Etiology of Cellulitis and Clinical Prediction of Streptococcal Disease: A Prospective Study

Bruun, Trond; Oppegaard, Oddvar; Kittang, Bård Reiakvam; Mylvaganam, Haima; Langeland, Nina; Skrede, Steinar

doi:10.1093/ofid/ofv181

Cited by 62 publications

(51 citation statements)

References 39 publications

(73 reference statements)

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“…2 In the case of streptococcal skin superinfection, anti-DNase B titres are increased more often. 3 Recurrent erysipelas are often caused by group A b-haemolytic streptococci, and sometimes by groups B, C and G. 1,2 To the best of our knowledge, two cases of recurrent erysipelas due to streptococcus with similarities to ours have been reported in the literature. 4,5 In both cases, the immunosuppressive treatment triggered infection and permitted streptococcus isolation.…”

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confidence: 76%

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Recurrent erysipelas of the face with hyperimmune reaction to group C streptococcus

Dequidt¹,

Jullié²,

Sénéschal³

et al. 2018

Br J Dermatol

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confidence: 76%

“…Serological tests may be conclusive but they do not confirm the exact group of streptococcus responsible for skin infection . In the case of streptococcal skin superinfection, anti‐DNase B titres are increased more often . Recurrent erysipelas are often caused by group A β‐haemolytic streptococci, and sometimes by groups B, C and G …”

mentioning

confidence: 99%

Recurrent erysipelas of the face with hyperimmune reaction to group C streptococcus

Dequidt¹,

Jullié²,

Sénéschal³

et al. 2018

Br J Dermatol

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“…3,11,12 The clinical presentations were also classical with diabetes mellitus as a major risk factor. 4,[13][14][15][16] Most of the patients received Inj crystalline penicillin and cloxacillin for Streptococci and Staphylococci. 13 Subcutaneous pressures were elevated in patients with cellulitis of the leg when compared to the normal leg.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous pressure in cellulitis of the leg: can it be a predictor for early surgical intervention?

Nadarajan¹,

Chase²,

Roopavathana³

et al. 2016

Int Surg J

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INTRODUCTIONCellulitis is a spreading bacterial infection of the dermis and subcutaneous tissues. It occurs among both men and women. 1 The incidence of lower limb cellulitis was reported relatively high with 199 cases per 100,000 person-years in a population based study. 2 The most common causative organisms are Streptococcus pyogenes and Staphylococcus aureus. 3 The risk factors are toe web intertrigo, leg ulcers, trauma causing breach in the skin continuity, venous insufficiency, lymphedema, diabetes, obesity and immuno-compromised conditions. The most common risk factors for recurrence are venous insufficiency and lymphedema and previous episode of cellulitis. 4 The most common pathogenesis is the breach in skin integrity especially the toe web space. The Streptococci and Staphylococci produce toxins which cause inflammatory mediator release, resulting in the edema and skin changes.5 If the infection is persisting in the subcutaneous plane, the edema worsens leading to local complications resulting in systemic sepsis and multiple organ dysfunction. The common clinical ABSTRACT Background: Cellulitis, an infection of skin and subcutaneous tissue is usually managed conservatively and surgical intervention is required for local complications. The aim of this study was to correlate the subcutaneous pressure with the need for early surgical intervention in cases of lower limb cellulitis. Methods: We prospectively measured subcutaneous pressures in the normal leg and in the leg with cellulitis. Patients managed with parenteral antibiotics were compared to those managed with parenteral antibiotics and surgical intervention with standard statistical tests. Results: The median subcutaneous pressure was 3 mmHg and 9 mmHg in the normal leg and the other with cellulitis respectively. The mean of difference in subcutaneous pressure in legs with cellulitis compared to normal legs was 5.93 mmHg and 8.29 mmHg in the conservative group and surgical intervention group respectively. The difference in subcutaneous pressure between the normal leg and in the leg with cellulitis was statistically significant (p<0.001). The difference in the average pressure between surgical intervention group and conservative group was 2.36 mmHg and was statistically significant (p<0.05). The optimal threshold (difference in pressure) was identified as >=7 with sensitivity of 85.7% and specificity of 57.1%. Area under the ROC curve (SE) was 0.71 (0.10) with 95% CI (0.51, 0.87). Conclusions:The subcutaneous pressure in leg with cellulitis is a predictor for the need for early surgical intervention. It can be used as an adjunct in management and clinical decision making for cases of cellulitis of lower limbs.

