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1.
PLoS One ; 15(3): e0229064, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32214338

RESUMO

Streptococcus pyogenes is a strict human pathogen responsible for more than 700 million infections annually worldwide. Strains of serotype M28 S. pyogenes are typically among the five more abundant types causing invasive infections and pharyngitis in adults and children. Type M28 strains also have an unusual propensity to cause puerperal sepsis and neonatal disease. We recently discovered that a one-nucleotide indel in an intergenic homopolymeric tract located between genes Spy1336/R28 and Spy1337 altered virulence in a mouse model of infection. In the present study, we analyzed size variation in this homopolymeric tract and determined the extent of heterogeneity in the number of tandemly-repeated 79-amino acid domains in the coding region of Spy1336/R28 in large samples of strains recovered from humans with invasive infections. Both repeat sequence elements are highly polymorphic in natural populations of M28 strains. Variation in the homopolymeric tract results in (i) changes in transcript levels of Spy1336/R28 and Spy1337 in vitro, (ii) differences in virulence in a mouse model of necrotizing myositis, and (iii) global transcriptome changes as shown by RNAseq analysis of isogenic mutant strains. Variation in the number of tandem repeats in the coding sequence of Spy1336/R28 is responsible for size variation of R28 protein in natural populations. Isogenic mutant strains in which genes encoding R28 or transcriptional regulator Spy1337 are inactivated are significantly less virulent in a nonhuman primate model of necrotizing myositis. Our findings provide impetus for additional studies addressing the role of R28 and Spy1337 variation in pathogen-host interactions.


Assuntos
Proteínas de Bactérias/genética , Fasciite Necrosante/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus pyogenes/genética , Streptococcus pyogenes/isolamento & purificação , Virulência/genética , Animais , Modelos Animais de Doenças , Fasciite Necrosante/patologia , Regulação Bacteriana da Expressão Gênica , Heterogeneidade Genética , Humanos , Camundongos , Polimorfismo Genético , Infecções Estreptocócicas/patologia , Transcriptoma , Fatores de Virulência/genética
3.
Rev. pediatr. electrón ; 16(3): 2-11, oct. 2019. tab
Artigo em Espanhol | LILACS | ID: biblio-1046276

RESUMO

INTRODUCCIÓN: La Infección Necrotizante de tejidos blandos (INTB) tiene una elevada morbimortalidad. El objetivo de este trabajo es describir del manejo perioperatorio de menores de 15 años que cursaron con INTB durante 15 años en un Hospital pediátrico. MATERIAL Y MÉTODOS: serie de pacientes identificados INTB entre 2000 y 2015 en el Hospital Roberto del Río. Se describen variables demográficas, clínicas, vacuna, tratamiento, cirugías, complicaciones, microorganismos, seguimiento, y fallecimientos. RESULTADOS: 22 pacientes, con mediana de 2 años y 9 meses de edad. 50% estaban cursando con una varicela. Dos fallecieron. Ninguno era previamente vacunado contra el virus varicela zoster. La localización fue tronco (14), extremidades (7), cuello (1). Los pacientes conscientes presentaron hiperestesia cutánea. Se realizó aseo quirúrgico con una mediana de 6,8 horas desde el inicio de la hiperestesia y 2 horas desde la sospecha diagnóstica. Los microorganismos fueron: S. pyogenes (38%) y E. coli (31%). Los antibióticos más frecuentes fueron penicilina más clindamicina. La herida se manejó con cierre primario, injertos y/o colgajos. Cinco evolucionaron con secuelas que necesitaron tratamiento. CONCLUSIÓN: Se identificó que la INTB puede presentarse con varicela. Debe sospecharse en lesiones cutáneas e hiperestesia desproporcionada. Resección amplia y precoz son fundamentales para el tratamiento.


