title: Unusual "flesh-eating" strains of Escherichia coli.
abstract: Monomicrobial necrotizing fasciitis (type II) is typically caused by group A streptococcus alone or in combination with Staphylococcus aureus. Escherichia coli has been isolated from polymicrobial or Fournier's gangrene but has rarely been reported in monomicrobial necrotizing fasciitis. We describe the clinical characteristics and outcomes of seven cases of monomicrobial E. coli necrotizing fasciitis and/or severe soft tissue infection diagnosed at a single institution during an 18-month period. Four isolates from three patients and two isolates from two patients with type I polymicrobial severe soft tissue infection (controls) were assayed by the randomly amplified polymorphic DNA (RAPD) analysis for fingerprinting and PCR amplification of primers in order to detect cytotoxic necrotizing factor 1 and 2 (cnf1 and cnf2) genes. All patients had some type of immune suppression. The limb was the most commonly involved organ. In all cases, E. coli was isolated as a monomicrobial pathogen from blood, fascia, or both. All patients died during hospitalization, three within the first 48 h. The RAPD amplification assay showed a high degree of genetic diversity among the "flesh-eating" strains and controls. The cnf1 toxin gene was identified in two out of three cases, but not in the controls. cnf2 was not detected in any of the patients. E. coli may be responsible for life-threatening necrotizing fasciitis. Further research is needed to reveal relevant risk factors, reservoirs, and modes of transmission of cnf1 E. coli.
authors.affiliation: Unit of Infectious Diseases, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
authors.forename: Hila
authors.initials: H
authors.lastname: Shaked
authors.forename: Zmira
authors.initials: Z
authors.lastname: Samra
authors.forename: Michal
authors.initials: M
authors.lastname: Paul
authors.forename: Liora
authors.initials: L
authors.lastname: Madar-Shapiro
authors.forename: Jonathan
authors.initials: J
authors.lastname: Cohen
authors.forename: Silvio
authors.initials: S
authors.lastname: Pitlik
authors.forename: Jihad
authors.initials: J
authors.lastname: Bishara
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001427:Bacterial Toxins / Q000235:genetics; D016172:DNA Fingerprinting; D004926:Escherichia coli / Q000145:classification / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D004927:Escherichia coli Infections / Q000382:microbiology* / Q000401:mortality / Q000473:pathology*; D029968:Escherichia coli Proteins / Q000235:genetics; D019115:Fasciitis, Necrotizing / Q000382:microbiology* / Q000401:mortality / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019105:Random Amplified Polymorphic DNA Technique; D013297:Streptococcus pyogenes / Q000145:classification / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity
chemical_list: D001427:Bacterial Toxins; D029968:Escherichia coli Proteins; C086995:cytotoxic necrotizing factor type 2; C060296:cytotoxic necrotizing factor type 1