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Pneumococcal soft-tissue infections: possible association with connective tissue diseases
M J DiNubile1, M A Albornoz, R J Stumacher
1Department of Medicine, Cooper Hospital/University Medical Center, Camden, NJ.
Abstract:
Streptococcus pneumoniae is not a well-recognized cause of soft-tissue infections. In less than 4 years, 12 cases of pneumococcal soft-tissue infection were identified through discussions with infections disease subspecialists in the Philadelphia area. Principal sites of involvement included skin and fascia, tongue, epiglottis, thyroid, brain, and breast. Pneumococcal bacteremia was documented in six cases (50%); in three of these, pneumococci were also cultured from the involved soft tissues. In the cases in which bacteremia was not demonstrated, pneumococci were isolated from the infected sites. Six patients had connective tissue diseases, of which five were diagnosed as systemic lupus erythematosus. Four of these patients were receiving corticosteroids when their infections developed. Two additional patients were HIV-seropositive intravenous drug users. S. pneumoniae may be a more important cause of soft-tissue infections than previously appreciated, especially in patients with connective tissue diseases.
Insights
Streptococcus pneumoniae, a common cause of pneumonia, can also lead to soft-tissue infections, particularly in immunocompromised individuals. This study highlights its underrecognized role, especially in patients with connective tissue diseases.
Area of Science:
- Infectious Diseases
- Microbiology
- Dermatology
Background:
- Streptococcus pneumoniae is primarily known for causing respiratory infections.
- Soft-tissue infections are typically attributed to other bacterial pathogens.
Observation:
- Twelve cases of soft-tissue infections caused by Streptococcus pneumoniae were identified over four years.
- Infections occurred in various sites, including skin, fascia, tongue, epiglottis, thyroid, brain, and breast.
- Pneumococcal bacteremia was present in 50% of cases.
Findings:
- Streptococcus pneumoniae was isolated from infected soft tissues in all cases, with or without bacteremia.
- Patients with connective tissue diseases, particularly systemic lupus erythematosus, were disproportionately affected.
- Corticosteroid use and HIV infection were identified as risk factors.
Implications:
- Streptococcus pneumoniae should be considered a potential cause of soft-tissue infections, especially in at-risk populations.
- Early recognition and appropriate antibiotic treatment are crucial for managing these infections.
- Further research is needed to understand the pathogenesis and epidemiology of pneumococcal soft-tissue infections.