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.
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Acknowledgements
The staff of the two wards in Tampere University Hospital and Hatanpää City Hospital is warmly thanked. We also thank research nurse P. Aitos (University of Helsinki) for the excellent technical assistance. This study was financially supported by grants from the Academy of Finland/MICMAN Research Programme 2003–2005 and the Competitive State Research Financing of the Expert Responsibility Area of Tampere University Hospital, grant no. R03212.
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Karppelin, M., Siljander, T., Haapala, AM. et al. Evidence of streptococcal origin of acute non-necrotising cellulitis: a serological study. Eur J Clin Microbiol Infect Dis 34, 669–672 (2015). https://doi.org/10.1007/s10096-014-2274-9
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DOI: https://doi.org/10.1007/s10096-014-2274-9