INTRODUCTION: Necrotizing soft tissue infection (NSTI) has a high morbidity and mortality. The objective of this study is to describe the perioperative management of children under 15 years of age who have had this condition for 15 years in a pediatric hospital. MATERIAL AND METHODS: cases series of patients identified by Pathological Anatomy with NSTI during 2000 and 2015 at the Dr. Roberto del Río Hospital. Demographic variables, treatment, antecedents of vaccination, surgeries, complications, microorganisms, follow-up, and deaths are described. RESULTS: 22 patients were identified, with a median of 2 years 9 months of age (interquartile range: 13 months to 5 years y 10 months). 50% of the cases were associated to chickenpox. Two died. No patient was previously vaccinated against varicella zoster virus. The location was trunk (14), extremities (7) and neck (1). All conscious patients presented cutaneous hyperesthesia. Surgical debridement was performed with a median of 6.8 hours from the onset of hyperesthesia and 2 hours from diagnostic suspicion. The most frequent microorganisms were: Streptococcus pyogenes (38%) and Escherichia coli (31%). The most frequent antibiotics used were penicillin plus clindamycin. The wound was handled with primary closure, grafts and / or flaps. Five patients evolved with sequelae that needed treatment. CONCLUSION: It was identified that STNI in children is associated with chickenpox. It should be suspected in cutaneous lesions and disproportionate hyperesthesia. Aggressive resection is essential for treatment


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Infecções dos Tecidos Moles/patologia , Infecções dos Tecidos Moles/terapia , Fasciite Necrosante/patologia , Fasciite Necrosante/terapia , Staphylococcus aureus/isolamento & purificação , Streptococcus pyogenes/isolamento & purificação , Infecções dos Tecidos Moles/cirurgia , Infecções dos Tecidos Moles/microbiologia , Fasciite Necrosante/cirurgia , Fasciite Necrosante/microbiologia , Assistência Perioperatória , Desbridamento , Escherichia coli/isolamento & purificação , Antibacterianos/uso terapêutico
4.
Pediatr Emerg Care ; 35(8): e138-e140, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31373950

RESUMO

Necrotizing soft tissue infections are a serious medical emergency that involve necrosis within the soft tissue space including the dermis, subcutaneous tissue, superficial fascia, deep fascia, and muscle. Inciting factors include recent varicella infection, omphalitis, trauma, intramuscular injections, perianal trauma, and surgery. Unlike adult cases, children presenting with necrotizing soft tissue infections are more likely to be immunocompetent and without underlying chronic illnesses. Although rare in children, familiarity with the clinical manifestations of necrotizing soft tissue infections is essential for early diagnosis and surgical debridement, as significant mortality is associated with advanced disease.


Assuntos
Fasciite Necrosante/diagnóstico , Infecções dos Tecidos Moles/etiologia , Streptococcus pyogenes/isolamento & purificação , Antibacterianos/uso terapêutico , Desbridamento , Diagnóstico Precoce , Serviço Hospitalar de Emergência , Fasciite Necrosante/patologia , Fasciite Necrosante/terapia , Feminino , Humanos , Lactente , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/terapia , Resultado do Tratamento
5.
Int Wound J ; 16(5): 1195-1198, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31407501

RESUMO

Necrotising fasciitis, widespread necrosis of the skin, subcutaneous tissue, and superficial fascia, may be caused by many factors, among which underlying malignancy is observed rarely. We report a case with necrotising fasciitis of the lower extremity because of a duodenum to retroperitoneum fistula caused by renal cell carcinoma invasion. A 62-year-old male with newly diagnosed renal cell carcinoma was diagnosed with necrotising fasciitis at the end of 2 days in hospital. One day after debridement surgery, biliary contamination of dressings and tomography demonstrated fistulation from the duodenum to retroperitoneum and then to the right thigh because of renal tumour invasion. The second operation was performed to repair the duodenum. Intravenous antibiotics and hydration were maintained postoperatively. Although there was no surgical complication, the patient died because of respiratory collapse at the 12th day postoperatively. Renal cell carcinoma may invade the duodenum and, with retroperitoneal fistulation, may be the cause of necrotising fasciitis of the thigh. Laparotomy may be needed to control the origin of infection. However, necrotising fasciitis may be fatal in spite of aggressive treatment. The fasciitis should be diagnosed early to initiate timely aggressive treatment, and a possible endogenous source should be kept in mind.


