Skin Manifestations of Systemic Bacterial Infections
The clinical manifestations of a systemic bacterial infection may be caused directly by the bacteria and/or by its toxins. Secondary locations of bacteremias occur mainly during the course of endocarditis or septic vasculitis during acute or chronic menin
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Pascal del Giudice and Olivier Chosidow
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The clinical manifestations of a systemic bacterial infection may be caused directly by the bacteria and/or by its toxins. Secondary locations of bacteremias occur mainly during the course of endocarditis or septic vasculitis during acute or chronic meningococcaemia and gonococcaemia. Ecthyma gangrenosum is a particular form of secondary septic location occurring mainly in neutropenic subjects and mainly caused by Pseudomonas aeruginosa. Toxinic manifestations are mainly caused by Staphylococcus aureus, responsible for toxic shock syndrome and staphylococcal scalded skin syndrome, and Streptococcus pyogenes, responsible for streptococcal toxic shock syndrome and scarlet fever. Purpura fulminans is a particular severe form of bacterial sepsis associated with vasculopathy and necrosis of the extremity.
The clinical manifestations of a systemic bacterial infection may be caused directly by the bacteria and/or by its toxins. Similar clinical manifestations may be caused by different bacteria, and the same bacteria may be responsible for different clinical manifestations. Therefore, the skin manifestations of systemic bacterial infections can be classified according to the
P. del Giudice (*) Infectiology and Dermatology Department, Hôpital Bonnet, 183600 Fréjus, France
clinical syndrome or to the bacteria (Table 1). For example, bacteria such as Staphylococcus. aureus may cause toxic shock syndrome, purpura fulminans and septic emboli. Indeed, a clinical syndrome such as purpura fulminans may be caused by different bacteria such as Neisseria meningitidis, Streptococcus pneumoniae or Staphylococcus. aureus.
13.1 Skin Manifestation Caused by Secondary Locations During the Course of a Bacteriemia 13.1.1 Skin Manifestations of Endocarditis Two main forms of endocarditis are described in patients with native cardiac valves, i.e., acute endocarditis mainly caused by S. aureus and sub-acute endocarditis caused by non-typable Streptococci or Enterococci. In rare cases, endocarditis is caused by non-cultivable bacteria such as Coxiella burnetti and others. In addition, an increasing number of cases of endocarditis occur on prosthetic valves. The physiopathology may thus differ from one type of endocarditis to another, and also according to the bacteria involved. Description of endocarditis-related skin manifestations is confusing; Janeway lesions and Osler’s nodes were described at the beginning of the twentieth century, a period where bacterial endocarditis was different from at the present [1]. Classically reported Janeway lesions are macular, purpuric lesions that occur on hands and feet (Fig. 13.1). Histologically, they show neutrophilic microab-
J. Revuz et al. (eds.), Life-Threatening Dermatoses and Emergencies in Dermatology, DOI: 10.1007/978-3-540-79339-7_13, © Springer-Verlag Berlin Heidelberg 2009
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P. del Giudice and O. Chosidow Table 13.1 Cutaneous features of bacterial infections Staphylococcus aureus
Beta-haemolytic Streptococ
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