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29. Pseudomonas infection - an infection caused by Pseudomonas aeruginosa (Pseudomonas)
Representatives of Pseudomonas - numerous gram-negative bacteria that live in soil and in water, are a common flora of wet rooms, including hospitals. They cause diseases mainly in newborns and children with insufficient defense mechanisms.
Etiology. Pseudomonas aeruginosa is a Gram-negative bacterium that causes hemolysis on blood agar. More than 90% of bacterial strains produce a bluish-green phenazine pigment (blue pus), as well as fluorescein, which is yellowish-green, diffusing into the nutrient medium, which stains around the colonies.
Epidemiology. Pseudomonas is often found in medical institutions on the skin, clothes and shoes of patients and attendants. It is able to grow in any humid environment.
Pathogenesis. For its development, Pseudomonas needs oxygen, the lack of which reduces the virulence of the microorganism.
Pseudomonas aeruginosa releases large amounts of exotoxins, including lecithinase, collagenase, lipase, and hemolysins, causing necrotic lesions on the skin.
Clinical manifestations. In healthy people, Pseudomonas aeruginosa, which has fallen into small wounds, causes suppuration and local abscesses, which contain green or blue pus. Skin lesions that develop during septicemia or direct inoculation of the pathogen into the skin initially look like pink spots, which, with the progression of the infection, turn into hemorrhagic nodules and undergo necrosis. In their place, scabs form, surrounded by a red rim (ecthyma gangrenosum). The reproduction of bacteria occurs in the affected areas.
Septicemia most often develops in children after the introduction of intravenous or urinary catheters. Pneumonia and septicemia are more common in children who are on artificial or assisted breathing. Peritonitis and septicemia develop when instruments used for peritoneal dialysis are contaminated. Pseuomonas and other Gram-negative bacteria are often found on wounds and burns.
Hemorrhagic necrosis can appear in all organs, including the skin in the form of purple nodules or areas of ecchymosis, rapidly undergoing necrosis. Inflammatory changes are usually hemorrhagic and necrotic.
Diagnosis and differential diagnosis. The diagnosis of Pseudomonas infection depends on the culture of the pathogen from blood, urine, CSF, or pus obtained from abscesses or sites of inflammation.
Treatment. Antibiotic therapy should be especially intense and prolonged in patients with impaired immunological reactivity. Patients with meningitis caused by Pseudomonas aeruginosa are treated with intravenous antibiotics.
Abscesses should be opened and drained, without which even long-term antibiotic treatment remains ineffective.
Author: Pavlova N.V.
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