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Nagayama J, Sato T, Takanori I, Kouji K, Mitsunobu N. Necrotising fasciitis with extensive necrosis caused by Lactobacillus: a case report. BMC Infect Dis 2024; 24:425. [PMID: 38649870 PMCID: PMC11034093 DOI: 10.1186/s12879-024-09291-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/04/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Necrotising fasciitis (NF) is a life-threatening soft-tissue infection that rapidly destroys the epidermis, subcutaneous tissue, and fascia. Despite their low virulence, Lactobacillus spp. can cause NF, and because of its rare incidence, there is limited information about its molecular and clinicopathological characteristics. We report a rare case of NF in a patient with type 2 diabetes mellitus diagnosed on admission and severe obesity due to infection with two types of Lactobacillus spp. that manifested in extensive necrosis. CASE PRESENTATION A 48-year-old woman was referred to our hospital with a complaint of difficulty walking due to severe bilateral thigh pain. She presented with mild erythema, swelling, and severe skin pain extending from the pubic region to the groin. The patient was morbidly obese, had renal dysfunction, and had diabetes mellitus diagnosed on admission.; her LRINEC (Laboratory Risk Indicator for Necrotising Fasciitis) score was 9, indicating a high risk of NF. An exploratory surgical incision was made, and NF was diagnosed based on fascial necrosis. Emergent surgical debridement was performed, and cultures of the tissue culture and aspirated fluid/pus revealed two types of Lactobacillus spp.: Lactobacillus salivarius and L. iners. The patient was admitted to the intensive care unit (ICU), where antibiotics were administered and respiratory and circulatory management was performed. Diabetic ketoacidosis was detected, which was treated by controlling the blood glucose level stringently via intravenous insulin infusion. The patient underwent a second debridement on day 11 and a skin suture and skin grafting on day 36. The patient progressed well, was transferred from the ICU to the general ward on day 41, and was discharged unassisted on day 73. CONCLUSIONS Lactobacillus spp. are rarely pathogenic to healthy individuals and can scarcely trigger NF. However, these bacteria can cause rare infections such as NF in immunocompromised individuals, such as those with diabetes and obesity, and an early diagnosis of NF is imperative; surgical intervention may be required for the prevention of extensive necrosis. The LRINEC score may be useful for the early diagnosis of NF, even for less pathogenic bacteria such as Lactobacillus.
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Affiliation(s)
- Jun Nagayama
- Advanced Medical Emergency Department and Critical Care Center, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-machi, 371-0811, Maebashi, Gunma, Japan.
| | - Takeo Sato
- Center for Community Clinical Education, Jichi Medical University, 3311-1 Yakushiji, 329-0498, Shimotsuke-shi, Tochigi-ken, Japan
| | - Ishida Takanori
- Advanced Medical Emergency Department and Critical Care Center, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-machi, 371-0811, Maebashi, Gunma, Japan
| | - Koga Kouji
- Advanced Medical Emergency Department and Critical Care Center, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-machi, 371-0811, Maebashi, Gunma, Japan
| | - Nakamura Mitsunobu
- Advanced Medical Emergency Department and Critical Care Center, Japanese Red Cross Maebashi Hospital, 389-1, Asakura-machi, 371-0811, Maebashi, Gunma, Japan
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Breidung D, Billner M, Megas IF, Edo AM, Reichert B, Malsagova AT. Increase in Streptococcal Necrotizing Fasciitis During and After the Coronavirus Disease 2019 Pandemic. Surg Infect (Larchmt) 2024; 25:169-174. [PMID: 38324002 DOI: 10.1089/sur.2023.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2024] Open
Abstract
Background: Necrotizing fasciitis (NF) is a life-threatening and rare condition. However, we report and analyze a remarkably high number of NF cases during the coronavirus disease 2019 (COVID-19) pandemic and especially in the first months after the COVID-19 pandemic. Patients and Methods: We conducted a retrospective analysis of 17 cases of NF treated in our clinic between January and May 2023. Data were collected on demographics, comorbidities, risk factors, laboratory findings, and clinical outcomes. For each individual case two risk indicating scores, the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and Laboratory and Anamnestic Risk Indicator for Necrotizing Fasciitis (LARINF) were calculated. Results: In the pandemic years 2021 and 2022 there were 21 and 30 patients with NF, respectively, treated in our clinic. Of the 17 included NF cases in this study from January until May 2023, 16 cases required intensive care unit (ICU) admission, six cases required limb amputation, and four cases resulted in death. The microbiologic examination revealed seven cases of polymicrobial infections, eight cases of monomicrobial infections primarily caused by Streptococcus pyogenes, and two cases without microbial growth. The LRINEC score showed a sensitivity of 82%, whereas the LARINF score demonstrated a sensitivity of 100% for identifying cases of NF. Conclusions: This study highlights a notable increase in NF during and after the COVID-19 pandemic, predominantly associated with Streptococcus pyogenes-induced infections. These cases demonstrate a highly aggressive nature, leading to limb amputation or death in more than half of the cases.
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Affiliation(s)
- David Breidung
- Department of Plastic, Reconstructive, and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Moritz Billner
- Department of Plastic, Reconstructive, and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Ioannis-Fivos Megas
- Department of Plastic, Reconstructive, and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Alejandro Marti Edo
- Department of Plastic, Reconstructive, and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Bert Reichert
- Department of Plastic, Reconstructive, and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
| | - Asja T Malsagova
- Department of Plastic, Reconstructive, and Hand Surgery, Center for Severe Burn Injuries, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany
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Brébant V, Eschenbacher E, Hitzenbichler F, Pemmerl S, Prantl L, Pawlik M. Pathogens and their resistance behavior in necrotizing fasciitis. Clin Hemorheol Microcirc 2024; 86:169-181. [PMID: 37807775 DOI: 10.3233/ch-238119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a rare but life-threatening condition in which extensive soft tissue destruction can occur very quickly if left untreated. Therefore, timely broad-spectrum antibiotic administration is of prognostic importance in addition to radical surgical debridement. AIM This study evaluates the cases of NF in our hospital during the last ten years retrospectively with respect to the pathogens involved and their antimicrobial resistance. This approach aims to provide guidance regarding the most targeted initial antibiotic therapy. METHODS We performed a retrospective microbiological study evaluating pathogen detection and resistance patterns including susceptibility testing of 42 patients with NF. RESULTS Type 1 NF (polymicrobial infection) occurred in 45% of the patients; 31% presented type 2 NF (monomicrobial infection). The most common pathogens detected were E. coli, staphylococci such as Staphylococcus aureus and Staphylococcus epidermidis, Proteus mirabilis, enterococci, and streptococci such as Streptococcus pyogenes. Twelve percent presented an additional fungus infection (type 4). Ten percent showed no cultivation. Two percent (one patient) presented cocci without specification. CONCLUSION Most pathogens were sensitive to antibiotics recommended by guidelines. This confirms the targeting accuracy of the guidelines. Further studies are necessary to identify risk factors associated with multidrug resistant infections requiring early vancomycin/meropenem administration.
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Affiliation(s)
- Vanessa Brébant
- University Centre for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Elisabeth Eschenbacher
- University Centre for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Florian Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Sylvia Pemmerl
- Department of Hygiene, Caritas-Hospital St. Josef, Regensburg, Germany
| | - Lukas Prantl
- University Centre for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Michael Pawlik
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Caritas St. Josef Medical Centre, University Medical Centre Regensburg, Regensburg, Germany
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Molasy B, Frydrych M. Necrotizing fasciitis - two case reports and literature review. Pol Przegl Chir 2023; 96:103-108. [PMID: 38348986 DOI: 10.5604/01.3001.0053.9501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
<b><br>Introduction:</b> Necrotizing fasciitis (NF) is a rare, rapidly progressing infection of the skin and subcutaneous tissue. NF can lead to massive tissue necrosis, resulting in sepsis, septic shock and death. In this disease, it is important to quickly diagnose and implement appropriate treatment.</br> <b><br>Aim:</b> Analysis of the diagnostic and therapeutic process in two clinical cases and a review of the literature on the methods of diagnosis and treatment of necrotizing fasciitis.</br> <b><br>Material and methods:</b> The medical data of two patients hospitalized in the St Alexander Hospital in Kielce from December 2022 to June 2023 due to necrotizing fasciitis were analyzed. Also literature search across PubMed, Medline and Research Gate databases from 2000 up to 2023 was performed. We reviewed English literature according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The following keywords were used: necrotizing fasciitis, etiopathogenesis, pathophysiology, management.</br> <b><br>Results:</b> The research group consisted of two male patients with NF after trauma, in different parts of the body. Based on the clinical examination, the results of laboratory and imaging tests, a diagnosis was made and appropriate treatment was initiated. Despite the applied treatment, one patient died as a result of progressive multiple organ failure.</br> <b><br>Conclusions:</b> Despite advances in diagnosis and treatment, including universal access to antibiotics, necrotizing fasciitis still cause high mortality. The microbiological complexity of the majority of cases and non-specific symptoms make the diagnostic and therapeutic process difficult. Taking into account necrotizing fasciitis each time in the differential diagnosis of inflammation of the skin and subcutaneous tissue, especially based on trauma, will allow to reduce morbidity and mortality in this disease.</br>.
