Skin clues in the diagnosis of life-threatening infections

Rev Infect Dis. 1986 Jan-Feb;8(1):1-11. doi: 10.1093/clinids/8.1.1.

Abstract

Skin lesions, an important clue to the cause of septicemia, result from five main processes: (1) disseminated intravascular coagulation and coagulopathy; (2) direct vascular invasion and occlusion by bacteria or fungi; (3) immune vasculitis and immune complex formation; (4) emboli from endocarditis; and (5) vascular effects of toxins. Disseminated intravascular coagulation probably plays only a minor role in pathogenesis. Vascular invasion by bacteria may result in a severe inflammatory reaction, as in meningococcemia, or in a minimal reaction, as in ecthyma gangrenosum. Gram-stained smears of scrapings from the base of skin lesions--a frequently neglected procedure--is an important diagnostic adjunct. Skin biopsies are particularly important in the diagnosis of Rocky Mountain spotted fever and infections caused by Candida.

Publication types

  • Review

MeSH terms

  • Antigen-Antibody Complex / analysis
  • Bacterial Toxins / pharmacology
  • Candidiasis / diagnosis
  • Cyanosis / complications
  • Disseminated Intravascular Coagulation / complications
  • Embolism / complications
  • Female
  • Gangrene / complications
  • Gonorrhea / diagnosis
  • Humans
  • Male
  • Meningitis, Meningococcal / diagnosis
  • Pseudomonas Infections / diagnosis
  • Purpura / complications
  • Rickettsia Infections / diagnosis
  • Salmonella Infections / diagnosis
  • Sepsis / complications
  • Sepsis / diagnosis*
  • Skin / drug effects
  • Skin Diseases / etiology*
  • Vasculitis / immunology

Substances

  • Antigen-Antibody Complex
  • Bacterial Toxins