Murata Satoru, Toyoshima Chie, Suzuki Satoshi, Sato Norio
Department of Emergency Medicine and Critical Care Medicine, Ehime University Graduate School of Medicine, Japan.
Department of Emergency Medicine and Intensive Care Medicine, Saiseikai Noe Hospital, Japan.
Ann Med Surg (Lond). 2022 Sep 30;82:104732. doi: 10.1016/j.amsu.2022.104732. eCollection 2022 Oct.
In approximately 50% of patients with necrotizing fasciitis, infection begins deep in the soft tissues. A history of trauma is often absent. The mechanism of spread has not been elucidated. We report a case of type II necrotizing fasciitis in which the streptococcal strain was identical to isolates from other locations in the same patient.
A 42-year-old man presented with left leg pain. Two days prior, he had a non-penetrating injury to the left thigh while playing futsal. Workup revealed swelling of the left gastrocnemius. He was admitted to orthopaedics. On the third hospital day, he was referred to our department for hypotension, impending respiratory failure, and decreased sensorium, and subsequently admitted to the ICU. A biopsy was done on the left gastrocnemius fascia. He was diagnosed with necrotizing fasciitis. On the seventh hospital day, left hip amputation and extensive debridement of the trunk were done. Patient improved and eventually recovered.
Group A streptococcus was isolated in from the fascia, blood, and pharyngeal ulcer. Pulsed field gel electrophoresis showed all isolates to be genetically identical. An oral route of infection was considered.
This is the first report in which etiologic agent of necrotizing fasciitis is genetically identical with isolates from other parts in the absence of trauma.
在大约50%的坏死性筋膜炎患者中，感染始于深部软组织。通常没有创伤史。其传播机制尚未阐明。我们报告一例II型坏死性筋膜炎病例，其中分离出的链球菌菌株与同一患者其他部位分离出的菌株相同。
一名42岁男性因左腿疼痛就诊。两天前，他在踢室内足球时左大腿受到非穿透性损伤。检查发现左腓肠肌肿胀。他被收入骨科。住院第三天，因低血压、即将出现呼吸衰竭和意识减退被转诊至我们科室，随后收入重症监护病房。对左腓肠肌筋膜进行了活检。他被诊断为坏死性筋膜炎。住院第七天，进行了左髋关节截肢术和躯干广泛清创术。患者病情好转并最终康复。
从筋膜、血液和咽部溃疡中分离出A组链球菌。脉冲场凝胶电泳显示所有分离株在基因上相同。考虑存在经口感染途径。
这是第一份关于坏死性筋膜炎的病原体在无创伤情况下与其他部位分离株基因相同的报告。
