title: Monomicrobial necrotizing fasciitis complicating pregnancy and puerperium.
abstract: BACKGROUND
  Necrotizing fasciitis is an uncommon, rapidly progressive, life-threatening infection involving the subcutaneous tissue and fascia. Usually, it is a synergistic polymicrobic infection that occurs in patients with coexisting factors predisposing them to bacterial inoculation and the spread of infection.
  
  
  METHODS
  We report a monomicrobial variant of necrotizing fasciitis affecting three otherwise healthy pregnant or postpartum women. The necrotizing fasciitis involved either the lower extremity or the abdominal wall. The causative bacteria were Streptococcus pyogenes (two cases) and Staphylococcus aureus (one). All patients presented with an acute fulminant infection, including one woman who died from overwhelming sepsis.
  
  
  CONCLUSIONS
  These cases raise a question about the possible role of increased bacterial virulence and the immunologic changes of pregnancy as potential predisposing factors in the development of necrotizing fasciitis.
authors.affiliation: Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA.
authors.forename: C R
authors.initials: CR
authors.lastname: McHenry
authors.forename: T
authors.initials: T
authors.lastname: Azar
authors.forename: A J
authors.initials: AJ
authors.lastname: Ramahi
authors.forename: P L
authors.initials: PL
authors.lastname: Collins
mesh_terms: D000328:Adult; D015984:Causality; D019115:Fasciitis, Necrotizing / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D008423:Maternal Age; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000382:microbiology*; D018566:Pregnancy, High-Risk; D011645:Puerperal Infection / Q000453:epidemiology / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000472:pathogenicity; D013297:Streptococcus pyogenes / Q000472:pathogenicity*; D014774:Virulence