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2011, Number 4

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Rev Med Inst Mex Seguro Soc 2011; 49 (4)

Necrotizing fasciitis and group A streptocaccal toxic shock syndrome in two patients without risk factors

Juan Jacobo Ayala-Gaytán, Claudia Elena Guajardo-Lara, Salvador Bruno Valdovinos-Chávez

Language: Spanish
References: 28
Page: 425-432
PDF size: 121.61 Kb.


ABSTRACT

Necrotizing fasciitis associated to group A streptococcus (S. pyogenes) infection is a deep-seated infection of the subcutaneous tissue that results in progressive destruction of fascia and fat, with a high mortality rate due to a rapid progression of the illness to shock and multiple organ dysfunction. The challenge is to perform a prompt diagnosis because it is often confused with a minor soft-tissue infection. This infection should be aggressively treated with systemic antimicrobials, surgical debridement, and critical care. We present two cases of necrotizing fasciitis associated to infection with Streptococcus pyogenes patients developed myonecrosis and toxic shock syndrome within the following 24 hours after admission. In addition, we reviewed the pathogenic mechanism, diagnosis and treatment of this syndrome and discuss published treatment recommendations.


REFERENCES

  1. Stevens DL. The flesh-eating bacterium: What´s next? J Infect Dis 1999;179(Supl 2):S366-S374.

  2. Lamagni TL, Neal S, Keshishian C, Alhaddad N, George R, Duckworth G, et al. Severe Streptococcus pyogenes infections, United Kingdom, 2003-2004. Emerg Infect Dis 2008;14(2):202-209.

  3. Morgan MS. Diagnosis and management of necrotizing fasciitis: a multiparametric approach. J Hosp Infect 2010; 75(4):249-257.

  4. Guzmán-Aguilar RM. Marcadores bioquímicos de riesgo para mortalidad por fascitis necrotizante. Rev Med Inst Mex Seguro Soc 2008;46(6):583-590.

  5. Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med 1996;334(4):240-245.

  6. The Working Group on Severe Sptreptococcal Infections. Defining the group A streptococcal toxic shock syndrome. Rationale and consensus definition. JAMA 1993;269 (3):390-391.

  7. Rainbow J, Jewell B, Danila RN, Boxrud D, Beal B, Van Beneden C, Lynfield R. Invasive group a streptococcal disease in nursing homes, Minnesota, 1995-2006. Emerg Infect Dis 2008;14(5):772-777

  8. Lamagni TL, Neal S, Keshishian C, Powell D, Potz N, Pebody R, et al. Predictors of death after severe Streptococcus pyogenes infection. Emerg Infect Dis 2009;15(8): 1304-1307.

  9. Stevens DL. Streptococcal toxic-choque syndrome: spectrum of disease, pathogenesis, and new concepts in treatment. Emerg Infect Dis 1995;1(3):69-78.

  10. Factor SH, Levine OS, Schwartz B, Harrison LH, Farley MM, McGeer A, et al. Invasive group A streptococcal disease: risk factors for adults. Emerg Infect Dis 2003;9 (8):970-977.

  11. Seal DV. Necrotizing fasciitis. Curr Opin Infect Dis 2001; 14(2):127-132.

  12. Bisno AL, Cockerill FR 3rd, Bermudez CT. The initial outpatient-physician encounter in group A streptococcal necrotizing fasciitis. Clin Infect Dis 2000;31(2):607-608.

  13. Bachmeyer C, Langman B, Blum L. Fulminant streptococcal necrotizing fasciitis. Dermatology 2004;209(4): 346-347.

  14. Hoadley DJ, Mark EJ. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 28-2002. A 35-year-old long- term traveler with a rapidly progressive soft-tissue infection. N Engl J Med 2002; 347(11):831-837.

  15. Filbin MR, Ring DC, Wessels MR, Avery LL, Kradin RL. Case records of the Massachusetts General Hospital. Case 2-2009. A 23-year-old man with pain and swelling of the right hand and hypotension. N Engl J Med 2009;360(3): 281-290.

  16. Stevens DL. Invasive group A streptococcus infections. Clin Infect Dis 1992;14(1):2-13.

  17. Musser JM, Kapur V, Szeto J, Pan X, Swanson DS, Martin DR. Genetic diversity and relationships among Streptococcus pyogenes strains expressing serotype M1 protein: recent intercontinental spread of a subclone causing episodes of invasive disease. Infect Immun 1995;63(3):994-1003.

  18. Bidet P, Lesteven E, Doit C, Liguori S, Mariani-Kurkdjian P, Bonacorsi S, et al. Subtyping of emm 1 group A streptococci causing invasive infections in France. J Clin Microbiol 2009; 47(12):4146-4149.

  19. Luca-Harari B, Darenberg J, Neal S, Siljander T, Strakova L, Tanna A, et al. Clinical and microbiological characteristics of severe Streptococcus pyogenes disease in Europe. J Clin Microbiol 2009;47(4):1155-1165.

  20. Le Hello S, Doloy A, Baumann F, Roques N, Coudene P, Rouchon B, et al. Clinical and microbial characteristics of invasive Streptococcus pyogenes disease in New Caledonia, a region in Oceania with a high incidence of acute rheumatic fever. J Clin Microbiol 2010;48(2):526-530.

  21. Lintges M, van der Linden M, Hilgers RD, Arlt S, Al- Lahham A, Reinert RR, et al. Superantigen genes are more important than the emm type for the invasiveness of group A Streptococcus infection. J Infect Dis 2010; 202(1):20-28.

  22. Norrby-Teglund A, Ihendyane N, Darenberg J. Intravenous immunoglobulin adjunctive therapy in sepsis, with special emphasis on severe invasive group A streptococcal infections. Scand J Infect Dis 2003;35(9):683-689.

  23. Darenberg J, Ihendyane N, Sjölin J, Aufwerber E, Haidl S, Follin P, et al. Intravenous immunoglobulin G therapy in streptococcal toxic shock syndrome: a European randomized, double-blind, placebo-controlled trial. Clin Infect Dis 2003;37(3):333-340.

  24. Darenberg J, Söderquist B, Normark BH, Norrby-Teqlund A. Differences in potency of intravenous polyspecific immunoglobulin G against streptococcal and staphylococcal superantigens: implications for therapy of toxic shock syndrome. Clin Infect Dis 2004;38(6):836-842.

  25. O´Loughlin RE, Roberson A, Cieslak PR, Lynfield R, Gershman K, Craig A, et al. The epidemiology of invasive group A streptococcal infection and potential vaccine implications: United States, 2000-2004. Clin Infect Dis 2007;45 (7):853-862.

  26. Azkárate-Ayerdi B, Wichmann de Miguel MA, Arruabarrena- Echeverría I, Martín-Rodríguez FJ, Izquierdo-Elena JM, Rodríguez-Arrondo F. Fascitis necrosante por Streptococcus pyogenes en dos pacientes previamente sanos. Enferm Infecc Microbiol Clin 2002;20(4): 173-175.

  27. Rodríguez-Lorenzo A, Midón-Míguez J, Martelo-Villar F. Síndrome del shock tóxico estreptocócico tras fascitis necrotizante por estreptococo pyogenes. Cir Plas Iberolatinoam 2007;33(4):257-262. Disponible en http://scielo.isciii.es/pdf/ cpil/v33n4/original8.pdf

  28. Saavedra-Soto JC, Márquez-Heine JC, Romero-Valdovinos M, Castillo-Rojas G, Martínez-Vélez N, Sierra-Martínez O, et al. Management and identification of the etiological agent of a complicated case of necrotizing fasciitis. Orthopedics 2005;28(3):327-328.




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