Saturday, September 30, 2006

Cellulitis and Your Child

Cellulitis and Your Child

What is cellulitis?

Cellulitis is a bacterial infection of the skin and surrounding tissue. It occurs most commonly around areas of broken skin, such as wounds, bug bites, or scrapes, but it can also occur in other areas. Severe and untreated cases of cellulitis may result in septicemia (blood poisoning), but cellulitis is not contagious.

What are the symptoms of cellulitis?

Swelling of the lymph glands
Redness around the area of infection
Pus or fluid drainage from the wound
The affected area is warm to the touch
Fever (temperature over 100 degrees Fahrenheit)

What can I do for my child at home?

If your child has symptoms of cellulitis, take him or her to see the doctor for a complete diagnosis and to prevent any complications. Other things you can do include:
Giving your child all medicine as directed by the doctor
Trying to keep your child from touching the infected area
Washing your hands before and after caring for the infected area
Not squeezing or puncturing the area
Using a warm compress on the affected area
Keeping the affected limb rested
Calling your doctor if you notice increased swelling, redness, or pain

Do children need to be hospitalized for cellulitis?

Although it is easily diagnosed and usually treated with antibiotics, some children may need to be hospitalized. Your child’s doctor may do blood work to test for blood poisoning. If admitted to the hospital, your child’s treatment may include:

Fluids and antibiotics given by IV
Warm compresses applied to the affected area
Resting or raising of the area

How can I prevent my child from getting cellulitis?

Clean the wounds or sores with soap and water.
Use an antibiotic ointment and bandage to cover wounds.
Do not allow your child to rub or scratch the affected area.
Make sure your child wears protective clothing when outdoors or playing sports.
Get prompt medical attention for any deep cuts or puncture wounds.

Questions to ask your child’s doctor

For how long and at what times of the day should I give my child medication, if any?
How should I store the medication? In the refrigerator?
When will my child start to feel better?
Will I need to bring my child back for a follow-up visit?
Should I keep my child home from school or day care?
From which activities should I limit my child?
Are certain foods or liquids more helpful?
Which over-the-counter pain relievers do you recommend?
Which over-the-counter medications/preparations are NOT recommended?
Which symptoms should I report to the doctor?

Cleveland Clinic

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Cellulitis is an infection of the skin and underlying tissues that can affect any area of the body. Not to be confused with cellulite - the cottage-cheese-like, lumpy fat often found on the hips, thighs, and buttocks, primarily of women - cellulitis begins in an area of broken skin, like a cut or scratch, allowing bacteria to invade and spread, causing inflammation, which includes pain, swelling, warmth, and redness.
Disorders that create breaks in the skin and allow bacteria to enter, such as eczema and severe acne, will put a child at risk for cellulitis.
Chickenpox and scratched insect bites are also common causes. Cellulitis may also start in areas of intact skin, especially in people who have diabetes or who are taking medicines that suppress the immune system.

Cellulitis can be caused by many different types of bacteria, but the most common are group A Streptococcus and Staphylococcus aureus. In special cases, other bacteria can cause cellulitis. Cellulitis after a cat or dog bite may be caused by Pasteurella multocida bacteria. Cellulitis due to Pseudomonas infection occurs after nail-puncture wounds through sneakers. Other types of bacteria from fish and farm animals can also cause cellulitis.

One specific type of cellulitis that can occur in children and requires close monitoring is periorbital cellulitis, an infection of the eyelid and tissues surrounding the eye. It can be the result of minor trauma to the area around the eye (such as an insect bite or a scratch), or it may be the extension of another site of infection, such as sinusitis. Periorbital cellulitis is treated with antibiotics and close follow-up. If untreated, it can progress to orbital cellulitis (infection of the eye orbit, or socket), a much more severe infection that results in a bulging eyeball, eye pain, restricted eye movements, or visual disturbances. This is an emergency that requires hospitalization and intravenous antibiotics.

Signs and Symptoms

Cellulitis begins as a small, inflamed area of pain, swelling, warmth, and redness on a child's skin. As this red area begins to spread, the child may begin to feel sick and develop a fever, sometimes with chills and sweats. Swollen lymph nodes (commonly called swollen glands) are sometimes found near the area of infected skin.


Cellulitis is not contagious.


You can prevent cellulitis by protecting your child's skin from cuts, bruises, and scrapes. This may not be easy, especially if you have an active child who loves to explore or play sports. Protective equipment worn to prevent other injuries during active play can also protect your child's skin: elbow and knee pads while skating, a bike helmet during bike riding, shin guards during soccer, long pants and long-sleeved shirts while hiking in the woods, sandals (not bare feet) on the beach, and seatbelts while riding in a motor vehicle.

