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Monomicrobial necrotizing fasciitis complicating pregnancy and puerperium
C R McHenry1, T Azar, A J Ramahi
1Department of Surgery, Case Western Reserve University School of Medicine, MetroHealth Medical Center, Cleveland, Ohio, USA.
Background:
Necrotizing fasciitis is an uncommon, rapidly progressive, life-threatening infection involving the subcutaneous tissue and fascia. Usually, it is a synergistic polymicrobic infection that occurs in patients with coexisting factors predisposing them to bacterial inoculation and the spread of infection.
Cases:
We report a monomicrobial variant of necrotizing fasciitis affecting three otherwise healthy pregnant or postpartum women. The necrotizing fasciitis involved either the lower extremity or the abdominal wall. The causative bacteria were Streptococcus pyogenes (two cases) and Staphylococcus aureus (one). All patients presented with an acute fulminant infection, including one woman who died from overwhelming sepsis.
Conclusion:
These cases raise a question about the possible role of increased bacterial virulence and the immunologic changes of pregnancy as potential predisposing factors in the development of necrotizing fasciitis.
Insights
Necrotizing fasciitis, a severe infection, can rarely be caused by a single bacterium (monomicrobial) in healthy pregnant or postpartum women. This highlights potential roles of bacterial virulence and pregnancy-related immune changes.
Area of Science:
- Infectious Diseases
- Obstetrics & Gynecology
Background:
- Necrotizing fasciitis is a rare, aggressive, and life-threatening infection of subcutaneous tissue and fascia.
- Typically, it involves multiple bacteria (polymicrobial) and occurs in immunocompromised individuals.
Observation:
- This study details three cases of monomicrobial necrotizing fasciitis in healthy pregnant or postpartum women.
- Infections affected the lower extremity or abdominal wall.
- Causative agents included Streptococcus pyogenes (2 cases) and Staphylococcus aureus (1 case).
Findings:
- All patients experienced acute, severe infections.
- One patient succumbed to overwhelming sepsis.
- The cases suggest a potential link between increased bacterial virulence and pregnancy-related immunologic alterations.
Implications:
- These findings prompt further investigation into the pathogenesis of necrotizing fasciitis in pregnancy.
- Highlights the need for vigilance in diagnosing and managing severe infections in this population.
- Suggests pregnancy may alter susceptibility to specific bacterial infections.