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60 yo Caucasian female w/ hx chronic asthma intubated in the ICU for respiratory distress due to acute exacerbation. on day 4, spikes fever. Chest x-ray reveals infiltrates. Skin lesion found on lower abd. At first well- circumscribed and erythematous. Evolves to bulla which quickly ruptures and becomes a necrotic center with erythematous border. yellpw-green pus present. Gram Stain + for gram - rods. Culture sent.
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Ecthyma Gangrenosum
- Tends to be P. auerignosa (not pathognomic for ecthyma gangrenosum)
- nosocomial infection which tends to occur in immunocompromised; esp w/ central venous catheter or urinary catheter
- Begins as a nodular erythematous skin lesion on mucous of skin; Evolves to be hemorhage, ulceration or necrosis
- treat with 2 abx: aminoglycoside (tobramycin/amikacin) + anti-psuedomonal ceph (ceftazidime/cefepime) or penicillin (pipercillan)
- mortality increased if concurrent pulmonary infection
- neutropenic: 14days/ ANC to baseline
- cather induced bacteremia: 7-10dys post cathether out
- Empiric therapy as timing influences cure rate
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43yo HIV+ white male w/ hx of IV drug use admitted with N/V, mouth,throat, epigastric pai. Dx'd w/ HIV 4yrs ago when presented with PCP which was successfully treated. Has been compliant with prophylaxis abx and HAART. TPN started via central catheter in hosp. Then became febrile, hypotensive, yachy, and tachypnic. Developed eye pain, photophobia. Fundoscopic exam: glistening off-white lesions w/ indistinct borders which extend from chorioretinal surface into vitreous. Decreased visual acuity
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This patient has oropharyngeal & esophageal candidiasis w/ dissemination.
Endogenous candida endophthalmitis
- caused by hematogenous seeding
- marker of wide spread dissemination
- clinical: ocular pain, photophobia, scotoma, fever
- RF: central venous catheter, TPN, bread spec abx, prior abd surgery, neutropenia, steroids, IV drug abuse
- RX: vitrectomy with systemic Amphtericin B/fluconazole (ketoconozole cannot reach therapeutic concentration in eye; Amp B cannot achieve therapeutic concentration in vitreous)
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MAC and eye manifestations
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- no ocular manifestations
- more GI
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CNS Cryptococcous
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- altered mental status
- HA
- N/V
- rare eye manifestations: papilledema, chorioretinitis, optic neuritis
- more pulmonary manifestations
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Aspergillous endophthalmitis
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-eye pain
- visual changes
- more pulmonary manifestations
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