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[Systemic infection due to group A Streptococcus pyogenes]
Insights
Group A Streptococcus pyogenes caused severe necrotizing fasciitis in a woman, leading to abscesses and systemic complications. Prompt surgical intervention and antibiotics successfully treated the infection, resulting in full recovery.
Area of Science:
- Infectious Diseases
- Dermatology
- Rheumatology
Background:
- Necrotizing fasciitis is a severe bacterial infection that can lead to rapid tissue destruction.
- Group A Streptococcus pyogenes (GAS) is a common cause of various infections, including skin and soft tissue infections.
Observation:
- A 47-year-old woman presented with oedematous swelling, joint pain, and fever, initially suspected as rheumatic disease.
- Swollen areas progressed to abscesses requiring surgical incision and drainage.
- Gallium scintigraphy identified a significant abscess over the left buttock.
Findings:
- White blood cell count was elevated with a left shift, and blood sedimentation rate was high, indicating significant inflammation.
- Histological examination of biopsies showed nonspecific inflammation.
- Blood cultures confirmed the presence of Group A Streptococcus pyogenes.
Implications:
- This case highlights the increasing incidence of GAS-associated necrotizing fasciitis and its potential for severe systemic complications.
- Early diagnosis, surgical debridement, and appropriate antibiotic therapy are crucial for successful management.
- Increased awareness among clinicians is necessary for timely recognition and treatment of this aggressive infection.
Abstract:
A 47-year-old woman developed oedematous swelling of the skin over the left hip and leg, with joint pains and reddening over joints of the hands and left ankle. 2 months before her son had had scarlet fever, following which the patient had two episodes of fever. Shortly before hospitalization she was treated with a glucocorticoid because a rheumatic disease had been suspected. On admission the blood sedimentation rate was 58/90, the white cell count was 15.100/microliters with left shift in the differential count. The swellings in arms and legs became abscesses which were incised. An abscess over the left buttock, diagnosed by 67-gallium whole-body scintigraphy, was also treated surgically. On the day of admission penicillin (10 mill. IU three times daily intravenously) and, from the 4th day onwards, gentamicin (80 mg three times daily intravenously) were administered. Histological examination of fascia and muscle biopsies revealed nonspecific inflammation without signs of malignancy, white blood culture grew group A Streptococcus pyogenes. 20 days after the surgical intervention the patient was discharged in full health. Necrotizing fasciitis caused by Streptococcus pyogenes has become more frequent in the last few years and has often been accompanied by severe systemic complications.