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Bacteremic pneumococcal cellulitis compared with bacteremic cellulitis caused by Staphylococcus aureus and
O Capdevila1, I Grau, M Vadillo
1Clinical Research Unit, Hospital de Bellvitge and University of Barcelona, Feixa Llarga s/n, 08907 L' Hospitalet, Barcelona, Spain.
Summary
Bacteremic cellulitis caused by Streptococcus pneumoniae is rare, often occurring in patients with severe underlying conditions. This infection typically spreads through the bloodstream, unlike cellulitis from Staphylococcus aureus or Streptococcus pyogenes.
Area of Science:
- Infectious Diseases
- Bacteriology
- Dermatology
Background:
- Bacteremic cellulitis is a serious skin infection.
- Streptococcus pneumoniae can cause bacteremia and cellulitis.
- Understanding pneumococcal cellulitis is important for patient management.
Purpose of the Study:
- To characterize bacteremic cellulitis caused by Streptococcus pneumoniae.
- To compare pneumococcal cellulitis with cellulitis caused by other bacteria.
- To identify risk factors and clinical features of pneumococcal cellulitis.
Main Methods:
- Retrospective review of 10 cases of bacteremic pneumococcal cellulitis at Hospital de Bellvitge (1984-2001).
- Literature review of 28 additional cases (Medline 1975-2001).
- Comparison of clinical features and outcomes with Staphylococcus aureus and Streptococcus pyogenes cellulitis.
Main Results:
- Pneumococcal cellulitis represented 0.9% of pneumococcal bacteremia and 3.2% of community-acquired bacteremic cellulitis.
- Facial/trunk cellulitis was linked to systemic lupus erythematosus and hematologic disorders; limb cellulitis to diabetes, alcoholism, and drug use.
- Pneumococcal cellulitis was associated with more severe underlying diseases and hematogenous spread compared to S. aureus or S. pyogenes.
- 30-day mortality was 10% for pneumococcal cellulitis, 13% for S. aureus, and 23% for S. pyogenes.
Conclusions:
- Bacteremic pneumococcal cellulitis is an uncommon but significant manifestation of pneumococcal disease.
- It predominantly affects patients with severe comorbidities and often results from hematogenous spread.
- Pathophysiology differs from S. aureus and S. pyogenes cellulitis.