Autopsy and Case Reports
https://www.autopsyandcasereports.org/article/doi/10.4322/acr.2023.467
Autopsy and Case Reports
Clinical Case Report

Necrotizing fasciitis and fatal septic shock associated with Streptococcus constellatus

Fareed Rajack; Shawn Medford; Tammey Naab

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Abstract

Streptococcus constellatus is usually a benign, commensal bacteria but has increased incidence in blood cultures and abscesses. This pathogenic involvement is most prevalent in individuals with underlying medical conditions, such as solid tumors and type 2 diabetes mellitus, as well as in cases of community-acquired infections. We report a 43-year-old male with a right medial thigh ulcer and necrotic scrotal skin. The wound culture from surgical debridement grew Streptococcus constellatus, and histology was consistent with stage III necrotizing fasciitis. Regardless of etiology, the mortality rate of patients with necrotizing fasciitis is greatly decreased with early intervention and thorough surgical debridement.

Keywords

Bacteremia, Debridement, Diabetic Ketoacidosis, Skin Ulcer, Streptococcus anginosus

References

1 Tymon-Rosario J, Atrio JM, Yoon HA, Erlichman D, Lerner V. Streptococcus constellatus peritonitis and subsequent septic shock following intrauterine device removal. Case Rep Obstet Gynecol. 2019;2019:6491617. http://dx.doi.org/10.1155/2019/6491617. PMid:31467746.

2 Jiang S, Li M, Fu T, Shan F, Jiang L, Shao Z. Clinical characteristics of infections caused by Streptococcus anginosus group. Sci Rep. 2020;10(1):9032. http://dx.doi.org/10.1038/s41598-020-65977-z. PMid:32493976.

3 Asam D, Spellerberg B. Molecular pathogenicity of Streptococcus anginosus. Mol Oral Microbiol. 2014;29(4):145-55. http://dx.doi.org/10.1111/omi.12056. PMid:24848553.

4 Reißmann S, Friedrichs C, Rajkumari R, et al. Contribution of Streptococcus anginosus to infections caused by groups C and G streptococci, southern India. Emerg Infect Dis. 2010;16(4):656-63. http://dx.doi.org/10.3201/eid1604.090448. PMid:20350380.

5 Ng KW, Mukhopadhyay A. Streptococcus constellatus bacteremia causing septic shock following tooth extraction: a case report. Cases J. 2009;2(1):6493. http://dx.doi.org/10.1186/1757-1626-2-6493. PMid:19829816.

6 Bert F, Bariou-Lancelin M, Lambert-Zechovsky N. Clinical significance of bacteremia involving the “Streptococcus milleri” group: 51 cases and review. Clin Infect Dis. 1998;27(2):385-7. http://dx.doi.org/10.1086/514658. PMid:9709892.

7 Jacobs JA, Pietersen HG, Stobberingh EE, Soeters PB. Bacteremia involving the “Streptococcus milleri” group: analysis of 19 cases. Clin Infect Dis. 1994;19(4):704-13. http://dx.doi.org/10.1093/clinids/19.4.704. PMid:7803636.

8 Issa E, Salloum T, Tokajian S. From Normal flora to brain abscesses: a review of Streptococcus intermedius. Front Microbiol. 2020;11:826. http://dx.doi.org/10.3389/fmicb.2020.00826. PMid:32457718.

9 Whiley RA, Beighton D, Winstanley TG, Fraser HY, Hardie JM. Streptococcus intermedius, Streptococcus constellatus, and Streptococcus anginosus (the Streptococcus milleri group): association with different body sites and clinical infections. J Clin Microbiol. 1992;30(1):243-4. http://dx.doi.org/10.1128/jcm.30.1.243-244.1992. PMid:1734062.

10 Kanamori S, Kusano N, Shinzato T, Saito A. The role of the capsule of the Streptococcus milleri group in its pathogenicity. J Infect Chemother. 2004;10(2):105-9. http://dx.doi.org/10.1007/s10156-004-0305-7. PMid:15160304.

11 Budziaszek J, Pilarczyk-Zurek M, Sitkiewicz I, Koziel J. The corruption of innate immunity by Streptococcus anginosus group. J Immunol. 2021;206( 1_Supplement):16.21. http://dx.doi.org/10.4049/jimmunol.206.Supp.16.21.

12 Olson AB, Kent H, Sibley CD, et al. Phylogenetic relationship and virulence inference of Streptococcus anginosus Group: curated annotation and whole-genome comparative analysis support distinct species designation. BMC Genomics. 2013;14(1):895. http://dx.doi.org/10.1186/1471-2164-14-895. PMid:24341328.

13 Chew TA, Smith JM. Detection of diacetyl (caramel odor) in presumptive identification of the “Streptococcus milleri” group. J Clin Microbiol. 1992;30(11):3028-9. http://dx.doi.org/10.1128/jcm.30.11.3028-3029.1992. PMid:1452678.

14 Davoudian P, Flint NJ. Necrotizing fasciitis. Contin Educ Anaesth Crit Care Pain. 2012;12(5):245-50. http://dx.doi.org/10.1093/bjaceaccp/mks033.

15 Freischlag JA, Ajalat G, Busuttill RW. Treatment of necrotizing soft tissue infections: the need for a new approach. Am J Surg. 1985;149(6):751-5. http://dx.doi.org/10.1016/S0002-9610(85)80180-X. PMid:4014552.

16 Sarani B, Strong M, Pascual J, Schwab CW. Necrotizing fasciitis: current concepts and review of the literature. J Am Coll Surg. 2009;208(2):279-88. http://dx.doi.org/10.1016/j.jamcollsurg.2008.10.032. PMid:19228540.

