Bacteria present in the subcutaneous tissue may be responsible for chronic soft tissue inflammation

Objectives. Inflammation of leg soft tissues becomes a frequent condition. Dermato-lymphangio-adenitis (DLA) occurs in about 50% of cases with obstructive lymphedema of lower and upper limbs. Each recurrence is followed by progression of edema and irreversible increase in limb size. Dermato-lipo-sclerosis in chronic venous insufficiency is a chronic tissue inflammation. Diabetic foot is a chronic inflammation leading to bone destruction. The subcutaneous tissue biopsy bacteriological cultures show presence of bacterial flora.  The question arises whether bacteria are permanently present in the affected tissues in a dormant state and become activated by trauma or remote inflammation.

Aim. To identify bacteria in lymphedematous tissues, their location, and migratory properties.

Methods. Study was carried out on 50 patients with obstructive lymphedema of lower limbs. Skin and subcutaneous tissue fragments were harvested under strict aseptic conditions in operating room. Scalpel, forceps and gauze were cultured. Bacterial fall-down was routinely measured. Specimens were placed on Hemoline plates and put into warm box for 3-5 weeks. Bacterial strains from colonies were identified. In 18 cases skin and subcutis fragments were evaluated in scanning electronmicroscopy.

Results. On-plate culture revealed delayed migration and confluent colony formation around and on tissue fragments in over 40% specimens. Strains were Staph. epidermidis and other coagulase-negatives. Staph. aureus meticillin-sensitive was other most common. All were sensitive to standard antibiotics. On electromicrographs single extracellular cocci and bacilli were identified. No colonies as seen on-plates were seen. There were few macrophages close to bacteria. Pictures of bacterial colonies on fragments of subcutis, veins, arteries and fascia will be presented.