Necrotizing fasciitis caused by Streptococcus pneumoniae

Abstract

A 69-year-old woman presented with shivering and pain in the lower extremities on 5 April 2006; she was referred to the dermatology division of our hospital on the following day with difficulty in walking. She had been suffering from non-viral, non-alcoholic liver cirrhosis, and was being treated by the Division of Internal Medicine. Physical examination showed edema in the lower extremities and light purpuras on the groin and legs. Low blood pressure had been observed since admission. Necrotizing fasciitis (NF) was suspected on the basis of the skin symptoms, systemic conditions, and magnetic resonance imaging. During surgical debridement under general anesthesia, cardiopulmonary arrest occurred, and the patient died 12 h after admission. NF, in its early stages, exhibits few skin changes. In order to differentiate it from other skin infections, it is necessary to take into account blood pressure, abnormal systemic conditions, and severe pain out of proportion to its minor skin changes. In the present case, Streptococcus pneumoniae was detected by blood culture. Soft tissue infectious diseases caused by S. pneumoniae, especially NF, are very rare. We have reviewed reported cases of NF caused by S. pneumoniae.

Modulation of connexin signaling by bacterial pathogens and their toxins

“…Moreover, this Grampositive bacterium is at this moment the prime cause of invasive bacterial disease in infants and the elderly [149][150][151][152][153][154]. With regard to acute otitis media, S. pneumoniae is one of the top-three isolates found in this pervasive illness in infants and children, next to Haemophilus influenzae and Moraxella catarrhalis [155] with the highest rates in developed and emerging countries [156].…”

Case Report of Necrotizing Fasciitis Associated withStreptococcus pneumoniae

“…Extensive surgical debridement and susceptibility-guided antibiotic treatment as well as aggressive supportive care are usually necessary to treat this devastating disease. High mortality rate of 80% was found in patients without surgical interventions [ 16 ]. By contrast, our patient recovered well on antibiotics and supportive therapy without extensive debridement.…”

Fatal Necrotizing Fasciitis Due toStreptococcus pneumoniae: A Case Report

“…The majority of these pneumococcal necrotizing fasciitis patients had immunocompromising conditions, such as systemic lupus erythematosus (10, 14, 16), diabetes mellitus (4, 5, 17), chronic renal failure (8, 15), chronic liver disease (4, 12), intravenous drug use (13) and cardiovascular disease (4). We also found reports of two patients who had undergone intramuscular injection with nonsteroidal anti-inflammatory drugs (6).…”

“…The five other cases involved the neck, flank and upper extremities (3, 4, 8, 14, 16). S. pneumoniae was isolated from the cultures of blood and site aspirations in 13 cases, while in 3 cases it was found only in the blood (10, 12, 14), and in 3 cases only in the local aspirates (3, 5, 7). …”