title: 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.affiliation: Department of Dermatology, Bispebjerg Hospital, Copenhagen, Denmark.
authors.forename: L
authors.initials: L
authors.lastname: Danielsen
authors.forename: E
authors.initials: E
authors.lastname: Balslev
authors.forename: G
authors.initials: G
authors.lastname: Döring
authors.forename: N
authors.initials: N
authors.lastname: Høiby
authors.forename: S M
authors.initials: SM
authors.lastname: Madsen
authors.forename: M
authors.initials: M
authors.lastname: Agren
authors.forename: H K
authors.initials: HK
authors.lastname: Thomsen
authors.forename: H H
authors.initials: HH
authors.lastname: Fos
authors.forename: H
authors.initials: H
authors.lastname: Westh
mesh_terms: D036002:ADP Ribose Transferases; D000328:Adult; D000818:Animals; D001427:Bacterial Toxins / Q000032:analysis; D016466:CHO Cells; D006224:Cricetinae; D005098:Exotoxins / Q000032:analysis; D005122:Exudates and Transudates / Q000276:immunology / Q000382:microbiology; D006801:Humans; D008297:Male; D011552:Pseudomonas Infections / Q000276:immunology / Q000382:microbiology / Q000473:pathology*; D011550:Pseudomonas aeruginosa / Q000254:growth & development* / Q000276:immunology; D013924:Thrombophlebitis / Q000276:immunology / Q000382:microbiology / Q000473:pathology; D014647:Varicose Ulcer / Q000382:microbiology* / Q000473:pathology* / Q000601:surgery; D037521:Virulence Factors; D014945:Wound Healing / Q000276:immunology; D000097668:Pseudomonas aeruginosa Exotoxin A
chemical_list: D036002:ADP Ribose Transferases; D001427:Bacterial Toxins; D005098:Exotoxins; D037521:Virulence Factors; D000097668:Pseudomonas aeruginosa Exotoxin A