Necrotizing fasciitis and necrotizing cellulitis - Abstracts

Subacute forms of necrotizing fasciitis and necrotizing cellulitis: diagnosis criteria and surgical decision-making

[Article in French]

Chosidow O.

Service de Medecine Interne, GH de la Pitie-Salpetriere, Paris, France.

Subacute cellulitis could be described as intermediary forms between benign erysipelas and life-threatening necrotizing fasciitis with toxic shock syndrome. The key point is to consider any cellulitis a possible indication for surgery. Subacute cellulitis may occur in the elderly or diabetic patients. Local signs (cyanosis, necrosis.) are sometimes isolated. They may occur during the evolution of cellulitis requiring a medical treatment. This emphasizes the importance of carefully following-up any patient treated by antibiotics for cellulitis, i.e. monitoring the extension of erythema (using a felt-pen) and atypical local signs. Complementary investigations are especially helpful when diagnosing cellulitis requiring a surgical treatment: fine-needle aspirations; histology; soft-tissue X-ray; MR imaging that can detect alterations of the cutis and fascia, myositis, and abscesses.

Surgery can be delayed for such patients, allowing for a better preparation. Sometimes, only surgical exploration may confirm cellulitis. Lastly, some cases may mimic surgical cellulitis but a prolonged course of antibiotics is able to control the disease. Abscesses requiring secondary surgical evacuation may complicate all these insidious features.

Publication Types:
Consensus Development Conference
Review

PMID: 11319370 [PubMed - indexed for MEDLINE]

* * * * *

What data is needed today to deal with cellulitis and necrotizing fasciitis?

Cazorla C.

Service des Maladies Infectieuses, Hopital Bellevue, Saint-Etienne, France.

Cellulitis and necrotizing fasciitis can be distinguished by the depth of the cutaneous lesion and classically by the different bacteria implicated. This classification is not taken into account by the practitioner because of a similar therapeutic strategy. That is why most authors used a single title: necrotizing soft tissue infection. The potential severity of these infections required a quick diagnosis to decrease the risk of mortality and severe functional consequences. The analysis of the literature doesn't allow to establish the incidence of these infections. It was demonstrated that infections due to Streptococcus serogroup A increased over the last few years, thanks to a specific surveillance system. Risk factors leading to these infections are: cutaneous trauma, age, diabetes, varicella in children, contact with people infected by Streptococcus. The most recent studies demonstrated a frequent polymicrobism of the infections, with anaerobes, Streptococcus, Staphylococcus, and gram-negative rods.

At the onset of the disease, the diagnosis is difficult to establish. Pain, induration of tissues, a rapid evolution, the inefficacy of antibiotic treatment suggest the diagnosis of necrotizing infection. MRI, when available, is a good technique to reveal the depth of the infection and necrosis. Surgery will confirm the diagnosis and allow for debridement of necrotized tissues. A delayed surgery increases the mortality risk factor, as stated in numerous studies.

Publication Types:
Consensus Development Conference
Review

PMID: 11319376 [PubMed - indexed for MEDLINE]

* * * * *

Management of necrotizing cellulitis and fasciitis

Derancourt C.

Service de dermatologie, hopital Robert-Debre, Reims, France.

A literature review did not reveal any controlled study on the management of necrotizing fasciitis.

Treatment protocol includes: - an immediate or early surgical management with debridement of all necrotic tissue and extensive fasciotomy followed by a surgical reexamination of the infected area in the following days; - an initial antibiotic therapy targeting aerobic Gram-positive and Gram-negative organisms and anaerobes (e.g: amoxicilline-clavulanic acid or vancomycin-metronidazole); - an adequate nutritional support, infusion, and resuscitation; - hyperbaric oxygen therapy may be considered as an associated treatment; but there is no randomized, controlled trial demonstrating its efficacy.