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Affiliation(s)
- Bartosz Molasy
- Jan Kochanowski University Medical College, Department of General Surgery, St. Alexander Hospital in Kielce, Kielce, Poland
| | - Mateusz Frydrych
- Department of General Surgery, St. Alexander Hospital in Kielce, Kielce, Poland
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Abstract
BACKGROUNDS Necrotizing fasciitis is a severe bacterial infection characterized by involvement of all skin's layers, including the superficial fascia. Diagnosis and treatment must be as quick as possible. Once suspected, extensive surgical debridement is required. METHODS All necrotizing fasciitis, managed in our hospital in Dijon, during the period from January 2011 to May 2021, were retrospectively analyzed. Demographics characteristics of patients, biological parameters, and type of bacteria were collected. Statistical analysis was performed on the cost of hospitalization, as well as on the death rate between type I and II NF and the speed of management. Student's t-test and Chi2 test were performed with a significant level P<0.05. FINDINGS A total of 65 patients were included over the period. The mean age was 68.8 years. The average length of stay was 32.4 days, with an average cost of 79,305 €. The main locations were the lower limbs (57%) and the perineum (35%). Cost of hospitalization did not differ between type I and II (P=0.21), unlike mortality rate (P=0.003). Furthermore, the mortality rate according to the speed of management did not vary in our series (P=0.45). CONCLUSION Necrotizing fasciitis is quickly fatal if left untreated. Early diagnosis, combined with surgical debridement and probabilistic antibiotic therapy are required. Our study shows the impact of necrotizing fasciitis in terms of cost to society and the importance of prevention of certain risk factors. A global management of the patient is necessary to increase the survival rate.
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Affiliation(s)
- V Rabuel
- Department of maxillofacial and plastic surgery, University Hospital of Burgundy, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon cedex, France.
| | - D Guillier
- Department of maxillofacial and plastic surgery, University Hospital of Burgundy, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon cedex, France.
| | - N Zwetyenga
- Department of maxillofacial and plastic surgery, University Hospital of Burgundy, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon cedex, France.
| | - V Moris
- Department of maxillofacial and plastic surgery, University Hospital of Burgundy, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon cedex, France.
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Vinkeles Melchers NVS, Nawijn F, Rümke LW, Dix LML, Vestjens SMT, Hietbrink F, Tjon-Kon-Fat R, Verspui-van der Eijk E, de Gier B, Vlaminckx BJM, Içli C, Quaak MSW, Huijskens EIGW. [Invasive group A streptococcal infections in the Netherlands]. Ned Tijdschr Geneeskd 2023; 167. [PMID: 36928399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Group A streptococcal (GAS) infections are caused by the Gram-positive bacterium Streptococcus pyogenes. Infection can occur via droplet infection from the throat and via (in)direct contact with infected people. GAS can cause a wide variety of diseases, ranging from superficial skin infections, pharyngitis and scarlet fever, to serious invasive diseases such as puerperal sepsis, pneumonia, necrotising soft tissue infections (NSTI) (also known as necrotising fasciitis/myositis), meningitis and streptococcal toxic shock syndrome (STSS). In invasive GAS infections, the bacteria has penetrated into a sterile body compartment (such as the bloodstream, deep tissues, or the central nervous system). Invasive GAS infections are rare but serious, with high morbidity and mortality. Since March 2022, the National Institute for Public Health and the Environment (RIVM) reported a national increase in notifiable invasive GAS infections (NSTI, STSS and puerperal fever). Particularly NSTI has increased compared to the years before the SARS-CoV-2 pandemic. Remarkably, the proportion of children aged 0 to 5 years with invasive GAS-infections is higher in 2022 than in the previous years (12% compared to 4%). While seasonal peaks occur, the current elevation exceeds this variation. To promote early recognition and diagnosis of invasive GAS infections different clinical cases are presented.
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Affiliation(s)
| | | | | | - Laura M L Dix
- Erasmus MC - Sophia Kinderziekenhuis, Rotterdam: Afd. Medische Microbiologie
| | | | | | | | | | | | - Bart J M Vlaminckx
- St. Antonius Ziekenhuis, afd. Medische Microbiologie & Immunologie, Nieuwegein
| | - Caner Içli
- Albert Schweitzer ziekenhuis, Dordrecht. Afd. Orthopedie
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Beuling MG, Zigterman BGR, Schreuder WH, Dubois L. [A human bite wound caused a severe life threatening infection]. Ned Tijdschr Tandheelkd 2022; 129:119-124. [PMID: 35258242 DOI: 10.5177/ntvt.2022.03.21139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Within 24 hours after a human bite trauma, a 34-year-old male patient became septic and ended up at an intensive care unit. The combination of a local damage of the skin or mucosa, aggressive micro-organisms, local host factors, and some bad luck resulted in necrotizing fasciitis for this patient. This is a very rapid progressive infection which can spread via fat tissue and the muscle fascia. The occurrence of extensive necrosis releases a lot of cytokines and acute-phase proteins, resulting in a systemic reaction. The consequential vasodilatation makes it necessary for the heart to pump harder in order to maintain the circular volume. The patient will soon become septic and hemodynamically unstable. This can also lead to multiple organ failure with potentially fatal consequences. Because necrotizing fasciitis can be caused by commensal bacteria, even young healthy patients are at risk for this invasive life threatening disease. Early recognition of the clinical manifestations can prevent a fatal outcome.
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Chen YC, Liou YT, Tsai WH, Chen LW. Prognostic Role of Subsequent Thrombocytopenia in Necrotizing Fasciitis Without Liver Disease. Ann Plast Surg 2022; 88:S99-S105. [PMID: 35225855 DOI: 10.1097/sap.0000000000003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a life-threatening disease with a fulminant presentation. Although early diagnosis can be aided by combining physical examination, the Laboratory Risk Indicator for Necrotizing Fasciitis score, and computed tomography, a mortality rate of 30% is still reported. In the modern times, an economical and efficient biomarker for predicting mortality in NF patients is still lacking. Platelet count is typically measured in routine blood tests and aids in predicting disease severity. We aimed to clarify the role of platelet count as a predictive factor for aspects of prognosis, such as mortality and surgical outcomes, in patients with NF. METHODS We identified 285 patients with NF between 2018 and 2020 in a single medical center in southern Taiwan. Medical records were collected for the evaluation of patients with thrombocytopenia. Univariate and multivariate analyses were performed for different outcomes. RESULTS We included 115 patients with confirmed diagnoses of NF. Twelve patients died with a mortality rate of 10.4%. Patients with thrombocytopenia exhibited a higher mortality rate (20.9% vs 4.2%, P = 0.006), more shock episodes (51.2% vs 11.1%, P < 0.001), higher intensive care unit admission rate (46.5% vs 13.9%, P < 0.001), and longer hospital length of stay (37.49 ± 24.12 days vs 28.82 ± 14.63 days, P = 0.037) than those without thrombocytopenia. All patients infected with Vibrio species exhibited thrombocytopenia. In multivariate analysis, independent risk factors for mortality were thrombocytopenia (odds ratio, 4.57; 95% confidence interval, 1.08-19.25) and single gram-negative bacterial culture from the wound (odds ratio 6.88; 95% confidence interval, 1.58-29.96). CONCLUSIONS In patients with NF and subsequent thrombocytopenia, a higher mortality rate, greater numbers of shock episodes, higher demand for intensive care unit, and longer hospital length of stay were observed than in those without thrombocytopenia. In patients with NF, platelet count is a valuable and economic indicator of prognosis. Once thrombocytopenia developed in patients with necrotizing fasciitis, aggressive antibiotic treatment and surgical management are required to improve the chances of recovery.
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Affiliation(s)
- Yu-Ching Chen
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
| | - Yaw-Tzeng Liou
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - Wei-Hsuan Tsai
- From the Division of Plastic and Reconstructive Surgery, Department of Surgery
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Lai CS, Liu PY, Lee CH, Ho CH, Chen WL, Lai KL, Su HY, Lin WL, Chung KC, Yang YY, You CW, Chen KT, Mao YC. The development of surgical risk score and evaluation of necrotizing soft tissue infection in 161 Naja atra envenomed patients. PLoS Negl Trop Dis 2022; 16:e0010066. [PMID: 35143522 PMCID: PMC8830662 DOI: 10.1371/journal.pntd.0010066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 12/06/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Naja atra bites cause wound necrosis, secondary infection, and necrotizing soft tissue infection (NSTI) requiring repetitive surgeries. Little information is known about the predictors for surgery after these bites. MATERIALS AND METHODS We retrospectively evaluated 161 patients envenomed by N. atra, 80 of whom underwent surgery because of wound necrosis and infection. We compared the patients' variables between surgical and non-surgical groups. To construct a surgical risk score, we converted the regression coefficients of the significant factors in the multivariate logistic regression into integers. We also examined the deep tissue cultures and pathological findings of the debrided tissue. RESULTS A lower limb as the bite site, a ≥3 swelling grade, bullae or blister formation, gastrointestinal (GI) effects, and fever were significantly associated with surgery in the multivariate logistic regression analysis. The surgical risk scores for these variables were 1, 1, 2, 1, and 2, respectively. At a ≥3-point cutoff value, the model has 71.8% sensitivity and 88.5% specificity for predicting surgery, with an area under the receiver operating characteristic curve of 0.88. The histopathological examinations of the debrided tissues supported the diagnosis of snakebite-induced NSTI. Twelve bacterial species were isolated during the initial surgery and eleven during subsequent surgeries. DISCUSSION AND CONCLUSIONS From the clinical perspective, swelling, bullae or blister formation, GI effects, and fever appeared quickly after the bite and before surgery. The predictive value of these factors for surgery was acceptable, with a ≥3-point risk score. The common laboratory parameters did not always predict the outcomes of N. atra bites without proper wound examination. Our study supported the diagnosis of NSTI and demonstrated the changes in bacteriology during the surgeries, which can have therapeutic implications for N. atra bites.
