Case and Research Letters
Staphylococcus lugdunensis: An Emerging Pathogen in Skin and Soft Tissue Infections
Staphylococcus lugdunensis: un patógeno emergente en infecciones de piel y partes blandas
B. Lozano-Masdemont
, L. Gómez-Recuero-Muñoz, A. Pulido-Pérez
Corresponding author
Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Lozano-Masdemont, L. Gómez-Recuero-Muñoz, A. Pulido-Pérez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "B." "apellidos" => "Lozano-Masdemont" "email" => array:1 [ 0 => "belenmasdemont@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "L." "apellidos" => "Gómez-Recuero-Muñoz" ] 2 => array:2 [ "nombre" => "A." "apellidos" => "Pulido-Pérez" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Servicio de Dermatología, Hospital General Universitario Gregorio Marañón, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleItalic">Staphylococcus lugdunensis</span>: un patógeno emergente en infecciones de piel y partes blandas" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1000 "Ancho" => 800 "Tamanyo" => 196549 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A fluctuating violaceous nodule on the left thigh.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Staphylococcus lugdunensis</span> belongs to the group of coagulase negative staphylococci (CoNS) that are members of the skin microbiota. In contrast to the other CoNS, <span class="elsevierStyleItalic">S. lugdunensis</span> presents microbiological characteristics associated with a high level of virulence and a capacity to produce suppurative infections, in both healthy and immunodepressed individuals.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> An increase in the incidence of community acquired infections has been reported in recent years, with the skin and subcutaneous cellular tissue being the main targets.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present 2 cases of pyoderma in which <span class="elsevierStyleItalic">S. lugdunensis</span> was isolated as the causative agent.</p><p id="par0015" class="elsevierStylePara elsevierViewall">The first patient was a 59-year-old man with type 2 diabetes. He consulted for a lesion that had arisen on the left thigh several weeks earlier and that he attributed to an insect bite. He did not report fever. Examination revealed a violaceous nodule of 2<span class="elsevierStyleHsp" style=""></span>cm diameter with a central orifice through which purulent material was draining. The lesion was clinically compatible with an abscess (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Surgical drainage was performed and samples were taken for microbiological analysis. Home treatment consisted of the application of fusidic acid cream twice a day after wound cleansing. The lesion healed in a week. <span class="elsevierStyleItalic">S. lugdunensis</span> was isolated from the culture (identification by MicroScan); the organism was sensitive to ampicillin, oxacillin, and to the other antibiotics tested (gentamycin, erythromycin, clindamycin, vancomycin, rifampicin, fosfomycin, trimethoprim-sulfamethoxazole, ciprofloxacin, norfloxacin, and daptomycin; antimicrobial sensitivity assay: broth microdilution).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The second patient was a woman aged 42 years with no past medical history of interest. She consulted for a painful lesion that had arisen a month earlier on the sole of the right foot. She did not recall any injury, but there had been superficial manipulation by a podologist before the discomfort started. On examination, a whitish plaque was observed that did not disrupt the dermatoglyphs. Curettage of the hyperkeratotic component revealed an abscessified cavity. Surgical lavage was performed and samples were sent for microbiology culture, from which <span class="elsevierStyleItalic">S. lugdunensis</span> (MicroScan) was isolated, showing an antimicrobial sensitivity pattern identical to that of the previous case. Antibiotic treatment with initiated with amoxicillin/clavulanic acid 875<span class="elsevierStyleHsp" style=""></span>mg/125<span class="elsevierStyleHsp" style=""></span>mg every 8<span class="elsevierStyleHsp" style=""></span>hours and 2% mupirocin cream twice a day for a week, with a satisfactory clinical course.