---

- Discussion:
    - caused by non hemolytic Strep and hemolytic Staph aureus;
    - although staph alone may show up on culture, special attention may must be paid to isolating the microaerophilic Streptococceae;
    - necrotizing fascitis may occur, especially in diabetics;
    - any hand infection that does not respond to local drainage, wet dressings, and antibiotics should be suspected of having a symbiotic infection;
    - if special techniques are not used, the diagnosis of a symbiotic infection will be missed, and Staph aureus, Bacillus pyocyaneus, Proteus, and Enterococci will predominate on culture