Evidence of streptococcal origin of acute non-necrotising cellulitis: a serological study

• Published in: European journal of clinical microbiology & infectious diseases Vol. 34; no. 4; pp. 669 - 672
• Main Authors: Karppelin, M., Siljander, T., Haapala, A.-M., Aittoniemi, J., Huttunen, R., Kere, J., Vuopio, J., Syrjänen, J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.04.2015; Springer Nature B.V
• Subjects: Animal bites; Antibiotics; Antibodies, Bacterial - blood; Bacterial Proteins - immunology; Biomedical and Life Sciences; Biomedicine; Case-Control Studies; Cellulitis; Cellulitis - drug therapy; Cellulitis - microbiology; Deoxyribonucleases - immunology; Endotoxins - immunology; Etiology; Female; Hospitals; Humans; Infectious diseases; Internal Medicine; Laboratories; Male; Medical Microbiology; Middle Aged; Patients; Penicillin; Penicillins - therapeutic use; Serology; Staphylococcus aureus; Staphylococcus infections; Streptococcal Infections - drug therapy; Streptococcal Infections - microbiology; Streptococcus; Streptolysins - immunology; Treatment Outcome; Sweden; Finland; Latex Agglutination Method; Erysipelas; Positive Serology; Cellulitis; Bacterial Aetiology
• DOI: 10.1007/s10096-014-2274-9
• ISSN: 0934-9723; 1435-4373

Bacteriological diagnosis is rarely achieved in acute cellulitis. Beta-haemolytic streptococci and Staphylococcus aureus are considered the main pathogens. The role of the latter is, however, unclear in cases of non-suppurative cellulitis. We conducted a serological study to investigate the bacterial aetiology of acute non-necrotising cellulitis. Anti-streptolysin O (ASO), anti-deoxyribonuclease B (ADN) and anti-staphylolysin (ASTA) titres were measured from acute and convalescent phase sera of 77 patients hospitalised because of acute bacterial non-necrotising cellulitis and from the serum samples of 89 control subjects matched for age and sex. Antibiotic treatment decisions were also reviewed. Streptococcal serology was positive in 53 (69 %) of the 77 cases. Furthermore, ten cases without serological evidence of streptococcal infection were successfully treated with penicillin. Positive ASO and ADN titres were detected in ten (11 %) and three (3 %) of the 89 controls, respectively, and ASTA was elevated in three patients and 11 controls. Our findings suggest that acute non-necrotising cellulitis without pus formation is mostly of streptococcal origin and that penicillin can be used as the first-line therapy for most patients.