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Andrews' pustular bacteremia: causes, symptoms, diagnosis, treatment
Medical expert of the article
Last reviewed: 07.07.2025
Andrews' bacterid pustulosis occurs when there are foci of infection in the body, therefore, in its pathogenesis, great importance is attached to the hypersensitivity reaction to streptococcal antigens. Clinically, it is characterized by the appearance of blisters and small pustules on the unchanged skin of the palms and soles. The blisters quickly turn into pustules, which are characterized by rapid growth; their diameter sometimes reaches 5-10 mm, they are surrounded by a narrow rim of erythema. The rash usually resolves within 2-3 weeks if the factor that provoked the disease is eliminated.
Pathomorphology of Andrews bacterium pustulosis: moderate acanthosis, hyperkeratosis, focal parakeratosis, intraepidermal pustules and blisters surrounded by a zone of mild spondylosis. Pustules are sometimes located one under another. The pustule cover consists of several rows of granular and spiny epithelial cells covered with horny scales. Pustules contain fibrin, neutrophilic granulocytes, single lymphocytes and remnants of destroyed epithelial cells. In the spiny layer - exocytosis. In the dermis - edema, vasodilation and pronounced perivascular infiltrates consisting of lymphocytes, histiocytes and neutrophilic granulocytes, sometimes with an admixture of plasma cells.
The nosological affiliation of Andrews' bacterid is debated. A.A. Kalamkarian et al. (1982) deny the existence of this disease, some consider it a localized form of subcorneal pustulosis, some - a variety of palmoplantar pustulosis, and DM Stevens and A.V. Ackemian (1984) - palmoplantar psoriasis.
Based on several observations, it is believed that Andrews' bacterid differs significantly from other localized pustuloses clinically and histologically. Clinically, by the presence of small vesicles along with pustules, as well as rapid dynamics of the rash, histologically, by the presence of an eczematous reaction and the absence of spongiform pustules.
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