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The growth of CoNS in skin cultures can typically be explained by its presence as a commensal organism. However, some species are associated with a higher risk of developing suppurative infections. In recent years, <span class="elsevierStyleItalic">S. lugdunensis</span> has been shown to be one of the main CoNS with pathogenic potential. It was first described by Freney et al. in 1988. The term <span class="elsevierStyleItalic">lugdunensis</span> derives from the city where the organism was first isolated: Lugdunum, the Latin name for Lyon, France.</p><p id="par0030" class="elsevierStylePara elsevierViewall">This staphylococcus has been described by some authors as a wolf in a lamb's skin”,<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> because of its high virulence and its ability to act as a pathogenic organism, in contrast to other CoNS.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Although it can affect healthy individuals, the risk is higher in patients with diabetes mellitus, kidney failure, or malignant disease, and in those on immunosuppressant treatment. Trauma or a solution of continuity after surgery are the main pathological states associated with infection by this microorganism.<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">As a colonizing organism, <span class="elsevierStyleItalic">S. lugdunum</span> is found in areas rich in apocrine sweat glands, such as the inguinoperineal and periareolar regions,<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a> although it can also be isolated from the nares of healthy individuals.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Clinical infection typically presents as skin and soft tissue infection in the form of a subcutaneous abscess. Nonpuerperal mastitis—often recurrent—warrants special mention.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> Bone and joint infection can arise by contiguous spread, highlighting the pathogenic potential of this staphylococcus. Less commonly, it has been associated with infections of the central nervous system<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> or urinary tract and with endocarditis.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">Its high virulence compared with other CoNS is due to a number of characteristics: the formation of a biofilm (it is also an emerging pathogen in prosthesis-related infections), production of adherence proteins, resistance to high concentrations of lysozyme, and production of heat-stable hemolysin.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">2,9</span></a> However, it does not produce Panton-Valentine leukocidin, the toxin responsible for the virulence of some strains of <span class="elsevierStyleItalic">Staphylococcus aureus.</span></p><p id="par0055" class="elsevierStylePara elsevierViewall">In contrast to other SCoN, <span class="elsevierStyleItalic">S. lugdunensis</span> presents an excellent sensitivity profile to a number of families of antimicrobials, including the penicillins, which makes control easier. Despite this, cases of methicillin resistance have already been reported.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">It should be noted that the rate of error of identification in automated instruments is not insignificant, meaning that the frequency of infection may be underestimated.</p><p id="par0065" class="elsevierStylePara elsevierViewall">The growing interest in this bacterium in dermatology is based not only on its elevated capacity to cause skin and soft tissue infections, but also on the correct interpretation of the culture, in order to recognize it as a pathogenic organism and not rule it out as a skin comensal.