Zhao Manna, Leng Xuejun, Xu Jie, Cui Juanjuan, Li Shuo, Zhao Weifeng
Department of Infectious Diseases, The First Affiliated Hospital of Soochow University, Suzhou, China.
Infectious Diseases Department, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China.
Front Med (Lausanne). 2024 Oct 21;11:1447703. doi: 10.3389/fmed.2024.1447703. eCollection 2024.
Cervicothoracic necrotizing fasciitis (CNF) is one form of necrotizing soft-tissue infections, which could lead to patient demise during short course. Therefore, early recognition and immediate treatment contribute to promising prognosis of patients.
A 58-year-old diabetic patient presented with a sore throat and progressive irritation of the neck and chest for 4 days. The initial diagnosis was considered to be soft-tissue infection and the clinician gave empirical anti-infectious medication for expectant treatment. During the course of disease, surgical incision was performed to relieve suffocation and shortness of breath. The drainage fluids were detected with microbiological culture and molecular sequencing. Nanopore sequencing technology (NST) helped to identify the coinfection of and spp., which was not recognized during the original period of 15 days. The precise identification of pathogen supported to guide the pharmacologic treatment with meropenem and linezolid. Ultimately, combined with the surgical observation and post-surgical pathological examination, the patient was diagnosed as CNF, which could be much more acute and serious than normal soft-tissue infections. The patient has been successfully treated with prompt antimicrobial medication and appropriate surgical debridement.
This case presented a CNF patient with type 2 diabetes, successfully recovered after prompt microbial detection, precise anti-infectious treatment, and appropriate surgical intervention. It highlights the importance of recognizing pathogen by applying rapid microbiological detection, including NST, in acute and serious infectious disease.
颈胸段坏死性筋膜炎（CNF）是坏死性软组织感染的一种形式，可在短期内导致患者死亡。因此，早期识别和立即治疗有助于患者获得良好预后。
一名58岁的糖尿病患者出现咽痛，并伴有颈部和胸部进行性疼痛4天。初步诊断为软组织感染，临床医生给予经验性抗感染药物进行预期治疗。在疾病过程中，进行了手术切开以缓解窒息和呼吸急促。对引流液进行了微生物培养和分子测序检测。纳米孔测序技术（NST）有助于鉴定出[具体菌种1]和[具体菌种2]的混合感染，这在最初的15天内未被识别。病原体的精确鉴定有助于指导使用美罗培南和利奈唑胺进行药物治疗。最终，结合手术观察和术后病理检查，患者被诊断为CNF，其可能比正常软组织感染更为急性和严重。该患者通过及时的抗菌药物治疗和适当的手术清创成功治愈。
本病例展示了一名患有2型糖尿病的CNF患者，在及时进行微生物检测、精确抗感染治疗和适当手术干预后成功康复。它强调了在急性和严重传染病中应用包括NST在内的快速微生物检测来识别病原体的重要性。
