Severe Relapsing Erysipelas Associated with ChronicStreptococcus agalactiaeVaginal Colonization

Abstract

We report a case of severe recurrent erysipelas of the breast due to infection with Streptococcus agalactiae and demonstrate that strains isolated from the skin were closely related to strains isolated from the vagina, which is consistent with the claim that the vagina acts as a reservoir for S. agalactiae isolates that are responsible for erysipelas relapse. Hypervirulence of strains and persistence of a bacterial reservoir may explain why 5 months of prophylaxis with penicillin V (1 million U daily) was necessary to achieve permanent eradication of vaginal carriage and to prevent recurrence of erysipelas caused by S. agalactiae infection.

Clinical Features of Group B Streptococcus Prosthetic Joint Infections and Molecular Characterization of Isolates

“…Serotypes Ia, III, and V were most prevalent, as previously reported (4,7,9). The isolates belonged mostly to CC1 and CC23, with the CC1 isolates exhibiting the lowest degree of genetic diversity.…”

Invasive Group B Streptococcal Disease in Non-pregnant Adults

“…This model is supported by two recently published case reports, showing identical strains isolated from the vagina and the blood [48,49].…”

“…Lymphatic or vascular insufficiency, a history of radiation therapy or chronic dermatological diseases are often present in skin and soft-tissue infections [12,49,50]. As a typical example of such a predisposing constellation to GBS infection, arm and chest wall cellulitis have been reported in patients with a history of breast cancer that has included surgical and radiation therapy [6,11,48].…”

“…Persistent gastrointestinal or genitourinary carriage of a certain GBS strain to which the host is susceptible (due to the pathogen's virulence, or to the host's immune status, or both) may serve as a reservoir for relapsing invasive diseases [48,49]. Another possibility includes repetitive acquisition of matching strains from intimate contact with a GBS carrier.…”

“…Bacterial persistence at the local site of infection has been also speculated as a cause of recurrent skin and soft-tissue infections [49]. In relapsing cellulitis, often observed as a chronic complication after surgery, lymphatic tissue is altered and may lead to locally impaired immune responses and insufficient bacterial clearance [12,48,51]. The observation of intracellular persistence in host cells could also help to explain relapsing infections; through this strategy, bacteria may escape common extracellular immunological mechanisms as well as bactericidal concentrations of antibiotic.…”