Staphylococcus lugdunensis  from gluteal abscess to destructive native triple valve endocarditis

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Abstract

We herein present the case of a 43-year-old male diabetic patient who presented with an aggressive form of infective endocarditis involving the tricuspid, mitral and aortic valves following a gluteal abscess due to infection with Staphylococcus lugdunensis. This coagulase-negative organism which is generally considered a component of the normal flora of the skin has however recently emerged as an unusually virulent pathogen responsible for both nosocomial and community-acquired infections. The case demonstrates the importance of paying utmost attention and ensuring a logical conclusion to the identification of persistent coagulase-negative blood cultures. In addition, it also shows the importance of early identification of this organism and aggressive antibiotic administration to avert endocarditis because of the unusual virulence of the organism. Staphylococcus lugdunensis is rarely a clinical specimen contaminant, and its isolation warrants further investigation and concerted treatment.

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Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles.

J Miro, J Gatell, Cristina F. Marco … (2005)

To evaluate the incidence and the clinical and echocardiographic features of infective endocarditis (IE) caused by Staphylococcus lugdunensis and to identify the prognostic factors of surgery and mortality in this disease. Prospective cohort study. Study at two centres (a tertiary care centre and a community hospital). 10 patients with IE caused by S lugdunensis in 912 consecutive patients with IE between 1990 and 2003. Prospective study of consecutive patients carried out by the multidisciplinary team for diagnosis and treatment of IE from the study institutions. English, French, and Spanish literature was searched by computer under the terms "endocarditis" and "Staphylococcus lugdunensis" published between 1989 and December 2003. Patient characteristics, echocardiographic findings, required surgery, and prognostic factors of mortality in left sided cases of IE. 10 cases of IE caused by S lugdunensis were identified at our institutions, representing 0.8% (four of 467), 1.5% (two of 135), and 7.8% (four of 51) of cases of native valve, prosthetic valve, and pacemaker lead endocarditis in the non-drug misusers. Native valve IE was present in four patients (two aortic, one mitral, and one pulmonary), prosthetic valve aortic IE in two patients, and pacemaker lead IE in the other four patients. All patients with left sided IE had serious complications (heart failure, periannular abscess formation, or shock) requiring surgery in 60% (three of five patients) of cases with an overall mortality rate of 80% (four of five patients). All patients with pacemaker IE underwent combined medical treatment and surgery, and mortality was 25% (one patient). In total 59 cases of IE caused by S lugdunensis were identified in a review of the literature. The combined analysis of these 69 cases showed that native valve IE (53 patients, 77%) is characterised by mitral valve involvement and frequent complications such as heart failure, abscess formation, and embolism. Surgery was needed in 51% of cases and mortality was 42%. Prosthetic valve endocarditis (nine of 60, 13%) predominated in the aortic position and was associated with abscess formation, required surgery, and high mortality (78%). Pacemaker lead IE (seven of 69, 10%) is associated with a better prognosis when antibiotic treatment is combined with surgery. S lugdunensis IE is an uncommon cause of IE, involving mainly native left sided valves, and it is characterised by an aggressive clinical course. Mortality in left sided native valve IE is high but the prognosis has improved in recent years. Surgery has improved survival in left sided IE and, therefore, early surgery should always be considered. Prosthetic valve S lugdunensis IE carries an ominous prognosis.

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Staphylococcus lugdunensis in several niches of the normal skin flora.

