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Pseudomonas aeruginosa Disease

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Pseudomonas aeruginosa disease 

  • Presentation
    • 4 main groups of people affected
      • Exposure to contaminated water of hot tubs/pools
        • Malignant otitis externa (MOE)
          • Severe infection of outer ear tissue exposed to water
          • Presents with severe pain and drainage
          • Untreated conditions can progress to osteomyelitis of skull
        • Rash (“hot tub folliculitis”)
          • infection of hair follicles exposed to contaminated water
          • Itchy, papulopustular rash over trunk and extremities
      • Cystic Fibrosis
        • Pneumonia 
          • Increased viscosity of airway in CF mucus impairs mucociliary escalator to clear bacteria
          • Recurrent respiratory infections with P. aeruginosa, diarrhea/steatorrhea, and failure to thrive are classic
      • Immunocompromised patients
        • Ecthyma gangrenosum
          • Rapidly progressive necrotic lesion that is manifestation of Pseudomonas bacteremia
          • Exotoxins and invasion of bacteria destroy blood vessels and surrounding tissue, causing necrosis
        • Often seen in patients with low absolute neutrophil count (e.g. cancer post-chemo, bone marrow transplant)
      • Indwelling (Foley) urinary catheter
        • UTIs (urinary tract infection)
    • Osteomyelitis may be seen in IV drug users/diabetic patients
    • Corneal ulcers/keratitis may be seen in contact lens wearers
    • Wound infection may be seen in burn victims
  • Treatment 
    • Piperacillin, ticarcillin
      • Only some extended spectrum penicillins are effective
    • Ceftazidime, cefepime
      • Note: ceftriaxone is NOT effective
    • Fluoroquinolones (e.g. ciprofloxacin, levofloxacin)
    • Carbapenems (e.g. meropenem, imipenem)
    • Aminoglycosides
    • Monobactams
    • Polymyxins (e.g. polymyxin B, colistin)