title: Acute bacterial, nonnecrotizing cellulitis in Finland: microbiological findings.
abstract: BACKGROUND
  Bacterial, nonnecrotizing cellulitis is a localized and often recurrent infection of the skin. The aim of this study was to identify the beta-hemolytic streptococci that cause acute nonnecrotizing cellulitis infection in Finland.
  
  
  METHODS
  A case-control study of 90 patients hospitalized for acute cellulitis and 90 control subjects was conducted during the period of April 2004-March 2005. Bacterial swab samples were obtained from skin lesions or any abrasion or fissured toe web. Blood culture samples were taken for detection of bacteremia. The patients, their household members, and control subjects were assessed for pharyngeal carrier status. beta-Hemolytic streptococci and Staphylococcus aureus were isolated and identified, and group A and G streptococcal isolates were further analyzed by T serotyping and emm and pulsed-field gel electrophoresis typing.
  
  
  RESULTS
  beta-Hemolytic streptococci were isolated from 26 (29%) of 90 patients, 2 isolates of which were blood-culture positive for group G streptococci, and 24 patients had culture-positive skin lesions. Group G Streptococcus (Streptococcus dysgalactiae subsp. equisimilis) was found most often and was isolated from 22% of patient samples of either skin lesions or blood, followed by group A Streptococcus, which was found in 7% of patients. Group G streptococci were also carried in the pharynx of 7% of patients and 13% of household members but was missing from control subjects. Several emm and pulsed-field gel electrophoresis types were present among the isolates. Six patients (7%) had recurrent infections during the study. In 2 patients, the group G streptococcal isolates recovered from skin lesions during 2 consecutive episodes had identical emm and pulsed-field gel electrophoresis types.
  
  
  CONCLUSIONS
  Group G streptococci, instead of group A streptococci, predominated in bacterial cellulitis. No clear predominance of a specific emm type was seen. The recurrent nature of cellulitis became evident during this study.
authors.affiliation: Department of Bacterial and Inflammatory Diseases, National Public Health Institute, Helsinki, Finland. tuula.siljander@ktl.fi
authors.forename: Tuula
authors.initials: T
authors.lastname: Siljander
authors.forename: Matti
authors.initials: M
authors.lastname: Karppelin
authors.forename: Susanna
authors.initials: S
authors.lastname: Vähäkuopus
authors.forename: Jaana
authors.initials: J
authors.lastname: Syrjänen
authors.forename: Maija
authors.initials: M
authors.lastname: Toropainen
authors.forename: Juha
authors.initials: J
authors.lastname: Kere
authors.forename: Risto
authors.initials: R
authors.lastname: Vuento
authors.forename: Tapio
authors.initials: T
authors.lastname: Jussila
authors.forename: Jaana
authors.initials: J
authors.lastname: Vuopio-Varkila
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001769:Blood / Q000382:microbiology; D002353:Carrier State / Q000382:microbiology; D016022:Case-Control Studies; D002481:Cellulitis / Q000453:epidemiology / Q000382:microbiology*; D003470:Culture Media; D016521:Electrophoresis, Gel, Pulsed-Field; D005191:Family Characteristics; D005260:Female; D005387:Finland / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010614:Pharynx / Q000382:microbiology; D013290:Streptococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D013291:Streptococcus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*
chemical_list: D003470:Culture Media