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The clinical presentation of pseudomonal infections depends on the site of infection and is often indistinguishable from other gram-negative organisms.
Glanders and melioidosis infections have different stages with varied clinical presentations.

    Bacteremia and sepsis

    • Clinical presentation is often identical to other gram-negative organisms.
    • Fever is usually present, except in very young or premature infants. Fever is often accompanied by tachycardia and tachypnea.
    • Patients appear toxic and may present with apprehension, disorientation, or obtundation.
    • Signs of shock, including hypotension, azotemia, or acute renal failure, may be observed.
    • Respiratory failure occurs in the presence of bacteremic pseudomonal pneumonia or in conjunction with airway restrictive disease syndrome.
    • Jaundice appears to occur more often than in other forms of gram-negative sepsis, but disseminated intravascular coagulation (DIC) is relatively uncommon.

Pseudomonal cellulitis presents with a dusky red–to–bluish green skin discoloration and purulent discharge. The typical fruity or mouselike odor has been linked to pseudomonal infection. Vesicles and pustules may occur as satellite lesions. The eruption may spread to cover wide areas and cause systemic manifestations.

  • CNS infections
    • Clinical signs of pseudomonal meningitis are indistinguishable from bacterial meningitis, except for the hallmark EG skin lesions.
    • Signs of CNS infections in neonates are often nonspecific and subtle (eg, fever, hypothermia, lethargy, seizures, irritability, bulging fontanel, respiratory distress, feeding intolerance, vomiting).
    • In children and adults, physical presentations of bacterial meningitis can include fever, photophobia, nuchal rigidity, lethargy, disorientation, coma, and ataxia.
  • Ear infections
    • Involvement of the ear can be mild to severe.
    • Pain can be elicited by traction of the tragus or pinna, although pain becomes persistent as the disease progresses.
    • Typical presentations include erythema, edema, pain, and warmth; however, many individuals who are immunocompromised may manifest no signs.
  • Eye infections
    • Ring ulcers can reportedly develop.
    • The corneal epithelium peripheral to the primary ulcer typically develops a diffuse, gray, ground-glass appearance. The ulcer is also associated with marked anterior chamber reaction and hypopyon formation.
    • Extensive keratitis can extend to the limbus and produce an infectious scleritis.
    • Diffuse epithelial disease is usually associated with hydrophilic contact lens wear.

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Individuals who are immunocompromised tend to be vulnerable to pseudomonal infections. People who work with animals or who are exposed to contaminated soil and water in certain endemic areas are at risk for glanders and melioidosis.
Risk factors and predisposing conditions include the following:

  • Bacteremia: Conditions that predispose disease progress to bacteremia include hematological malignancies, immunoglobulin deficiency states, neutropenia, diabetes mellitus (DM), organ transplantation, severe burns, diffuse dermatitis, and AIDS. Other predisposing factors include cancer chemotherapy that causes neutropenia or ulceration of the respiratory and GI tracts, steroid administration, antibiotic therapy, placement of IV lines, urinary tract instrumentation or catheterization, surgery, trauma, and premature birth. IV lines should be inserted under sterile conditions and should be changed per hospital protocol.
  • Bone infections: Individuals at risk include persons who abuse IV drugs; postsurgical patients; patients with penetrating trauma, diabetes, peripheral vascular disease, or rheumatoid arthritis; older persons; and patients with chronic debilitation.

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