Publication Types:
Consensus Development Conference
Review

PMID: 11319377 [PubMed - indexed for MEDLINE]

* * * * *

Related Links:

Necrotizing soft tissue infections: a primary care review (Complete Article)

Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients (Abstract)

Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality (Abstract)

Necrotizing fasciitis: report of 39 pediatric cases (Abstract)

Postoperative antibiotics decrease incidence of seroma-related cellulitis.

Abstract

Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma-related cellulitis.

Edwards C, Angstadt J, Whipple O, Grau R.

Department of Surgery, Mercer University School of Medicine, Memorial Health University Medical Center, Savannah, Georgia, USA.

Seroma formation has been documented as a common complication in laparoscopic ventral herniorraphy. However, there are no recent studies documenting the incidence of or protective strategies against seroma-related cellulitis. The purpose of this study was to evaluate 65 laparoscopic ventral herniorraphies and to determine if seroma-related cellulitis can be prevented by the routine use of postoperative prophylactic antibiotics. A retrospective case review of 65 laparoscopic ventral herniorraphies was done at our institution from February 2002 to January 2004.

All were performed using either Gore-Tex DualMesh or Bard Composix mesh and performed under the direct supervision of a single surgeon. Twenty patients received only preoperative third-generation cephalosporins or fluoroquinolones. All other patients received either 7 days of postoperative oral cephalosporins or fluoroquinolones in addition to preoperative antibiotics. Sixty-five patients underwent laparoscopic ventral hernia repair.

There were 45 patients in the postoperative antibiotic group and 20 patients in the preoperative-only antibiotic group. Twenty-one patients developed seromas. Twelve of these developed cellulitis.

The rates of seroma formation were similar in the two groups with 30 per cent in the preoperative only group and 33 per cent in the postoperative antibiotic group. However, 100 per cent of the seromas in the preoperative antibiotic group developed seroma-related cellulitis. Only 40 per cent of seromas in the postoperative antibiotic group developed cellulitis. In addition, two seromas in the preoperative antibiotics-only group progressed to frank mesh infection necessitating operative removal.

There were no complications related to antibiotic administration. Laparoscopic ventral hernia repair is a safe and effective procedure. Our seroma rate is 30 per cent and compares equally with prior reported studies. Seroma-related cellulitis is a common problem that can lead to mesh infection, postoperative morbidity, and further need for operative care. The administration of 7 days of postoperative prophylactic antibiotics appears to be a safe and effective means to limit seroma-related cellulitis.

PMID: 16372611 [PubMed - indexed for MEDLINE]

Cellulitis incidence in a defined population

Epidemiology and Infection

Copyright © 2005 Cambridge University Press
Copyright © 2005 Cambridge University Press
doi:10.1017/S095026880500484X
Published Online

S. M. ELLIS SIMONSEN a1, E. R. VAN ORMAN a1, B. E. HATCH a1, S. S. JONES a1, L. H. GREN a1, K. T. HEGMANN a1 and J. L. LYON a1c1a1

Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT 84108, USA

Abstract

A population-based insurance claims database was used to examine cellulitis incidence, anatomical sites of infection, complicating diagnoses, source of health service, and recurrence rates. Insurance claim files were searched for cellulitis ICD-9-CM codes 681.0–682.9. Complications of cellulitis including erysipelas, lymphadenitis, lymphangitis, and necrotizing fasciitis were also identified by ICD-9-CM codes. We found a cellulitis incidence rate of 24·6/1000 person-years, with a higher incidence among males and individuals aged 45–64 years. The most common site of infection was the lower extremity (39·9%). The majority of patients were seen in an outpatient setting (73·8%), and most (82·0%) had only one episode of cellulitis during the 5-year period studied. There was a very low incidence of cellulitis complications, including necrotizing fasciitis. Cellulitis is fairly common, usually treated in outpatient settings, and is infrequently complicated by erysipelas, lymphadenitis, lymphangitis, or necrotizing fasciitis.

