Shayegani A, MacFarlane D, Kazim M, Grossman M E
Harkness Eye Institute, Columbia University, New York, New York, USA.
Am J Ophthalmol. 1995 Dec;120(6):784-92. doi: 10.1016/s0002-9394(14)72732-1.
Streptococcal gangrene, also termed streptococcal necrotizing fasciitis, is resurgent but remains exceedingly rare. Ophthalmologists and dermatologists must be aware of streptococcal gangrene, as eyelids are the most commonly affected area of the head and neck.
We studied two cases of streptococcal gangrene of the orbit with clinical manifestations indistinguishable from common nonnecrotizing orbital cellulitis.
Infection progressed with dramatic rapidity to produce eyelid necrosis, respiratory failure, sepsis, and severe permanent visual loss caused by ophthalmic artery occlusions. Histopathologic analysis disclosed vascular thrombosis, necrosis, acute inflammation, and the presence of gram-positive cocci. Cultures grew heavy group A beta hemolytic Streptococcus. The first patient was infected with M type 1 carrying exotoxins A and B. The second patient was also infected with Streptococcus carrying exotoxin A.
Early diagnosis of this life-threatening infection is of paramount importance because survival may depend on early surgical debridement.
链球菌性坏疽，也称为链球菌性坏死性筋膜炎，虽有复发但仍然极为罕见。眼科医生和皮肤科医生必须了解链球菌性坏疽，因为眼睑是头颈部最常受累的部位。
我们研究了两例眼眶链球菌性坏疽病例，其临床表现与常见的非坏死性眼眶蜂窝织炎难以区分。
感染迅速进展，导致眼睑坏死、呼吸衰竭、败血症以及由眼动脉闭塞引起的严重永久性视力丧失。组织病理学分析显示血管血栓形成、坏死、急性炎症以及革兰氏阳性球菌的存在。培养物中生长出大量A组β溶血性链球菌。首例患者感染了携带外毒素A和B的1型M株。第二例患者也感染了携带外毒素A的链球菌。
早期诊断这种危及生命的感染至关重要，因为生存可能取决于早期手术清创。
