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Necrotizing fasciitis due to group A streptococci: a clinicopathological study of six patients
1Department of Internal Medicine, Saga Medical School, Japan.
Abstract:
The recent worldwide appearance of invasive group A streptococcal infections has again called attention to streptococcal necrotizing fasciitis. However, in contrast to polymicrobial necrotizing fasciitis, the streptococcal form has not been thoroughly studied clinically. The objective of the study was to elucidate the characteristic features of recent cases of necrotizing fasciitis due exclusively to pure group A streptococci. We encountered six patients with these criteria at a single hospital in Japan during the last 12 years. A clinicopathological analysis was performed in these six patients. In three patients, the clinical signs and the laboratory findings were characteristic of systemic toxicity. In this group, the clinical presentation was a pale or blue-gray lesion associated with severe intravascular coagulation histologically involving the vessels in the lesion. In the three patients without signs of systemic toxicity, a swollen, erythematous skin lesion persisted for as long as one week; histologically, the intravascular coagulation within these lesions was mild. In clinicopathological terms, the entity in these six patients could be clearly classified as either fulminant or subacute. In the fulminant type, immediate surgical debridement of necrotic fascia is required; in the subacute type, incision and drainage alone are sufficient.
Insights
This study differentiates two forms of group A streptococcal necrotizing fasciitis: fulminant and subacute. Early surgical debridement is crucial for the fulminant type, while incision and drainage suffice for the subacute form.
Area of Science:
- Infectious Diseases
- Pathology
- Dermatology
Background:
- Recent global rise in invasive group A streptococcal infections highlights the need to understand streptococcal necrotizing fasciitis.
- Clinical data on pure group A streptococcal necrotizing fasciitis remain limited compared to polymicrobial forms.
Purpose of the Study:
- To identify and characterize the clinical and pathological features of necrotizing fasciitis caused solely by group A Streptococcus.
- To differentiate between distinct clinical presentations and guide treatment strategies.
Main Methods:
- Clinicopathological analysis of six patients with pure group A streptococcal necrotizing fasciitis over 12 years.
- Evaluation of clinical signs, laboratory findings, and histological examination of lesions.
Main Results:
- Two distinct clinicopathological types were identified: fulminant and subacute.
- Fulminant type (3 patients) presented with systemic toxicity, pale/blue-gray lesions, and severe intravascular coagulation.
- Subacute type (3 patients) showed erythematous skin lesions without systemic toxicity and mild intravascular coagulation.
Conclusions:
- Group A streptococcal necrotizing fasciitis can be classified as either fulminant or subacute based on clinicopathological findings.
- Fulminant cases necessitate immediate surgical debridement of necrotic fascia.
- Subacute cases can be managed with incision and drainage alone.