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Affiliation(s)
- Chih-Sheng Lai
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Yu Liu
- Division of Infection, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Rong Hsing Research Center for Translational Medicine, National Chung Hsing University
| | - Chi-Hsin Lee
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Core Laboratory of Antibody Generation and Research, Taipei Medical University, Taipei, Taiwan
| | - Cheng-Hsuan Ho
- Department of Emergency Medicine, Tri-Service General Hospital, Taipei, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Ling Chen
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Psychiatry Department, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan
- Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Kuo-Lung Lai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Hung-Yuan Su
- Department of Emergency Medicine, E-Da Hospital and I-Shou University, Kaohsiung, Taiwan
- The School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung, Taiwan
| | - Wen-Loung Lin
- Taichung Wildlife Conservation Group, Taichung, Taiwan
| | - Kuo-Chen Chung
- Division of Traumatology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Yi-Yuan Yang
- School of Medical Laboratory Science and Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- PhD Program in Medical Biotechnology, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan
- Core Laboratory of Antibody Generation and Research, Taipei Medical University, Taipei, Taiwan
| | | | | | - Yan-Chiao Mao
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Division of Clinical Toxicology, Department of Emergency Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- * E-mail:
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Hutchinson LE, Franke JD, Mailey BA. Necrotizing fasciitis secondary to lake water inoculation with Aeromonas sobria: A case report. Medicine (Baltimore) 2021; 100:e24981. [PMID: 33725868 PMCID: PMC7969264 DOI: 10.1097/md.0000000000024981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Necrotizing fasciitis (NF) is a rapidly progressing bacterial soft tissue infection with a high mortality rate. It is characterized by significant soft tissue destruction with associated sepsis. The mainstay of treatment is coverage with appropriate broad-spectrum antibiotic therapy and emergent surgical debridement. PATIENT CONCERNS A previously healthy 66-year-old female presented with a deep laceration to her right, posterior calf with subsequent contamination with lake water. After the wound was irrigated and closed, the patient developed NF. DIAGNOSIS Laceration of the right lower extremity complicated by NF secondary to Aeromonas sobria. INTERVENTIONS The patient underwent emergent surgical debridements with intravenous broad-spectrum antibiotics and negative pressure wound therapy. The lower extremity was reconstructed with split-thickness skin grafts. OUTCOMES The patient's initial penetrating trauma was closed in the emergency room, and the patient was discharged home with antibiotics. She returned the next day with unstable vitals and was admitted to the intensive care unit. Her condition continued to deteriorate, and she underwent serial surgical debridements. Her condition improved and was discharged home after 13 days in the hospital. LESSONS LEARNED Close monitoring for NF is important for tissue infections sustained in aquatic environments. Timely identification and surgical management of NF increases overall survival.
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Affiliation(s)
| | - Jacob D. Franke
- Southern Illinois University School of Medicine, Springfield, IL
| | - Brian A. Mailey
- Institute for Plastic Surgery, Southern Illinois University School of Medicine
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Pamidimukkala U, Sudhaharan S, Kancharla A, Vemu L, Challa S, Karanam SD, Chavali P, Prakash H, Ghosh AK, Gupta S, Rudramurthy SM, Chakrabarti A. Mucormycosis due to Apophysomyces species complex- 25 years' experience at a tertiary care hospital in southern India. Med Mycol 2020; 58:425-433. [PMID: 31342074 DOI: 10.1093/mmy/myz081] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/06/2019] [Accepted: 07/03/2019] [Indexed: 12/18/2022] Open
Abstract
Apophysomyces elegans species complex is an important cause of cutaneous mucormycosis in India. However, majority of those cases are reported as case reports only. We desired to analyze our patients with Apophysomyces infection reported over 25 years (1992-2017) to understand the epidemiology, management, and outcome of the disease. During the study period 24 cases were reported, and the majority (95.8%) of them presented with necrotizing fasciitis following accidental/surgical/iatrogenic trauma. One patient presented with continuous ambulatory peritoneal dialysis (CAPD) related peritonitis. Healthcare related Apophysomyces infection was noted in 29.2% patients. In addition to trauma, comorbidities were noted in 37.5% patients (type 2diabetes mellitus-6, chronic alcoholism-2, and chronic kidney disease-1). Of the 24 isolates, 11 isolates starting from year 2014 were identified as Apophysomyces variabilis by molecular methods. Majority (95.8%) of the patients were managed surgically with or without amphotericin B deoxycholate therapy, while one patient was treated with amphotericin B deoxycholate alone. Among 24 patients, seven (29.1%) recovered, six (25%) patients could not afford antifungal management and left the hospital against medical advice, and 11 (45.9%) patients died.The present case series highlights that necrotizing fasciitis caused by A. variabilis is prevalent in India, and the disease may be healthcare related. Although diagnosis is not difficult, awareness among surgeons is still limited about the infection, leading to a delay in sending samples to the mycology laboratory. Apophysomyces infection must be considered in the differential diagnosis in apatient with progressive necrosis of a wound who is not responding to antibacterial therapy.
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Affiliation(s)
- Umabala Pamidimukkala
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Sukanya Sudhaharan
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Anuradha Kancharla
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Lakshmi Vemu
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Sundaram Challa
- Dept. of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Sandhya Devi Karanam
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Padmasri Chavali
- Department of Microbiology, Nizam's Institute of Medical Sciences, Hyderabad, Telengana state, India
| | - Hariprasath Prakash
- Department of Medical Microbiology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anup Kumar Ghosh
- Department of Medical Microbiology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunita Gupta
- Department of Medical Microbiology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Post graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Post graduate Institute of Medical Education and Research, Chandigarh, India
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12
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Albasanz-Puig A, Rodríguez-Pardo D, Pigrau C, Lung M, Roldan E, Corona PS, Almirante B, Ruiz-Camps I. Necrotizing fasciitis in haematological patients: a different scenario. Ann Hematol 2020; 99:1741-1747. [PMID: 32399706 DOI: 10.1007/s00277-020-04061-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
To describe and compare the characteristics of necrotizing fasciitis (NF) in patients with and without haematological malignancy. All adult patients diagnosed with NF and treated at our hospital were included (January 2010-March 2019). Diagnosis was based on intraoperative findings or consistent clinical/radiological characteristics, and patients were classified as group A (with haematological malignancy) or group B (without haematological malignancy). Student's t (quantitative), Fisher's exact (qualitative), and Kaplan-Meyer tests were used for the statistical analysis. The study included 29 patients: 8 in group A and 21 in group B. All haematological patients had severe neutropenia (0.2 [0.02-0.5] ×109 cells/L; p < 0.001) and positive blood cultures (100% vs. 61.9%; p = 0.04) at diagnosis. Gram-negative bacilli NF was more common in group A (87.5% vs. 9.5%; p = 0.001), predominantly due to Escherichia coli (50% vs. 9.5%; p = 0.056). Surgical treatment was less common in haematological patients (5 [62.5%] vs. 21 [100%]; p = 0.015). Overall, 9 (31%) patients died: 4 (50%) in group A and 5 (23.8%) in group B (p = 0.17). The univariate analysis showed that mortality tended to be higher (OR 3.2; 95%CI 0.57-17.7; p = 0.17) and to occur earlier (2.2 ± 2.6 vs. 14.2 ± 19.9 days; p = 0.13) in haematological patients. The LRINEC index > 6 did not predict mortality in either group. In our study, NF in patients with haematological malignancies was mainly due to Gram-negative bacilli, associated to high and early mortality rates. In our experience, the LRINEC scale was not useful for predicting mortality.
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Affiliation(s)
- A Albasanz-Puig
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - D Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | - C Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - M Lung
- Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Roldan
- Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P S Corona
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Reconstructive and Septic Surgery Division, Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - I Ruiz-Camps
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
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13
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Olsen RJ, Zhu L, Musser JM. A Single Amino Acid Replacement in Penicillin-Binding Protein 2X in Streptococcus pyogenes Significantly Increases Fitness on Subtherapeutic Benzylpenicillin Treatment in a Mouse Model of Necrotizing Myositis. Am J Pathol 2020; 190:1625-1631. [PMID: 32407732 DOI: 10.1016/j.ajpath.2020.04.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/14/2020] [Accepted: 04/21/2020] [Indexed: 12/15/2022]
Abstract
Invasive strains of Streptococcus pyogenes with significantly reduced susceptibility to β-lactam antibiotics have been recently described. These reports have caused considerable concern in the international infectious disease, medical microbiology, and public health communities because S. pyogenes has remained universally susceptible to β-lactam antibiotics for 70 years. Virtually all analyzed strains had single amino acid replacements in penicillin-binding protein 2X (PBP2X), a major target of β-lactam antibiotics in pathogenic bacteria. We used isogenic strains to test the hypothesis that a single amino acid replacement in PBP2X conferred a fitness advantage in a mouse model of necrotizing myositis. We determined that when mice were administered intermittent subtherapeutic dosing of benzylpenicillin, the strain with a Pro601Leu amino acid replacement in PBP2X that confers reduced β-lactam susceptibility in vitro was more fit, as assessed by the magnitude of colony-forming units recovered from disease tissue. These data provide important pathogenesis information that bears on this emerging global infectious disease problem.
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Affiliation(s)
- Randall J Olsen
- Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, Texas; Clinical Microbiology Laboratory, Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Luchang Zhu
- Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, Texas
| | - James M Musser
- Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, Texas; Clinical Microbiology Laboratory, Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas; Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York.
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14
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Kampouri E, Filippidis P, Lhopitallier L, Pham TT, Schuhler C, Toutous Trellu L, Mombelli M, Huttner B. [ Rubor, calor, dolor, tumor : skin and soft tissue infections]. Rev Med Suisse 2020; 16:732-738. [PMID: 32301307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Skin infections are a frequent cause of consultation, yet the diagnosis can be challenging for physicians. Microbiological documentation is rare, and empiric antibiotic regimens should cover the most commonly identified bacteria, i.e. streptococci Staphylococcus aureus. Other pathogens should be considered in case of immunosuppression or certain exposures. Necrotizing fasciitis (NF) is a severe but rare infection. Early surgical management in parallel with antibiotics is the cornerstone of treatment. Despite the high incidence of these infections, little progress has been made in their management and some areas of uncertainty exist, especially regarding the optimal duration of treatment, the prevention of recurrences and the use of polyclonal immunoglobulins for NF. This article reviews the main aspects of diagnosis and treatment of these infections.
