title: Helicobacter cinaedi cellulitis and bacteremia in immunocompetent hosts after orthopedic surgery.
abstract: At various times after orthopedic operations (more than a few weeks, with an average of 29.9 days), 11 patients had a sudden onset of high temperature (average 38.9 degrees C) and local cellulitis at different sites on the operated sides. The wounds had completely healed, without complicated infections, when the cellulitis occurred. The clinical picture of cellulitis in all patients was atypical: diffuse salmon-pink skin color, local heat, swelling, spontaneous pain, and tenderness but no eruptions. No patient had any underlying immunocompromising conditions or had been given immunosuppressive agents. Gram-negative spiral bacteria were isolated from blood cultures and were identified as Helicobacter cinaedi on the basis of 16S rRNA gene sequencing and DNA-DNA hybridization using standard strains. By means of phylogenetic analysis, we divided these clinical isolates into two clones. The H. cinaedi strain isolated via fecal cultures from two patients without intestinal symptoms was the same clone as the blood isolate. All isolates were quite susceptible to various antibiotics, and clinical and inflammatory symptoms of bacteremia and cellulitis improved after treatment with penicillins and cephalosporins. A relatively high incidence of recurrence of the same disease was observed, however. Almost all patients responded immunologically to the infection, as evidenced by the production of serum antibody against H. cinaedi. We thus suggest that H. cinaedi should not be regarded as simply an opportunistic pathogen but that it may be a pathogen in immunocompetent hosts and may cause infections together with bacteremia and cellulitis.
authors.affiliation: Department of Orthopedics, Kumamoto Orthopedic Hospital, Japan.
authors.forename: Toshio
authors.initials: T
authors.lastname: Kitamura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Kiyofumi
authors.initials: K
authors.lastname: Ohkusu
authors.forename: Takayuki
authors.initials: T
authors.lastname: Masaki
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Iwashita
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sawa
authors.forename: Shigemoto
authors.initials: S
authors.lastname: Fujii
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Okamoto
authors.forename: Takaaki
authors.initials: T
authors.lastname: Akaike
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000382:microbiology*; D015373:Bacterial Typing Techniques; D002481:Cellulitis / Q000382:microbiology* / Q000473:pathology; D018834:Chaperonin 60 / Q000235:genetics; D004269:DNA, Bacterial / Q000032:analysis; D004275:DNA, Ribosomal / Q000032:analysis; D005260:Female; D016998:Helicobacter / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D016481:Helicobacter Infections / Q000382:microbiology / Q000473:pathology; D006801:Humans; D007121:Immunocompetence; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009693:Nucleic Acid Hybridization; D019637:Orthopedic Procedures / Q000009:adverse effects*; D009985:Orthopedics; D010802:Phylogeny; D012336:RNA, Ribosomal, 16S / Q000235:genetics; D017422:Sequence Analysis, DNA
chemical_list: D018834:Chaperonin 60; D004269:DNA, Bacterial; D004275:DNA, Ribosomal; D012336:RNA, Ribosomal, 16S