counts, underlying conditions, treatment, and outcomes.

Main Results:

• 16 episodes of P. aeruginosa skin infections (8 ecthyma gangrenosum, 8 cellulitis) occurred in 7 patients.
• All blood cultures were negative for P. aeruginosa.
• Infections occurred in ambulatory patients, some with neutrophil counts > 1 x 10(9)/L.
• Common underlying conditions included acute lymphoblastic leukemia and aplastic anemia.
• All patients achieved lesion resolution without fatal complications.
• Cellulitis required a mean of 9.2 days of IV antibiotics; ecthyma gangrenosum required 17.8 days (P < 0.05).

Conclusions:

• P. aeruginosa skin infections can manifest in immunocompromised children without concurrent bacteremia.
• These infections can occur even with preserved neutrophil counts.
• Prompt antibiotic treatment leads to favorable outcomes for both cellulitis and ecthyma gangrenosum.