Bacterial pathogens associated with hidradenitis suppurativa, France

Hélène Guet-Revillet, Hélène Coignard-Biehler, Jean-Philippe Jais, Gilles Quesne, Eric Frapy, Sylvain Poirée, Anne-Sophie Le Guern, Anne Le Flèche-Matéos, Alain Hovnanian, Paul-Henry Consigny, Olivier Lortholary, Xavier Nassif, Aude Nassif, Olivier Join-Lambert, Hélène Guet-Revillet, Hélène Coignard-Biehler, Jean-Philippe Jais, Gilles Quesne, Eric Frapy, Sylvain Poirée, Anne-Sophie Le Guern, Anne Le Flèche-Matéos, Alain Hovnanian, Paul-Henry Consigny, Olivier Lortholary, Xavier Nassif, Aude Nassif, Olivier Join-Lambert

Abstract

Hidradenitis suppurativa (HS) is a skin disease characterized by recurrent nodules or abscesses and chronic suppurating lesions. In the absence of clear pathophysiology, HS is considered to be an inflammatory disease and has no satisfactory medical treatment. Recently, prolonged antimicrobial treatments were shown to improve or resolve HS lesions. We prospectively studied the microbiology of 102 HS lesions sampled from 82 patients using prolonged bacterial cultures and bacterial metagenomics on 6 samples. Staphylococcus lugdunensis was cultured as a unique or predominant isolate from 58% of HS nodules and abscesses, and a polymicrobial anaerobic microflora comprising strict anaerobes, milleri group streptococci, and actinomycetes was found in 24% of abscesses or nodules and in 87% of chronic suppurating lesions. These data show that bacteria known to cause soft tissue and skin infections are associated with HS lesions. Whether these pathogens are the cause of the lesions or are secondary infectious agents, these findings support targeted antimicrobial treatment of HS.

Figures

Figure
Figure
Microbial diversity of hidradenitis suppurativa (HS) lesions as assessed by high-throughput 454 sequencing. The bacterial diversity of 6 consecutive and representative HS lesions was assessed by high-throughput sequencing. Sample 1 corresponded to an acute Staphylococcus lugdunensis abscess sampled by needle aspiration. Samples 2–3 (swabs) corresponded to Hurley stage 2 lesions of the axilla and inguinal folds, respectively. Samples 4–6 (swabs) corresponded to Hurley stage 3 lesions of the inguinal, axilla and gluteal fold, respectively. Staphylococcus spp. represented >99% of sequences of sample 1, whereas Prevotella spp. represented the most abundant taxon in 4/5 of these chronic suppurative lesions.

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