Differential Diagnosis for Haemorrhagic Dermal Bullae in Wound Infections

• Single most likely diagnosis
  • Streptococcus pyogenes: This bacterium is known for causing severe infections, including necrotizing fasciitis, which can present with hemorrhagic bullae. It's a common cause of wound infections that can lead to such severe skin manifestations.
• Other Likely diagnoses
  • Clostridium perfringens: This bacterium can cause gas gangrene, a condition characterized by severe tissue damage and can include hemorrhagic bullae as part of its presentation. It's a significant concern in wounds contaminated with soil or feces.
  • Coagulase-negative Staphylococcus: While less commonly associated with hemorrhagic bullae compared to Streptococcus pyogenes, coagulase-negative staphylococci can cause severe infections, especially in immunocompromised patients or when associated with medical devices.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Clostridium tetani: Although tetanus infection primarily causes muscle rigidity and spasms, in rare cases, it can lead to local tissue damage around the wound site. Missing this diagnosis could be fatal due to the toxin's effect on the nervous system.
• Rare diagnoses
  • Vibrio vulnificus: This bacterium can cause severe wound infections, particularly in individuals with exposure to contaminated water. It can lead to hemorrhagic bullae but is less common compared to the other listed pathogens.
  • Other anaerobic bacteria: Various anaerobic bacteria can cause severe wound infections, including those that might present with hemorrhagic bullae. These are less common but should be considered, especially in wounds with significant tissue damage or in immunocompromised patients.