If your child does get a scrape, wash the wound well with soap and water. Apply an antibiotic ointment and cover the wound with an adhesive bandage or gauze. Check with your child's doctor if your child has a large cut, deep puncture wound, or bite (animal or human).


period varies, depending on the type of bacteria causing the cellulitis. For example, cellulitis caused by Pasteurella multocida has a very short incubation period - less than 24 hours after an animal bite. But other types of bacteria may have incubation periods of several days.


Cellulitis usually resolves after a few days of antibiotic therapy. However, it's very important that the child receives the medication on schedule for as many days, usually 7 to 10, as the doctor directs.


Your child's doctor can usually make the diagnosis of cellulitis by asking a few questions and examining the area of affected skin. Sometimes, especially in younger children, the doctor may also order blood cultures - samples of your child's blood that are examined in the laboratory for growth of bacteria.

Positive blood cultures mean that bacteria from your child's skin infection have spread into the bloodstream, a condition known as bacteremia. This can potentially lead to septicemia, a generalized infection affecting many systems of the body. Bacteremia can also be a cause of cellulitis in certain cases.

Professional Treatment

If your child has severe cellulitis, your child's doctor may decide to treat him or her in the hospital using intravenous (IV) antibiotics.

Home Treatment

Children with milder cellulitis can be treated at home with the entire course of prescribed oral antibiotics, but with follow-up from the doctor to make sure symptoms are improving. The doctor may also suggest that the affected part of the body be immobilized and elevated to reduce swelling and pain. Using pain-relievers such as acetaminophen or ibuprofen may also help reduce discomfort.

After 1 or 2 days of antibiotics at home, your child's doctor may schedule an office visit to check that the area of cellulitis has improved and that the antibiotics are working to heal the infection.

When to Call Your Child's Doctor

Call your child's doctor whenever any area of your child's skin becomes red, warm, and painful - with or without fever and chills. This is especially important if the area of skin is on your child's face, or if your child has a chronic illness (like diabetes) or a condition that suppresses the immune system.

Because cellulitis can happen very quickly after an animal bite, call your child's doctor whenever your child is bitten by an animal, especially if the puncture wound is deep. Human bites can also cause dangerous skin infections and should be seen by a doctor. If red streaks develop from the infected area or symptoms worsen despite antibiotic treatment, your child should be reexamined.

Reviewed by: Elana Pearl Ben-Joseph, MD


Friday, September 22, 2006

Cellulitis of the breast as a complication of breast-conserving surgery and irradiation.

Cellulitis of the breast as a complication of breast-conserving surgery and irradiation.

Hughes LL,
Styblo TM,
Thoms WW,
Schwarzmann SW,
Landry JC,
Heaton D,
Carlson GW,
Wood WC.
Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia, USA.

Breast-conserving therapy (BCT) has become a standard treatment option for patients with early-stage breast cancer. We have observed cellulitis of the treated breast as a complication occurring before, during, and after breast irradiation. The cases of five women (median follow-up, 28 months; range, 24-65 months) who developed cellulitis before (n = 1), during (n = 2), or after (n = 2) breast irradiation were reviewed. A consecutive series of BCT patients at Emory University was reviewed to determine the incidence of this complication. Four of five women had an axillary dissection, yielding a median of 14 negative lymph nodes (range, 6-22 nodes).

Two of four patients developed axillary seromas requiring aspiration. In these four patients, only the breast was irradiated. A fifth patient had no axillary dissection and had breast and supraclavicular/axillary irradiation. The median whole breast dose was 50 Gy (range, 46-50.4 Gy). The clinical features of cellulitis included erythema, edema, tenderness, and warmth in all patients. Cellulitis was a relapsing problem for four of the five patients. The incidence of this complication in our series of BCT patients was approximately 1%. Cellulitis in the ipsilateral breast can be a relapsing complication of BCT and can be seen before, during, or after breast irradiation. Axillary seromas and aspiration seem to indicate a subset of patients at risk of early cellulitis.

Late cellulitis may be caused by a variety of factors related to modifications of vascular and skin integrity by surgery and radiotherapy. Prompt diagnosis and appropriate antibiotic therapy is recommended. This problem need not interrupt a course of breast irradiation, and does not necessarily lead to a poor cosmetic result.

