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
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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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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 22 | 24 | 46 |
| 2024 Octubre | 160 | 122 | 282 |
| 2024 Septiembre | 173 | 83 | 256 |
| 2024 Agosto | 225 | 119 | 344 |
| 2024 Julio | 192 | 96 | 288 |
| 2024 Junio | 174 | 104 | 278 |
| 2024 Mayo | 156 | 101 | 257 |
| 2024 Abril | 125 | 51 | 176 |
| 2024 Marzo | 122 | 45 | 167 |
| 2024 Febrero | 129 | 38 | 167 |
| 2024 Enero | 86 | 57 | 143 |
| 2023 Diciembre | 101 | 22 | 123 |
| 2023 Noviembre | 125 | 39 | 164 |
| 2023 Octubre | 88 | 35 | 123 |
| 2023 Septiembre | 73 | 49 | 122 |
| 2023 Agosto | 85 | 35 | 120 |
| 2023 Julio | 97 | 49 | 146 |
| 2023 Junio | 81 | 42 | 123 |
| 2023 Mayo | 104 | 37 | 141 |
| 2023 Abril | 124 | 21 | 145 |
| 2023 Marzo | 78 | 36 | 114 |
| 2023 Febrero | 72 | 30 | 102 |
| 2023 Enero | 71 | 38 | 109 |
| 2022 Diciembre | 75 | 42 | 117 |
| 2022 Noviembre | 59 | 38 | 97 |
| 2022 Octubre | 43 | 45 | 88 |
| 2022 Septiembre | 49 | 47 | 96 |
| 2022 Agosto | 39 | 39 | 78 |
| 2022 Julio | 41 | 51 | 92 |
| 2022 Junio | 33 | 23 | 56 |
| 2022 Mayo | 105 | 63 | 168 |
| 2022 Abril | 86 | 39 | 125 |
| 2022 Marzo | 97 | 48 | 145 |
| 2022 Febrero | 64 | 26 | 90 |
| 2022 Enero | 75 | 39 | 114 |
| 2021 Diciembre | 51 | 54 | 105 |
| 2021 Noviembre | 79 | 56 | 135 |
| 2021 Octubre | 78 | 66 | 144 |
| 2021 Septiembre | 74 | 44 | 118 |
| 2021 Agosto | 56 | 43 | 99 |
| 2021 Julio | 45 | 36 | 81 |
| 2021 Junio | 50 | 45 | 95 |
| 2021 Mayo | 47 | 45 | 92 |
| 2021 Abril | 64 | 86 | 150 |
| 2021 Marzo | 82 | 48 | 130 |
| 2021 Febrero | 56 | 35 | 91 |
| 2021 Enero | 40 | 33 | 73 |
| 2020 Diciembre | 39 | 26 | 65 |
| 2020 Noviembre | 27 | 32 | 59 |
| 2020 Octubre | 42 | 30 | 72 |
| 2020 Septiembre | 36 | 16 | 52 |
| 2020 Agosto | 44 | 22 | 66 |
| 2020 Julio | 34 | 22 | 56 |
| 2020 Junio | 39 | 33 | 72 |
| 2020 Mayo | 31 | 25 | 56 |
| 2020 Abril | 36 | 28 | 64 |
| 2020 Marzo | 49 | 26 | 75 |
| 2020 Febrero | 12 | 8 | 20 |
| 2020 Enero | 4 | 2 | 6 |
| 2019 Diciembre | 8 | 5 | 13 |
| 2019 Noviembre | 4 | 6 | 10 |
| 2019 Septiembre | 8 | 8 | 16 |
| 2019 Agosto | 4 | 2 | 6 |
| 2019 Julio | 2 | 4 | 6 |
| 2019 Junio | 6 | 30 | 36 |
| 2019 Mayo | 1 | 39 | 40 |
| 2019 Abril | 0 | 19 | 19 |
| 2019 Marzo | 2 | 8 | 10 |
| 2019 Febrero | 0 | 5 | 5 |
| 2019 Enero | 4 | 0 | 4 |
| 2018 Noviembre | 1 | 2 | 3 |
| 2018 Octubre | 3 | 0 | 3 |
| 2018 Septiembre | 4 | 0 | 4 |
| 2018 Junio | 0 | 3 | 3 |
| 2018 Mayo | 0 | 14 | 14 |
| 2018 Abril | 0 | 11 | 11 |
| 2018 Marzo | 0 | 9 | 9 |
| 2018 Febrero | 40 | 12 | 52 |
| 2018 Enero | 41 | 7 | 48 |
| 2017 Diciembre | 33 | 11 | 44 |
| 2017 Noviembre | 35 | 10 | 45 |
| 2017 Octubre | 23 | 12 | 35 |
| 2017 Septiembre | 32 | 18 | 50 |
| 2017 Agosto | 28 | 18 | 46 |
| 2017 Julio | 31 | 22 | 53 |
| 2017 Junio | 37 | 35 | 72 |
| 2017 Mayo | 34 | 28 | 62 |
| 2017 Abril | 21 | 6 | 27 |
| 2017 Marzo | 10 | 62 | 72 |
| 2017 Febrero | 20 | 9 | 29 |
| 2017 Enero | 17 | 16 | 33 |
| 2016 Diciembre | 29 | 22 | 51 |
| 2016 Noviembre | 32 | 14 | 46 |
| 2016 Octubre | 29 | 45 | 74 |
| 2016 Septiembre | 0 | 6 | 6 |
| 2016 Agosto | 0 | 8 | 8 |
| 2016 Julio | 0 | 2 | 2 |
| 2016 Junio | 1 | 2 | 3 |
| 2016 Mayo | 0 | 4 | 4 |
| 2016 Abril | 0 | 3 | 3 |
| 2016 Marzo | 0 | 3 | 3 |
| 2016 Febrero | 0 | 4 | 4 |
| 2016 Enero | 0 | 5 | 5 |
| 2015 Diciembre | 0 | 9 | 9 |
| 2015 Noviembre | 0 | 9 | 9 |
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