Acute Infection by Staphylococcus simulans in the Hand of a Man | Dermatology | JAMA Dermatology | JAMA Network
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Observation
September 2016

Acute Infection by Staphylococcus simulans in the Hand of a Man

Author Affiliations
  • 1Department of Dermatology, Hospital 12 de Octubre, Madrid, Spain
JAMA Dermatol. 2016;152(9):1060. doi:10.1001/jamadermatol.2016.0959

Staphylococcus simulans is a common animal pathogen that occasionally can colonize human skin.

Report of a Case

A man in his 60s with a history of hypertension and diabetes mellitus, who worked as a butcher and occasional hunter and had contact with hares and rabbits, presented with lesions on left hand evolving over 3 days. Initially, vesiculobullous lesions appeared on the dorsal aspect of his left hand and extended into the web space between the first and second fingers (Figure, A). Within 2 days, the lesion extended to the palm and ventral aspect of the thumb with an eroded area on which pustules appeared (Figure, B). No fever or other systemic symptoms were present.

Figure.  Clinical Images of the Patient’s Affected Left Hand
Clinical Images of the Patient’s Affected Left Hand

A, Initially hemorrhagic bullous lesions appeared. B, The disease evolved over 2 days to include surface erosion with pustular lesions.

Considering the acute onset of vesiculobullous and pustular lesions of the hand in a patient in repeated contact with animals, the differential diagnosis included bullous impetigo and ringworm, which are more common in the general population, or erysipelas, an infection typically associated with uncooked meat.

A fungal culture was negative; the bacterial culture showed S simulans. A biopsy specimen of the lesion was obtained for polymerase chain reaction analysis for Erysipelothrix rhusiopathiae, but the findings were negative. Thus, the diagnosis was pyoderma with S simulans. The patient was treated with azithromycin, 500 mg/d, for 3 days, and the lesions resolved within the next week.

Discussion

Staphylococcus simulans is a common animal pathogen that occasionally can colonize human skin. Human infections with S simulans have rarely been reported, but they do occur in patients who have repeated contact with animals (eg, butchers and veterinarians). Most cases reported are cardiac or osteoarticular infections.1-4 A few reports have associated S simulans with bacteremia, infectious endocarditis, postsurgical osteomyelitis, prosthetic joint infection, and urinary tract infection. Pyoderma by S simulans has been frequently described in animals but to our knowledge has not been reported in humans. The clinical appearance is similar to bullous impetigo. It is important to keep in mind that patients in contact with animals may be infected with S simulans of the hands. Diagnosis and early treatment are important to prevent infection of vital organs.

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Article Information

Corresponding Author: Fátima Tous Romero, MD, Avda de Córdoba s/n, CP 28041, Madrid, Spain (Fatimatousro@gmail.com).

Published Online: May 4, 2016. doi:10.1001/jamadermatol.2016.0959.

Conflict of Interest Disclosures: None reported.

References
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Razonable  RR, Lewallen  DG, Patel  R, Osmon  DR.  Vertebral osteomyelitis and prosthetic joint infection due to Staphylococcus simulans Mayo Clin Proc. 2001;76(10):1067-1070.PubMedGoogle ScholarCrossref
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Vallianou  N, Evangelopoulos  A, Makri  P,  et al.  Vertebral osteomyelitis and native valve endocarditis due to Staphylococcus simulans: a case report.  J Med Case Rep. 2008;2:183.PubMedGoogle ScholarCrossref
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Désidéri-Vaillant  C, Nédelec  Y, Guichon  JM,  et al.  Staphylococcus simulans osteitis in a diabetic patient.  Diabetes Metab. 2011;37(6):560-562.PubMedGoogle Scholar
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Mallet  M, Loiez  C, Melliez  H, Yazdanpanah  Y, Senneville  E, Lemaire  X.  Staphylococcus simulans as an authentic pathogenic agent of osteoarticular infections.  Infection. 2011;39(5):473-476.PubMedGoogle ScholarCrossref
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