Abstract
In order to better characterize bacteremic cellulitis caused by Streptococcus pneumoniae, a review was conducted of 10 cases of bacteremic pneumococcal cellulitis, which represented 0.9% of all cases of pneumococcal bacteremia (n=1,076) and 3.2% of all cases of community-acquired bacteremic cellulitis (n=312) that occurred in the Hospital de Bellvitge, Barcelona, from 1984 to 2001. In addition to these 10 cases, 28 cases of bacteremic pneumococcal cellulitis from the literature (Medline 1975–2001) were reviewed. Pneumococcal cellulitis of the face, neck, and trunk was observed more frequently in patients with systemic lupus erythematosus and hematologic disorders, while pneumococcal cellulitis of the limbs was more common in patients with diabetes, alcoholism, and parenteral drug use. In the Hospital de Bellvitge group, bacteremic cellulitis due to Streptococcus pneumoniae was more frequently associated with severe underlying diseases than that due to Staphylococcus aureus or Streptococcus pyogenes (100%, 57%, and 72%, respectively; P=0.01). A concomitant extracutaneous focus of infection (e.g., respiratory tract infection) suggesting hematogenous spread with metastatic cellulitis was more frequent in patients with pneumococcal cellulitis, while a local cutaneous entry of microorganisms was feasible in most patients with Staphylococcus aureus or Streptococcus pyogenes cellulitis. The 30-day mortality was 10% in patients with pneumococcal cellulitis, 13% in patients with Staphylococcus aureus cellulitis, and 23% in patients with Streptococcus pyogenes cellulitis (P=0.3). Thus, bacteremic pneumococcal cellulitis is an unusual manifestation of pneumococcal disease and occurs mainly in patients with severe underlying diseases. In most cases, pneumococcal cellulitis has a different pathophysiologic mechanism than cellulitis caused by Staphylococcus aureus or Streptococcus pyogenes.
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References
Durand ML, Calderwood SB, Weber DJ, et al. (1993) Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med 328:21–28
Taylor SN, Sanders CV (1999) Unusual manifestations of invasive pneumococcal infection. Am J Med 107 [Suppl 1]:12–27
Pallares R, Capdevila O, Grau I (1999) Treatment options for resistant pneumococcal infections. Clin Microbiol Infect 5 [Suppl 4]:3–11
Peters NS, Eykyn SJ, Rudd AG (1989) Pneumococcal cellulitis: a rare manifestation of pneumococcaemia in adults. J Infect 19:57–59
Swartz MN (2000) Skin and soft-tissues infection. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 5th edn. Churchill Livingstone, New York, pp 1037–1057
Waldvogel FA (2000) Staphylococcus aureus. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 5th edn. Churchill Livingstone, New York, pp 2069–2092
Lewis RJ, Richmond AS, McGrory JP (1975) Diplococcus pneumoniae cellulitis in drug addicts. JAMA 232:52–55
Milstein P, Gleckman R (1975) Pneumococcal erysipelas: a unique case in an adult. Am J Med 59:293–296
McGavin CR, Clancy LJ (1977) Cellulitis in complicated pneumococcal pneumonia. Br J Dis Chest 71:213–214
Varghese R, Melo JC, Chun CH, Raff MJ (1979) Erysipelas-like syndrome caused by Streptococcus pneumoniae. South Med J 72:757–758
Rose FB, Garman RF, Falkenberg KJ, Camp CJ (1982) Adult epiglottitis, cellulitis, and Streptococcus pneumoniae bacteremia. Scand J Infect Dis 14:301–303
Mujais S, Uwaydah M (1983) Pneumococcal cellulitis. Infection 11:173–174
Rodloff AC, Vobberg W (1983) Pneumococcal cellulitis. Infection 11:346
Dacso CC, Lokey RH, Davis SA, Myers TC (1984) Pneumococcal cellulitis and systemic lupus erythematosus: a distinctive clinical syndrome. Clin Res 32:847A
Peyronnet P, Aldigier JC, Bernard P, Weinbreck P, Leroux-Robert C (1985) Cellulite pneumococcique chez une malade immunodeprimee. Presse Med 14:1386
Dhaene M, Thys JP, Askenasi R, Toussaint C (1986) Pneumococcal cellulitis. Am J Emerg Med 4:225–226
Plotkin GR, Patel BR, Shah VN (1986) "Diabetic foot" complicated by pneumococcal cellulitis. South Med J 79:390
Hinnen RM, Trachtenbarg DE, Miller MA, Coon JJ (1986) Streptococcus pneumoniae cellulitis. Ill Med J 170:84–86
