Nambiar Sudheer, Karippot Asha, Devasahayam Joe, Oliver Tony
Pulmonary Critical Care Medicine, Medical City Denton, Denton, TX, USA.
Hematology and Oncology, Medical City Denton, Denton, TX, USA.
Case Rep Crit Care. 2017;2017:3718360. doi: 10.1155/2017/3718360. Epub 2017 Nov 16.
Necrotizing soft tissue infections are characterized clinically by fulminant tissue destruction, systemic signs of toxicity, and high mortality. Accurate diagnosis and appropriate treatment must include early surgical intervention and antibiotic therapy. Mortality rate is very high and could be even higher in an immunocompromised host. We present a 57-year-old female with history of rheumatoid arthritis on oral corticosteroid and methotrexate therapy with painful swelling of the left hand following a cat bite that was diagnosed as having group A streptococcus pyogenes-associated necrotizing fasciitis. Treatment with ampicillin-sulbactam, Clindamycin, and surgical debridement was performed. In spite of all the adequate therapy she succumbed to death from streptococcal toxic shock and related complications after thirty-two days of treatment in intensive care unit. Necrotizing fasciitis is an uncommon but life-threatening complication in immunocompromised hosts. Tissue infections in cat bite wounds are commonly caused by pathogenic bacterium known as . Group A streptococcal infections are not reported following cat bites. A high index of suspicion must be maintained to suspect group A streptococcal associated necrotizing fasciitis following cat bites and an early medical and surgical intervention should be made for any best possible outcome.
坏死性软组织感染的临床特征为迅速的组织破坏、全身中毒症状和高死亡率。准确的诊断和恰当的治疗必须包括早期手术干预和抗生素治疗。死亡率很高，在免疫功能低下的宿主中可能更高。我们报告一例57岁女性，有类风湿关节炎病史，正在接受口服皮质类固醇和甲氨蝶呤治疗，因猫咬伤后左手出现疼痛性肿胀，被诊断为A组化脓性链球菌相关性坏死性筋膜炎。给予氨苄西林-舒巴坦、克林霉素治疗并进行手术清创。尽管进行了所有充分的治疗，但在重症监护病房治疗32天后，她仍因链球菌中毒性休克及相关并发症死亡。坏死性筋膜炎在免疫功能低下的宿主中是一种罕见但危及生命的并发症。猫咬伤伤口的组织感染通常由一种名为……的致病细菌引起。猫咬伤后未报告A组链球菌感染。对于猫咬伤后怀疑A组链球菌相关性坏死性筋膜炎必须保持高度警惕，应尽早进行医学和手术干预以获得最佳可能结果。 （注：原文中“known as.”后面内容缺失）
