GRAM-NEGATIVE TOE WEB INFECTION

Gram-negative toe web infection (GNTWI) is an uncommon bacterial infection of the web spaces, usually precipitated the constant wearing of shoes.

• Males predominate with a ratio of 4:1.
• In a review of 123 cases, Pseudomonas aeruginosa was the prevailing pathogen, but E. coli, Proteus mirabilis, and Morganella morganii were also found. (Of note, gram-negative bacteria can be cultured in 10% of normal appearing web spaces.)
• Interdigital tinea commonly predisposes primarily by two mechanisms: 1) Damage to the stratum corneum facilitating bacterial invasion and 2) Secretion of penicillin and streptomycin-like antibacterial substances favoring colonization by gram-negative bacteria.
• Chronically wet feet is a risk factor. This is usually via the chronic wearing of shoes and the profession e.g., coal miners; or occasionally hyperhidrosis.

Clinical

Initially, the toe web becomes white and macerated. Later, wetness, inflammation, and odor develops. In the full-blown setting, the web spaces of all toes are eroded, malodorous, and inflamed. Green-tinted pus and/or even skin may be seen. The web spaces may fluoresce under Wood's light.

Gram negative toe web infection with Id Reaction.

RegionalDerm

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