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

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.
AuthorsL Danielsen, E Balslev, G Döring, N Høiby, S M Madsen, M Agren, H K Thomsen, H H Fos, H Westh
JournalAPMIS : acta pathologica, microbiologica, et immunologica Scandinavica (APMIS) Vol. 106 Issue 7 Pg. 721-6 (Jul 1998) ISSN: 0903-4641 [Print] DENMARK
PMID9740512 (Publication Type: Case Reports, Journal Article)
Chemical References
  • Bacterial Toxins
  • Exotoxins
  • Virulence Factors
  • ADP Ribose Transferases
  • toxA protein, Pseudomonas aeruginosa
  • 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)

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