Two Unusual Cases of Severe Soft Tissue Infection Caused by Streptococcus dysgalactiae subsp. equisimilis

Abstract

We present two cases of invasive infection caused by Streptococcus dysgalactiae subsp. equisimilis, one that showed rapidly developing necrotizing fasciitis in a previously healthy man and one that showed severe cellulitis and septic shock even though the bacterium possessed a mutated emm gene, predicted to encode a truncated M protein. CASE REPORTPatient 1 was a 48-year-old, previously healthy man admitted to Haukeland University Hospital in Western Norway with a fever and a rapidly spreading erythema of the skin overlying his right knee. The symptoms were preceded by a minor trauma toward the right knee 5 h prior to admission, leading to a disruption of the skin barrier. Blood pressure upon admission was 127/68 mm Hg, pulse rate 90/min, and temperature 39.6°C. Blood cultures were taken, and intravenous treatment with penicillin G at 5 million IU four times a day (q.i.d.) and clindamycin at 900 mg three times a day (t.i.d.) was started. Surgical exploration was performed 2 h later because of rapid deterioration of the patient's condition, and necrotic subcutaneous tissue and fascia of the lateral margin of the patella and the upper part of the calf were excised. Hypotension (blood pressure, 85/45 mm Hg) developed postoperatively, and normal blood pressure was reestablished after 5 to 6 h of intensive intravenous fluid therapy. Neither renal, hepatic, nor respiratory failure developed. The international normalized ratio (INR; normal range, Ͻ1

Invasive infection caused by Streptococcus dysgalactiae subsp. equisimilis: characteristics of strains and clinical features

“…Person-to-person transmission routes of SDSE should be determined in detail by future surveillance. The prevalence of invasive SDSE infection has increased over the years elsewhere in Asia [6,36], in Europe [37][38][39][40][41][42][43], and in America [5,31,44], as well as in Japan. As for age distribution, population-based surveillance carried out by Broyles et al (n = 212) [5] found that most patients with invasive diseases (59.0%) were adults less than 65 years old, while the majority in our study (74.0%) were at least 65 years old [3].…”

Differences in Clinical Features and Outcomes between Group A- and Group G Streptococcus-Induced Cellulitis

“…Isolates identified as GAS or GGS were further speciated based on the results of biologic tests, which were performed with use of rapid ID-32 strep (Sysmex-bioMérieux). Since SDSE may posses Lancefield A, C or G and these substantial overlaps exist between species, general phenotypic characteristics were not adequate for providing accurate identification [9,10,11]. Streptococcal infection was also confirmed by the increase in anti-streptolysin O (ASO) titers in most cases.…”

Staphylococcal and Streptococcal Superantigen Exotoxins

“…Other beta-hemolytic streptococci, including group B, C, and G strains, also have the ability to cause serious human illnesses, including streptococcal TSS with or without necrotizing fasciitis and myositis (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). Additionally, group B streptococci are well known to cause neonatal sepsis and meningitis, and group C and G strains cause pharyngitis.…”