A new article published in Dermatology discussed that cellulitis – a common bacterial skin infection, is characterized by a significant risk of readmission and a high predilection for recurrence. 

Hypotheses relates – the traditional “re-infection hypothesis” that interprets the increased recurrence risk as the consequence of local tissue modifications, induced by a preceding disease episode, which predispose to re-infection in the same skin area; and an alternative pathophysiologic explanation of recurring cellulitis—recurrences may be local “relapses” of a latent infection—owing to pathogen survival and persistence in the already affected tissues. 

The two major cellulitis pathogens Streptococcus pyogenes (GAS) and Staphylococcus aureus as well as many of the less frequent ones, like Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii can establish dormancy by at least two distinct mechanisms – intracellular survival and biofilm formation. 

Currently, the standard of care for the uncomplicated cellulitis comprises short courses (5 days) of beta-lactam antibiotics. It is noteworthy that in about 30% of GAS infections, penicillinfails to eradicate the pathogen;and in nearly the same fraction of patients, recurrences occur.

The therapeutic efficacy of eradication schemes seems to support the in situ pathogen dormancy as an important pathophysiologic mechanism of “relapsing” cellulitis.The treatment of the first-ever disease episode must be implemented as an intervention strategy to prevent cellulitis relapses.

Source: Dermatology. 2021; 237:142–144. doi: 10.1159/000505538