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Affiliation(s)
| | | | | | - Truong-Thanh Pham
- Service des maladies infectieuses, HUG, 1211 Genève
- Service de chirurgie orthopédique et traumatologie de l'appareil moteur, HUG, Genève
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15
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Dahmam A, Devinck F, Choughri H, Pelissier P. Finger necrotizing fasciitis caused by Vibriovulnificus. Hand Surg Rehabil 2020; 39:336-338. [PMID: 32251740 DOI: 10.1016/j.hansur.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/03/2020] [Accepted: 03/16/2020] [Indexed: 11/30/2022]
Affiliation(s)
- A Dahmam
- Department of plastic, reconstructive and aesthetic surgery - burns and hand surgery unit, François-Xavier Michelet Center, Bordeaux university hospital, place Amélie Raba-Léon, 33000 Bordeaux, France.
| | - F Devinck
- Department of plastic, reconstructive and aesthetic surgery - burns and hand surgery unit, François-Xavier Michelet Center, Bordeaux university hospital, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - H Choughri
- Department of plastic, reconstructive and aesthetic surgery - burns and hand surgery unit, François-Xavier Michelet Center, Bordeaux university hospital, place Amélie Raba-Léon, 33000 Bordeaux, France
| | - P Pelissier
- Department of plastic, reconstructive and aesthetic surgery - burns and hand surgery unit, François-Xavier Michelet Center, Bordeaux university hospital, place Amélie Raba-Léon, 33000 Bordeaux, France
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16
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Eraso JM, Kachroo P, Olsen RJ, Beres SB, Zhu L, Badu T, Shannon S, Cantu CC, Saavedra MO, Kubiak SL, Porter AR, DeLeo FR, Musser JM. Genetic heterogeneity of the Spy1336/R28-Spy1337 virulence axis in Streptococcus pyogenes and effect on gene transcript levels and pathogenesis. PLoS One 2020; 15:e0229064. [PMID: 32214338 PMCID: PMC7098570 DOI: 10.1371/journal.pone.0229064] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 01/28/2020] [Indexed: 12/20/2022] Open
Abstract
Streptococcus pyogenes is a strict human pathogen responsible for more than 700 million infections annually worldwide. Strains of serotype M28 S. pyogenes are typically among the five more abundant types causing invasive infections and pharyngitis in adults and children. Type M28 strains also have an unusual propensity to cause puerperal sepsis and neonatal disease. We recently discovered that a one-nucleotide indel in an intergenic homopolymeric tract located between genes Spy1336/R28 and Spy1337 altered virulence in a mouse model of infection. In the present study, we analyzed size variation in this homopolymeric tract and determined the extent of heterogeneity in the number of tandemly-repeated 79-amino acid domains in the coding region of Spy1336/R28 in large samples of strains recovered from humans with invasive infections. Both repeat sequence elements are highly polymorphic in natural populations of M28 strains. Variation in the homopolymeric tract results in (i) changes in transcript levels of Spy1336/R28 and Spy1337 in vitro, (ii) differences in virulence in a mouse model of necrotizing myositis, and (iii) global transcriptome changes as shown by RNAseq analysis of isogenic mutant strains. Variation in the number of tandem repeats in the coding sequence of Spy1336/R28 is responsible for size variation of R28 protein in natural populations. Isogenic mutant strains in which genes encoding R28 or transcriptional regulator Spy1337 are inactivated are significantly less virulent in a nonhuman primate model of necrotizing myositis. Our findings provide impetus for additional studies addressing the role of R28 and Spy1337 variation in pathogen-host interactions.
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Affiliation(s)
- Jesus M. Eraso
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Priyanka Kachroo
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Randall J. Olsen
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
- Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
| | - Stephen B. Beres
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Luchang Zhu
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Traci Badu
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Sydney Shannon
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Concepcion C. Cantu
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Matthew Ojeda Saavedra
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Samantha L. Kubiak
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
| | - Adeline R. Porter
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States of America
| | - Frank R. DeLeo
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, United States of America
| | - James M. Musser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, United States of America
- Departments of Pathology and Laboratory Medicine and Microbiology and Immunology, Weill Cornell Medical College, New York, New York, United States of America
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17
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Kachroo P, Eraso JM, Olsen RJ, Zhu L, Kubiak SL, Pruitt L, Yerramilli P, Cantu CC, Ojeda Saavedra M, Pensar J, Corander J, Jenkins L, Kao L, Granillo A, Porter AR, DeLeo FR, Musser JM. New Pathogenesis Mechanisms and Translational Leads Identified by Multidimensional Analysis of Necrotizing Myositis in Primates. mBio 2020; 11:e03363-19. [PMID: 32071274 PMCID: PMC7029145 DOI: 10.1128/mbio.03363-19] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 01/06/2020] [Indexed: 01/08/2023] Open
Abstract
A fundamental goal of contemporary biomedical research is to understand the molecular basis of disease pathogenesis and exploit this information to develop targeted and more-effective therapies. Necrotizing myositis caused by the bacterial pathogen Streptococcus pyogenes is a devastating human infection with a high mortality rate and few successful therapeutic options. We used dual transcriptome sequencing (RNA-seq) to analyze the transcriptomes of S. pyogenes and host skeletal muscle recovered contemporaneously from infected nonhuman primates. The in vivo bacterial transcriptome was strikingly remodeled compared to organisms grown in vitro, with significant upregulation of genes contributing to virulence and altered regulation of metabolic genes. The transcriptome of muscle tissue from infected nonhuman primates (NHPs) differed significantly from that of mock-infected animals, due in part to substantial changes in genes contributing to inflammation and host defense processes. We discovered significant positive correlations between group A streptococcus (GAS) virulence factor transcripts and genes involved in the host immune response and inflammation. We also discovered significant correlations between the magnitude of bacterial virulence gene expression in vivo and pathogen fitness, as assessed by previously conducted genome-wide transposon-directed insertion site sequencing (TraDIS). By integrating the bacterial RNA-seq data with the fitness data generated by TraDIS, we discovered five new pathogen genes, namely, S. pyogenes 0281 (Spy0281 [dahA]), ihk-irr, slr, isp, and ciaH, that contribute to necrotizing myositis and confirmed these findings using isogenic deletion-mutant strains. Taken together, our study results provide rich new information about the molecular events occurring in severe invasive infection of primate skeletal muscle that has extensive translational research implications.IMPORTANCE Necrotizing myositis caused by Streptococcus pyogenes has high morbidity and mortality rates and relatively few successful therapeutic options. In addition, there is no licensed human S. pyogenes vaccine. To gain enhanced understanding of the molecular basis of this infection, we employed a multidimensional analysis strategy that included dual RNA-seq and other data derived from experimental infection of nonhuman primates. The data were used to target five streptococcal genes for pathogenesis research, resulting in the unambiguous demonstration that these genes contribute to pathogen-host molecular interactions in necrotizing infections. We exploited fitness data derived from a recently conducted genome-wide transposon mutagenesis study to discover significant correlation between the magnitude of bacterial virulence gene expression in vivo and pathogen fitness. Collectively, our findings have significant implications for translational research, potentially including vaccine efforts.
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Affiliation(s)
- Priyanka Kachroo
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Jesus M Eraso
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Randall J Olsen
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, USA
| | - Luchang Zhu
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Samantha L Kubiak
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Layne Pruitt
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Prasanti Yerramilli
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Concepcion C Cantu
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Matthew Ojeda Saavedra
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Johan Pensar
- Department of Mathematics and Statistics, Helsinki Institute of Information Technology, University of Helsinki, Helsinki, Finland
| | - Jukka Corander
- Department of Mathematics and Statistics, Helsinki Institute of Information Technology, University of Helsinki, Helsinki, Finland
- Department of Biostatistics, University of Oslo, Oslo, Norway
| | - Leslie Jenkins
- Comparative Medicine Program, Houston Methodist Research Institute, Houston, Texas, USA
| | - Lillian Kao
- Department of Surgery, University of Texas McGovern Medical School, Houston, Texas, USA
| | - Alejandro Granillo
- Department of Internal Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
| | - Adeline R Porter
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - Frank R DeLeo
- Laboratory of Bacteriology, Rocky Mountain Laboratories, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Hamilton, Montana, USA
| | - James M Musser
- Center for Molecular and Translational Human Infectious Diseases Research, Department of Pathology and Genomic Medicine, Houston Methodist Research Institute and Houston Methodist Hospital, Houston, Texas, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York, USA
- Department of Microbiology and Immunology, Weill Cornell Medical College, New York, New York, USA
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18
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Kontou E, Bontzos G, Triantafyllou D, Garnavou-Xirou C, Ragkousis A, Xirou T. Conservative management of streptococcal necrotizing periorbital fasciitis following primary VZV infection. G Chir 2020; 41:114-117. [PMID: 32038022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 45-year old male patient, with a past history of illicit drug abuse and hepatitis C, presented with a 2 day history of worsening eyelid edema. Examination of the globe was impossible due to eyelid fusion caused by extensive soft tissue damage. Based on the examination, a diagnosis of necrotic fasciitis secondary to VZV infection was Romamade. The patient received empirical treatment with intravenous acyclovir, meropenem and vancomycin. CT imaging demonstrated no ocular involvement. Lesions were cultivated, revealing presence of Streptococcus pyogenes. Intravenous clindamycin was added to his course. Improvement was gradually observed. The patient received treatment for a total of 21 days, resulting in excellent final outcome. His final visual acuity was 0.9 on a Snellen chart, without signs of ocular inflammation. No surgical intervention was required and lesions fully healed with conservative management. Clinical outcomes depend on prompt treatment initiation, whilst delay in the diagnosis can prove fatal.
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19
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Ng BW, Ong KC, Ahmad-Azraf A, Abdul-Muttalib AW. Necrotising fasciitis caused by aeromonas sobria: Not just a simple catfish sting. Med J Malaysia 2019; 74:543-544. [PMID: 31929484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Necrotising fasciitis is a life-threatening infection of the soft tissue which can be caused by different microorganisms, but infection caused by Aeromonas spp. or Vibrio spp. is frequently associated with higher mortality rate. Necrotising fasciitis progresses rapidly and often need aggressive surgical intervention. We present a rare case of necrotising fasciitis cause by Aeromonas sobria which mortality was successfully prevented by swift diagnosis and aggressive surgery.