(Accepted April 27 2005)

Correspondence:c1 Department of Family and Preventive Medicine, 375 Chipeta Way, Suite A, Salt Lake City, UT 84108, USA. (Email: jlyon@dfpm.utah.edu)

Cambridge Journals Online

------------------

At Risk Populations

Individuals withthe following conditions are at higher risk of cellulitis then the general population and special consideration should be taken in account in the treatment, management and prevention of the infection.

• Diabetes
• Immunodeficiency - of any type
• Other systemic illness
• Varicella
• Impaired peripheral circulation (arterial insufficiency stasis)
• Lymphandenectomy following tumor excision, such as mastectomy
• Postvenectomy status following saphenous vein stripping
• Individuals with regular or chronic steroid use
• Lymphedema and lymphatics obstructions
• Cancer patients undergoing treatment, especially chemotherapy
• Acute burn patients
• patients with systemic lupus erythematous (SLE)

------------------

Related Article:

Risk factors for acute cellulitis of the lower limb: a prospective case-control study.

Bjornsdottir S, Gottfredsson M, Thorisdottir AS, Gunnarsson GB, Rikardsdottir H, Kristjansson M, Hilmarsdottir I.Department of Medicine, Division of Infectious Diseases, Landspitali University Hospital, Reykjavik, Iceland.

BACKGROUND:

Acute bacterial cellulitis is a potentially serious infection that commonly recurs. The identification of preventable risk factors could reduce infection-related morbidity and cost and improve patient management. The aim of this study was to identify the risk factors associated with lower-limb cellulitis, including both analysis of risk factors associated with cellulitis in either limb and risk factors in a single limb associated with cellulitis in the same limb. We placed particular emphasis on dermatophytic infections of the foot and bacterial infection and colonization of the toe webs. METHODS: We conducted a prospective case-control study of 100 subjects with cellulitis and 200 control subjects, matched for age and sex, who were admitted to a university hospital during the period October 2000-February 2004. Data were obtained with a questionnaire and from examination of lower limbs and microbiological analyses of samples from the feet.

RESULTS:

The median age of the participants was 66.5 years (interquartile range, 48.8-77.0). The following risk factors were strongly and independently associated with cellulitis: previous history of cellulitis (OR, 31.04; 95% CI, 4.15-232.20), the presence of Staphylococcus aureus and/or beta -hemolytic streptococci in the toe webs (OR, 28.97; 95% CI, 5.47-153.48), presence of leg erosions or ulcers (OR, 11.80; 95% CI, 2.47-56.33), and prior saphenectomy (OR, 8.49; 95% CI, 1.62-44.52). Tinea pedis interdigitalis was associated with cellulitis only when toe web bacteria were excluded from the analysis (OR, 3.86; 95% CI, 1.32-11.27).

CONCLUSIONS:

Risk factors for acute bacterial cellulitis in hospitalized patients include predisposing factors and the presence of sites of pathogen entry on legs and toe webs. These findings indicate that improved awareness and management of toe web intertrigo, which may harbor bacterial pathogens, and other skin lesions might reduce the incidence of cellulitis.

University of Chicago Press

Economic evaluation of linezolid, flucloxacillin and vancomycin in the empirical treatment of cellulitis in UK Hospitals

Economic evaluation of linezolid, flucloxacillin and vancomycin in the empirical treatment of cellulitis in UK hospitals: a decision analytical model.

Vinken A, Li Z, Balan D, Rittenhouse B, Wilike R, Nathwani D.The Lewin Group, Hoofddorp, The Netherlands.

Standard antibiotic treatment of infections has become more difficult and costly due to treatment failure associated with the rise in bacterial resistance. New antibiotics that can overcome such resistant pathogens have the potential for great clinical and economic impact. Linezolid is a new antibiotic that is effective in the treatment of both antibiotic-susceptible and antibiotic-resistant Gram-positive bacterial infections, including those resistant to other available antibiotics.

This breadth of activity is unique in existing antibiotics for Gram-positive bacteria and serves as the rationale for exploring the hypothesis that linezolid is an appropriate choice when considering empirical treatment of cellulitis in complicated or compromised patients in the nosocomial setting.

