Molecular diagnosis of necrotizing fasciitis by 16S rRNA gene sequencing and superantigen gene detection.
We report the use of molecular techniques in the diagnosis of a case of culture-negative necrotizing fasciitis occurring in a 32-year-old female with no significant past medical history and who died within 36 hours of admission. Paraffin-embedded tissue sections from the popliteal fossa region obtained at autopsy showed hemorrhage, necrosis, and mild inflammation by hematoxylin and eosin staining. Tissue gram stain showed numerous gram-positive organisms arranged in clusters. The sequences of the first 500 bp of bacterial 16S rRNA gene amplified from the lesion were identical to a Lancefield group A beta-hemolytic Streptococcus pyogenes. Streptococcal pyrogenic exotoxin A and B superantigen genes were detected and an emm type 1 was determined by polymerase chain reaction and sequencing from the lesion. This confirmed the etiology of the patient's rapid deterioration with multisystem organ failure.
Muldrew
Kenneth L
KL
Molecular Infectious Disease Laboratory, Vanderbilt University Hospital, 4605 TVC, Nashville, TN 37232-5310, USA.
Simpson
Jean F
JF
Stratton
Charles W
CW
Tang
Yi-Wei
YW
D000328:Adult; D005205:Fascia / Q000473:pathology; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000235:genetics*; D005260:Female; D006801:Humans; D012336:RNA, Ribosomal, 16S / Q000235:genetics*; D017422:Sequence Analysis, DNA; D018089:Superantigens / Q000235:genetics*
D012336:RNA, Ribosomal, 16S; D018089:Superantigens