1887

Abstract

It is often difficult to obtain a bacteriological diagnosis in patients with cellulitis. We examined the utility of molecular techniques and skin and throat cultures, as well as serology, in providing evidence of either or group A (GAS) presence in patients with cellulitis. Samples were collected from patients with a clinical diagnosis of cellulitis who were recruited into a prospective placebo-controlled clinical trial (C4C study, EudraCT 2013-001218-14). Specific PCR, paired serology and culture for both organisms were carried out on a variety of samples where appropriate. Despite utilizing a range of diagnostic methods, a bacteriological diagnosis was only achieved in 43 % of patients with a clinical diagnosis of cellulitis. Seventeen per cent of patients tested positive for GAS by any method but only 4 % were positive by PCR, whilst was detected in 34% of samples. Bacterial diagnosis in cases of cellulitis remains challenging. This is probably due to a very low bacterial burden with toxin production resulting in inflammation mediating skin damage. Further consideration for the need for long courses of antimicrobial therapy for cellulitis therefore appears merited.

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/content/journal/jmm/10.1099/jmm.0.000191
2016-01-01
2019-12-08
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References

  1. Bernard P. , Bedane C. , Mounier M. , Denis F. , Catanzano G. , Bonnetblanc J. M. . ( 1989;). Streptococcal cause of erysipelas and cellulitis in adults. A microbiologic study using a direct immunofluorescence technique. Arch Dermatol 125: 779–782 [CrossRef] [PubMed].
    [Google Scholar]
  2. Hung G. C. , Nagamine K. , Li B. , Lo S. C. . ( 2012;). Identification of DNA signatures suitable for use in development of real-time PCR assays by whole-genome sequence approaches: use of Streptococcus pyogenes in a pilot study. J Clin Microbiol 50: 2770–2773 [CrossRef] [PubMed].
    [Google Scholar]
  3. Jeng A. , Beheshti M. , Li J. , Nathan R. . ( 2010;). The role of (β-hemolytic streptococci in causing diffuse, nonculturable cellulitis: a prospective investigation. Medicine (Baltimore) 89: 217–226 [CrossRef] [PubMed].
    [Google Scholar]
  4. Johnson K. E. , Kiyatkin D. E. , An A. T. , Riedel S. , Melendez J. , Zenilman J. M. . ( 2012;). PCR offers no advantage over culture for microbiologic diagnosis in cellulitis. Infection 40: 537–541 [CrossRef] [PubMed].
    [Google Scholar]
  5. Karppelin M. , Siljander T. , Haapala A. M. , Aittoniemi J. , Huttunen R. , Kere J. , Vuopio J. , Syrjänen J. . ( 2014;). Evidence of streptococcal origin of acute non-necrotising cellulitis: a serological study. Eur J Clin Microbiol Infect Dis 34: 669–667 [PubMed].[CrossRef]
    [Google Scholar]
  6. Kilic A. , Muldrew K. L. , Tang Y. W. , Basustaoglu A. C. . ( 2010;). Triplex real-time polymerase chain reaction assay for simultaneous detection of Staphylococcus aureus and coagulase-negative staphylococci and determination of methicillin resistance directly from positive blood culture bottles. Diagn Microbiol Infect Dis 66: 349–355 [CrossRef] [PubMed].
    [Google Scholar]
  7. Leppard B. J. , Seal D. V. , Colman G. , Hallas G. . ( 1985;). The value of bacteriology and serology in the diagnosis of cellulitis and erysipelas. Br J Dermatol 112: 559–567 [CrossRef] [PubMed].
    [Google Scholar]
  8. Pallin D. J. , Binder W. D. , Allen M. B. , Lederman M. , Parmar S. , Filbin M. R. , Hooper D. C. , Camargo C. A. Jr. . ( 2013;). Clinical trial: comparative effectiveness of cephalexin plus trimethoprim-sulfamethoxazole versus cephalexin alone for treatment of uncomplicated cellulitis: a randomized controlled trial. Clin Infect Dis 56: 1754–1762 [CrossRef] [PubMed].
    [Google Scholar]
  9. Thors V. , Morales-Aza B. , Pidwill G. , Vipond I. , Muir P. , Finn A. . ( 2015;). Population density profiles of nasopharyngeal carriage of five bacterial species in pre-school children measured using quantitative PCR offer potential insights into the dynamics of transmission. Hum Vaccin Immunother, Epub ahead of print.. .
  10. Turner C. E. , Dryden M. , Holden M. T. , Davies F. J. , Lawrenson R. A. , Farzaneh L. , Bentley S. D. , Efstratiou A. , Sriskandan S. . ( 2013;). Molecular analysis of an outbreak of lethal postpartum sepsis caused by Streptococcus pyogenes . J Clin Microbiol 51: 2089–2095 [CrossRef] [PubMed].
    [Google Scholar]
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