Arcanobacterium Haemolyticum Clinical Presentation

Updated: Apr 24, 2017
  • Author: Nicole Ufkes; Chief Editor: William D James, MD  more...
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Presentation

History

The most common symptoms include the following [41, 42] :

  • Sore throat (97-100%)

  • Pruritus (33%)

  • Nonproductive cough (33%)

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Physical Examination

Physical examination findings include fever (40-64%), pharyngeal erythema (97-100%), tonsillar exudate (70%), lymphadenopathy (41-48%), and rash (0-75%). The fever ranges from 37.6-40°C. [41, 51]

Pharyngitis

The pharyngeal exudate is patchy and gray-to-white. It is difficult to scrape off. Although the appearance of the posterior aspect of the pharynx is similar to that of scarlet fever, no associated hemorrhagic macules on the palate or findings on the tongue are present. [41]

Exanthem

The exanthem has been described only in patients with pharyngitis, not in patients with infection of other sites. It usually develops 1-4 days after the pharyngitis, although occasionally, it is the initial manifestation of the infection.

It has been described as erythematous (see the image below), pruritic, urticarial, scarlatiniform, and maculopapular.

Rash associated with pharyngitis caused by Arcanob Rash associated with pharyngitis caused by Arcanobacterium haemolyticum. Note the erythematous nature of the rash.

It usually begins on the extensor surfaces of the extremities, where it is most severe (see the images below). Over the next 2-3 days, it spreads centrally to the neck and the trunk.

The rash associated with pharyngitis caused by Arc The rash associated with pharyngitis caused by Arcanobacterium haemolyticum is most prominent on the extremities. Note the rash on the upper limbs.
The rash associated with pharyngitis caused by Arc The rash associated with pharyngitis caused by Arcanobacterium haemolyticum is most prominent on the extremities. Note the rash on the lower limbs.

It almost always spares the face (see the image below), the palms, and the soles, and the abdomen and the buttocks are relatively spared.

Rash associated with pharyngitis caused by Arcanob Rash associated with pharyngitis caused by Arcanobacterium haemolyticum. Note the significant involvement of the extremities and the relative sparing of the face.

It usually persists longer than 48 hours, and mild desquamation may occur during resolution. [41] No long-term sequelae have been noted.

Although the onset of rash and the constitutional symptoms are similar to those of scarlet fever, the rash in scarlet fever is centrifugal and has prominent Pastia lines. In both conditions, desquamation may occur during resolution of the rash.

Lymphadenopathy

Patients may develop anterior cervical or submandibular lymphadenopathy that is bilateral, tender, and 1-1.5 cm in size.

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Causes

No risk factors are known for A haemolyticum infection. Although purely speculative, Parija et al [24] suggested in 2005 that close contact with animals such as cows and buffaloes and handling or consumption of unpasteurized milk might put patients at risk. A 2006 investigation did isolate a strain of A haemolyticum (DSM 20595T) from preputial swabs of European bison (Bison bonasus) bulls with balanoposthitis. [59]

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Complications

Peritonsillar abscess has been reported in 5 patients. The patients presented with severe sore throat and fever (37.3-40.1°C). After drainage, resolution occurred in all patients. [41, 53, 54]

Sepsis, with isolation of A haemolyticum from blood cultures, has occurred in patients with pharyngitis. [55, 56, 57, 58, 60]

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