Bilateral Necrotizing Fasciitis of the Foot Associated with Group B Streptococcus

Emerging infection: streptococcal toxic shock-like syndrome caused by group B Streptococcus (GBS), Streptococcus agalactiae

Streptococcus agalactiae or Group B Streptococcus (GBS) infections are commonly associated with infections in neonates and pregnant women. However, there has been a rising incidence in nonpregnant adults. The risk of GBS infection in nonpregnant adults is increased for patients of advanced age and those with underlying medical conditions such as diabetes mellitus and cancer. We present a 77-year-old female with type-2 diabetes mellitus, hypertension, and bilateral foot ulcers that presented in probable septic shock with necrotic foot ulcers and necrotizing fasciitis and underwent bilateral lower limb amputations. The patient fulfilled the Streptococcal Toxic Shock Syndrome (STSS) criteria as defined by The Working Group on Severe Streptococcal Infections. These criteria were created for group A Streptococcus (Streptococcus pyogenes). Our patient fulfilled the Working Group's criteria, except that the blood culture was positive for group B Streptococcus (Streptococcus agalactiae). Numerous studies demonstrate the importance of early detection and antibiotic treatment for GBS infections in general and early surgical management for necrotizing soft tissue infections (NSTIs) such as necrotizing fasciitis.

Bilateral non-contiguous necrotizing fasciitis of the lower extremities

Necrotizing fasciitis (NF) is an uncommon soft tissue infection. Multifocal-extremity NF is a rarity with high mortality rates. Herein we report a case of bilateral non-contiguous NF of the lower extremities due to Escherichia coli with a fatal outcome, stressing the necessity of rapid and aggressive intervention in suspected cases.

Surgical Strategies: Necrotizing Fasciitis of the Foot and Ankle Treated With Dermal Regeneration Matrix for Limb Salvage

Although necrotizing fasciitis is a life-threatening entity that needs expeditious treatment, cases involving the lower extremity are less commonly encountered than in the upper extremity. Surgical intervention is often required and likely lead to amputation (below-knee or above-knee) vs debridement in the lower extremity.Coverage options in the foot and ankle after serial debridements can present many challenges for limb salvage. Patients are often left with large soft tissue defects requiring coverage with a subsequent increase in relative morbidity. Treatment options for coverage in these cases include negative-pressure wound therapy, split-thickness skin grafting, free flap coverage, or higher-level amputation. In the diabetic population, who present with a lower extremity necrotizing infection, limb salvage is often a challenge given the multiple comorbidities associated with these patients including peripheral vascular disease, immunocompromised state, and neuropathy. Optimal treatment strategies for these necrotizing infections in the foot and ankle remain uncertain.We offer a technique tip for utilization of a dermal regeneration matrix to allow coverage of large soft tissue defect with exposed tendon and/or bone without the need for free flap coverage or higher-level amputation, thus allowing for an additional limb salvage option.Level of Evidence: Level V, expert opinion.

Streptococcus agalactiae-Induced Soft Tissue Infection in a Nonpregnant Adult After a Gynecological Procedure

Patient: Female, 24-year-old

Final Diagnosis: Necrotizing fasciitis

Symptoms: Chest pain • chills • fatigue • fever • neck pain • range of motion limitation • right shoulder pain

Medication: —

Clinical Procedure: —

Specialty: Infectious Diseases • General and Internal Medicine • Obstetrics and Gynecology

Fulminant group B Streptococcal necrotizing fasciitis in a patient with undiagnosed malignancy: a case report

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Group B Streptococcus rarely causes necrotizing fasciitis in immunocompetent adults.

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Invasive group B Streptococcal infections may be increasing in non-pregnant adults.

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We describe a case of severe fasciitis in a woman with an undiagnosed malignancy.

Group A Streptococcus is well established as the most common pathogen causing necrotizing fasciitis. In contrast, Group B Streptococcus (GBS, or Streptococcus agalactiae) is a rare cause of necrotizing fasciitis, particularly in adults. We present the case of a patient who developed a fulminant case of GBS necrotizing fasciitis on a backdrop of a previously undiagnosed malignancy, and review the relevant literature.