17 Thulin P, Johansson L, Low DE, et al. Viable group A Streptococci in macrophages during acute soft tissue infection. PLoS Med. 2006;3(3):e53. http://dx.doi.org/10.1371/journal.pmed.0030053. PMid:16401174.

18 Reid SD, Chaussee MS, Doern CD, et al. Inactivation of the group A Streptococcus regulator srv results in chromosome wide reduction of transcript levels, and changes in extracellular levels of Sic and SpeB. FEMS Immunol Med Microbiol. 2006;48(2):283-92. http://dx.doi.org/10.1111/j.1574-695X.2006.00150.x. PMid:16999824.

19 Vayvada H, Demirdover C, Menderes A, Karaca C. Necrotizing fasciitis: diagnosis treatment and review of the literature. Ulus Travma Acil Cerrahi Derg. 2012;18(6):507-13. http://dx.doi.org/10.5505/tjtes.2012.97523. PMid:23588910.

20 Swain RA, Hatcher JC, Azadian BS, Soni N, De Souza B. A five-year review of necrotising fasciitis in a tertiary referral unit. Ann R Coll Surg Engl. 2013;95(1):57-60. http://dx.doi.org/10.1308/003588413X13511609956093. PMid:23317730.

21 Anaya DA, McMahon K, Nathens AB, Sullivan SR, Foy H, Bulger E. Predictors of mortality and limb loss in necrotizing soft tissue infections. Arch Surg. 2005;140(2):151-7. http://dx.doi.org/10.1001/archsurg.140.2.151. PMid:15723996.

22 Long B. Emergent management of necrotizing soft-tissue infections [Internet]. Medscape; 2019 [cited 2023 Sept 26]. Available from: https://emedicine.medscape.com/article/784690-overview?form=fpf

23 Schulz S. Necrotizing fasciitis: background, pathophysiology, etiology [Internet]. Medscape; 2019 [cited 2023 Sept 26]. Available from: https://emedicine.medscape.com/article/2051157-overview

24 Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535-41. http://dx.doi.org/10.1097/01.CCM.0000129486.35458.7D. PMid:15241098.

25 Sandner A, Moritz S, Unverzagt S, Plontke SK, Metz D. Cervical necrotizing fasciitis: the value of the laboratory risk indicator for necrotizing fasciitis score as an indicative parameter. J Oral Maxillofac Surg. 2015;73(12):2319-33. http://dx.doi.org/10.1016/j.joms.2015.05.035. PMid:26079692.

26 Wronski M, Slodkowski M, Cebulski W, Karkocha D, Krasnodebski IW. Necrotizing fasciitis: early sonographic diagnosis. J Clin Ultrasound. 2011;39(4):236-9. http://dx.doi.org/10.1002/jcu.20766. PMid:21480291.

27 Ramirez-Schrempp D, Dorfman DH, Baker WE, Liteplo AS. Ultrasound soft-tissue applications in the pediatric emergency department: to drain or not to drain? Pediatr Emerg Care. 2009;25(1):44-8. http://dx.doi.org/10.1097/PEC.0b013e318191d963. PMid:19148015.

28 Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51(8):344-62. http://dx.doi.org/10.1067/j.cpsurg.2014.06.001. PMid:25069713.

29 Bakleh M, Wold LE, Mandrekar JN, Harmsen WS, Dimashkieh HH, Baddour LM. Correlation of histopathologic findings with clinical outcome in necrotizing fasciitis. Clin Infect Dis. 2005;40(3):410-4. http://dx.doi.org/10.1086/427286. PMid:15668865.

30 Wang YS, Wong CH, Tay YK. Staging of necrotizing fasciitis based on the evolving cutaneous features. Int J Dermatol. 2007;46(10):1036-41. http://dx.doi.org/10.1111/j.1365-4632.2007.03201.x. PMid:17910710.

31 McHenry CR, Piotrowski JJ, Petrinic D, Malangoni MA. Determinants of mortality for necrotizing soft-tissue infections. Ann Surg. 1995;221(5):558-65. http://dx.doi.org/10.1097/00000658-199505000-00013. PMid:7748037.

32 Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J Bone Joint Surg Am. 2003;85(8):1454-60. http://dx.doi.org/10.2106/00004623-200308000-00005. PMid:12925624.

33 Mok MY, Wong SY, Chan TM, Tang WM, Wong WS, Lau CS. Necrotizing fasciitis in rheumatic diseases. Lupus. 2006;15(6):380-3. http://dx.doi.org/10.1191/0961203306lu2314cr. PMid:16830885.

34 Bilton BD, Zibari GB, McMillan RW, Aultman DF, Dunn G, McDonald JC. Aggressive surgical management of necrotizing fasciitis serves to decrease mortality: a retrospective study. Am Surg. 1998;64(5):397-400. PMid:9585771.

35 Hammond KL. Practical issues in the surgical care of the obese patient. Ochsner J. 2013;13(2):224-7. PMid:23789009.

36 Royal Australasian College of Surgeons. Lessons from the Audit. Brisbane: RACS; 2014. (vol. 13).

37 Pierpont YN, Dinh TP, Salas RE, et al. Obesity and surgical wound healing: a current review. ISRN Obes. 2014;2014:638936. http://dx.doi.org/10.1155/2014/638936. PMid:24701367.
 


Submitted date:
09/26/2023

Accepted date:
12/14/2023

Publication date:
01/08/2024

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