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Affiliation(s)
- B W Ng
- Hospital Segamat, Department of Orthopaedics, Segamat, Johor, Malaysia.
| | - K C Ong
- Hospital Segamat, Department of Orthopaedics, Segamat, Johor, Malaysia
| | - A Ahmad-Azraf
- Hospital Segamat, Department of Orthopaedics, Segamat, Johor, Malaysia
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20
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Tsujimoto Y, Kanzawa Y, Seto H, Nakajima T, Ishimaru N, Waki T, Kinami S. Necrotizing fasciitis and sepsis caused by Aeromonas hydrophila. Infez Med 2019; 27:429-435. [PMID: 31846994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aeromonas hydrophila (A. hydrophila) occasionally causes necrotizing fasciitis (NF) and sepsis in immunocompromised hosts. NF is associated with high mortality. In cases of septic shock due to A. hydrophila, mortality is nearly 100%. Our 47-year-old male patient was diagnosed with NF and septic shock due to A. hydrophila. He had not been exposed to fresh or slightly salty water, which is where the bacterium is typically found, so its origin in this case is unclear. This is the first known case in which the patient was able to be completely cured without amputation. NF was suspected from his sepsis, medical history including alcoholic cirrhosis, and a severely poor general condition, but his skin lesions were mild. We promptly made an exploratory incision and debrided his legs. NF could then be diagnosed. At an early stage, A. hydrophila was recognized as a possible pathogen of NF because of the patient's medical background and the Gram stain findings of intraoperative exudate. Minocycline in addition to carbapenem and vancomycin plus clindamycin were administered as empiric therapy. When A. hydrophila was detected in the blood culture, ciprofloxacin was administered as definitive therapy. Successful treatment of NF requires early diagnosis, prompt debridement from onset and adequate empirical antibiotic therapy.
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Affiliation(s)
| | - Yohei Kanzawa
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Hiroyuki Seto
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Takahiro Nakajima
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Takahiro Waki
- Department of Orthopedics, Akashi Medical Center, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, Japan
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21
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Fernández-Bravo A, Kilgore PB, Andersson JA, Blears E, Figueras MJ, Hasan NA, Colwell RR, Sha J, Chopra AK. T6SS and ExoA of flesh-eating Aeromonas hydrophila in peritonitis and necrotizing fasciitis during mono- and polymicrobial infections. Proc Natl Acad Sci U S A 2019; 116:24084-24092. [PMID: 31712444 PMCID: PMC6883842 DOI: 10.1073/pnas.1914395116] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
An earlier report described a human case of necrotizing fasciitis (NF) caused by mixed infection with 4 Aeromonas hydrophila strains (NF1-NF4). While the NF2, NF3, and NF4 strains were clonal and possessed exotoxin A (ExoA), the NF1 strain was determined to be phylogenetically distinct, harboring a unique type 6 secretion system (T6SS) effector (TseC). During NF1 and NF2 mixed infection, only NF1 disseminated, while NF2 was rapidly killed by a contact-dependent mechanism and macrophage phagocytosis, as was demonstrated by using in vitro models. To confirm these findings, we developed 2 NF1 mutants (NF1ΔtseC and NF1ΔvasK); vasK encodes an essential T6SS structural component. NF1 VasK and TseC were proven to be involved in contact-dependent killing of NF2 in vitro, as well as in its elimination at the intramuscular injection site in vivo during mixed infection, with overall reduced mouse mortality. ExoA was shown to have an important role in NF by both NF1-exoA (with cis exoA) and NF2 during monomicrobial infection. However, the contribution of ExoA was more important for NF2 than NF1 in the murine peritonitis model. The NF2∆exoA mutant did not significantly alter animal mortality or NF1 dissemination during mixed infection in the NF model, suggesting that the ExoA activity was significant at the injection site. Immunization of mice to ExoA protected animals from NF2 monomicrobial challenge, but not from polymicrobial infection because of NF2 clearance. This study clarified the roles of T6SS and ExoA in pathogenesis caused by A. hydrophila NF strains in both mouse peritonitis and NF models in monomicrobial and polymicrobial infections.
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Affiliation(s)
- Ana Fernández-Bravo
- Unidad de Microbiología, Departamento de Ciencias Médicas Básicas, Facultad de Medicina y Ciencias de la Salud, Instituto de Investigación Sanitaria Pere Virgili, Universidad Rovira i Virgili, 43201 Reus, Spain
| | - Paul B Kilgore
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555
| | - Jourdan A Andersson
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555
- Department of Pathology and Immunology and Texas Children's Microbiome Center, Baylor College of Medicine, Houston, TX, 77030
| | - Elizabeth Blears
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555
| | - Maria José Figueras
- Unidad de Microbiología, Departamento de Ciencias Médicas Básicas, Facultad de Medicina y Ciencias de la Salud, Instituto de Investigación Sanitaria Pere Virgili, Universidad Rovira i Virgili, 43201 Reus, Spain
| | - Nur A Hasan
- Research and Development Department, CosmosID Inc., Rockville, MD 20850
- Center for Bioinformatics and Computational Biology, University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD 20742
| | - Rita R Colwell
- Research and Development Department, CosmosID Inc., Rockville, MD 20850
- Center for Bioinformatics and Computational Biology, University of Maryland Institute for Advanced Computer Studies, University of Maryland, College Park, MD 20742
- Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD 21205
| | - Jian Sha
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555;
| | - Ashok K Chopra
- Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, TX, 77555;
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Chen PC, Tsai SH, Wang JC, Tzeng YS, Wang YC, Chu CM, Chu SJ, Liao WI. An elevated glycemic gap predicts adverse outcomes in diabetic patients with necrotizing fasciitis. PLoS One 2019; 14:e0223126. [PMID: 31581199 PMCID: PMC6776331 DOI: 10.1371/journal.pone.0223126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 09/13/2019] [Indexed: 01/08/2023] Open
Abstract
Background Diabetes is the most common comorbidity of necrotizing fasciitis (NF), but the effect of stress-induced hyperglycemia (SIH) on diabetic patients with NF has never been investigated. The aim of this study was to assess whether SIH, as determined by the glycemic gap between admission glucose levels and A1C-derived average glucose levels, predicts adverse outcomes in diabetic patients hospitalized with NF. Methods We retrospectively reviewed the glycemic gap and clinical outcomes in 252 diabetic patients hospitalized due to NF from 2011 to 2018 in a single medical center in Taiwan. A receiver operating characteristic (ROC) curve was used to analyze the optimal cutoff values for predicting adverse outcomes. Univariate and multivariate logistic regression analyses were employed to identify significant predictors of adverse outcomes. Results In total, 194 diabetic NF patients were enrolled. Compared with patients without adverse outcomes, patients with adverse outcomes had significantly higher glycemic gaps, Acute Physiology and Chronic Health Evaluation (APACHE) II scores and C-reactive protein (CRP) levels; lower albumin and hemoglobin levels; greater incidence of limb loss; and longer hospital and intensive care unit stays. The glycemic gap positively correlates with the laboratory risk indicator for NF scores, APACHE II scores and CRP levels. A glycemic gap of 146 mg/dL was the optimal cutoff value for predicting adverse outcomes using the ROC curve. Compared with patients with glycemic gaps ≤146 mg/dL, those with glycemic gaps >146 mg/dL had higher APACHE II scores and incidence rates of adverse outcomes, especially bacteremia and acute kidney injury. Multivariate analysis revealed that a glycemic gap >146 mg/dL and APACHE II score >15 were independent predictors of adverse outcomes, while the presence of hyperglycemia at admission was not. Conclusions An elevated glycemic gap was significantly independently associated with adverse outcomes in diabetic NF patients. Further prospective studies are warranted to validate the role of the glycemic gap in NF patients with diabetes.
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Affiliation(s)
- Po-Chuan Chen
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Shih-Hung Tsai
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- Department of Physiology and Biophysics, Graduate Institute of Physiology, National Defense Medical Center, Taipei, Taiwan
| | - Jen-Chun Wang
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yuan-Sheng Tzeng
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yung-Chih Wang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Ming Chu
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Shi-Jye Chu
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-I Liao
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- * E-mail:
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Fadel ZT, Burke E, Joukhadar N, Samargandi OA, Bezuhly M. Effects of seasonal changes in temperature and humidity on incidence of necrotizing soft tissue infections in Halifax, Canada, 2001-2015. Saudi Med J 2019; 40:469-474. [PMID: 31056624 PMCID: PMC6535159 DOI: 10.15537/smj.2019.5.24096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 03/12/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To explore weather seasonal variation in Necrotizing soft tissue infections (NSTI) in Halifax, Nova Scotia, Canada could be attributed to changes in environmental factors of temperature and humidity specifically. METHODS A retrospective chart review of NSTIs between 2001 and 2015. Regional temperature and humidity data were obtained from the Environment Canada Agency, Halifax, Canada. Chi-square was used for categorical variables and continuous data was used for correlation analyses. Logistic regression was performed to analyze mortality. Results: Of 170 NSTI patients identified, more presented from March to July, especially when the temperature was greater than 10ºC. Higher incidence per 100,000 persons correlated with increased monthly temperatures (p less than 0.01). Monthly NSTI incidence was inversely related to mean humidity (p=0.005). Causative organism was associated with mean weekly temperature (p less than 0.01) but not humidity (p=0.66). Low body mass index, higher American Society of Anesthesiologists class, long intensive care unit stay, and shorter overall hospital stay were associated with mortality. No correlation was identified between temperature and humidity and mortality. CONCLUSION This study demonstrates a tendency toward more frequent cases of NSTI with warmer, but less humid weather, without effect on severity or mortality.
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Affiliation(s)
- Zahir T Fadel
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada. E-mail.
