Bacteriological studies of blood, tissue fluid, lymph and lymph nodes in patients with acute dermatolymphangioadenitis (DLA) in course of 'filarial' lymphedema

Filarial lymphedema is complicated by frequent episodes of dermatolymphangi oadenitis (DLA). Severe systemic symptoms during attacks of DLA resemble th ose of septicemia. The question we asked was whether bacterial isolates can be found in the peripheral blood of patients during the episodes of DLA. O ut of 100 patients referred to us with 'filarial' lymphedema 14 displayed a cute and five subacute symptoms of DLA. All were on admission blood microfi lariae negative but had a positive test in the past. Blood bacterial isolat es were found in nine cases, four acute (21%) and five subacute (26%). In 1 0 acute cases blood cultures were found negative. Six blood isolates belong ed to Bacilli, four to Cocci and one was Sarcina. To identify the sites of origin of bacterial dissemination, swabs taken from the calf skin biopsy wo unds and tissue fluid, lymph and lymph node specimens were cultured. Swabs from the calf skin biopsy wound contained isolates in nine (47%) cases. The y were Bacilli in nine, Cocci in three, Acinetobacter and Erwinia in two ca ses. Tissue fluid was collected from 10 patients and contained Bacilli in f our (40%) and Staphylococci in three (30%). Lymph was drained in four patie nts and contained isolates in all samples (100%). They were Staphylococcus epidermis, xylosus and aureus, Acinetobacter, Bacillus subtilis and Sarcina . Three lymph nodes were biopsied and contained Staphylococcus chromogenes, xylosus, Enterococcus and Bacillus cereus. In six cases the same phenotypi cally defined species of bacteria were found in blood and limb tissues or f luids. In the 'control' group of patients with lymphedema without acute or subacute changes all blood cultures were negative. Interestingly, swabs fro m biopsy wound of these patients contained isolates in 80%, tissue fluid in 68%, lymph in 70% and lymph nodes in 58% of cases. In healthy controls, ti ssue fluid did not contain bacteria, and lymph isolates were found only in 12% of cases. This study demonstrates that patients with acute episodes of DLA reveal bacteriemia in a high percentage of cases. Diversity of blood an d tissue bacterial isolates in these patients points to a breakdown of the skin immune barrier in lymphedema and subsequently indiscriminate bacterial colonization of deep tissues and spread to an blood circulation. (C) 1999 Elsevier Science B.V. All rights reserved.