Assuntos
Carcinoma de Células Renais/patologia , Neoplasias Duodenais/secundário , Fasciite Necrosante/patologia , Neoplasias Renais/patologia , Coxa da Perna/cirurgia , Antibacterianos , Carcinoma de Células Renais/terapia , Terapia Combinada , Progressão da Doença , Neoplasias Duodenais/cirurgia , Fasciite Necrosante/etiologia , Fasciite Necrosante/terapia , Evolução Fatal , Humanos , Neoplasias Renais/terapia , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Células Neoplásicas Circulantes/patologia , Medição de Risco , Índice de Gravidade de Doença , Coxa da Perna/fisiopatologia
6.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(7): 689-693, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31302971

RESUMO

Perianal necrotizing fasciitis is a serious soft tissue infectious disease of perianal and perineal regions, where a synergistic action of multiple bacteria (including aerobic bacteria and anaerobic bacteria) results in suppurative necrosis of the skin and soft tissue. The disease progress may rapidly cause systemic sepsis through blood circulation, often with complicating shock and MODS, or death. Any delay in diagnosis and treatment of early acute infections may lead to higher mortality because of lack of standardized treatment. The Clinical Guidelines Committee aims to formulate expert consensus on the treatment of perianal necrotizing fasciitis in terms of etiology and pathology, clinical manifestations, laboratory and imaging study, preoperative preparation, surgical treatment (the application of antibiotics, the timing and key points of debridement, assistant therapy), postoperative wound care, nutritional support, surgical reconstruction and rehabilitation. This consensus is a reference for clinicians based on patient conditions.


Assuntos
Doenças do Ânus/diagnóstico , Doenças do Ânus/terapia , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/terapia , Antibacterianos/uso terapêutico , Doenças do Ânus/patologia , China , Consenso , Fasciite Necrosante/patologia , Humanos , Necrose , Períneo/patologia , Períneo/cirurgia
7.
Forensic Sci Med Pathol ; 15(4): 616-621, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31359306

RESUMO

Even if there are well-known consequences of anabolic androgenic steroid (AAS) abuse, their full pathway of action is still being investigated. In this context, the presented case report aims to discuss and provide evidence of unusual adverse effects linked to immunodeficiency in an AAS abuser. In fact, this kind of chronic complication, even if not usually considered, may lead sudden death. In this case a 31-year-old aesthetic weightlifter, who presented to the emergency department due to an accidental fall that resulted in left thigh trauma. This subsequently developed into left thigh necrotizing myofasciitis in the following few days. Although surgery and hyperbaric therapy were carried out, the man died. An autopsy with complete biological sampling for toxicological studies was performed. This case highlights the close relationship between AAS abuse and immunodeficiency and highlights it's importance for further studies. However, it should be considered that of all the dangerous effects produced by AAS use, necrotizing fasciitis is not such an unusual consequence.


Assuntos
Anabolizantes/efeitos adversos , Fasciite Necrosante/etiologia , Hospedeiro Imunocomprometido , Miosite/etiologia , Transtornos Relacionados ao Uso de Substâncias/complicações , Acidentes por Quedas , Adulto , Anabolizantes/administração & dosagem , Fasciite Necrosante/patologia , Evolução Fatal , Humanos , Injeções Intramusculares , Masculino , Miosite/patologia , Coxa da Perna , Levantamento de Peso
8.
Eur J Clin Microbiol Infect Dis ; 38(11): 1999-2004, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31325061

RESUMO

Vibrio vulnificus is a Gram-negative bacterium that belongs to the Vibrionaceae family. It represents a deadly opportunistic human pathogen which grows in water with the proper temperature and salinity, and is mostly acquired from seafood eating or direct contact. In susceptible individuals, a traumatic infection could be fatal, causing severe wound infection and even septic shock, and may require amputation. Global warming plays an important role in the geographical area expanding of Vibrio disease. The pathogenesis of Vibrio vulnificus-associated sepsis is very complex, including iron intake, cell injury, and adhesion-related protein and virulence regulation. Vibrio vulnificus infection mainly manifests clinical subtypes such as primary sepsis, traumatic infection, and gastroenteritis, with rapid symptom progression and signs of multiple organ dysfunction syndrome (MODS). It is important to assess these pathogenetic mechanisms in order to select more appropriate measures to prevent and treat Vibrio vulnificus infections, including antibiotic usage and surgical intervention. In this work, we report a typical case of successful treatment of necrotizing fasciitis caused by Vibrio vulnificus, and review the epidemiology, pathogenetic mechanism, clinical characteristics, and treatment of Vibrio vulnificus infection.