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“…Las distintas puertas de entrada, más frecuentes en miembros inferiores, están constituidas por lesiones traumáticas, excoriaciones, (17)(18)(19)(20) intertrigos interdigitales y traumatismos cerrados . También se deben considerar dentro de los factores predisponentes locales a las vasectomías, vaciamientos ganglionares, mastectomías y tejidos afectados por radioterapia que afectan fundamentalmente el tórax.…”

Section: Introductionunclassified

Skin and soft tissues infections

Peralta

Taboada

2017

Rev. virtual Soc. Parag. Med. Int

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RESUMENIntroducción: las infecciones de piel y partes blandas (IPPB) son motivo de consulta frecuente y el espectro clínico va desde procesos banales hasta letales. En los últimos años, el Staphylococcus aureus meticilino resistente ha sido el principal agente causal. Objetivos: determinar las características clínicas y microbiológicas de IPPB provenientes de la comunidad, aplicar regla de Shapiro para calcular la rentabilidad de los cultivos. Metodología: diseño observacional, descriptivo, prospectivo, que incluyó a 181 pacientes adultos internados en el Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) durante 2015 y 2016. Resultados: la edad media fue 56 años, hubo predominio de sexo masculino (57%). La IPPB más frecuentemente diagnosticada fue la celulitis: 106 pacientes (59%), seguido por fascitis necrotizante 61 (34%). La comorbilidad más frecuente fue la diabetes mellitus tipo 2. El Staphylococcus aureus fue el germen más frecuentemente aislado. Relacionando a los pacientes según el resultado de hemocultivo y la regla de Shapiro, los pacientes que tuvieron puntajes mayores a 5 tuvieron mayor reporte de hemocultivos positivos. Presentaron sepsis 85 pacientes, requirieron intervención quirúrgica 44% y fallecieron 5 sujetos. Conclusiones: la celulitis fue la IPPB más frecuente, la mayoría causada por Staphylococcus aureus. La diabetes mellitus fue la comorbilidad más frecuente. La aplicación de la regla de Shapiro para la selección de pacientes a quienes realizar hemocultivos mejoraría su rentabilidad.Palabras claves: celulitis, erisipela, fascitis necrotizante, Staphylococcus aureus resistente a meticilina ABSTRACT Introduction: Skin and soft tissues infections (SSTI) are common reasons for consulting and the clinical spectrum ranges from trivial to lethal processes. In the last years, methicillin resistant Staphylococcus aureus has been the main causative agent. Objectives: To determine the clinical and microbiological characteristics of SSTI from the community and apply Shapiro rule to calculate the profitability of cultures. Methodology: Observational descriptive and prospective design that included 181 adult patients admitted in the Clinical Service of the National Hospital (Itauguá, Paraguay) during 2015 and 2016. Results: Mean age was 56 years and there was a predominance of male sex (57%). The most frequently diagnosed SSTI was cellulitis: 106 (59%) patients followed by 61 (34%) patients with necrotizing fasciitis. The most frequent comorbidity was type 2 diabetes mellitus. Staphylococcus aureus was the most

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Etiology of Cellulitis and Clinical Prediction of Streptococcal Disease: A Prospective Study

Cited by 62 publications

References 39 publications

Recurrent erysipelas of the face with hyperimmune reaction to group C streptococcus

Recurrent erysipelas of the face with hyperimmune reaction to group C streptococcus

Subcutaneous pressure in cellulitis of the leg: can it be a predictor for early surgical intervention?

Skin and soft tissues infections

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