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Goret NE, Goret CC, Ozkan OF. Necrotizing fasciitis after intramuscular self-injection A case report. Ann Ital Chir 2019; 8:S2239253X19028421. [PMID: 31112521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Necrotizing fasciitis (NF) is a rare, life-threatening soft tissue infection that affects the skin, subcutaneous tissue, fascia, and muscle, and is characterized by rapid spread and invasion of pathogens. Treatment is possible with early diagnosis, appropriate antibiotic therapy, and quick surgical intervention. Nevertheless, despite all interventions, it is sometimes difficult to manage NF. The Authors present the case of a patient with extensive NF caused by multidrug-resistant Acinetobacter baumannii (A. baumannii) that developed following an intramuscular injection of diclofenac sodium administered at home by someone who was not a healthcare professional. Wound sample culture revealed multidrug-resistant A. baumannii. The patient was treated using negative-pressure wound therapy along with antibiotic treatment and extensive surgical debridement. KEY WORDS: Multidrug-resistant acinetobacter baumannii, Necrotizing fasciitis, Negative-pressurelf-injection, Wound therapy.
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Scapaticci M, Marchetto S, Nardi A, Zoppelletto M, Bartolini A. A case of necrotizing fasciitis caused by Finegoldia magna in a patient with type 2 diabetes mellitus. Infez Med 2018; 26:359-363. [PMID: 30555141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Diabetes mellitus is one of the serious conditions associated with necrotizing fasciitis, a severe bacterial skin infection that spreads quickly and is characterized by extensive necrosis of the deep and superficial fascia resulting in devascularization and necrosis of the associated tissues. In addition to debridement and aggressive surgery procedures, the effectiveness of therapy depends on choosing the appropriate antibacterial agents. Hence the key to successful management is an early and accurate diagnosis. We report a case of necrotizing fasciitis caused by Finegoldia magna in a patient with type 2 diabetes mellitus.
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Affiliation(s)
| | - Sabina Marchetto
- Diabetic Foot Surgery Department, San Camillo Hospital, Treviso, Italy
| | - Andrea Nardi
- Diabetic Foot Surgery Department, San Camillo Hospital, Treviso, Italy
| | - Maira Zoppelletto
- Laboratory Medicine, San Bassiano Hospital, AULSS 7 Pedemontana, Bassano del Grappa, Italy
| | - Andrea Bartolini
- Laboratory Medicine, San Bassiano Hospital, AULSS 7 Pedemontana, Bassano del Grappa, Italy
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Hite M, McCrae AL, Privette A. Fungal Necrotizing Fasciitis after Penetrating Trauma. Am Surg 2018; 84:e302-e304. [PMID: 30454456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Melissa Hite
- Division of General Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Belliraj L, Sani R, Issoufou I, Lakranbi M, Ouadnouni Y, Smahi M. Primitive necrotizing fasciitis of the thoracic wall: Fatal complication of diabetic patient. Tunis Med 2018; 96:520-523. [PMID: 30430532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION necrotizing fasciitis of the chest wall is a rare condition in subcutaneous tissues and deep fascia. Primary thoracic involvement is exceptional and is a diagnostic and therapeutic emergency. AIM To report our experience in the management of this rare pathology of which clinical picture is unknown by most practitioners. METHODS This is a retrospective study carried out over a period of 07 years, compiling 07 cases of primitive necrotizing fasciitis of the thoracic wall at the department of thoracic surgery at the CHU Hassan II in Fez. RESULTS Patients were five men and two women, with an average age of 58 years. All our patients were known to have poorly balanced diabetes. The reason for consultation was a swelling of the chest wall with fever in all patients. On the results of thoracic computed tomography (CT), the presence of a deep collection of soft tissue was found in all patients. The treatment was a large necrosectomy, taking away the skin as well as the adjacent muscle. Postoperative follow-up was favorable in five patients. We noted two deceased patients due to postoperaive septic shock. CONCLUSION Necrotizing chest wall fasciitis is a medical and surgical emergency, requiring early diagnosis and rapid and appropriate management which will determine the prognosis.
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Abstract
BACKGROUND We investigated the clinical progress and bacteriological characteristics of infectious adverse events (AEs) following acupuncture and compared patient characteristics between serious and non-serious outcome groups. METHODS A retrospective observational study was conducted in 1,174 patients with infectious complications associated with acupuncture at the emergency department (ED) in a tertiary hospital in Korea between 2010 and 2014. Serious outcome was defined as development of septic shock, admission to intensive care unit (ICU) or attaining permanent morbidity. RESULTS Forty-eight patients had certain causality and cellulitis, necrotizing fasciitis and osteomyelitis were common in order. Among them, 9 patients (18.8%) were categorized into serious outcome group, and they showed devastating outcomes such as septic shock (n = 2), ICU admission (n = 4), and permanent sequelae (n = 5). The serious group had delayed admission to the ED after acupuncture (30.0 [4.0-55.0] vs. 3.0 [1.0-10.0] days, P = 0.023). Methicillin-sensitive Staphylococcus aureus was the most frequently identified microorganism. The patients in the serious group required longer treatment duration (139.0 [49.0-183.5] vs. 14.0 [7.0-34.0] days, P < 0.001) as well as more operation with local (44.4% vs. 10.3%, P = 0.031) or general anaesthesia (33.3% vs. 2.6%, P = 0.017). CONCLUSION The infectious AEs after acupuncture may cause serious outcomes. Patients and primary physicians should be aware of the risk of infectious complications and make efforts to prevent them.
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Affiliation(s)
- Youn-Jung Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Han Kim
- Department of Infectious Diseases, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Hak Jin Lee
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Won Young Kim
- Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Lin YS, Juhasz ES. Eikenella corrodens retroperitoneal necrotising fasciitis post-endoscopic retrograde cholangio-pancreatography. N Z Med J 2018; 131:69-73. [PMID: 29723181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Yee Sing Lin
- House Officer, Department of General Surgery, Waitemata District Health Board, Auckland
| | - Eva Susan Juhasz
- General Surgeon, Department of General Surgery, Waitemata District Health Board, Auckland
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Hubbard J, Jariwala B, Hill A, Gega A, Palesty JA. A New Bacterium, Lactobacillus acidophilus, Causing Necrotizing Fasciitis. Am Surg 2018; 84:e61-e63. [PMID: 30454480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Abstract
Incidence and severity of invasive group A Streptococcus infections are of increasing concern in France and worldwide. The risk for secondary infection of close contacts is known but rarely described. We report a case of intrafamilial and life-threatening transmission of emm12 group A Streptococcus.
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Moris V, Chapuis A, Guillier D, Jeudy G, Huther M, Auffret N, Piroth L, Blot M. Necrotizing fasciitis caused by genogroup × Neisseria meningitidis. QJM 2017; 110:589-590. [PMID: 28911029 DOI: 10.1093/qjmed/hcx109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- V Moris
- Service de Chirurgie Maxillo-Faciale
| | | | | | | | | | | | - L Piroth
- Service de Maladies Infectieuses et Tropicales, CHU François Mitterand, Dijon, France
| | - M Blot
- Service de Maladies Infectieuses et Tropicales, CHU François Mitterand, Dijon, France
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Milani-Nejad N, Tyler K, Grieco CA, Kaffenberger BH. Pasteurella multocida ecthyma complicated by necrotizing fasciitis. Dermatol Online J 2017; 23:13030/qt1h02t0tc. [PMID: 28541874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/19/2017] [Indexed: 06/07/2023] Open
Abstract
Necrotizing fasciitis is a serious infection of the skin and soft tissues. Pasteurella multocida is rarely reported to cause necrotizing fasciitis and is associated with high mortality. We describe a female patient with a past medical history of diabetes mellitus and myeloproliferative disorder presenting with bullae and erythema of the right forearm secondary to P. multocida infection after possible cat bite. Despite adequate antibiotic coverage she developed necrotizing fasciitis diagnosed clinically and on diagnostic imaging. Patient was taken to the operating room emergently and underwent irrigation and debridement with subsequent split-skin graft. She recovered well after the surgeries and was discharge on intravenous antibiotics. At clinic follow-up, her wounds were healing well without any significant new symptoms.
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Affiliation(s)
- Nima Milani-Nejad
- Medical Scientist Training Program, Ohio State University Wexner Medical Center, Columbus, Ohio, Department of Internal Medicine, Division of Dermatology, Ohio State University Wexner Medical Center, Columbus, Ohio.
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Marchesi A, Marcelli S, Parodi PC, Perrotta RE, Riccio M, Vaienti L. Necrotizing Fasciitis in Aesthetic Surgery: A Review of the Literature. Aesthetic Plast Surg 2017; 41:352-358. [PMID: 28062962 DOI: 10.1007/s00266-016-0754-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/25/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a rare, potentially fatal, infective complication that can occur after surgery. Diagnosis is still difficult and mainly based on clinical data. Only a prompt pharmacological and surgical therapy can avoid dramatic consequences. There are few reports regarding NF as a complication after aesthetic surgical procedures, and a systematic review still lacks. MATERIALS AND METHODS We have performed a systematic review of English literature on PubMed, covering a period of 30 years. Keywords used were "necrotising fasciitis" matched with "aesthetic surgery complications", "breast surgery", "mammoplasty", "blepharoplasty", "liposuction", "facelift", "rhinoplasty fasciitis", "arm lift", "thigh lift", "otoplasty" and "abdominoplasty fasciitis". No additional search and temporal limitation were set. RESULTS Among 3782 papers concerning NF, only 18 were related to NF after an aesthetic surgical procedure. Liposuction was the most affected procedure, with buttocks and lower extremity the most involved anatomical regions. The majority of the infections were monomicrobial, promoted by Streptococcus pyogenes. In most cases, NF occurred within the third post-operative day with non-specific signs and symptoms. In 14 cases, a single or multiple surgical interventions were performed and survival was achieved in 11 patients. CONCLUSIONS In case of infection after aesthetic surgery, we should always bear in mind NF. Clinical hallmarks still guide NF management. Because early signs and symptoms are usually non-specific, a strict clinical control is highly suggested. Once clinical suspicion is raised, prompt antibacterial therapy should be administered, followed by surgical debridement in case of ineffective response. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Andrea Marchesi
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy.
