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

Eur J Clin Microbiol Infect Dis. 2015 Apr;34(4):669-72. doi: 10.1007/s10096-014-2274-9. Epub 2014 Nov 18.

Abstract

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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Antibodies, Bacterial / blood*
  • Bacterial Proteins / immunology
  • Case-Control Studies
  • Cellulitis / drug therapy
  • Cellulitis / microbiology*
  • Deoxyribonucleases / immunology*
  • Endotoxins / immunology
  • Female
  • Humans
  • Male
  • Middle Aged
  • Penicillins / therapeutic use
  • Streptococcal Infections / drug therapy
  • Streptococcal Infections / microbiology*
  • Streptolysins / immunology*
  • Treatment Outcome

Substances

  • Antibodies, Bacterial
  • Bacterial Proteins
  • Endotoxins
  • Penicillins
  • Streptolysins
  • streptolysin O
  • staphylolysin
  • Deoxyribonucleases
  • deoxyribonuclease B