PMID: 9256885 [PubMed - indexed for MEDLINE]

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Delayed cellulitis associated with conservative therapy for breast cancer.

Miller SR,
Mondry T,
Reed JS,
Findley A,
Johnstone PA.

Breast Health Center, Naval Medical Center, San Diego, California 92134-5000, USA.


Delayed breast cellulitis is an infrequently reported entity after conservation therapy for breast cancer. We describe our experience with this entity at Naval Medical Center, San Diego.


Eight patients who presented with delayed cellulitis after wide local excision/axillary dissection and breast radiotherapy (RT) are presented. Their clinical characteristics and therapy are described and possible causative factors are analyzed.


The latency of breast cellulitis is variable after breast conservation therapy, although most cases in our experience and in the literature occur within a year post-RT. These infections are frequently refractory to a single course of antibiotics (n = 4 cases in our experience). Some patients suffer multiple episodes separated by months.


Breast cancer patients are at risk for delayed cellulitis after conservative surgery and RT. The mechanism of such events probably involves lymph stasis, however, therapy is no different from the more frequently occurring cases of cellulitis presenting perioperatively.

PMID: 9579371 [PubMed - indexed for MEDLINE]

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Delayed breast cellulitis following breast conserving operation.

Zippel D,
Siegelmann-Danieli N,
Ayalon S,
Kaufman B,
Pfeffer R,
Zvi Papa M.
Department of Surgical Oncology, Chaim Sheba Medical Center, Israel.

A complication of breast conservation, which has been increasingly reported in the literature, is 'delayed cellulitis' in the treated breast. This is to be distinguished from wound infection in the breast following lumpectomy.

This study reports 16 cases diagnosed with delayed cellulitis following breast conserving surgery, unresponsive to antibiotic therapy. Diagnostic criteria included: pain, erythema and edema in the operated breast. Symptoms appeared up to 10 months after surgery and time to resolution was seven and a half months. No patients had positive cytology and bacteriology tests were negative. Thirteen patients were observed, and three patients were treated with antibiotics with no apparent immediate effect.

The appearance of breast cellulitis after surgery poses a problematic diagnostic and management dilemma. It is important to distinguish between this entity and infection, or inflammatory carcinoma. The picture may be attributed to impairment or occlusion of the lymphatic circulation in the breast. This seems to be a newly defined complication with an incidence of 3-5%.

PMID: 12711284 [PubMed - indexed for MEDLINE]

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The dilemma of delayed cellulitis after breast conservation therapy.

Staren ED,
Klepac S,
Smith AP,
Hartsell WF,
Segretti J,
Witt TR,
Griem KL,
Bines SD.
Department of General Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, III, USA.


To determine the clinicopathologic characteristics of patients with breast cancers in whom delayed breast cellulitis developed after conservation therapy (lumpectomy, axillary dissection, and radiation).


Breast cellulitis developing after conservation therapy represents a difficult diagnostic and management dilemma because determination of its origin may be necessary before further treatment decisions can be made.


In this retrospective evaluation of 184 sequential patients with breast cancers who underwent conservation therapy, 10 study patients (5%) in whom breast cellulitis developed 3 or more months after surgery were compared with the 174 patients in whom cellulitis did not develop.


There was no significant difference in clinicopathologic characteristics of the study patients compared with control patients. The cellulitis resolved in 5 patients (50%) and persisted from 4 months to more than 1 year in 5 patients (50%). The cellulitis recurred in 1 patient who responded to repeated therapy. The 5 patients with persistent cellulitis underwent biopsies, and recurrent cancer was found in 1 patient. Recurrent cancer did not develop in the patients whose cellulitis resolved within 4 months with a minimum follow-up of 24 months.


Delayed-onset cellulitis occurs in a small percentage of patients with breast cancers treated by conservation therapy. The cellulitis may take several weeks to clear, and/or it may recur or persist. If the condition persists after 4 months of therapy, a biopsy should be performed to rule out recurrent cancer.

PMID: 8645074 [PubMed - indexed for MEDLINE]

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Breast cellulitis after conservative surgery and radiotherapy.

Rescigno J,
McCormick B,
Brown AE,
Myskowski PL.
Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY.


Cellulitis is a previously unreported complication of conservative surgery and radiation therapy for early stage breast cancer. Patients who presented with breast cellulitis after conservative therapy are described.


Eleven patients that developed cellulitis of the breast over a 38-month period of observation are the subject of this report. Clinical characteristics of patients with cellulitis and their treatment and outcome are reported. Potential patient and treatment-related correlates for the development of cellulitis are analyzed.


