Taniyama Daisuke, Maruki Taketomo, Maeda Takahiro, Yoshida Haruno, Takahashi Takashi
Department of General Internal Medicine, Tokyo Saiseikai Central Hospital, Tokyo, Japan.
Laboratory of Infectious Diseases, Kitasato Institute for Life Sciences & Graduate School of Infection Control Sciences, Kitasato University, Tokyo, Japan.
IDCases. 2020 May 6;20:e00793. doi: 10.1016/j.idcr.2020.e00793. eCollection 2020.
Previously reported cases of recurrent cellulitis/erysipelas affecting chronically lymphedematous skin regions have been demonstrated to be due to isolates with closely related genetic background which may be suggestive of relapse rather than reinfection. Herein, we report the occurrence of three episodes of repetitive cellulitis caused by strains with different genotypic and phenotypic characteristics, including different antimicrobial susceptibility patterns (tetracycline, macrolide/lincosamide, and fluoroquinolone classes), in the left upper extremity of a patient with lymphedema, following left mastectomy and axillary lymph node dissection. The genotypic and phenotypic characteristics of the three isolates were confirmed based on the random amplified polymorphic DNA patterns, DNA profiles of virulence factors (----), data on biofilm formation and cell invasion, antimicrobial susceptibility testing results, antimicrobial resistance (AMR) genotypes, and amino acid mutations associated with AMR. These results revealed that reinfection with , rather than recurrence, occurred during the three episodes. In conclusion, microbiologic studies such as blood cultures or tissue cultures are certainly helpful in the management of recurrent infections or invasive infections such as bacteremia in order to better target antimicrobial therapy, regardless of the data previously presented.
先前报道的复发性蜂窝织炎/丹毒累及慢性淋巴水肿皮肤区域的病例已被证明是由于具有密切相关遗传背景的分离株引起的，这可能提示复发而非再感染。在此，我们报告了1例左乳房切除和腋窝淋巴结清扫术后发生淋巴水肿的患者，其左上肢出现了3次由具有不同基因型和表型特征（包括不同的抗菌药物敏感性模式，即四环素类、大环内酯类/林可酰胺类和氟喹诺酮类）的菌株引起的重复性蜂窝织炎。基于随机扩增多态性DNA图谱、毒力因子（----）的DNA谱、生物膜形成和细胞侵袭数据、抗菌药物敏感性测试结果、抗菌药物耐药（AMR）基因型以及与AMR相关的氨基酸突变，对这3株分离株的基因型和表型特征进行了确认。这些结果显示，在这3次发作期间发生的是再感染，而非复发。总之，无论之前提供的数据如何，血培养或组织培养等微生物学研究对于复发性感染或侵袭性感染（如菌血症）的管理肯定是有帮助的，以便更好地指导抗菌治疗。
