Division of Acute Care Surgery, University of Florida , Gainesville, FL, USA.
Surg Infect (Larchmt). 2010 Oct;11(5):469-74. doi: 10.1089/sur.2009.026.
Bacillus cereus has been increasingly recognized as a virulent pathogen, particularly in immunocompromised patients.
Presented is a case report of a 24-year-old man with end-stage liver disease secondary to primary sclerosing cholangitis, who developed necrotizing fasciitis of the right lower leg due to B. cereus. The bacterium isolated from the patient was compared with environmental strains for quantity of secreted proteins as well as hemolytic and cytotoxic activities.
Despite above-the-knee amputation and aggressive antibiotic therapy, the patient expired on hospital day 13. The patient isolate demonstrated a protein secretion pattern and cytotoxicity similar to those of an environmental strain known to produce exotoxins. However, the isolate did produce a larger ratio of zone of hemolysis to colony size on blood agar plates compared with the environmental strain.
To the best of our knowledge, this is the only report of B. cereus as the etiology of necrotizing fasciitis in a patient with end-stage liver disease. Because the infecting bacterium correlates with the environmental strain, the severity of the patient's disease is likely related to his immunocompromised state. Therefore, B. cereus should be considered a potential pathogen rather than a contaminant.
蜡样芽胞杆菌已被越来越多地认为是一种毒力很强的病原体，特别是在免疫功能低下的患者中。
本报告介绍了一例 24 岁的男性患者，患有原发性硬化性胆管炎继发的终末期肝病，因蜡样芽胞杆菌导致右下腿坏死性筋膜炎。从患者中分离出的细菌与环境菌株进行了比较，比较了它们分泌蛋白的数量、溶血活性和细胞毒性。
尽管进行了膝上截肢和积极的抗生素治疗，但患者在入院第 13 天死亡。患者分离株表现出与已知产生外毒素的环境菌株相似的蛋白分泌模式和细胞毒性。然而，与环境菌株相比，分离株在血琼脂平板上产生的溶血区与菌落大小的比例更大。
据我们所知，这是首例终末期肝病患者蜡样芽胞杆菌引起坏死性筋膜炎的报告。由于感染细菌与环境菌株相关，患者疾病的严重程度可能与他的免疫功能低下有关。因此，应将蜡样芽胞杆菌视为一种潜在的病原体，而不是一种污染物。
