Alavi Seyed Mohammad Amin, Petri Francesco, Mahmoud Omar K, Igwilo-Alaneme Rita, El Zein Said, Nassr Ahmad N, Gori Andrea, Berbari Elie F
Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz 6135715794, Iran.
Division of Public Health, Infectious Diseases and Occupational Medicine, Department of Medicine, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, MN 55905, USA.
J Clin Med. 2024 Sep 28;13(19):5802. doi: 10.3390/jcm13195802.
The incidence of culture-negative NVO (CN-NVO) cases is increasing, presenting significant diagnostic and therapeutic challenges due to the inability to isolate causative organisms with conventional microbiological methods. Factors influencing the diagnosis of CN-NVO include prior antimicrobial therapy, low pathogen burden, fastidious or intracellular organisms, technical issues, and non-infectious mimickers. Diagnosis often relies on imaging modalities like magnetic resonance imaging (MRI) and computed tomography (CT)-guided biopsy, though these methods can sometimes fail to yield positive microbiological results. Advanced diagnostic tools, such as polymerase chain reaction (PCR), metagenomic next-generation sequencing (mNGS), and cell-free DNA analysis, may be necessary to identify the pathogen. The causative pathogen cannot be isolated in some patients, among which an empirical antimicrobial therapy should be initiated. This narrative review discusses the management, monitoring, surgical indications, and outcomes for patients with CN-NVO.
培养阴性的坏死性筋膜炎（CN-NVO）病例的发生率正在上升，由于无法用传统微生物学方法分离出致病微生物，给诊断和治疗带来了重大挑战。影响CN-NVO诊断的因素包括先前的抗菌治疗、病原体负荷低、苛养菌或细胞内微生物、技术问题以及非感染性模仿物。诊断通常依赖于磁共振成像（MRI）和计算机断层扫描（CT）引导下活检等成像方式，尽管这些方法有时无法获得阳性微生物学结果。可能需要先进的诊断工具，如聚合酶链反应（PCR）、宏基因组下一代测序（mNGS）和游离DNA分析来识别病原体。在一些患者中无法分离出致病病原体，对此应启动经验性抗菌治疗。这篇叙述性综述讨论了CN-NVO患者的管理、监测、手术指征和治疗结果。