A decision-modelling approach was used to compare the predicted first-line treatment efficacy and direct medical costs of linezolid with standard treatment of cellulitis among hospitalized patients. For the purposes of this analysis, standard care is defined along two main pathways: (1) initiating care with intravenous (iv) flucloxacillin, switching to vancomycin if the pathogen is found to be resistant to flucloxacillin, or maintaining flucloxacillin if the pathogen is found susceptible, or when culture and sensitivity analysis is inconclusive; or (2) initiating care with vancomycin, switching to iv flucloxacillin if the pathogen is found susceptible to flucloxacillin, maintaining vancomycin if the infection is found resistant, or when culture and sensitivity are inconclusive.

For those patients taking iv flucloxacillin, a switch to oral flucloxacillin was allowed when clinically appropriate. We hypothesized that the cost of care of initiating treatment with linezolid would be less than that for both vancomycin and flucloxacillin in resistance risk ranges typically encountered in UK hospitals. In addition, while the registration trials showed equivalence of linezolid with the comparators in known or suspected methicillin-resistant Staphylococcus aureus (MRSA) and in known or suspected methicillin-susceptible Staphylococcus aureus (MSSA) (vancomycin and oxacillin) respectively, we hypothesized that first-line success rates would be higher in empiric treatment with linezolid.

Efficacy data were obtained from recent clinical trials with linezolid and standard treatment, and medical resource utilization was obtained from an expert panel of clinicians who were questioned regarding resistant and susceptible infections separately. UK hospital direct medical costs of treatment were determined using standard costing techniques. Base case analyses assumed a residual 80% unknown pathogen rate after culture and susceptibility based on a physician survey and supported in the literature.

The analysis in this model predicts that initiating empirical treatment of cellulitis with linezolid will (1) result in higher overall success rates than flucloxacillin for first-line treatment, regardless of resistance risk and (2) be less costly than initiating treatment with flucloxacillin when the likelihood of a patient being infected by a resistant pathogen is greater than 24.1%. Furthermore, initiating treatment with linezolid is predicted to result in higher overall success rates and be less costly than vancomycin across the entire spectrum of the patients' risk of being infected by a resistant pathogen.

Publication Types:
Evaluation Studies

PMID: 11926436 [PubMed - indexed for MEDLINE]

DIABETIC PERFORATING ULCERS WITH OSTEITIS, CELLULITIS, OR NECROSIS TREATED BY ORTHOPAEDIC SURGERY

DIABETIC PERFORATING ULCERS WITH OSTEITIS, CELLULITIS, OR NECROSIS TREATED BY ORTHOPAEDIC SURGERY: RESULTS AND CONTRIBUTION OF PREOPERATIVE BACTERIOLOGY AND COMPLEMENTARY RADIOGRAPHY

Journal of Bone and Joint Surgery, 2004 by Besse, J L, Michon, P, Kawchagie, M, Ducottet, X, Et al

Purpose: Since 1996, our multidisciplinary mcdicosurgical team has decided to propose orthopaedic treatment for diabetic perforating ulcers with osteitis, cellulitis. or necrosis ("cooling down" the acute infected ulcers before programmed surgery) rather than conservative treatment with prolonged antibiotic therapy. We present here a prospective study of 44 cases of diabetic perforating ulcers.

Material and methods. Thirty-two diabetic patients underwent surgery: 77% males, mean age 65.2±8.6 year (range 43-86 years). 87% type 2 diabetes. 52% with a history of perforating ulcers. 45% with minor amputations, and 14% with history of vascular surgery. The lesions-perforating ulcer with osteitis (n=34). vascular necrosis of the toes (n=2). "acute fuel" with cellulitis (n=8)-had progressed over 13.2±15.1 weeks. The preoperative work-up included: bacteriology samples 89%: standard x-rays of the foot 100% (osteitis 84%); duplex Doppler of the lower limb arteries 77% (tibial arteriopathy 87%); double bone scintigraphy 34% (osteitis 93%);TcPO2 (40±14mmHg): artcriography 27%: vascular surgery consultation 18%. Before surgery. 77% of the patients were hospitalised in an endocrinology unit (13±3 days) and 88% were on an antibiotic regimen for 26±18days(50% i.V.).

