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[Subcutaneous emphysema of unusual extent]

S Besier1, T M Bingold, F Walcher

  • 1Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Klinikum der Johann Wolfgang Goethe-Universität, 60596, Frankfurt am Main. s.besier@em.uni-frankfurt.de

Der Chirurg; Zeitschrift Fur Alle Gebiete Der Operativen Medizen
|April 14, 2007
PubMed

Insights

Streptococcus agalactiae, a cause of neonatal meningitis, can lead to severe invasive disease like necrotizing fasciitis and toxic shock syndrome in adults. Early intervention is crucial for patient outcomes.

Area of Science:

  • Infectious Diseases
  • Clinical Microbiology
  • Critical Care Medicine

Background:

  • Streptococcus agalactiae (Group B Streptococcus) is a primary cause of meningitis and septicemia in neonates.
  • Invasive infections by S. agalactiae are increasingly recognized in nonpregnant adults, particularly those with chronic conditions.
  • Risk factors include chronic diseases and immunodeficiency, predisposing individuals to Group B Streptococcal disease.

Observation:

  • This case report details a severe necrotizing fasciitis (NF) with streptococcal toxic shock-like syndrome (STSS).
  • The patient was a 76-year-old diabetic with subcutaneous emphysema.
  • The causative agent was identified as S. agalactiae, serotype V.

Findings:

  • The patient experienced a fulminant course of necrotizing fasciitis and streptococcal toxic shock-like syndrome.
  • S. agalactiae serotype V was identified as the pathogen responsible for the invasive infection.
  • Subcutaneous emphysema was noted in the context of this severe invasive S. agalactiae infection.

Implications:

  • Clinicians must maintain a high index of suspicion for invasive S. agalactiae infections in adults, especially those with risk factors like diabetes and subcutaneous emphysema.
  • Prompt diagnosis and management, including early surgical intervention, antimicrobial therapy, and intensive care, are critical for improving outcomes in patients with NF and/or STSS.
  • This case highlights the potential for S. agalactiae to cause life-threatening infections in the elderly population.

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