Ulcer bed infection. Report of a case of enlarging venous leg ulcer colonized by Pseudomonas aeruginosa.

Abstract

We report a case of ulcer bed infection in an enlarging venous leg ulcer without clinical signs of cellulitis in the surrounding tissues. Signs of infection in the leg ulcer were: 1) cocci-like structures and bacteria-like rods around vessel walls in the viable ulcer bed, 2) vasculitis-like inflammation of deeply situated vessels of the viable tissue, 3) Pseudomonas aeruginosa-specific antibodies in the serum (other than against exotoxin A), 4) extensive epidermolysis of normal human skin by the wound exudate in vitro, and 5) P. aeruginosa exotoxin A in the wound exudate (23 ng/ml). In an in vitro cell assay, the wound exudate was cytotoxic and rabbit antibodies to exotoxin A, but not a serine proteinase inhibitor, inhibited this cytotoxicity. P. aeruginosa exotoxin A might contribute to the pathogenesis of the ulcer enlargement. The ulcer improved after the third skin graft, probably mainly due to effective treatment with a long-stretch compression bandage.

• Authors: L Danielsen, E Balslev, G Döring, N Høiby, S M Madsen, M Agren, H K Thomsen, H H Fos, H Westh
• Journal: APMIS : acta pathologica, microbiologica, et immunologica Scandinavica (APMIS) Vol. 106 Issue 7 Pg. 721-6 (Jul 1998) ISSN: 0903-4641 [Print] DENMARK
• PMID: 9740512 (Publication Type: Case Reports, Journal Article)

Chemical References

• Bacterial Toxins
• Exotoxins
• Virulence Factors
• ADP Ribose Transferases
• toxA protein, Pseudomonas aeruginosa

Topics

• ADP Ribose Transferases
• Adult
• Animals
• Bacterial Toxins (analysis)
• CHO Cells
• Cricetinae
• Exotoxins (analysis)
• Exudates and Transudates (immunology, microbiology)
• Humans
• Male
• Pseudomonas Infections (immunology, microbiology, pathology)
• Pseudomonas aeruginosa (growth & development, immunology)
• Thrombophlebitis (immunology, microbiology, pathology)
• Varicose Ulcer (microbiology, pathology, surgery)
• Virulence Factors
• Wound Healing (immunology)