SESSION TITLE: Infectious Disease Cases I
SESSION TYPE: Affiliate Case Report Slide
PRESENTED ON: Sunday, October 27, 2013 at 07:30 AM - 08:30 AM
INTRODUCTION: Necrotizing fasciitis is characterized by fulminant soft-tissue destruction, systemic toxicity, and high mortality. Infections are classically caused by beta-hemolytic Streptococcal species or anaerobic organisms. Group C Streptococcal species are endogenous to humans and domestic animals but are infrequently reported to cause infections in humans. To date, animal exposure has not been documented as a direct cause of systemic infection with Group C subspecies. Guinea pigs are known to be carriers of Streptococcus equi and we present a case of necrotizing fasciitis and septic shock caused by Group C Streptococcal bacteremia following guinea pig exposure.
CASE PRESENTATION: A 44 year old Caucasian male with a past medical history significant for asthma presented to an urgent care center with headache, myalgias, and bilateral thigh pain. Rapid flu swab was negative and he was sent home with a prescription for Tamiflu. Two days later he presents to the emergency department with extensive erythema and swelling of bilateral lower extremities. Crepitus and blistering were observed in bilateral thighs and he was taken promptly for fasciotomies and debridement. He then went on to develop septic shock requiring vasopressor support and blood cultures were positive on two successive days for Streptococcus equi. Despite appropriate antibiotic therapy he developed progressive lower extremity and abdominal wall necrosis requiring further surgical debridement. Subsequent questioning revealed that our patient had received two guinea pigs from a pet store in addition to two others he already owned one week prior to the onset of symptoms. Cultures of all four guinea pigs performed by the CDC were positive for Streptococcus equi.
DISCUSSION: This case illustrates a rapidly progressive, necrotizing soft tissue infection caused by a Group C Streptococcal species directly related to guinea pig exposure. Previous case reports have not shown a link to animal exposure or the severity of symptoms observed in this previously health patient. Early diagnosis and aggressive surgical debridement along with hemodynamic support and broad antibiotic coverage remain the mainstays of treatment. Despite prompt initiation of treatment the mortality remains as high as 34%.
CONCLUSIONS: Necrotozing fasciitis and septic shock are not well-documented complications of Group C Stretococcal infection. Our case illustrates direct animal to human transmission resulting in multi-system organ failure in a previously immunocompetent host. Better screening of domestic animals available for purchase as pets may be needed to prevent similar outbreaks in the future.
Reference #1: Broyles LN, Van Beneden C, Beall B, et al. Population-based study of invasive disease due to beta-hemolytic streptococci or groups other than A and B. Clin Infect Dis 2009; 48:706
DISCLOSURE: The following authors have nothing to disclose: Daniel Fitelson, Charles Read, Megan Flynn
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