Related Experiment Video
Updated: Jun 2, 2025
Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus MRSA
Published on: February 9, 2011
Streptococcus pyogenes M1UK Variant-Associated Sartorius Muscle Necrotizing Soft Tissue Infection: A Case Report and
Kyoko Baba1,2, Risako Ito2, Yuki Ando2
1Department of Plastic and Aesthetic Surgery, Kitasato University School of Medicine, Sagamihara Kanagawa, JPN.
Abstract:
Necrotizing soft tissue infections (NTSIs) represent a concept of necrotizing infections involving the skin, subcutaneous tissue, fascia, and muscle, and it is a potentially fatal disease. Early exploratory incision is strongly recommended for both the diagnosis and treatment of necrotizing soft tissue infections. Treatment of necrotizing soft tissue infections requires the administration of appropriate antimicrobial agents and adequate surgical debridement. The emergence of M1UK-lineage Streptococcus pyogenes (S. pyogenes) is recently reported in the UK, Canada, the USA, and the Netherlands. We report a Japanese case of sartorius muscle (SM) NTSI caused by M1UK-lineage S. pyogenes. A 34-year-old man developed redness and swelling of his right thigh anterior compartment with fever in October 2024. The closed and deep effusions by active exploratory incision/debridement on hospital days one to three yielded the presence of Gram-positive cocci, although two sets of blood cultures upon admission revealed no bacterial growth; its species identification results indicated S. pyogenes. Clinical and pathological diagnosis was streptococcal SM NTSI (without toxic shock syndrome (TSS)). Negative pressure wound therapy with instillation and dwelling (NPWTi-d) to promote his soft tissue cure was performed along with antimicrobial regimens. The patient recovered and received micrografting (carrier: artificial dermis made from collagen sponge and silicon film, Pelnac Gplus® (Gunze Limited, Osaka, Japan) using the Rigenera® system (Rignera HBW, Candiolo, Italy). Thereafter, he developed bronchitis: the sputum yielded S. pyogenes growth: he recovered uneventfully. Split-thickness skin grafting (STG) was performed. Split-thickness skin grafting was fully engrafted, and the wounds achieved complete healing. The patient could walk by himself. Microbiological genetic analyses using both DNAs from effusion/sputum-origin strains revealed the emm1.0 and speA-speB-smeZ profiles. rofA-gldA-pstB sequencing results indicated M1UK-specific single-nucleotide polymorphisms. The streptococcal inhibitor of the complement-mediated lysis gene allele was the streptococcal inhibitor of the complement-mediated lysis-1.02 allele. Micrografting using the Rigenera® system and STG following NPWTi-d can be beneficial approaches. Clinicians should perform cultures using sterile specimens (deep effusions/tissues) from infection foci through exploratory incision/debridement, along with two sets of blood cultures, when examining patients with/without underlying medical conditions.
Insights
Necrotizing soft tissue infections (NTSIs) caused by M1UK-lineage Streptococcus pyogenes can be treated with surgical debridement, antimicrobials, and advanced wound therapies. Early diagnosis via exploratory incision is crucial for managing this potentially fatal condition.
Area of Science:
- Infectious Diseases
- Microbiology
- Surgery
Background:
- Necrotizing soft tissue infections (NTSIs) are severe, potentially fatal conditions requiring prompt diagnosis and treatment.
- The M1UK-lineage of Streptococcus pyogenes has emerged globally, posing a significant public health concern.
- Early surgical intervention, including exploratory incision and debridement, is critical for managing NTSIs.
Observation:
- A case of sartorius muscle NTSI in Japan caused by M1UK-lineage S. pyogenes in a 34-year-old male is presented.
- Diagnosis was confirmed by Gram-positive cocci in deep effusions, identified as S. pyogenes, despite negative blood cultures.
- The patient developed subsequent bronchitis with S. pyogenes growth, which resolved uneventfully.
Findings:
- Genetic analysis confirmed the M1UK-lineage, including specific emm1.0, speA-speB-smeZ profiles, and M1UK-specific single-nucleotide polymorphisms.
- Treatment involved antimicrobial regimens, negative pressure wound therapy with instillation and dwelling (NPWTi-d), micrografting (Rigenera® system), and split-thickness skin grafting (STG).
- The patient achieved complete wound healing and functional recovery, demonstrating the efficacy of the multimodal treatment approach.
Implications:
- This case highlights the successful management of a rare sartorius muscle NTSI caused by the emerging M1UK-lineage S. pyogenes.
- The combination of NPWTi-d, micrografting, and STG represents a beneficial therapeutic strategy for severe soft tissue infections.
- Emphasizes the importance of obtaining cultures from deep tissues via exploratory incision for accurate diagnosis of NTSIs.