Assuntos
Vibrioses , Vibrio vulnificus/patogenicidade , Idoso , Amputação , Antibacterianos/uso terapêutico , Mordeduras e Picadas/complicações , Mordeduras e Picadas/microbiologia , Fasciite Necrosante/epidemiologia , Fasciite Necrosante/etiologia , Fasciite Necrosante/patologia , Fasciite Necrosante/terapia , Feminino , Humanos , Insuficiência de Múltiplos Órgãos/epidemiologia , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/patologia , Insuficiência de Múltiplos Órgãos/terapia , Resultado do Tratamento , Vibrioses/complicações , Vibrioses/epidemiologia , Vibrioses/patologia , Vibrioses/terapia
9.
PLoS Pathog ; 15(6): e1007841, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31206562

RESUMO

DNA methylation is pervasive across all domains of life. In bacteria, the presence of N6-methyladenosine (m6A) has been detected among diverse species, yet the contribution of m6A to the regulation of gene expression is unclear in many organisms. Here we investigated the impact of DNA methylation on gene expression and virulence within the human pathogen Streptococcus pyogenes, or Group A Streptococcus. Single Molecule Real-Time sequencing and subsequent methylation analysis identified 412 putative m6A sites throughout the 1.8 Mb genome. Deletion of the Restriction, Specificity, and Methylation gene subunits (ΔRSM strain) of a putative Type I restriction modification system lost all detectable m6A at the recognition sites and failed to prevent transformation with foreign-methylated DNA. RNA-sequencing identified 20 genes out of 1,895 predicted coding regions with significantly different gene expression. All of the differentially expressed genes were down regulated in the ΔRSM strain relative to the parent strain. Importantly, we found that the presence of m6A DNA modifications affected expression of Mga, a master transcriptional regulator for multiple virulence genes, surface adhesins, and immune-evasion factors in S. pyogenes. Using a murine subcutaneous infection model, mice infected with the ΔRSM strain exhibited an enhanced host immune response with larger skin lesions and increased levels of pro-inflammatory cytokines compared to mice infected with the parent or complemented mutant strains, suggesting alterations in m6A methylation influence virulence. Further, we found that the ΔRSM strain showed poor survival within human neutrophils and reduced adherence to human epithelial cells. These results demonstrate that, in addition to restriction of foreign DNA, gram-positive bacteria also use restriction modification systems to regulate the expression of gene networks important for virulence.


Assuntos
Proteínas de Bactérias/metabolismo , Metilação de DNA , Enzimas de Restrição-Modificação do DNA , DNA Bacteriano , Regulação Bacteriana da Expressão Gênica , Streptococcus pyogenes , Animais , Proteínas de Bactérias/genética , Citocinas/metabolismo , Enzimas de Restrição-Modificação do DNA/genética , Enzimas de Restrição-Modificação do DNA/metabolismo , DNA Bacteriano/genética , DNA Bacteriano/metabolismo , Fasciite Necrosante/genética , Fasciite Necrosante/metabolismo , Fasciite Necrosante/patologia , Feminino , Humanos , Camundongos , Streptococcus pyogenes/genética , Streptococcus pyogenes/metabolismo , Streptococcus pyogenes/patogenicidade
10.
BMC Infect Dis ; 19(1): 524, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200657

RESUMO

BACKGROUND: The occurrence of adverse events following immunization (AEFI) in national immunization programmes is very rare; however, if they occur causality assessment is conducted to identify the associated cause. In the report, we describe a case of severe necrotizing fasciitis in the left arm of a 9-month old boy following administration of the measles vaccine. CASE PRESENTATION: A 9-month old boy presented with swelling on the left upper arm and adjoining the chest area, low-grade continuous fever, frequent passage of loose watery stool and persistent cries 24 h after measles vaccine was administered on the left upper arm. On examination, he was mildly pale, febrile, anicteric. Extensive erythema of the left upper arm occurred thereafter with extensive scalded skin lesions involving the deltoid area, the upper chest wall and arm. This was followed by desquamation of the affected areas and severe necrosis. A diagnosis of severe necrotizing fasciitis was made. A causality assessment was conducted by the state AEFI committee using the detailed AEFI investigation forms to identify the cause of the incidence. CONCLUSION: Here we present a rare case of necrotizing fasciitis which could have been caused by incorrect use of reconstituted measles vaccine. Hence we recommend training of routine immunization service providers on proper vaccine management as well as intensified supervision of immunization sessions.


