Ballon-Landa G R, Gherardi G, Beall B, Krosner S, Nizet V
Department of Medicine, Scripps Mercy Hospital, San Diego, CA, USA.
J Infect. 2001 May;42(4):272-7. doi: 10.1053/jinf.2000.0801.
Necrotizing fasciitis (NF) is a life-threatening infection involving rapid necrosis of subcutaneous and fascial tissues. Streptococcus pneumoniae (SPN) soft tissue infection is exceedingly uncommon, reported primarily in patients with immunosuppression or other underlying conditions. We report a case of NF and septic shock in a healthy 32-year-old man, whose only predisposing factor was antecedent blunt trauma. Pathological examination and culture of the extensive tissue debridement were positive only for SPN. The serotype 9V isolate was penicillin (PCN)-resistant (MIC=2.0), and closely-related by pulse field gel electrophoresis and multilocus fingerprinting to clone France 9V-3, an important genetic reservoir for increasing PCN-resistance worldwide. This unique case has implications for our pathogenic under-standing and empiric management of NF.
坏死性筋膜炎（NF）是一种危及生命的感染，涉及皮下和筋膜组织的快速坏死。肺炎链球菌（SPN）软组织感染极为罕见，主要报道于免疫抑制患者或其他基础疾病患者。我们报告一例健康的32岁男性发生NF和感染性休克的病例，其唯一的诱发因素是既往钝性创伤。广泛组织清创的病理检查和培养仅SPN呈阳性。9V血清型分离株对青霉素（PCN）耐药（MIC = 2.0），通过脉冲场凝胶电泳和多位点指纹图谱与法国9V - 3克隆密切相关，法国9V - 3克隆是全球PCN耐药性增加的重要基因库。这一独特病例对我们理解NF的发病机制和经验性治疗具有启示意义。