Orthopaedic surgery (without tourniquet, anaesthesia block, mean duration 53±24 min) involved: partial resection of a toe 23%; amputation of a ray 36% (first ray one. second ray five, third ray one. fourth ray two. tilth ray six); transmetatarsal amputation 32%: resection of the metatarsal heads 4%; calcanectomy (n=1): below knee amputation (n=1): and systematic and multiple samples for bacteriology (deep soft tissue and bone tissue) and for pathology.

Results: Mean hospital stay in the surgery unit was 4±1 days, followed by 18±10 days in the endocrinology unit with antibiotics(oral for 88%) for 34±22 days, 91% of the lesions healed within 33±18 days; four required repeated procedures (two transmetatarsal amputations, one amputation of the first ray. one lower limb amputation): three lesions relapsed.

The peroperative bacteriology samples of the deep soft tissue and bone tissue demonstrated, in comparison with the preoperative samples, that antibiotics had sterilised only 14% of the lesions; with discordant comparison in 40%. partial concordance in 24%. and total concordance in 24%. For the diagnosis of osteitis (confirmed by histology of peroperative bone samples), the x-ray interpretations were largely confirmed (79%, exact diagnosis, 87% sensitivity, false positives 12%), as were the bone scintigrams with labelled polymorphonuclears (exact diagnosis 93%, sensitivity 93%. false positives 7%).

Conclusion: This prospective study demonstrated the advantages of programmed surgery over emergency surgery, including for "acute feet": limited resection, primary suture, rapid wound healing, short antibiotic treatment. It raises some questions concerning the validity of non-surgical bacteriological samples for perforating ulcers, even when performed under rigorous conditions (unique strain isolated from 76% of the samples) and on the possibility of antibiotic pressure on bacterial selection.

J.L. Besse. P. Michon. M. Kawchagie. X. Ducottct, B. Moyen, J. Orgiazzi
Service de Chirurgie Orthopedique, Centre Hospitalier Lyon Sud, 69495 Pierre-Benite, cedex. France

Article

RECURRENT CELLULITIS WITH GROUP G STREPTOCOCCUS BACTEREMIA IN A CANCER PATIENT: A CASE REPORT

Petros E. Tsambiras, MD,1 Jose A. Montero, MD,2 John N. Greene,MD,2 and Ramon Sandin, MD3 The departments of Internal Medicine,1 Infectious Diseases,2 and Pathology3 at the University of South Florida, Tampa, Fla

Introduction

Beta-Hemolytic streptococcal infections can be categorized into Lancefield groups A to H and K to V. Groups A, B, C, D, and G are most often involved in human disease. Group A (Streptococcus pyogenes), one of the most common causes of pharyngitis, produces a variety of skin and soft-tissue infections including cellulitis, erysipelas, and necrotizing fasciitis. Group B (S. agalactiae) has been associated with a history of breast cancer1,2 and with sepsis and meningitis in neonates and peripartum fever in women. Group D includes the nonenterococci (ie, S. bovis) that are associated with gastrointestinal neoplasms and the enterococci (ie, Enterococcus faecalis, E. faecium) that are associated with urinary tract infections and polymicrobial intra-abdominal infections. Less commonly, beta-hemolytic streptococcal infections are caused by Lancefield groups C and G.

Group G streptococcus (GGS) causes a variety of infections including bursitis, tenosynovitis, septic arthritis, osteomyelitis, pleuropulmonary infections, puerperal sepsis, septic abortion, skin and soft-tissue infections, bacteremia, endocarditis, peritonitis, meningitis, and ophthalmitis.3 It has long been recognized as part of the normal flora of the skin, oropharynx, and the intestinal and genital tracts. Predisposing conditions leading to infection with GGS include malignancy, diabetes mellitus, alcoholism, rheumatoid arthritis, and other immunosuppressive states. Unlike group A streptococcus (GAS), GGS had not been associated with toxin production4,5 or recurrent infections5-8 until recently. We report a case of GGS bacteremia and recurrent cellulitis with toxin-like properties.

Case Description

A 67-year-old woman with stage IB squamous cell carcinoma of the cervix underwent radical hysterectomy, bilateral salpingo-oophorectomy, pelvic nodal dissection, and postoperative radiation therapy 10 years prior to admission. A long history of chronic lymphedema of the lower left leg resulted from prior surgery and radiation of the pelvic malignancy. She presented with a two-day history of fever, chills, nausea and vomiting, and pain in the left hip and leg with swelling. She concomitantly developed a warm, tender, erythematous rash over separate regions of her left hip and lower left leg. The patient denied any history of recent trauma or injury. Further questioning revealed at least six similar clinical presentations involving the same leg over the past seven years, including four documented episodes at our institute. One prior episode of similar presentation at another facility presented with positive blood cultures for GAS. In each of the previous occasions at our institute, the presence of acute, deep, venous thrombosis was eliminated by transvenous Doppler ultrasound, and the patient recovered after empirical intravenous antibiotics followed by oral penicillin at discharge. After she was discharged from the most recent hospital admission, desquamation of the skin involving the hands and lower legs followed the resolution of cellulitis of the left lower leg.

Physical examination was notable for a heart rate of 110 beats per minute, fever (T >102°F), chronic lymphedema, and pronounced swelling of the left lower leg. Discrete areas of blanching erythema, warmth, and tenderness involved the skin of the left mid abdomen, the anterior regions of the left leg, and the left buttock region (Figure). Admission laboratory values were unremarkable with the exception of a mild leukocytosis (white blood cell count of 15,200/mm3). A blood culture obtained on admission grew GGS.

After initial intravenous oxacillin and later ticarcillin/clavulanate, 3 million units of intravenous penicillin G every four hours was administered after the blood culture was reported positive. The fever defervesced promptly, and all areas of erythema improved markedly within three days. Ultrasound Doppler studies of her left lower extremity demonstrated no evidence of acute venous thrombosis. Repeat blood cultures were all negative. Pharyngeal and vaginal cultures obtained after initiation of antimicrobial therapy revealed normal flora but no GGS. The patient was discharged after one week of intravenous antibiotics on a course of oral penicillin V. She also was to follow a regimen of monthly intramuscular injections of 2.4 million units of benzathine penicillin for one year to prevent further recurrences of cellulitis.

Discussion

GGS infections are known to colonize and infect patients with a history of underlying malignancies.9-11 From October 1986 to February 1998, only seven cases of GGS bacteremia have been documented at our institution. Bacteremias have more notably been seen in those with pre-existing edema due to a variety of causes.10 The usual portal of entry into the bloodstream is the skin, but areas of mucosal colonization could result in bacteremia. In our patient, chronic lymphedema and potential GGS colonization of the skin or genital tract could have led to recurrent infections, as was the case in a patient with chronic colonization of the esophagus by GGS.12 Monthly intramuscular injections of benzathine penicillin or oral penicillin V for at least a year should prevent these frequent recurrences.

Although GGS is a known cause of cellulitis and bacteremia, recurrences have rarely been reported.5-8 Our patient presented with her seventh episode of cellulitis in a seven-year period. On this most recent admission, her blood culture was positive for GGS. Unfortunately, during previous admissions at our institute, only one set of blood cultures was obtained after antibiotic therapy was initiated, which revealed no growth. The distribution of her erythema included separate areas on her left lower extremity as well as left buttock and left abdominal region. Also, a previous episode was followed by desquamation of the palms and soles. This suggests that a possible toxin-mediated mechanism might be involved in the clinical syndrome.