The risk of cellulitis persists years after initial breast cancer therapy. The clinical course of our patients was variable: some patients required aggressive, long-duration antibiotic therapy, while others had rapid resolution with antibiotics. Three patients suffered from multiple episodes of cellulitis.


Patients with breast cancer treated with conservative surgery and radiotherapy are at risk for breast cellulitis. Systematic characterization of cases of cellulitis may provide insight into diagnosis, prevention, and more effective therapy for this uncommon complication.

PMID: 8175424 [PubMed - indexed for MEDLINE]

Sunday, September 17, 2006

Ultrasound treatment of cellulitis in the maxillofacial region: a ten-year experience.

Ultrasound treatment of cellulitis in the maxillofacial region: a ten-year experience.

Folia Med (Plovdiv). 2006;48(1):50-4

Department of Oral Surgery, Faculty of Dentistry, Medical University, Plovdiv, Bulgaria.
AIM: To evaluate the effect of therapeutic ultrasound in the treatment of cellulitis in the maxillofacial region.


We report our experience in the management of maxillofacial cellulitis in thirty six patients using therapeutic ultrasound as an adjunct to the standard treatment. The patients were allocated to two groups: group A, treated by surgery, drugs and ultrasound therapy, and group B, where the patients were treated only surgically and medicamentously. The effect of treatment was evaluated on the basis of inflamed tissue volume reduction and normalization of tissue structure determined by ultrasonography.


The dynamic changes in the mean values of inflamed tissue volume indicated more rapid reduction in group A in which therapeutic ultrasound was applied. Analysis of the ultrasonographic images in group A demonstrated merging of the miliary liquid foci as early as the first day of treatment. They coalesced, and this coincided with the initiation of purulent discharge. The reduction in volume was due to the accelerated elimination of breakdown inflammatory products from the tissues.


The better results in group A compared with group B suggest that the method for ultrasound management was effective and could be recommended for use in clinical practice.
PMID: 16918055 [PubMed - in process]

Friday, September 08, 2006

Facial cellulitis associated with Pseudomonas aeruginosa complicating ophthalmic herpes zoster

Facial cellulitis associated with Pseudomonas aeruginosa complicating ophthalmic herpes zoster

Facial cellulitis associated with Pseudomonas aeruginosa complicating ophthalmic herpes zoster Laura Atzori MD1, Caterina Ferreli MD1, Myriam Zucca MD1, Daniela Fanni MD2, and Nicola Aste MD1 Dermatology Online Journal 10 (2): 20 1. Clinica Dermatologica - Università di Cagliari. 2. I Cattedra di Anatomia Patologica – Università di Cagliari via Ospedale 54 - 09124 Cagliari (Italy)


Cellulitis is a rare and severe soft-tissue infection characterized by acute, diffuse, spreading inflammation, often associated with systemic symptoms such as malaise and fever. Surgery of the head and neck, dental infections, sinusitis, upper respiratory tract infections, and trauma are the most common portal of entry for pathogens in facial cellulitis. A very unusual case complicating an ophthalmic herpes zoster in a 74-year-old woman was observed at the department of dermatology, Cagliari University (Italy). Culture of skin swabs showed growth of numerous Gram-negative bacilli, further identified as Pseudomonas aeruginosa. Therapy with intravenous ciprofloxacin was promptly instituted on the basis of the culture and sensitivity report. She was initially treated with daily drainage and twice-daily topical fusidic acid. The lesion completely resolved in 4 weeks, and no general complications or recurrence have been observed for 6 months. Early recognition and management of facial cellulitis is mandatory to avoid serious and generalized complications. Pseudomonas aeruginosa is rarely reported in facial cellulitis; there are apparently no reports of this infection occurring as a complication of ophthalmic herpes zoster. Herpetic damage of the anatomic barrier as well as impairment of defense mechanisms because of decompensated diabetes mellitus may have facilitated the colonization and proliferation of this opportunistic pathogen in our patient.


