Pseudomonas Aeruginosa Otochondritis Complicating Localized Cutaneous Leishmaniasis: Prevention of Mutilation by Early Antibiotic Therapy

Abstract

A patient with an ulcerated cutaneous leishmaniasis of the pinna had suppurative otochondritis after a first unsuccessful course of treatment with meglumine antimoniate. Although the Leishmania ulceration healed after a second course of meglumine antimoniate, and despite three oral dicloxacillin or pristinamycin courses, the otochondritis extended and an abscess developed. Pus from the abscess revealed a pure culture of Pseudomonas aeruginosa. Five days of oral ciprofloxacin plus rifampin led to a marked improvement. The P. aeruginosa isolate was sensitive to ciprofloxacin but fully resistant to rifampin. Healing with minimal mutilation was obtained at the end of a six-week course of multiple antibiotic therapy. Pseudomonas aeruginosa otochondritis was a co-factor of cartilage mutilation in this patient. Thus, infection with P. aeruginosa should be promptly treated when present in tender cutaneous or mucosal leishmaniasis lesions near cartilaginous areas.

Travelers With Cutaneous Leishmaniasis Cured Without Systemic Therapy

“…Typically, cutaneous leishmaniasis (CL) presents as 1 or several chronic, infiltrated lesions on exposed parts of the body [1]. CL lesions are not spontaneously painful, but they do result in marked local discomfort when ulcerated or infected with bacteria [2]. In immunocompetent subjects, wide dissemination of CL is uncommon and visceral spread causing pathology is exceptional [1].…”

Two cases of cutaneous leishmaniasis in Dutch military personnel treated with oral miltefosine

“…Chiclero's ulcer is a relatively rare clinical presentation that does not easily heal spontaneously and may be both mutilating due to secondary bacterial otochondritis and difficult to treat 10. Currently, CL due to L. braziliensis is usually treated to accelerate cure and to prevent mucosal involvement 2.…”

Biodegradable nanocarriers coated with polymyxin B: Evaluation of leishmanicidal and antibacterial potential

“…Even with technological approaches (such as NPs) to enhance the leishmanicidal effect, the treatment for CL does not rely solely on parasite elimination. Most secondary infections in CL ulcers present Gram-negative bacteria, as Klebsiella pneumoniae and Pseudomonas aerugionosa [5], which do not impair leishmaniasis healing; however, Pseudomonas secondary infection can be a co-factor in mutilation induced by CL [12], besides inhibition of phagocytosis due to alginate supported biofilms [13]. Treatment for dermal infection caused by Pseudomonas and other Gram-negative bacteria includes the antimicrobial peptides called polymyxins, which are also active against few strains of Gram-positive bacteria [14].…”