[Flesh-eating bacteria infection of an immunocompromised patient].
After years of steadily declining morbidity and mortality due to group A streptococcal infections, a resurgence of severe, invasive disease has been ongoing since 1980, leading to the recognition of streptococcal shock syndrome (STSS), necrotizing fasciitis, the most severe form of invasive infection. The patients suffer from rapid local deep soft tissue destruction, severe septic shock and multi organ failure. The increased incidence of these infections has been accompanied by remarkable vigor in virulence and severity of the disease. The reason for this impressive change in the epidemiology and clinical manifestation of group A streptococcal infections remains unknown. The possible etiological factor is changing in virulence factor or the lack of protective immunity of the population (immunocompromise) against the invasive strains. We describe a severe necrotizing fasciitis of a 41-year-old previously immunocompromised woman. The patient developed severe septic shock, multi organ failure and perineal and lower abdominal skin, fat and fascia necrosis due to mixed GAS (aerob, anaerob) infection of the perineum and the Bartholini glands. After an aggressive surgical debridement, antibiotic and supportive therapy the generalised and local infection was treated.
Slavei
K
K
Semmelweis Egyetem Aneszteziológiai és Intenzív Terápiás Klinika, 1125 Budapest, Kútvölgyi út 4. Krisztinaslavei@hotmail.com
Hauser
B
B
Pénzes
I
I
Ondrejka
P
P
Faller
J
J
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D001172:Arthritis, Rheumatoid / Q000188:drug therapy; D001472:Bartholin's Glands / Q000382:microbiology; D003646:Debridement; D004322:Drainage; D019115:Fasciitis, Necrotizing / Q000382:microbiology* / Q000628:therapy; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008775:Methylprednisolone / Q000009:adverse effects; D010502:Perineum / Q000382:microbiology* / Q000601:surgery; D012772:Shock, Septic / Q000382:microbiology* / Q000628:therapy; D013290:Streptococcal Infections / Q000382:microbiology* / Q000628:therapy; D013297:Streptococcus pyogenes / Q000302:isolation & purification; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone