Wasserzug Oshri, Valinsky Lea, Klement Eyal, Bar-Zeev Yael, Davidovitch Nadav, Orr Nadav, Korenman Zina, Kayouf Raid, Sela Tamar, Ambar Ruhama, Derazne Estela, Dagan Ron, Zarka Salman
Army Health Branch, Medical Corps, Israeli Defense Force, Ramat Gan, Israel.
Clin Infect Dis. 2009 May 1;48(9):1213-9. doi: 10.1086/597770.
Ecthyma is an invasive, ulcerated skin infection. Four ecthyma outbreaks occurred in different infantry units in the Israeli Defense Force from October 2004 through February 2005. Morbidity attack rates in the first 3 outbreaks were 89% (49 of 55 soldiers), 73% (32 of 44), and 82% (37 of 45). In the fourth outbreak, in which early intervention (antimicrobial treatment and improvement of hygiene) was applied, the attack rate was 25% (10 of 40 soldiers). In the first outbreak cluster, 4 soldiers experienced poststreptococcal glomerulonephritis, and 5 cases of systemic sequelae were recorded (1 case of severe septic shock, 3 cases of pneumonia, and 1 case of septic olecranon bursitis).
Streptococcus pyogenes and Staphylococcus aureus were isolated from ecthyma sores, oropharynx, and anterior nares of affected and unaffected soldiers involved in all 4 outbreaks.
Although the S. aureus isolates had different genomic profiles, >90% of S. pyogenes isolates were identified as belonging to a single clone, emm type 81, T type 8. Epidemiological investigation revealed that the hygiene levels of the soldiers and their living conditions were probably the most important cause for the difference in attack rates, wound severity, and systemic sequelae found between and within the units.
Our study demonstrates the possible ramifications of the combination of a virulent and highly infective S. pyogenes strain and poor living conditions, and it emphasizes the importance of early intervention in such conditions.
深脓疱病是一种侵袭性溃疡性皮肤感染。2004年10月至2005年2月期间，以色列国防军的不同步兵部队发生了4次深脓疱病暴发。前3次暴发的发病率分别为89%（55名士兵中的49名）、73%（44名中的32名）和82%（45名中的37名）。在第4次暴发中，采取了早期干预措施（抗菌治疗和改善卫生条件），发病率为25%（40名士兵中的10名）。在第一次暴发群体中，4名士兵发生了链球菌感染后肾小球肾炎，并记录到5例全身性后遗症（1例严重感染性休克、3例肺炎和1例感染性鹰嘴滑囊炎）。
从参与所有4次暴发的患病和未患病士兵的深脓疱疮、口咽部和前鼻孔中分离出化脓性链球菌和金黄色葡萄球菌。
虽然金黄色葡萄球菌分离株具有不同的基因组图谱，但90%以上的化脓性链球菌分离株被鉴定为属于单一克隆，即emm型81、T型8。流行病学调查显示，士兵的卫生水平及其生活条件可能是各部队之间以及部队内部发病率、伤口严重程度和全身性后遗症存在差异的最重要原因。
我们的研究证明了高毒力和高传染性的化脓性链球菌菌株与恶劣生活条件相结合可能产生的后果，并强调了在此类情况下早期干预的重要性。
