Western University, London, Ontario, Canada.
BMC Infect Dis. 2013 Aug 20;13:381. doi: 10.1186/1471-2334-13-381.
Fournier's gangrene is a rare necrotizing soft tissue infection of the scrotum and penis. We report, to our knowledge, the first case of Fournier's gangrene caused by Streptococcus dysgalactiae subsp. equisimilis (SDSE), a strain of pyogenic β-hemolytic streptococci that is increasingly being recognized as an important human pathogen.
We describe a healthy 59 year-old Caucasian male who presented to the emergency department with Fournier's gangrene of the penis and scrotum, with extension to the anterior abdominal wall. He underwent urgent surgical debridement of his scrotum, penis, and anterior abdomen. Swabs from the scrotum grew Gram-positive cocci, which were initially identified as Streptococcus anginosus group by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). However, polymerase chain reaction (PCR) amplification and sequencing of the 16S rRNA gene identified the isolate as Streptococcus dysgalatiae subspecies equisimilis (SDSE). The incidences of invasive S. anginosus group and SDSE infections at the London Health Sciences Centre, a tertiary-care institution in southwestern Ontario, were determined between August 1, 2011 and August 31, 2012, revealing a slightly lower rate of SDSE (3.2 cases per 100,000 population) than other studies.
This case highlights a unique disease manifestation of the emerging human pathogen Streptococcus dysgalatiae subspecies equisimilis that has not been previously reported. This case also underscores the limitations of MALDI-TOF MS in differentiating between closely-related streptococcal species which may have different pathogenic profiles.
Fournier 坏疽是一种罕见的阴囊和阴茎坏死性软组织感染。据我们所知，我们报告了首例由无乳链球菌（SDSE）引起的 Fournier 坏疽，这种化脓性β-溶血性链球菌越来越被认为是一种重要的人类病原体。
我们描述了一位健康的 59 岁白人男性，因阴茎和阴囊的 Fournier 坏疽，延伸至前腹壁而到急诊科就诊。他接受了阴囊、阴茎和前腹部的紧急清创术。阴囊拭子培养出革兰阳性球菌，最初通过基质辅助激光解吸电离飞行时间质谱（MALDI-TOF MS）鉴定为咽峡炎链球菌群。然而，聚合酶链反应（PCR）扩增和 16S rRNA 基因测序鉴定分离株为无乳链球菌亚种 equisimilis（SDSE）。在安大略省西南部的三级保健机构伦敦健康科学中心，确定了 2011 年 8 月 1 日至 2012 年 8 月 31 日侵袭性咽峡炎链球菌群和 SDSE 感染的发生率，SDSE 的发生率略低于其他研究（每 10 万人中有 3.2 例）。
本病例突出了新兴人类病原体无乳链球菌亚种 equisimilis 的一种独特疾病表现，以前没有报道过。本病例还强调了 MALDI-TOF MS 在区分密切相关的链球菌种方面的局限性，这些链球菌种可能具有不同的致病谱。
