Bacteriological studies of blood, tissue fluid, lymph andudlymph nodes in patients with acuteuddermatolymphangioadenitis (DLA) in course of ‘filarial’udlymphedema

摘要

Filarial lymphedema is complicated by frequent episodes of dermatolymphangioadenitis (DLA). Severe systemicudsymptoms during attacks of DLA resemble those of septicemia. The question we asked was whether bacterial isolatesudcan be found in the peripheral blood of patients during the episodes of DLA. Out of 100 patients referred to us withud‘filarial’ lymphedema 14 displayed acute and five subacute symptoms of DLA. All were on admission bloodudmicrofilariae negative but had a positive test in the past. Blood bacterial isolates were found in nine cases, four acuteud(21%) and five subacute (26%). In 10 acute cases blood cultures were found negative. Six blood isolates belonged toudBacilli, four to Cocci and one was Sarcina. To identify the sites of origin of bacterial dissemination, swabs taken fromudthe calf skin biopsy wounds and tissue fluid, lymph and lymph node specimens were cultured. Swabs from the calfudskin biopsy wound contained isolates in nine (47%) cases. They were Bacilli in nine, Cocci in three, Acinetobacter andudErwinia in two cases. Tissue fluid was collected from 10 patients and contained Bacilli in four (40%) andudStaphylococci in three (30%). Lymph was drained in four patients and contained isolates in all samples (100%). Theyudwere Staphylococcus epidermis, xylosus and aureus, Acinetobacter, Bacillus subtilis and Sarcina. Three lymph nodesudwere biopsied and contained Staphylococcus chromogenes, xylosus, Enterococcus and Bacillus cereus. In six cases theudsame phenotypically defined species of bacteria were found in blood and limb tissues or fluids. In the ‘control’ group of patients with lymphedema without acute or subacute changes all blood cultures were negative. Interestingly, swabsudfrom biopsy wound of these patients contained isolates in 80%, tissue fluid in 68%, lymph in 70% and lymph nodesudin 58% of cases. In healthy controls, tissue fluid did not contain bacteria, and lymph isolates were found only in 12%udof cases. This study demonstrates that patients with acute episodes of DLA reveal bacteriemia in a high percentageudof cases. Diversity of blood and tissue bacterial isolates in these patients points to a breakdown of the skin immuneudbarrier in lymphedema and subsequently indiscriminate bacterial colonization of deep tissues and spread to an bloodudcirculation. © 1999 Elsevier Science B.V. All rights reserved.