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lozano-Masdemont B, Gómez-Recuero-Muñoz L, Pulido-Pérez A. <span class="elsevierStyleItalic">Staphylococcus lugdunensis</span>: un patógeno emergente en infecciones de piel y partes blandas. Actas Dermosifiliogr. 2015;106:769–770.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1000 "Ancho" => 800 "Tamanyo" => 196549 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A fluctuating violaceous nodule on the left thigh.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "From clinical microbiology to infection pathogenesis: how daring to be different works for <span class="elsevierStyleItalic">Staphylococcus lugdunensis</span>" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "K.L. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 21 | 24 | 45 |
| 2024 October | 160 | 122 | 282 |
| 2024 September | 173 | 83 | 256 |
| 2024 August | 225 | 119 | 344 |
| 2024 July | 192 | 96 | 288 |
| 2024 June | 174 | 104 | 278 |
| 2024 May | 156 | 101 | 257 |
| 2024 April | 125 | 51 | 176 |
| 2024 March | 122 | 45 | 167 |
| 2024 February | 129 | 38 | 167 |
| 2024 January | 86 | 57 | 143 |
| 2023 December | 101 | 22 | 123 |
| 2023 November | 125 | 39 | 164 |
| 2023 October | 88 | 35 | 123 |
| 2023 September | 73 | 49 | 122 |
| 2023 August | 85 | 35 | 120 |
| 2023 July | 97 | 49 | 146 |
| 2023 June | 81 | 42 | 123 |
| 2023 May | 104 | 37 | 141 |
| 2023 April | 124 | 21 | 145 |
| 2023 March | 78 | 36 | 114 |
| 2023 February | 72 | 30 | 102 |
| 2023 January | 71 | 38 | 109 |
| 2022 December | 75 | 42 | 117 |
| 2022 November | 59 | 38 | 97 |
| 2022 October | 43 | 45 | 88 |
| 2022 September | 49 | 47 | 96 |
| 2022 August | 39 | 39 | 78 |
| 2022 July | 41 | 51 | 92 |
| 2022 June | 33 | 23 | 56 |
| 2022 May | 105 | 63 | 168 |
| 2022 April | 86 | 39 | 125 |
| 2022 March | 97 | 48 | 145 |
| 2022 February | 64 | 26 | 90 |
| 2022 January | 75 | 39 | 114 |
| 2021 December | 51 | 54 | 105 |
| 2021 November | 79 | 56 | 135 |
| 2021 October | 78 | 66 | 144 |
| 2021 September | 74 | 44 | 118 |
| 2021 August | 56 | 43 | 99 |
| 2021 July | 45 | 36 | 81 |
| 2021 June | 50 | 45 | 95 |
| 2021 May | 47 | 45 | 92 |
| 2021 April | 64 | 86 | 150 |
| 2021 March | 82 | 48 | 130 |
| 2021 February | 56 | 35 | 91 |
| 2021 January | 40 | 33 | 73 |
| 2020 December | 39 | 26 | 65 |
| 2020 November | 27 | 32 | 59 |
| 2020 October | 42 | 30 | 72 |
| 2020 September | 36 | 16 | 52 |
| 2020 August | 44 | 22 | 66 |
| 2020 July | 34 | 22 | 56 |
| 2020 June | 39 | 33 | 72 |
| 2020 May | 31 | 25 | 56 |
| 2020 April | 36 | 28 | 64 |
| 2020 March | 49 | 26 | 75 |
| 2020 February | 12 | 8 | 20 |
| 2020 January | 4 | 2 | 6 |
| 2019 December | 8 | 5 | 13 |
| 2019 November | 4 | 6 | 10 |
| 2019 September | 8 | 8 | 16 |
| 2019 August | 4 | 2 | 6 |
| 2019 July | 2 | 4 | 6 |
| 2019 June | 6 | 30 | 36 |
| 2019 May | 1 | 39 | 40 |
| 2019 April | 0 | 19 | 19 |
| 2019 March | 2 | 8 | 10 |
| 2019 February | 0 | 5 | 5 |
| 2019 January | 4 | 0 | 4 |
| 2018 November | 1 | 2 | 3 |
| 2018 October | 3 | 0 | 3 |
| 2018 September | 4 | 0 | 4 |
| 2018 June | 0 | 3 | 3 |
| 2018 May | 0 | 14 | 14 |
| 2018 April | 0 | 11 | 11 |
| 2018 March | 0 | 9 | 9 |
| 2018 February | 40 | 12 | 52 |
| 2018 January | 41 | 7 | 48 |
| 2017 December | 33 | 11 | 44 |
| 2017 November | 35 | 10 | 45 |
| 2017 October | 23 | 12 | 35 |
| 2017 September | 32 | 18 | 50 |
| 2017 August | 28 | 18 | 46 |
| 2017 July | 31 | 22 | 53 |
| 2017 June | 37 | 35 | 72 |
| 2017 May | 34 | 28 | 62 |
| 2017 April | 21 | 6 | 27 |
| 2017 March | 10 | 62 | 72 |
| 2017 February | 20 | 9 | 29 |
| 2017 January | 17 | 16 | 33 |
| 2016 December | 29 | 22 | 51 |
| 2016 November | 32 | 14 | 46 |
| 2016 October | 29 | 45 | 74 |
| 2016 September | 0 | 6 | 6 |
| 2016 August | 0 | 8 | 8 |
| 2016 July | 0 | 2 | 2 |
| 2016 June | 1 | 2 | 3 |
| 2016 May | 0 | 4 | 4 |
| 2016 April | 0 | 3 | 3 |
| 2016 March | 0 | 3 | 3 |
| 2016 February | 0 | 4 | 4 |
| 2016 January | 0 | 5 | 5 |
| 2015 December | 0 | 9 | 9 |
| 2015 November | 0 | 9 | 9 |
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