Ayala-Gaytán JJ, Martínez-Vela Á, Náńez-Terreros H, Guajardo-Lara CE, Valdovinos-Chávez SB

Language: Spanish
References: 17
Page: 458-461
PDF size: 168.61 Kb.

ABSTRACT

Background: Necrotizing fasciitis (NF), myositis, and streptococcal toxic shock syndrome (STSS) associated with group G β-hemolytic streptococcus (GGS) occasionally coincide.
Clinical case: We describe a case of GGS simultaneously occurring with NF, myositis, arthritis, and STSS in an 83-year-old woman with sequelae of cerebrovascular disease, hospitalized after two days of fever and with a painful swollen left foot. She was hypotensive, her foot had purplish discoloration, which showed blisters spreading to the lower third of the leg, and no crepitus was present. Fluid, vasopressive support, tigecyclin, and clindamycin were used. Debrided tissue and fl uid aspirated from the knee joint revealed Gram-positive cocci. The patient developed renal and respiratory failure on the fi fth day, requiring support. She underwent amputation above the knee of the left leg, after which her condition improved. She was discharged one month later.
Conclusion: GGS can cause life-threatening infections such as NF, myositis, and/or STSS. GGS usually affl icts aging patients with comorbid states, and occasionally healthy subjects.

REFERENCES

1. Stevens DL. The fl esh-eating bacterium: what´s next. J Infect Dis. 1999;179(suppl 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;14:202-9.

3. Morgan MS. Diagnosis and management of necrotising fasciitis: a multiparametric approach. J Hosp Infect. 2010; 75:249-57.

4. Sharma M, Khatib R, Fakih M. Clinical Characteristics of necrotizing fasciitis caused by group G Streptococcus: Case report and review of the literature. Scand J Infect Dis. 2002; 34:468-71.

5. Sylvetsky N, Raveh D, Schlesinger Y, Rudensky B, Yinnon AM. Bacteremia due to Beta-hemolytic Streptococcus Group G: increasing incidence and clinical characteristics of patients. Am J Med. 2002;112:622-6.

6. Cohen-Poradosu R, Jaffe J, Lavi D, Grisariu-Greenzaid S, Nir-Paz R, Valinsky L, et al. Group G Sreptococcocal bacteremia in Jerusalem. Emerg Infect Dis. 2004;10:1455-60.

7. Gillespie SH. Microbes sans frontičres. Lancet. 2002;359:93-5.

8. Humar D, Datta V, Bast DJ, Beall B, De Azavedo JCS, Nizet V. Streptolysin S and necrotising infections produced by group G Streptococcus. Lancet. 2002; 359:124-9.

9. Broyles LN, Van Beneden C, Beall B, Facklam R, Shewmaker PL, Malpiedi P, et al. Population-based study of invasive disease due to β-hemolytic Streptococci of groups other than A and B. Clin Infect Dis. 2009;48:706-12.

10. Lopardo HA, Vidal P, Sparo M, Jeric P, Centron D, Facklam R, et.al. Six-Month multicenter study of invasive infections due to Streptococcus pyogenes and Streptococcus dysgalactiae subsp. equisimilis in Argentina. J Clin Microbiol. 2005;43:802-7.

11. Gaunt N, Rogers K, Seal D, Denham M, Lewis J. Necrotising fasciitis due to group C and G haemolytic streptococcus after chiropody. Lancet 1984;1:516.

12. Barker FG, Leppard BJ, Seal DV. Streptococcal necrotising fasciitis: comparison between histological and clinical features. J Clin Pathol. 1987 March; 40(3):335-41.

13. Jarrett P, Rademaker M, Duffi ll M. The clinical spectrum of necrotising fasciitis. A review of 15 cases. Aust N Z J Med. 1997;27(1):29-34.

14. Wagner JG, Schlievert PM, Assimacopoulos AP, Stoehr JA, Carson PJ, Komadina K. Acute Group G streptococcal myositis associated with streptococcal toxic shock syndrome. Case report and review. Clin Infect Dis. 1996;23:1159-61.

15. Hirose Y, Yagi K, Honda H, Shibuya H, Okazaki E. Toxic shock-like syndrome caused by non-Group A β-hemolytic streptococci. Arch Intern Med. 1997; 157:1891-4.

16. Kugi M, Tojo H, Haraga I, Takata T, Handa K, Tanaka K. Toxic shock-like syndrome cause by group G Streptococcus. J Infect. 1998;37:308-9.

17. Kittang BR, Langeland N, Skrede S, Mylvaganam H. Two unusual cases of severe soft tissue infections caused by Streptococcus dysgalactiae subsp. equisimilis. J Clin Microbiol. 2010;48:1484-7.