Assuntos
Fasciite Necrosante/etiologia , Vacina contra Sarampo/efeitos adversos , Vacinação/efeitos adversos , Causalidade , Fasciite Necrosante/patologia , Fasciite Necrosante/terapia , Humanos , Lactente , Masculino , Vacina contra Sarampo/administração & dosagem , Nigéria , Vacinação/normas
11.
BMC Infect Dis ; 19(1): 513, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185920

RESUMO

BACKGROUND: Monofocal necrotizing fasciitis (MONF) involves a single site in a rapidly progressing infection and necrosis of the fascia and surrounding soft tissue. Synchronous multifocal necrotizing fasciitis (SMNF), the simultaneous development of NF in multiple noncontiguous sites, is rarely reported. This study aimed to compare the clinical characteristics and outcomes between patients with SMNF and MONF, and to determine the risk factors of SMNF. METHODS: Our retrospective case-control study compared the clinical characteristics and outcomes, between January 2006 and January 2013, of patients with SMNF and of patients with MONF of the extremities. RESULTS: We enrolled 144 patients with NF of the extremities: 19 with SMNF and 125 with MONF. The duration of symptoms before admission was significantly shorter for the former than for the latter (1.7 days vs. 3.3 days, p = 0.001); the prevalence of shock at the initial visit significantly higher (73.7% vs. 36%, p = 0.002); and the total-case postoperative mortality rate significantly higher (68.4% vs. 14.4%, p <  0.001). In further analysis of the total-case mortality, 9 in 13 SMNF deaths (69.2%) within 7 days after fasciotomy were in the majority while 13 with 28-day mortality (72.2%) was the majority of MONF deaths (p <  0.001). SMNF was significantly more likely to involve bacteremia (89.5% vs. 36%, p <  0.001). Independent risk factors for SMNF were liver cirrhosis (LC) (odds ratio [OR] 6.0, p = 0.001) and end-stage renal disease (ESRD) (OR 7.1, p = 0.035). Gram-negative bacteria were most common in SMNF, and Gram-positive bacteria in MONF (83.3% vs. 53.3%, p = 0.005). Vibrio species were the most common single microbial cause (35.4%) of all NF patients and were the overwhelming cause (73.7%) of SMNF. Staphylococcus aureus and group A ß-hemolytic streptococcus (45.6%) were the other predominant causes of MONF while both (10.5%) rarely caused multifocal NF. CONCLUSIONS: SMNF was more fulminant than was MONF. SMNF was attributable primarily to marine Gram-negative bacteria. Physicians should be aware of SMNF because of its extremely high mortality rate.


Assuntos
Fasciite Necrosante/epidemiologia , Fasciite Necrosante/patologia , Idoso , Estudos de Casos e Controles , Coinfecção/epidemiologia , Coinfecção/microbiologia , Comorbidade , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taiwan/epidemiologia
14.
Eur Radiol ; 29(7): 3414-3423, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30887193

