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Ecthyma gangrenosum and ecthyma-like lesions: review article

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Abstract

The generally accepted definition of ecthyma gangrenosum (EG) states that this condition is pathognomonic of Pseudomonas septicemia (Pseudomonas aeruginosa) and that it should usually be seen in immunocompromised patients, particularly those with underlying malignant disease. The cases described in the literature present a somewhat different picture. Our objective was to analyze this controversy. The review analyzes 167 cases of EG that were described in the literature from 1975 to 2014. All articles on EG cases with EG-specific tissue defect that had signs of general and/or local infection and skin necrosis were included and analyzed, whatever the etiology detected. Necrotic lesions of the skin diagnosed as EG have various microbiological etiology, can occur in immunocompetent or even healthy persons, and are not necessarily connected with septicemia. In published cases, P. aeruginosa was detected in 123 cases (73.65 %); of them, there were only 72 cases (58.5 %) with sepsis. Other bacterial etiology was detected in 29 cases (17.35 %) and fungi were detected in 15 cases (9 %). While the clinical picture of the disease and the treatment strategy remain the same, there is no need to invent two separate definitions for Pseudomonas and non-Pseudomonas cases. We suggest accepting a broader definition of EG.

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Authors and Affiliations

  1. Department of Otolaryngology, Assaf HaRofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    M. Vaiman

  2. Department of Microbiology, Assaf HaRofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    T. Lazarovitch

  3. Department of Plastic Surgery, Assaf HaRofeh Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    L. Heller

  4. Pediatric Surgery Department, Assaf HaRofeh Medical Center, Affiliated to the Sackler Medical School, Tel Aviv University, Zerifin, Israel

    G. Lotan

  5. 33 Shapiro Street, Bat Yam, 59561, Israel

    M. Vaiman

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  1. M. Vaiman
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Vaiman, M., Lazarovitch, T., Heller, L. et al. Ecthyma gangrenosum and ecthyma-like lesions: review article. Eur J Clin Microbiol Infect Dis 34, 633–639 (2015). https://doi.org/10.1007/s10096-014-2277-6

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