Varicella zoster is a common infection worldwide with a generally benign course, especially because the availability of specific antiviral treatment. Cellulitis is a severe, acute soft-tissue infection characterized by rapidly spreading erythema that progresses to abscess formation and is usually accompanied by malaise and fever [
1, 2, 3]. Precipitating factors are usually necessary to allow pathogen invasion of the dermis and subcutis; in the facial region the most common portals of entry are dental infections, sinusitis, upper respiratory tract infection, surgery, and trauma [3, 4, 5]. Other conditions predisposing to cellulitis are malignancies, chemotherapy (especially when associated with persistent leukopenia), and acquired immunosuppression (AIDS). Cellulitis rarely presents as a cutaneous complication of an oral herpes simplex infection [3]. When it occurs, the responsible organisms are most often Staphylococcus aureus, β-hemolytic Streptococcus, and anaerobic bacteria such as Hemophilus influenzae [4, 5, 6]. Pseudomonas aeruginosa has rarely been reported as responsible for facial cellulitis [4, 5, 6, 7], and never as a complication of ophthalmic herpes zoster. This Gram-negative bacillus is cosmopolitan in distribution of low virulence potential in healthy patients [8, 9]. Local anatomic changes or general impairment of defense mechanisms usually facilitate colonization and proliferation of this opportunistic pathogen. Once the microorganism has passed the mucocutaneous barrier, the risk of life-threatening complications is very high [3].
Early recognition and management of facial cellulitis is mandatory to avoid serious and generalized complications. Antibiotic treatment has to be guided by the culture and sensitivity report (antibiogram), and prompt surgical debridement is also generally required [
1, 2, 3, 6, 7, 8, 9].

Clinical Synopsis

A 74-year-old woman presented to the dermatology department of the University of Cagliari (Italy) with a tender large tumor on her left supraorbital and frontal region. On examination the entire left-supraorbital region appeared occupied by a 6-cm round, erythematosus, edematous tumescence; the surface was interrupted by deep, confluent, undermined ulcerations. The necrotic fundus of these ulcers was filled with dense, yellow, purulent and bloody material (Fig. 1). The lesion was painful and extremely tender to palpation. There was no hyperpyrexia. There was no ocular or mucous membrane involvement; there were no palpable lymph nodes. The patient had been evaluated in the same department about 12 days previously for a typical ophthalmic herpes zoster; she was treated with oral famcyclovir (750 mg daily) with substantial initial improvement. Unexpectedly, the patient noted breakdown and painful swelling of some of the crusted herpetic lesions; these became confluent within few days, forming a subcutaneous abscess. The familial and pathologic history was unremarkable, except for longstanding insulin-dependent diabetes. Preliminary laboratory investigations revealed 11.3 x 109 /L WBC (normal value [nv] 4.00-10.00), erythrocyte sedimentation rate of 88 mm 1st hour; C-reactive protein of 61.1 mg/L (nv <>

Intravenous ciprofloxacin (400 mg per day) was started with a rapid improvement; it was continued for 10 days and then changed to oral administration (500 mg twice daily for another 10 days). The antibiogram performed at day 12 showed no bacterial growth. Initial daily drainage was done to remove necrotic, purulent material from the lesion. Topical fusidic acid was applied twice daily until complete second-intent closure occurred for the central ulcer; Healing progressed very slowly and was complete in a 4 weeks, resulting in a slightly fibrous, hypertrophic scar (Fig. 3). No relapse or complications were observed in a 6-month follow-up visit.


This case represents a peculiar and severe condition requiring prompt systemic treatment and daily surgical drainage in order to avoid life-threatening complications. Facial cellulitis is a rare infection; it is characterized by an acute inflammatory process involving the dermis and subcutaneous tissue and evolution to abscess formation [
1, 2, 3]. Most primary cases are caused by Gram-positive organisms, but secondary forms associated with local infection, trauma, or surgery (especially of the head and neck region) [3, 4, 5, 6] are often polymicrobial, and some cases caused by Pseudomonas aeruginosa have been reported [4, 5, 6, 7]. This ubiquitous Gram-negative bacillus produces infections in many different organs, including the skin and soft tissues; these infections range from minor lesions to potentially life-threatening septicemia. Pseudomonas is rarely able to initiate the pathologic process unless there is a local or general impairment of defense mechanisms [7, 8, 9]. With regard to our patient, herpes zoster lesions provided the disruption of the cutaneous barrier, in spite of early aggressive antiviral treatment. Manipulation, poor hygiene, and the coexistence of uncontrolled diabetes mellitus in this elderly woman might have favored this uncommon infection. No major defect of cellular immunity was detected in our patient, but a minimal dysfunction is putatively responsible for susceptibility to cutaneous infection in diabetic patients[10]. Identification of Pseudomonas aeruginosa as causative agent, with the potentiality to cause septicemia and mortality [3, 6, 7, 8, 9], prompted us to start a systemic treatment. A good therapeutic response ensued, which we attribute to ciprofloxacin, daily drainage to remove purulent and necrotic material from the lesion, and the use of a topical antiseptic agent. The patient recovered, and the only residual was a modest hypertrophic scar that was judged acceptable; no further surgical correction was required.
Facial cellulitis very rarely presents as a complication of herpes zoster. This is the first report in which Pseudomonas aeruginosa is the associated pathogen. Early recognition, appropriate antibiotic treatment, and constant monitoring of the patient are crucial to avoid serious complications.