Unlike S. aureus and GAS,13 GGS has not been associated with toxin production until recently. In the first reported case,4 a woman presented with acute diffuse GGS myositis in association with toxic shock. The organism did not produce Group A streptococcal pyrogenic exotoxins, but it produced at least one new toxin with similar biologic properties. In another case,5 a woman with squamous cell carcinoma of the tongue presented with recurrent episodes of pharyngitis due to GGS. This strain also produced a novel toxin with biologic properties in common with those of GAS. This case highlights emerging aspects of GGS infections that were previously unknown -- its ability to exhibit toxin-like properties and to produce recurrent invasive infection.

References

1. Jackson LA, Hilsdon R, Farley MM, et al. Risk factors for group B streptococcal disease in adults. Ann Intern Med. 1995; 123:415-420
2. Harrison LH, Ali A, Dwyer DM, et al. Relapsing invasive group B streptococcal infection in adults. Ann Intern Med. 1995; 123:421-427.
3. Vartian C, Lerner PI, Shlaes DM, et al. Infections due to Lancefield group G streptococci. Medicine. 1995;64:75-88.
4. Wagner JG, Schlievert PM, Assimacopoulos AP, et al. Acute group G streptococcal myositis associated with streptococcal toxic shock syndrome: case report and review. Clin Infect Dis. 1996;23:1159-1161.
5. Poblete J, Greene JN, Sandin RL, et al. Toxin-producing group G streptococcus: a case report and review. Infect Dis Clin Pract. 1997;6:618-619.
6. Nohlgard C, Bjorklind A, Hammar H. Group G streptococcal infections on a dermatological ward. Acta Derm Venereol. 1992;72:128-130.
7. Armstrong D, Blevins A, Louria DB, et al. Groups B, C, and G streptococcal infections in a cancer hospital. Ann N Y Acad Sci. 1970;174:511-522.
8. Raucher BG, Clark R, Bottone EJ. Group G streptococcal sacroiliitis. Diagn Microbiol Infect Dis. 1986;4:255-257.
9. Gill MV, Cunha BA. Group G streptococci: review. Infect Dis Clin Pract. 1995; 4:162-166.
10. Auckenthaler R, Hermans PE, Washington JA II. Group G streptococcal bacteremia: clinical study and review of the literature. Rev Infect Dis. 1983;5:196-204.
11. Butt AA, Janney A. Clinical characteristics of group G streptococcal bacteremia. Infect Dis Clin Pract. 1998;7:43-48.
12. Karlawish JH. Group G streptococcal bacteremia caused by an asymptomatic esophageal cancer in an elderly man. South Med J. 1994;87:667-668.
13. Manders SM, Heymann WR, Atillasoy E, et al. Recurrent toxin-mediated perineal erythema. Arch Derm. 1996;132:57-

Infections in Oncology

Bilateral breast bacterial cellulitus secondary to Streptococcus agalactiae septicemia.

Abstract

Conscience I, Perceau G, Le Berruyer PY, Bernard P.

Service de Dermatologie, CHU Robert Debre, Reims.

BACKGROUND:

We report a case of group B streptococcal septicemia of digestive origin with secondary bilateral breast dermal-hypodermal localization.

CASE REPORT:

A 71 year-old woman with a past history of bilateral breast cancer treated by conservation therapy was hospitalized because of the sudden occurrence of two clearly delimited, inflammatory, dermal-hypodermal cutaneous plaques located on each breast, associated with fever (39 degrees C), 4 days after a colonoscopy. Further investigations eliminated carcinomatous mastitis and blood cultures were positive for group B B-hemolytic streptococcus (Streptococcus agalactiae). Histological examination of a sigmoid polyp revealed a tubular adenocarcinoma.

DISCUSSION:

We report the first documented case of secondary dermal-hypodermal bacterial skin infection (cellulitis) due to group B B-hemolytic streptococcus. The occurrence after colonoscopy examination, chronology of clinical features, bilaterality and positive blood cultures are arguments in favor of the secondary nature of the skin infection process.

PMID: 16508605

[PubMed - in process]