Verhelst JA, Delvigne C (1988) Pneumococcal osteomyelitis and cellulitis in an adult patient with diabetes mellitus. Diabet Med 5:393–395
DiNubile MJ, Albornoz MA, Stumacher RJ, Van Uitert BL, Paluzzi SA, Bush LM, Nelson SC, Myers AR (1991) Pneumococcal soft-tissue infections: possible association with connective tissue diseases. J Infect Dis 163:897–900
Hammad A, Zittel M, Kalmuk E, Mylotte J (1992) Pneumococcal cellulitis and dysgammaglobulinemia. NY State J Med 92:113–114
Lawlor MT, Crowe HM, Quintiliani R (1992) Cellulitis due to Streptococcus pneumoniae: case report and review. Clin Infect Dis 14:247–250
Haubrich RH, Keroack MA (1992) Pneumococcal crepitant cellulitis caused by bronchocutaneous fistula. Chest 101:566–567
Molyneux AJ, Judd PA, Jones PH (1992) A fatal case of pneumococcal cellulitis. J Infect 25:238–239
Rodriguez-Barradas MC, Musher DM, Hamill RJ, Dowell M, Bagwell JT, Sanders CV (1992) Unusual manifestations of pneumococcal infection in human immunodeficiency virus-infected individuals: the past revisited. Clin Infect Dis 14:192–199
Peetermans WE, Buyse B, Vanhoof J (1993) Pyogenic abscess of the gluteal muscle due to Streptococcus pneumoniae. Clin Infect Dis 17:939
Patel M, Ahrens JC, Moyer DV, DiNubile MJ (1994) Pneumococcal soft-tissue infections: a problem deserving more recognition. Clin Infect Dis 19:149–151
Cuenca-Estrella M, Ramos JM, Esteban J, Soriano F (1995) Pneumococcal soft-tissue infections. Clin Infect Dis 21:697–698
Kragsbjerg P, Noren T, Soderquist B (1995) Deep soft-tissue infections caused by Streptococcus pneumoniae. Eur J Clin Microbiol Infect Dis 14:1002–1004
Cortes E, Pigrau C, Barbera J, Almirante B (1995) Cellulitis and spondylitis due to Streptococcus pneumoniae. Clin Infect Dis 21:696
House NS, Helm KF, Marks JG Jr (1996) Acute onset of bilateral leg lesions. Pneumococcal cellulitis. Arch Dermatol 132:81–82, 84–85
Lalin P, Jacquot JM, Hemmi P, Di Castri A (1996) Cellulite pneumococcique, arthrite septique secondaire. Presse Med 25:38
Lopez J, Eres N, Fernandez X, Buti M (1997) Celulitis por Streptococcus pneumoniae asociada a espondilodiscitis tras cuadro de otitis media supurativa. Enferm Infec Microbiol Clin 15:171–172
Hill MD, Karsh J (1997) Invasive soft tissue infections with Streptococcus pneumoniae in patients with systemic lupus erythematosus: case report and review of the literature. Arthritis Rheum 40:1716–1719
Souweine B, Mom T, Bret L, Klisnick A, Baguet JC, Gilain L (1997) Cellulitis due to Streptococcus pneumoniae with diminished susceptibility to penicillin in an immunocompromised patient. Scand J Infect Dis 29:518–519
Ejlerstsen T, Dossing K (1997) Pneumococcal pyomyositis secondary to pneumonia. Scand J Infect Dis 29:520–521
Naseib S, Watanakunakorn C (1999) Orbital cellulitis due to Streptococcus pneumoniae in a previously healthy adult. Clin Infect Dis 29:1361–1362
Parada JP, Maslow JN (1999) Adult pneumococcal cellulitis: case report and review. Clin Infect Dis 28:918
Mofredj A, Guerin JM, Leibinger F, Masmoudi R (2000) Pneumococcal cellulitis in an HIV-infected adult. Infection 28:175–177
Parada JP, Maslow JN (2000) Clinical syndromes associated with adult pneumococcal cellulitis. Scand J Infect Dis 32:133–136
Working Group on Severe Streptococcal Infections (1993) Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. JAMA 269:390–391
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This study was supported in part by a grant (FIS no. 97/0716) from the Fondo de Investigaciones Sanitarias, Spanish Pneumococcal Study Network G03/103, National Health Service, Madrid, Spain, and a grant from the Agencia d'Avaluacio de Tecnologia Medica, Generalitat de Catalunya, Barcelona, Spain
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Capdevila, O., Grau, I., Vadillo, M. et al. Bacteremic Pneumococcal Cellulitis Compared with Bacteremic Cellulitis Caused by Staphylococcus aureus and Streptococcus pyogenes . Eur J Clin Microbiol Infect Dis 22, 337–341 (2003). https://doi.org/10.1007/s10096-003-0945-z
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DOI: https://doi.org/10.1007/s10096-003-0945-z