L. Bieber, G. Kahlmeter (2010)

Staphylococcus lugdunensis is a coagulase-negative staphylococcus (CNS). Its pathogenicity and virulence are more similar to Staphylococcus aureus than to a CNS. It causes severe infections with high mortality, such as endocarditis, but more often painful and prolonged skin- and soft-tissue infections. Little is known of its normal habitat. Whether it is an integral part of the normal skin flora like many other CNS has been questioned, since it is rarely seen in blood cultures. This study was designed to determine whether S. lugdunensis has a niche in the normal skin flora and to compare S. lugdunensis and S. aureus in these niches.From 75 healthy subjects in Kronoberg County, Sweden, 525 swabs were obtained from the nose, axilla, perineum, groin, breast, toe and nail bed of the first toe. Significantly more of the 525 skin samples as well as of the 75 healthy subjects yielded S. lugdunensis (50/75) as opposed to S. aureus.(16/75). Swabs from the nose frequently yielded S. aureus, but only rarely S. lugdunensis. Swabs from the groin and the lower extremities, especially the nail bed of the first toe, often yielded S. lugdunensis but rarely S. aureus. This study shows that S. lugdunensis is an integral part of the normal skin flora, primarily of the lower abdomen and extremities, and that the niches of this coagulase-negative staphylococcus are distinctly different from those of S. aureus. The predominant niches of S. lugdunensis explain why the bacterium is an uncommon contaminant of blood cultures.

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Staphylococcus lugdunensis Infections of the Skin and Soft Tissue: A Case Series and Review

Lucas Heldt Manica, Philip R. Cohen (2017)

Introduction Staphylococcus lugdunensis (S. lugdunensis) is a coagulase-negative, Gram-positive bacterium that can be isolated as a component of normal skin flora in humans. However, more recently, it has also been documented as a culprit in skin and soft tissue infections. We describe the clinical features of five individuals with S. lugdunensis-associated skin infections. We review the characteristics of other patients that were previously described with this organism as the causative agent of skin infection. Methods Staphylococcus lugdunensis was correlated with the development of significant skin and soft tissue infections in five patients. The Pubmed database was used to search for the following terms: “abscess,” “cellulitis,” “cutaneous,” “lugdunensis,” “paronychia,” “skin,” “soft,” “staphylococcus,” and “tissue.” The relevant and reference papers generated by the search were reviewed. Results One woman and four men developed S. lugdunensis-related skin infections from February 19, 2015 to May 30, 2017. The patients’ ages at the onset of the infection ranged from 30 to 82 years; the median age was 70 years. Four patients were older than 65 years. The back was the most common location for the infection, followed by digits. The infection presented as cystic lesions with cellulitis or periungual abscesses. The lesions were incised or spontaneously ruptured. Patients were empirically treated with oral antibiotics; if necessary, the management was adjusted based on the culture-derived sensitivities of the organisms. The infections resolved within 10–30 days after commencing treatment. Conclusion Staphylococcus lugdunensis has previously been considered as a nonpathogenic organism and to be a component of normal skin flora. However, S. lugdunensis can result in significant skin and soft tissue infections, perhaps more frequently in older individuals. Its antibiotic sensitivities appear to be similar to those of methicillin-susceptible Staphylococcus aureus.

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Journal

Journal ID (nlm-ta): Saudi Med J

Journal ID (iso-abbrev): Saudi Med J

Title: Saudi Medical Journal

Publisher: Saudi Medical Journal (Saudi Arabia )

ISSN (Print): 0379-5284

Publication date (Print): October 2018

Volume: 39

Issue: 10

Pages: 1050-1053

Affiliations

[1] From the Division of Infectious Diseases, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia

Author notes

Address correspondence and reprint request to: Dr. Fahad M. AL Majid, Chief of Infectious Disease’s Division, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail: falmajid@ 123456gmail.com ORCID ID: orcid.org/0000-0003-2719-5103

Article

Publisher ID: SaudiMedJ-39-1050

DOI: 10.15537/smj.2018.10.22905

PMC ID: 6201034

PubMed ID: 30284590

SO-VID: a843f650-6609-4125-baa5-0937d85ca41d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Staphylococcus lugdunensis from gluteal abscess to destructive native triple valve endocarditis

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Most cited references 10

Staphylococcus lugdunensis infective endocarditis: description of 10 cases and analysis of native valve, prosthetic valve, and pacemaker lead endocarditis clinical profiles.

Staphylococcus lugdunensis in several niches of the normal skin flora.

Staphylococcus lugdunensis Infections of the Skin and Soft Tissue: A Case Series and Review

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