Necrotizing fasciitis and meningitis due to Streptococcus pneumoniae serotype 9 N: a case report

Abstract

Background Necrotizing fasciitis is a deep infection of the fascia and subcutaneous tissue with a high mortality rate. Meningitis is an infection of the membranes surrounding the brain with a likewise high mortality rate. Streptococcus pneumoniae is the most frequent cause of bacterial meningitis and it is an extremely rare cause of necrotizing fasciitis. Different subcapsular serotypes of S. pneumoniae are known to have diverse virulence. The serotype 9 N is associated with a high risk of death. Case presentation We report a case of a previously healthy 68-year-old female who presented at our clinic with complaints of pain in her left calf since having experienced a very painful leg cramp 3 weeks prior. Within a few hours after admission, she developed fever, neck stiffness and an altered mental state. Concurrently, the pain in her leg worsened. Upon further examination it was found that she suffered from both meningitis and necrotizing fasciitis due to S. pneumoniae , serotype 9 N. The patient survived and avoided leg amputation. Conclusions The patient suffered from two very lethal infections simultaneously. Both of them were caused by S. pneumoniae . We believe that her favorable outcome was, a result of prompt surgical intervention and appropriate antibiotic treatment. Our case underlines the importance of continuous reevaluation of the symptoms and clinical findings in patients with unclear causes of severe illness, especially if the patient’s condition changes.

Evidence for continuity of interstitial spaces across tissue and organ boundaries in humans

“…Interstitial spaces across the human body could act as pathways for both commensal micro-organisms of the human microbiome and various pathogens. Direct continuity across tissue planes may explain necrotizing fasciitis, a fulminant form of soft tissue infection resulting from virulent bacterial strains that gain access to the interstitial spaces and cause widespread necrosis of subcutaneous and perimuscular fascia and even cross the blood:brain barrier to cause meningitis 31 . Continuity across the layers of the intestine and through the mesenteric and portal vein adventitia may provide a direct route for the translocation of gut bacteria to the liver (gut–liver axis) 32 , 33 .…”

Interstitial spaces are continuous across tissue and organ boundaries in humans

“…Direct continuity across tissue planes may explain necrotizing fasciitis, a fulminant form of soft tissue infection resulting from virulent bacterial strains that gain access to the interstitial spaces and cause widespread necrosis of subcutaneous and perimuscular fascia and even cross the blood:brain barrier to cause meningitis. 27 Continuity across the layers of the intestine and through the mesenteric and portal vein adventitia may provide a direct route for the translocation of gut bacteria to the liver ("gut-liver axis"). 28,29 The existence of these pathways, in parallel with the mesenteric lymphatic and portal venous systems, may play a significant role in gut microbiota signaling not only in chronic liver disease and cirrhosis, but also in the context of autoimmune disorders, both liver-specific (autoimmune hepatitis) and systemic.…”

Skin and soft tissue infection caused by Streptococcus pneumoniae: report of 15 cases

“…Nuestro paciente presentó una evolución clínica favorable tras desbridamiento quirúrgico precoz y tratamiento antibiótico prolongado. El abordaje inmediato resulta vital para conseguir una evolución clínica satisfactoria [18]. Respecto al estudio de sensibilidad de las cepas de S. pneumoniae, el porcentaje de sensibilidad a penicilina fue del 57,1%, siendo mayor que lo publicado en otras series [4].…”