| | - Stefano Marcelli
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy
| | - Pier C Parodi
- Department of Plastic and Reconstructive Surgery, University of Udine, Udine, Italy
| | - Rosario E Perrotta
- Department of Medical and Surgery Specialties, Section of Plastic Surgery, University of Catania, Catania, Italy
| | - Michele Riccio
- Department of Reconstructive Plastic Surgery-Hand Surgery, AOU "Ospedali Riuniti", Ancona, Italy
| | - Luca Vaienti
- Dipartimento di Chirurgia Plastica Ricostruttiva, I.R.C.C.S. Policlinico San Donato, Università degli Studi di Milano, Via Morandi, 30, 20097, San Donato Milanese, Milan, Italy
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Abstract
Periocular necrotizing fasciitis developed in a 12-month-old boy with swelling of both eyes and redness and a discharge from the left eye approximately 36 hours after blunt trauma. Computed tomography revealed preseptal and soft-tissue edema on the left side, but no signs of orbital involvement, orbital fractures, or drainable abscess in the anterior left lower eyelid. The inflammatory signs worsened over the next day, and there was purulent discharge from the left lower eyelid and an abscess and necrosis of the lower eyelid skin. He did well following surgical debridement and treatment with intravenous antibiotics. His course highlights the difficulty in diagnosing necrotizing fasciitis and the necessity for prompt surgical debridement and empirical broad-spectrum antibiotic therapy.
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Affiliation(s)
- Alan D Proia
- Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA.
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Peker KD, Ilhan BM. Rare Complication of Stomas: Peristomal Necrotizing Fasciitis. Wounds 2016; 28:E47-E52. [PMID: 28054929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION A stoma formation is a frequently performed procedure in patients undergoing colorectal surgery. Although stoma formation is a simple process, it should be performed with caution. The aim of this study was to attract physicians' attention to this rare disease and also to identify the surgical and medical treatment options for peristomal necrotizing fasciitis as a rare complication. MATERIALS AND METHODS Risk factors including age, sex, additional diseases, previous surgical procedures, source of infection, physical findings, and vital signs of 14 patients with peristomal necrotizing fasciitis over a period of 10 years from 2005 to 2015 were retrospectively evaluated. RESULTS Of the 14 patients, 9 were men and 5 were women. The average age was 63.28 years (range, 45-85 years). Risk factors were also observed: diabetes mellitus, 4 (28.57%); obesity, 3 (21.42%); alcoholism, 1 (7.14%); and malignancy, 10 (71.42%). Prophylactic antibiotic treatment was given to all patients, and they all underwent debridement and stoma replacement. CONCLUSION Peristomal necrotizing fasciitis is an urgent and mortal disease. Risk factors, physical findings, and infection sources should be determined, and treatment modalities should be applied immediately. Medical treatment and surgical options should be performed, and vacuum devices should also be considered when treating this complication.
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Affiliation(s)
- Kivanc Derya Peker
- Department of General Surgery, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Burak M Ilhan
- Department of General Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
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He R, Qi X, Wen B, Li X, Guo L. Successful treatment of a rare extended retroperitoneal necrotizing soft tissue infection caused by extended-spectrum beta-lactamase-producing Escherichia coli: A case report. Medicine (Baltimore) 2016; 95:e5576. [PMID: 27930570 PMCID: PMC5266042 DOI: 10.1097/md.0000000000005576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
RATIONALE Retroperitoneal necrotizing soft tissue infection (NSTI) is a rare but life-threatening disease. Here, we present a case of extended retroperitoneal NSTI caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E coli). PATIENT CONCERNS The patient complained of progressive redness, swelling, and right flank pain for 10 days, extending to the scrotum for 1 day. DIAGNOSES He was admitted with an initial diagnosis of cellulitis. INTERVENTIONS Debridement was performed after the scrotum developed necrosis on day 2 of hospitalization. The source of infection was found to be an idiopathic retroperitoneal abscess, which was confirmed by computed tomography. Two consecutive microbiological cultures (aerobic plus anaerobic) of the tissue revealed the presence of ESBL-producing E coli. With the application of negative pressure wound therapy (NPWT), we sutured the wound after consecutive debridement. OUTCOMES During the 32 months of follow-up, the patient recovered very well and felt extremely satisfied. LESSONS This case reminds us that ESBL-producing E coli can cause retroperitoneal abscesses, which may induce NSTI. Aggressive debridement and broad-spectrum antibiotics should be administrated immediately when NSTI is suspected, and NPWT is an effective adjuvant therapy for wound closure.
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Affiliation(s)
- Rui He
- Department of Plastic Surgery and Burn
| | - Xin Qi
- Department of Plastic Surgery and Burn
| | - Bing Wen
- Department of Plastic Surgery and Burn
| | | | - Li Guo
- Department of Radiology, Peking University First Hospital, Beijing, People's Republic of China
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Christensen L, Evans H, Cundick D, Mcshane M, Penna K, Sadoff R. Necrotizing Fasciitis. Case Presentation and Literature Review. J Mich Dent Assoc 2016; 98:36-39. [PMID: 30726643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Necrotizing fasciitis is a rare, rapidly progressing infection with significant morbidity and high mortality rates. Rarely does necrotizing fasciitis appear in the head and neck region; rather, it usually affects the limbs and abdomen of patients. This article presents our institution's experience with the disease and provides a discussion of propoied treatment options.
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Abstract
CONCLUSION RPA and NF was diagnosed with a sensitivity/specificity of 100%/94% in patients with acute tonsillitis and without suspicion for disease complication after ENT examination, but an age >35 years and serum CRP >15.5mg/dl. BACKGROUND Acute tonsillitis represents a frequent disease in the otorhinolaryngology. Some patients exhibit disease aggravations resulting in (descending) peritonsillar abscess (PTA, dPTA), para-/retropharyngeal abscess (PPA, RPA), or necrotising fasciitis (NF). The study analyses the underlying predisposing factors. METHODS The retrospective cohort study includes a total of 1636 patients comprising 852 outpatients with acute bacterial tonsillitis, 279 in-patients with acute bacterial tonsillitis, 452 patients with PTA, 31 patients with dPTA/PPA, 12 patients with RPA, and 10 patients with NF. Patients were analysed for disease-related data. RESULTS While leucocytes do not distinguish the sub-groups, C-reactive protein demonstrated a significant increase resulting in the highest level for RPA and NF (p < 0.0001). PTA and RPA are usually caused by streptococcus, dPTA/PPA by anaerobic bacterias, and NF mixed infections (p < 0.0001). Patients with PTA were younger than dPTA/PPA (p = 0.002) or RPA/NF (p < 0.0001). Subsequently, the rate of internistic comorbidities was significantly increased in RPA/NF (p < 0.0001). ROC-analysis identified cut-offs for age <36 years and CRP <15.5mg/dl to distinguish acute bacterial tonsillitis from RPA.
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Affiliation(s)
- Constanze Gahleitner
- a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany
| | - Benedikt Hofauer
- a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany
| | - Thomas Stark
- a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany
| | - Andreas Knopf
- a Department of Otorhinolaryngology/Head and Neck Surgery , Technical University of Munich , Munich , Germany
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Chandler RE, Lee LE, Townes JM, Taplitz RA. Transmission of Group A Streptococcus Limited to Healthcare Workers with Exposure in the Operating Room. Infect Control Hosp Epidemiol 2016; 27:1159-63. [PMID: 17080371 DOI: 10.1086/508819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Accepted: 09/08/2005] [Indexed: 11/03/2022]
Abstract
Background.Nosocomial transmission of group A Streptococcus (GAS) has been well described. A recent report of an outbreak investigation suggested that transmission can be extensive and that standard infection control measures may not be adequate to prevent transmission from patients with severe, invasive disease to healthcare workers (HCWs).Objective.A case of pharyngitis in an HCW caring for a patient with GAS pharyngitis and necrotizing fasciitis prompted an investigation of the extent and risk factors for nosocomial transmission of GAS.Setting.A 509-bed, tertiary care center in Portland, Oregon with 631,100 patient visits (hospital and clinic) and 11,500 employees in the year 2003.Methods.HCWs with exposure to the index patient (“contacts”) were identified for streptococcal screening and culture and completion of a questionnaire regarding the location and duration of exposure, use of personal protective equipment, and symptoms of GAS infection.Results.We identified 103 contacts of the index patient; 89 (86%) submitted oropharyngeal swabs for screening and culture. Only 3 (3.4%) of contacts had a culture that yielded GAS; emm typing results and pulsed-field gel electrophoresis patterns of GAS isolates from 2 HCWs were identical to those for the isolate from the index patient. Both HCWs were symptomatic, with febrile pharyngitis and reported prolonged contact with the open wound of the patient in the operating room.Conclusions.In this investigation, nosocomial transmission was not extensive, and standard precautions provided adequate protection for the majority of HCWs. Transmission was restricted to individuals with prolonged intraoperative exposure to open wounds. As a result, infection control policy for individuals was modified only for HCWs with exposure to GAS in the operating room.
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Affiliation(s)
- Rebecca E Chandler
- Division of Infectious Diseases, Department of Medicine, Oregon Health and Science University, Portland, OR 97293, USA.
