Gardam M A, Low D E, Saginur R, Miller M A
Department of Microbiology, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
Arch Intern Med. 1998;158(15):1704-8. doi: 10.1001/archinte.158.15.1704.
Necrotizing fasciitis, which is a severe and uncommon infection involving the subcutaneous tissues, is usually caused by group A streptococci. To our knowledge, however, group B streptococci (Streptococcus agalactiae) have been reported to cause necrotizing fasciitis in only 4 instances (2 involving neonates) over the past 4 decades. We report 3 cases of group B streptococcal necrotizing fasciitis in adults that occurred in southern Ontario and Quebec within a 10-month period. All 3 patients had significant underlying illness, and all required surgical debridement in addition to antibiotic therapy. One of the cases fulfilled the criteria for streptococcal toxic shock-like syndrome. Group B streptococcus has been recognized as a frequent cause of serious disease in adults. It has become evident over the past decade that invasive streptococcal infections are on the increase. We speculate that group B streptococcus has recently acquired an increased ability to cause necrotizing fasciitis and suggest that this may represent the emergence of a new clinical syndrome in adults.
坏死性筋膜炎是一种累及皮下组织的严重且罕见的感染，通常由A组链球菌引起。然而，据我们所知，在过去40年里，仅报告过4例B组链球菌（无乳链球菌）引起的坏死性筋膜炎（其中2例涉及新生儿）。我们报告了在安大略省南部和魁北克省10个月内发生的3例成人B组链球菌坏死性筋膜炎病例。所有3例患者都有严重的基础疾病，除抗生素治疗外均需手术清创。其中1例符合链球菌中毒性休克样综合征的标准。B组链球菌已被公认为成人严重疾病的常见病因。在过去十年中，侵袭性链球菌感染呈上升趋势已变得明显。我们推测B组链球菌最近导致坏死性筋膜炎的能力有所增强，并表明这可能代表成人中一种新的临床综合征的出现。
