Zhang Jia, Wang Zhijian, Jiang Yushan, Zhang Dan, Den Wanyan, Wang Danni, Peng Jiayi, Li Jiajun, Huang Wenxiang
Department of Geriatrics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Department of Emergency and Critical Care, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Infect Drug Resist. 2024 Sep 30;17:4251-4256. doi: 10.2147/IDR.S479192. eCollection 2024.
, also known as Group A (GAS), can cause severe invasive diseases with high fatality rates. We report a case of necrotizing fasciitis and myositis complicated by Streptococcal Toxic Shock-Like Syndrome (STSS) caused by the invasive 22/ST46 strain of in China. A previously healthy 57-year-old Chinese Canadian man presented with right calf pain and ulceration following a hike in the Gobi Desert, which progressed to unconsciousness and severe infection. Despite initial treatment, his condition deteriorated, leading to his transfer to our intensive care unit. Metagenomic Next-Generation Sequencing identified , and antimicrobial susceptibility testing revealed resistance to erythromycin, tetracycline, and clindamycin. Despite broad-spectrum antimicrobial therapy, debridement, and supportive measures, the patient's condition necessitated amputation of the right lower limb. He recovered and was discharged from the hospital on Day 43. Whole-genome sequencing of the isolate identified 15 multiple virulence factors. Phylogenetic analysis revealed that the closest relative of the isolate was a strain identified in China. This case underscores the importance of early recognition and treatment of invasive GAS infections to prevent severe outcomes, and we should pay attention to invasive 22/ST46 GAS infections in China.
A群链球菌（GAS），也被称为A组链球菌，可引发具有高致死率的严重侵袭性疾病。我们报告了1例在中国由侵袭性A群链球菌22/ST46菌株引起的坏死性筋膜炎和肌炎，并伴有链球菌中毒性休克样综合征（STSS）的病例。一名既往健康的57岁华裔加拿大男性在戈壁沙漠徒步旅行后出现右小腿疼痛和溃疡，病情进展为昏迷和严重感染。尽管进行了初始治疗，但其病情仍恶化，随后被转至我们的重症监护病房。宏基因组下一代测序鉴定出A群链球菌，抗菌药物敏感性试验显示该菌株对红霉素、四环素和克林霉素耐药。尽管采取了广谱抗菌治疗、清创术和支持措施，但患者的病情仍需要截肢右下肢。他康复后于第43天出院。对分离株进行全基因组测序鉴定出15种多种毒力因子。系统发育分析显示，该分离株的最相近亲缘菌株是在中国鉴定出的一株菌株。该病例强调了早期识别和治疗侵袭性A群链球菌感染以预防严重后果的重要性，并且我们应关注中国的侵袭性A群链球菌22/ST46感染。