RESUMO

OBJECTIVES: To develop and validate a scoring system integrating MRI and laboratory findings to differentiate necrotizing fasciitis (NF) from non-necrotizing fasciitis (non-NF). METHODS: This retrospective study included 144 subjects who underwent surgery in one of three tertiary referral centers for NF or cellulitis with non-NF. The development cohort consisted of 96 subjects (NF = 47; non-NF = 49) from one center, and the validation cohort consisted of 48 subjects (NF = 23; cellulitis with non-NF = 25) from two different centers. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system and five MRI findings (thickening of the intermuscular deep fascia ≥ 3 mm, extensive involvement of the deep fascia, multi-compartmental involvement in one extremity, presence of gas, and contrast-enhancement pattern) were included in univariate and multivariate logistic regression analysis to identify independent predictors of NF. An additive scoring system was developed using the coefficients of the final regression model. Model performance was assessed for discrimination and calibration. The scoring system was externally validated. RESULT: The final scoring system consisted of three variables: thickening of the deep fascia ≥ 3 mm, multi-compartmental involvement, and LRINEC score. The new predictive model showed improved performance (area under the receiver operating characteristic curve [AUC], 0.862; positive and negative predictive values, 82% and 79%, respectively), compared with the LRINEC score alone (0.814, 77% and 67%, respectively). The model also showed good discrimination with the external validation dataset (AUC, 0.933). CONCLUSIONS: Differentiation of NF from severe cellulitis with non-NF can be achieved with the new predictive scoring system. KEY POINTS: • The new predictive scoring system integrating two MRI findings with the LRINEC score can help in the differentiation of necrotizing fasciitis from severe cellulitis with non-necrotizing fasciitis. • Thickening of the deep fascia ≥ 3 mm and multi-compartmental involvement were the most important MRI findings for the differentiation.


Assuntos
Fasciite/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Diagnóstico Diferencial , Fáscia/diagnóstico por imagem , Fáscia/patologia , Fasciite/patologia , Fasciite/cirurgia , Fasciite Necrosante/diagnóstico por imagem , Fasciite Necrosante/patologia , Fasciite Necrosante/cirurgia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco/métodos , Fatores de Risco , Sensibilidade e Especificidade , Adulto Jovem
15.
Diagn Microbiol Infect Dis ; 94(2): 183-187, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30713116

RESUMO

This study aimed to characterize patients with monomicrobial gram-negative necrotizing fasciitis in three university hospitals in Korea. In this study, of the 115 patients with community-acquired necrotizing fasciitis, 67 (58%) had monomicrobial infections: 31 (27%) in the gram-negative group and 36 (31%) in the gram-positive group. The majority of patients in the gram-negative group were infected with Escherichia coli followed by Klebsiella pneumoniae and Vibrio vulnificus. More patients in the gram-negative group showed liver cirrhosis than those in the gram-positive group (39% vs. 14%, P = 0.02). In a multivariable logistic regression analysis, liver cirrhosis (adjusted odds ratio [aOR], 13.7; 95% confidence interval [CI], 2.9-67.0), treatment with antibiotics without surgery (aOR, 10.2; 95% CI, 2.1-48.3), and lower level of albumin (aOR 4.9; 95% CI, 1.6-14.9) were associated with 30-day mortality. Our findings suggest that gram-negative necrotizing fasciitis is more often associated with liver cirrhosis and has poorer outcomes than gram-positive necrotizing fasciitis.


Assuntos
Fasciite Necrosante/patologia , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/patologia , Infecções Comunitárias Adquiridas/epidemiologia , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/mortalidade , Infecções Comunitárias Adquiridas/patologia , Fasciite Necrosante/mortalidade , Bactérias Gram-Negativas/classificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/mortalidade , Bactérias Gram-Positivas/classificação , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais Universitários , Humanos , Coreia (Geográfico)/epidemiologia , Fatores de Risco , Análise de Sobrevida
16.
Surg Infect (Larchmt) ; 20(4): 305-310, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30716012

RESUMO

Background: Necrotizing soft-tissue infection (NSTI) is a devastating disease associated with high rates of morbidity and mortality. Hyperglycemia is associated with poor wound healing; however, there are no studies evaluating glycemic control outcomes in patients with NSTI. The objective of this study was to examine disease progression and death in patients with NSTI who achieved early glycemic control (EGC) compared with patients that did not. Methods: A retrospective chart review of patients with NSTI was conducted between November 2011 and August 2017. Early glycemic control was defined as a daily average blood glucose concentration ≤150 mg/dL for a minimum of two consecutive days from admission to hospital day three. The primary outcome of this study was a composite of ≤3 debridement procedures by hospital day 14 and survival to discharge. Secondary outcomes were the total number of debridement procedures, amputation, hospital length of stay (LOS), intensive care unit (ICU) LOS, number of hypoglycemic events throughout hospitalization, and discharge disposition. Results: One-hundred five patients were included in the analysis. There were 62% male patients, mean age of 55.3 years, mean weight of 106.9 kg, and 57.1% with diabetes mellitus (DM). The 54 (51.4%) patients with EGC were less likely to have DM (29.6% versus 86.3%; p < 0.001), had a lower median admission glucose concentration (120.5 [97-144] versus 198 [153-295.5] mg/dL; p < 0.001), and had lower median daily glucose values during the first 96 hours after admission (p < 0.001). There was no significant difference in the primary outcome (83.3%% versus 84.3%; p > 0.99) or incidence of hypoglycemia (14.8% versus 23.5%; p = 0.32). Patients with EGC were more likely to return home after discharge (44.4% versus 23.5%; p = 0.039). Conclusion: Overall, there was no difference in composite clinical outcomes between patients with EGC and those without, although more patients who achieved EGC were discharged home. Patients with DM were less likely to achieve EGC.


