Tuesday, February 14, 2012
A case of streptococcal toxic shock syndrome due to Group G streptococci identified as Streptococcus dysgalactiae subsp. equisimilis.
A case of streptococcal toxic shock syndrome due to Group G streptococci identified as Streptococcus dysgalactiae subsp. equisimilis.
Source
Division of Intensive Care Unit and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan, takahitonei@gmail.com.
Abstract
A 79-year-old man with a 3-month history of lymphedema of the lower limbs, and diabetes mellitus, was admitted to our hospital for suspected deep venous thrombosis. Several hours after admission, leg pain and purpura-like skin color appeared. On the 2nd hospital day, he was referred to our department for possible acute occlusive peripheral artery disease (PAD) and skin necrosis with blisters; however, computed tomography with contrast showed no occlusive lesions. He had already developed shock and necrotizing deep soft-tissue infections of the left lower leg. Laboratory findings revealed renal dysfunction and coagulation system collapse. Soon after PAD was ruled out, clinical findings suggested necrotizing deep soft-tissue infections, shock state, disseminated intravascular coagulation, and multiple organ failure. These symptoms led to a high suspicion of the well-recognized streptococcal toxic shock syndrome (STSS). With a high suspicion of STSS, we detected Group G β-hemolytic streptococci (GGS) from samples aspirated from the leg bullae, and the species was identified as Streptococcus dysgalactiae subsp. equisimilis (SDSE) by 16S-ribosomal RNA sequencing. However, unfortunately, surgical debridement was impossible due to the broad area of skin change. Despite adequate antimicrobial therapy and intensive care, the patient died on the 3rd hospital day. The M-protein gene (emm) typing of the isolated SDSE was revealed to be stG6792. This type of SDSE is the most frequent cause of STSS due to GGS in Japan. We consider it to be crucial to rapidly distinguish STSS from acute occlusive PAD to achieve life-saving interventions in patients with severe soft-tissue infections.
Labels: 16S-ribosomal RNA sequencing, blisters, deep venous thrombosis, Group G streptococci, lymphedema, skin necrosis, toxic shock syndrome
Friday, March 14, 2008
Management of common bacterial infections of the skin
Curr Opin Infect Dis. 2008 Apr
Bernard P.
Department of Dermatology, Robert Debré Hospital, Reims, France.
PURPOSE OF REVIEW: Bacterial skin infections commonly encountered in the community include impetigo, folliculitis/furunculosis, simple abscesses, erysipelas and other nonnecrotizing cellulitis. The review focuses on recent epidemiological, bacteriological and therapeutic advances.
RECENT FINDINGS: Impetigo and erysipelas occur in about 20 and 1 person/1000/year, respectively. Main risk factors for erysipelas are toe-web intertrigo and lymphedema. The true incidence of furunculosis is unknown, whereas outbreaks in small communities are reported worldwide. Staphylococcus aureus is the predominant pathogen for impetigo and furunculosis, and methicillin-resistant strains play a growing role in both diseases.
Erysipelas are mainly caused by streptococci, whereas local complications (i.e. abscesses or blisters) may be due to staphylococci, including methicillin-resistant strains in involved geographic areas. Recent trends for treating impetigo and furunculosis predate community-acquired methicillin-resistant S. aureus.
For outbreaks of furunculosis, stringent decolonization measures are showing promise, whereas there is no validated therapeutic regimen for chronic furunculosis.
Current trends for erysipelas involve ambulatory treatments and reduced duration of antibiotics.
SUMMARY: Despite better epidemiological or bacteriological knowledge of common bacterial skin infections, the exact role of methicillin-resistant staphylococci needs regular surveys in involved geographic areas. Antibiotic treatment must be active on staphylococci and, to a lesser degree, on streptococci.
Lippincott, Williams & Wilkins
Labels: common bacterial infections. skin infections, erysipelas impetigo, furuncles, furunculosis, lymphedema, staphylococci, streptococci, toe-web intertrigo
Thursday, November 15, 2007
Erysipelas: a common potentially dangerous infection.
Acta Dermatovenerol Alp Panonica Adriat. 2007 Sept
Celestin R, Brown J, Kihiczak G, Schwartz RA.
New Jersey Medical School, 185 South Orange Avenue, Newark, NJ 07103-2714, USA.
Erysipelas is an acute superficial cutaneous cellulitis that commonly occurs not only in elderly and immunocompromised persons, but also in neonates and small children subsequent to bacterial inoculation through a break in the skin barrier. Group A Beta-hemolytic streptococcus (GABHS, Streptoccocus pyogenes) is the usual etiologic agent. Factors that predispose pediatric patients to the development of erysipelas include very young age, diabetes mellitus, an immunocompromised state, and nephrotic syndrome. Patients typically have a well-demarcated, erythematous, indurated, rapidly spreading patch with a palpable advancing border on the face or extremities. Fever with chills and general malaise may be prominent symptoms. Antibiotics are usually effective. Patients handled in a timely manner tend to recover without problems. However, potential complications include abscess formation, necrotizing fasciitis, septicemia, recurrent infection, and lymphedema.
PMID: 17994173 [PubMed - as supplied by publisher]
* * * * * *
Erysipelas today
Gvozdenović E, Dulović O.
Klinicki centar Srbije, Beograd. elika@eunet.yu
INTRODUCTION: Erysipelas is a form of cellulitis and a bacterial infection affecting the most superficial layers of the skin which is caused by group A--hemolytic Streptococcus. The symptoms of erysipelas usually arise quite suddenly and they are often accompanied by fever, chill and shivering. The affected skin is distinguished from other forms of cellulitis by well-defined, raised edge. The affected skin is red, swollen and may be finely dimpled (like an orange skin).
TREATMENT OF ERYSIPELAS: Uncomplicated erysipelas can be treated on an outpatient basis. Indications for hospitalization include a severe clinical picture and socioeconomics factors. Most patients suffering from erysipelas in Belgrade are treated at the Institute of Infectious and Tropical Diseases, and the aim of this study was to analyze patients treated during 2002 and 2003, in order to determine characteristics of erysipelas at the beginning of the XXI century.
MATERIAL AND METHODS: During the studied period, we treated 60 patients (26.7%) of all registrated erysipelas cases in Belgrade. The male/female ratio was 1:1.6.
DISCUSSION AND CONCLUSION: Prevalence was higher during the summer months. In most cases, the severity and the need for hospitalization were recognized at the beginning; therefore, 74% of patients were hospitalized during the first five days from the onset of nonspecific signs of illness. Laboratory tests showed mild leukocytosis (med 12.05 x 10/9/l), with predominant neutrophils (74.8%) and increased fibrinogen (med 5.4 g/l). Predisposing factors were present in 83.3% of cases; of them, in 35% of cases this was not the first episode of this illness. In 85% of cases erysipelas of the leg was established, and it was the most frequent localization of all.
PMID: 17988064 [PubMed - in process]
Labels: cutaneous cellulitis, erysipelas, GABHS, Group A Beta-hemolytic streptococcus, lymphedema, necrotizing fasciitis, recurrent infection, septicemia, Streptoccocus pyogenes
