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Updated: Nov 13, 2025
Isolation of Human Lymphatic Endothelial Cells by Multi-parameter Fluorescence-activated Cell Sorting
Published on: May 1, 2015
Is lymphangitic streaking associated with different pathogens?
Rotem Kimia1, Berenika Voskoboynik1, Joel D Hudgins1
1Boston Children's Hospital, Department of Emergency Medicine, USA.
Objectives:
Little is known regarding the differences in microbiology associated with cellulitis or abscess with or without lymphangitic streaking. The objective of our study is to assess whether there are differences in the pathogens identified from wound cultures of patients with paronychia with and without associated lymphangitis.
Methods:
Retrospective cross-sectional study at a tertiary pediatric emergency department over 25 years. We opted to assess patients with paronychia of the finger, assuming that these cases will have a greater variety of causative pathogens compared to other cases of cellulitis and soft tissue abscess that are associated with nail biting. Case identification was conducted using a computerized text-screening search that was refined by manual chart review. We included patients from 1 month to 20 years of age who underwent an incision and drainage (I&D) of a paronychia and had a culture obtained. The presence or absence of lymphangitis was determined from the clinical narrative in the medical record. We excluded patients treated with antibiotics prior to I&D as well as immune-compromised patients. We used descriptive statistics for prevalence and χ2 tests for categorical variables.
Results:
Two hundred sixty-six patients met inclusion criteria. The median age was 9.7 years [IQR 4.7, 15.4] and 45.1% were female. Twenty-two patients (8.3%) had lymphangitic streaking associated with their paronychia. Patients with lymphangitis streaking were similar to those without lymphangitis in terms of age and sex (p = 0.52 and p = 0.82, respectively). Overall, the predominant bacteria was MSSA (40%) followed by MRSA (26%). No significant differences were found between the pathogens in the 22 patients with associated lymphangitis compared to the 244 patients without.
Conclusion:
Staphylococcus aureus represent the majority of pathogens in paronychia, although streptococcal species and gram-negative bacteria were also common. Among patients with paronychia of the finger, there seems to be no association between pathogen type and presence of lymphangitic streaking.
Insights
This study found no significant differences in the types of bacteria causing paronychia, regardless of whether lymphangitic streaking was present. Staphylococcus aureus was the most common pathogen identified in finger infections.
Area of Science:
- Infectious Diseases
- Microbiology
- Pediatric Emergency Medicine
Background:
- Paronychia, a common finger infection, can sometimes present with lymphangitic streaking, indicating potential spread.
- The specific microbiology of paronychia with and without lymphangitic streaking is not well understood.
Purpose of the Study:
- To investigate if there are differences in the identified pathogens from wound cultures in patients with paronychia, comparing those with and without associated lymphangitis.
Main Methods:
- A retrospective cross-sectional study was conducted over 25 years at a tertiary pediatric emergency department.
- Included were 266 patients aged 1 month to 20 years who underwent incision and drainage (I&D) for paronychia with obtained cultures.
- Patients treated with antibiotics pre-I&D or who were immunocompromised were excluded.
Main Results:
- Of 266 patients, 8.3% (22) had lymphangitic streaking; age and sex were similar between groups.
- The predominant bacteria were Methicillin-sensitive Staphylococcus aureus (MSSA, 40%) and Methicillin-resistant Staphylococcus aureus (MRSA, 26%).
- No significant differences in pathogen types were found between patients with and without lymphangitis.
Conclusions:
- Staphylococcus aureus is the primary pathogen in paronychia, with streptococcal and gram-negative bacteria also being common.
- In pediatric paronychia of the finger, the presence of lymphangitic streaking does not appear to be associated with specific pathogen types.
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