Assuntos
Fasciite Necrosante/mortalidade , Fasciite Necrosante/patologia , Hiperglicemia/complicações , Hiperglicemia/tratamento farmacológico , Infecções dos Tecidos Moles/mortalidade , Infecções dos Tecidos Moles/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação/estatística & dados numéricos , Cuidados Críticos/estatística & dados numéricos , Desbridamento , Progressão da Doença , Fasciite Necrosante/cirurgia , Feminino , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções dos Tecidos Moles/cirurgia , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
17.
J Clin Invest ; 129(2): 887-901, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30667377

RESUMO

Necrotizing fasciitis and myositis are devastating infections characterized by high mortality. Group A streptococcus (GAS) is a common cause of these infections, but the molecular pathogenesis is poorly understood. We report a genome-wide analysis using serotype M1 and M28 strains that identified GAS genes contributing to necrotizing myositis in nonhuman primates (NHP), a clinically relevant model. Using transposon-directed insertion-site sequencing (TraDIS), we identified 126 and 116 GAS genes required for infection by serotype M1 and M28 organisms, respectively. For both M1 and M28 strains, more than 25% of the GAS genes required for necrotizing myositis encode known or putative transporters. Thirteen GAS transporters contributed to both M1 and M28 strain fitness in NHP myositis, including putative importers for amino acids, carbohydrates, and vitamins and exporters for toxins, quorum-sensing peptides, and uncharacterized molecules. Targeted deletion of genes encoding 5 transporters confirmed that each isogenic mutant strain was significantly (P < 0.05) impaired in causing necrotizing myositis in NHPs. Quantitative reverse-transcriptase PCR (qRT-PCR) analysis showed that these 5 genes are expressed in infected NHP and human skeletal muscle. Certain substrate-binding lipoproteins of these transporters, such as Spy0271 and Spy1728, were previously documented to be surface exposed, suggesting that our findings have translational research implications.


Assuntos
Proteínas de Bactérias , Proteínas de Transporte , Fasciite Necrosante , Regulação Bacteriana da Expressão Gênica , Miosite , Streptococcus pyogenes , Animais , Proteínas de Bactérias/biossíntese , Proteínas de Bactérias/genética , Proteínas de Transporte/biossíntese , Proteínas de Transporte/genética , Linhagem Celular , Modelos Animais de Doenças , Fasciite Necrosante/genética , Fasciite Necrosante/metabolismo , Fasciite Necrosante/patologia , Humanos , Camundongos , Miosite/genética , Miosite/metabolismo , Miosite/microbiologia , Miosite/patologia , Streptococcus pyogenes/genética , Streptococcus pyogenes/metabolismo , Streptococcus pyogenes/patogenicidade
18.
J Invest Dermatol ; 139(6): 1284-1293, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30543898

RESUMO

Group A Streptococcus causes severe invasive infections, including necrotizing fasciitis. The expression of an array of virulence factors targeting specific host immune functions impedes successful bacterial clearance. The virulence factor streptococcal DNase Sda1 was previously shown to interfere with the entrapment of bacteria through neutrophil extracellular traps and TLR9 signaling. In this study, we showed that plasmacytoid dendritic cells are recruited to the infected tissue during group A streptococcal necrotizing fasciitis. We found that the streptococcal DNase Sda1 impairs plasmacytoid dendritic cell recruitment by reducing IFN-1 levels at the site of infection. We found that streptococcal DNase Sda1 interferes with stabilization of the DNA by the host molecule HMGB1 protein, which may account for decreased IFN-1 levels at the site of infection.