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Ofikwu G, Saeed S, Ramcharan A. Fatal Fulminant Retroperitoneal Necrotizing Fasciitis Caused by Streptococcus viridans. Am Surg 2016; 82:E84-E86. [PMID: 27097613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Godwin Ofikwu
- Department of Surgery, Harlem Hospital Columbia University Medical Center, New York, New York, USA
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Hau E, Bouaziz JD, Lafaurie M, Saussine A, Masson V, Rausky J, Bagot M, Guibal F. Necrotizing cellulitis with multiple abscesses on the leg caused by Serratia marcescens. Cutis 2016; 97:E8-E12. [PMID: 27023094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Serratia marcescens is an unusual cause of severe skin infection initially described in immunocompromised patients. We report a case of necrotizing cellulitis of the leg caused by S marcescens in a 68-year-old woman with diabetes mellitus and a history of chronic lymphoedema of the leg. We reviewed the literature and found 49 cases of severe skin infections from S marcescens that included 20 cases of necrotizing fasciitis (NF) as well as 29 cases of severe skin infections without NF (non-NF cases). Patients were immunocompromised in 59% to 70% of cases. The mortality rate was high in NF cases (60%) versus non-NF cases (3%). Surgery was required in 95% of NF cases and in 24% of non-NF cases. The other clinical manifestations of S marcescens skin infection reported in the literature included disseminated papular eruptions in patients infected with human immunodeficiency virus with folliculitis on the trunk. Serratia marcescens is naturally resistant to amoxicillin alone and amoxicillin associated with clavulanic acid. Broad-spectrum antibiotics are indicated to treat S marcescens skin infections, and surgery should be promptly considered in cases of severe skin infections if appropriate antibiotic therapy does not lead to rapid improvement.
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Affiliation(s)
- Estelle Hau
- Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France
| | - Jean-David Bouaziz
- Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France
| | - Matthieu Lafaurie
- Department of Infectious Diseases, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France
| | - Anne Saussine
- Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France
| | - Vincent Masson
- Department of Plastic Surgery, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France
| | - Jonathan Rausky
- Department of Plastic Surgery, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France
| | - Martine Bagot
- Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France
| | - Fabien Guibal
- Department of Dermatology, Saint Louis Hospital and Université Paris Diderot, Sorbonne Paris Cité, AP-HP, France
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Endo A, Matsuoka R, Mizuno Y, Doi A, Nishioka H. Sequential necrotizing fasciitis caused by the monomicrobial pathogens Streptococcus equisimilis and extended-spectrum beta-lactamase-producing Escherichia coli. J Infect Chemother 2016; 22:563-6. [PMID: 26912298 DOI: 10.1016/j.jiac.2016.01.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Revised: 01/13/2016] [Accepted: 01/21/2016] [Indexed: 11/19/2022]
Abstract
Necrotizing fasciitis is a rapidly progressing bacterial infection of the superficial fascia and subcutaneous tissue that is associated with a high mortality rate and is caused by a single species of bacteria or polymicrobial organisms. Escherichia coli is rarely isolated from patients with monomicrobial disease. Further, there are few reports of extended-spectrum beta-lactamase (ESBL)-producing E. coli associated with necrotizing fasciitis. We report here our treatment of an 85-year-old man who was admitted because of necrotizing fasciitis of his right thigh. Streptococcus equisimilis was detected as a monomicrobial pathogen, and the infection was cured by amputation of the patient's right leg and the administration of antibiotics. However, 5 days after discontinuing antibiotic therapy, he developed necrotizing fasciitis on his right upper limb and died. ESBL-producing E. coli was the only bacterial species isolated from blood and skin cultures. This case demonstrates that ESBL-producing E. coli can cause monomicrobial necrotizing fasciitis, particularly during hospitalization and that a different bacterial species can cause disease shortly after a previous episode.
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Affiliation(s)
- Akiko Endo
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Ryosuke Matsuoka
- Department of Pathology, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Yasushi Mizuno
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Asako Doi
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan; Department of Infectious Disease, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan; Department of Infectious Disease, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe, Hyogo 650-0047, Japan.
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Libanore M, Merlo R, Borin M, Marchesi E, Rossi MR, Fabbris C, Pelucchi S, Stomeo F, Ciorba A, Malagutti N. Listeria Monocytogenes: an uncommon pathogen of cervical necrotizing fasciitis. B-ENT 2016; 12:245-247. [PMID: 29727131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
The aim of this paper is to present a unique case of neck-necrotizing fasciitis caused by Listeria Monocytogenes in a young woman, successfully treated by surgery and IV antibiotic therapy. Necrotizing fasciitis is a rare, rapidly progressing and potentially life-threatening infection that infrequently occurs in the head and neck region. Pathogens involved in necrotizing fasciitis are heterogeneous and include aerobic and anaerobic bacteria. To the best of our knowledge, this is the only case of neck necrotizing fasciitis caused by Listeria Monocytogenes studied in literature so far.
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Kitamura C, Yamauchi Y, Yamaguchi T, Aida Y, Ito K, Ishizawa Y, Saitoh K, Kasai T, Ohnishi M. Successful Treatment of a Case of Necrotizing Fasciitis due to Vibrio vulnificus in a Cold Climate in Japan. Intern Med 2016; 55:1007-10. [PMID: 27086822 DOI: 10.2169/internalmedicine.55.5231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Vibrio vulnificus infection often occurs in warm regions, frequently leading to necrotizing fasciitis, sepsis, and death. We herein report a rare case presenting in a cold climate region in northern Japan, Aomori district, of a V. vulnificus infection complicated by necrotizing fasciitis and septic shock. The patient's prior history of injury and typical clinical course were helpful clues to the diagnosis of V. vulnificus infection, and early initiation of antimicrobial treatment saved his life. V. vulnificus infection should be considered even in cold regions, particularly if patients have risk factors.
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Affiliation(s)
- Chiho Kitamura
- Department of General Medicine, Aomori Prefectural Central Hospital, Japan
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Ho SWL, Ang CL, Ding CSL, Barkham T, Teoh LC. Necrotizing Fasciitis Caused by Cryptococcus gattii. Am J Orthop (Belle Mead NJ) 2015; 44:E517-E522. [PMID: 26665255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Necrotizing fasciitis (NF) is a severe soft-tissue infection that can lead to high morbidity and mortality. The etiology of NF is often polymicrobial. Although rare, fungal organisms have been known to cause NF. Cryptococcus is a fungal infection that may lead to NF. Here we report the case of a 73-year-old man who had diabetes and presented with pain and swelling in the left hand after being bitten by an insect over the dorsum of the hand. Operative débridement revealed NF caused by Cryptococcus gattii. Antifungal medication was started, and the patient underwent multiple débridements of the hand with subsequent skin grafting. Four months later, the hand wound was completely healed. Authors have reported several cases of NF secondary to Cryptococcus neoformans in immunocompromised patients. The emerging C gattii pathogen affects immunocompetent patients. Although the transmission route is mainly respiratory, direct inoculation has been described as well. Ours is the first reported case of NF secondary to C gattii. It is important to consider fungal elements as a source of NF. Appropriate treatment includes aggressive surgical débridement and antifungal therapy.
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Affiliation(s)
- Sean Wei Loong Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore.
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Harris AM, Yazzie D, Antone-Nez R, Dinè-Chacon G, Kinlacheeny J, Foley D, Yasmin S, Adams L, Livar E, Terranella A, Yeager L, Komatsu K, Van Beneden C, Langley G. Community-acquired invasive GAS disease among Native Americans, Arizona, USA, Winter 2013. Emerg Infect Dis 2015; 21:177-9. [PMID: 25531562 PMCID: PMC4285242 DOI: 10.3201/eid2101.141148] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Marinis A, Voultsos M, Foteinos A, Tselioti P, Avraamidou A, Paschalidis N, Rizos S. Necrotizing soft tissue infection of the right anterolateral abdominal wall caused by a ruptured gangrenous appendix in an elderly diabetic patient. Infez Med 2015; 23:182-186. [PMID: 26110301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Necrotizing soft tissue infections (NSTIs) of the abdominal wall usually occur when either a common superficial soft tissue infection progresses down to, or an injury (e.g. knife stab) penetrates, the investing muscle fascia, or an intra-abdominal infection spreads directly to the muscle layers of the abdominal wall. These infections are severe and associated with significant morbidity and mortality. We present an 83-year-old female diabetic patient who was admitted to the surgical emergency department complaining of right abdominal pain after a fall to the floor. She had previously received oral antibiotics for a minor superficial skin infection attributed to her subcutaneous use of insulin. On admission she exhibited signs of agitation and dyspnoea with hypotension and tachycardia (systolic arterial pressure 90mmHg, heart rate >110 bpm, oxygen saturation 88%). Furthermore, she had a tender right abdomen but without any demonstrable pathology on her skin or crepitus. Arterial blood gases revealed metabolic acidosis and hypoxaemia. An abdominal computed tomography (CT) scan demonstrated signs of infection of the entire right anterior abdominal wall and the LRINEC score was calculated to be 13. Subsequent operative aggressive necrosectomy of all the involved layers of the right anterolateral abdominal wall sparing the peritoneum was undertaken. Unfortunately, the patient died the next day due to multiple organ failure.
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Affiliation(s)
- Athanasios Marinis
- First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece
| | - Mavroudis Voultsos
- First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece
| | - Argyrios Foteinos
- First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece
| | - Paraskevi Tselioti
- First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece
| | - Alexandra Avraamidou
- First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece
| | - Nikolaos Paschalidis
- First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece
| | - Spyros Rizos
- First Department of Surgery, Department of Radiology and Intensive Care Unit, Tzaneion General Hospital, Piraeus, Greece
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Carr L, Michelotti B, Potochny J, Armen S, Keshtkar-Jahromi M, Crook T, Whitener CJ. Scedosporium: an unlikely cause of fungal necrotizing fasciitis. Am Surg 2015; 81:E253-E254. [PMID: 26031258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Logan Carr
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania, USA
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Umemura H, Hiragushi K, Sasaki S, Doi H, Shiota N, Kabutan K, Asagoe K. A male with group B streptococcal necrotizing fasciitis at multiple sites secondary to multifocal septic arthritis. Acta Derm Venereol 2015; 95:614-5. [PMID: 25403478 DOI: 10.2340/00015555-2015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hiroshi Umemura
- Department of Dermatology, Tohoku University, Graduate School of Medicine, Seiryo-machi 1-1, Aobaku, Sendai, 980-8574, Japan.
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