. Ginsberg MB. Cellulitis: analysis of 101 cases and review of the literature. South Med J. 1981 May;74(5):530-3. PubMed2. Elders D, Elenitsas R, Jaworsky C, Johnson B. Erysipelas. In: Elders D (ed): LeverÕs histopathology of the skin. 8th ed. Philadelphia, Lippincott-Raven Publishers, pp: 459, 1997.3. Carratala J, Roson B, Fernandez-Sabe N, Shaw E, del Rio O, Rivera A, Gudiol F. Factors associated with complications and mortality in adult patients hospitalized for infectious cellulitis. Eur J Clin Microbiol Infect Dis. 2003; 22:151-7. PubMed4. Weiss A, Friendly D, Eglin K, Chang M, Gold B. Bacterial periorbital and orbital cellulitis in childhood. Ophthalmology. 1983 Mar;90(3):195-203. PubMed5. Kimura AC, Pien FD. Head and neck cellulitis in hospitalized adults. Am J Otolaryngol. 1993 Sep-Oct;14(5):343-9. PubMed6. Fleisher G, Ludwig S. Cellulitis: a prospective study. Ann Emerg Med. 1980 May;9(5):246-9. PubMed7. Tallamraju A, Greene JN, Ganguly R, Sandin RL. Facial cellulitis by Pseudomonas aeruginosa in a neutropenic patient. Cancer Control. 2001 Jul-Aug;8(4):364-7. PubMed8. Silvestre JF, Betlloch MI. Cutaneous manifestations due to Pseudomonas infection. Int J Dermatol. 1999 Jun;38(6):419-31. PubMed9. Aste N, Atzori L, Zucca M, Pau M, Biggio P. Gram-negative bacterial toe web infection: a survey of 123 cases from the district of Cagliari, Italy. J Am Acad Dermatol. 2001 Oct;45(4):537-41. PubMed10. Moutschen MP, Scheen AJ, Lefebvre PJ. Impaired immune responses in diabetes mellitus: analysis of the factors and mechanisms involved. Relevance to the increased susceptibility of diabetic patients to specific infections. Diabete Metab. 1992 May-Jun;18(3):187-201. PubMed

Dermatology Online Journal

Friday, September 01, 2006

A case of severe necrotizing cellulitis caused by group G Streptococcus dysgalactiae subsp. equisimilis

A case of severe necrotizing cellulitis caused by group G Streptococcus dysgalactiae subsp. equisimilis
Kansenshogaku Zasshi. 2006 Jul;80(4):436-9.

Misawa Y,
Okugawa S,
Ubukata K,
Okuzumi K,
Okada M,
Moriya K,
Koike K.

Department of Infection Control and Prevention, The University of Tokyo Hospital.
Group G streptococcus (GGS) is infrequently associated with severe invasive soft tissue infection and toxic shock syndrome.

A 74-year-old woman with a history of lymphedema of the lower extremities after surgical and radiation therapy for uterine cancer and diabetic mellitus and admitted for swelling of the right leg, fever, and dyspnea. She presented with shock and necrotizing cellulitis of the right lower extremity.

Laboratory tests showed leukocytepenia, acute renal and liver dysfunction, and muscle damage. She rapidly developed multiple organ failure and necrotizing cellulitis. A swab from skin vesicle, throat, and blood culture grew Group G Streptococcus dysgalactiae subsp. equisimilis. Despite endotoxin hemoadsorption therapy, administration of antibiotics, and intravenous immunoglobulin, she died 9 days after admission due to toxic shock syndrome caused by GGS.

The M-protein gene (emm) typing of GGS isolated from both blood and skin lesion showed stG 485.0. Three virulence genes, sagA, slo and skcg, were detected from GGS isolated from them.

PMID: 16922490
[PubMed - in process]

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Characterization of Group C and G Streptococcal Strains That Cause Streptococcal Toxic Shock Syndrome

Streptococcal toxic shock syndrome: a case report]

Lethal end of a group C streptococcal necrotizing fasciitis in a healthy female