Assuntos
Células Dendríticas/imunologia , Desoxirribonuclease I/metabolismo , Fasciite Necrosante/imunologia , Interferon-alfa/imunologia , Infecções Estreptocócicas/imunologia , Células A549 , Animais , Biópsia , DNA/metabolismo , Fragmentação do DNA , Desoxirribonuclease I/imunologia , Modelos Animais de Doenças , Fáscia/citologia , Fáscia/imunologia , Fáscia/microbiologia , Fáscia/patologia , Fasciite Necrosante/microbiologia , Fasciite Necrosante/patologia , Proteína HMGB1/metabolismo , Voluntários Saudáveis , Humanos , Interferon-alfa/metabolismo , Camundongos , Camundongos Knockout , Cultura Primária de Células , Estudos Prospectivos , Receptor de Interferon alfa e beta/genética , Pele/citologia , Pele/imunologia , Pele/microbiologia , Pele/patologia , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/patologia , Streptococcus pyogenes/imunologia , Streptococcus pyogenes/metabolismo
19.
J Wildl Dis ; 55(3): 717-720, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30507336

RESUMO

A free-ranging Iberian lynx (Lynx pardinus) was found dead after 16 mo of being reintroduced. On gross necropsy, necrotic areas in the left biceps femoris and intercostal muscles were identified. Streptococcus canis was isolated from both groups of muscles and was confirmed by PCR, corroborating a necrotizing myositis diagnostic.


Assuntos
Fasciite Necrosante/veterinária , Lynx , Miosite/veterinária , Infecções Estreptocócicas/veterinária , Animais , Animais Selvagens , Fasciite Necrosante/microbiologia , Fasciite Necrosante/patologia , Evolução Fatal , Feminino , Miosite/microbiologia , Miosite/patologia , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/patologia
20.
Wounds ; 30(12): E116-E120, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30561371

RESUMO

INTRODUCTION: Necrotizing myositis (NM) is an extremely rare necrotizing soft tissue infection involving muscle. Unlike similar infections (eg, necrotizing fasciitis, clostridial myonecrosis) that can be more readily diagnosed, NM can have a benign presentation then rapidly progress into a life-threatening condition with a mortality rate of 100% without surgical intervention. CASE REPORT: A 74-year-old man with a history of prostate cancer with radiation therapy, seed implants, and 2 transurethral resection procedures presented to the emergency department after a fall. He was initially diagnosed and treated for urosepsis. Sixteen hours after presentation, he complained of pain and swelling of his right groin. Computed tomography of the abdomen and pelvis showed gas findings suspicious for necrotizing infection of the bilateral thighs. Surgical exploration revealed NM. Separate cultures from the left thigh and bladder grew Streptococcus intermedius, Clostridium clostridioforme, and Peptostreptococcus, suggesting a possible common source of infection from the prostate gland or the osteomyelitic pubic symphysis, which subsequently spread to the bilateral thighs. CONCLUSIONS: To the best of the authors' knowledge, this is the first reported case of S intermedius and C clostridioforme causing NM. A high index of suspicion is required for extremely rare conditions like NM, because early diagnosis and surgical intervention significantly reduce mortality.


Assuntos
Fasciite Necrosante/patologia , Músculo Esquelético/patologia , Miosite/patologia , Neoplasias da Próstata/radioterapia , Sínfise Pubiana/patologia , Lesões por Radiação/patologia , Infecções dos Tecidos Moles/patologia , Coxa da Perna/patologia , Idoso , Infecções por Clostridium , Fasciite Necrosante/diagnóstico por imagem , Fasciite Necrosante/etiologia , Fasciite Necrosante/terapia , Humanos , Oxigenação Hiperbárica , Masculino , Músculo Esquelético/diagnóstico por imagem , Miosite/diagnóstico por imagem , Miosite/terapia , Tratamento de Ferimentos com Pressão Negativa , Sínfise Pubiana/diagnóstico por imagem , Lesões por Radiação/diagnóstico por imagem , Infecções dos Tecidos Moles/diagnóstico por imagem , Infecções dos Tecidos Moles/terapia , Infecções Estreptocócicas , Coxa da Perna/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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