Necrotizing fasciitis and toxic shock-like syndrome caused by group B streptococcus

• Published in: Southern medical journal (Birmingham, Ala.) Vol. 93; no. 11; pp. 1096 - 1098
• Main Authors: HOLMSTROM, Björn, GRIMSLEY, Edwin W
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.11.2000
• Subjects: Anti-Bacterial Agents - therapeutic use; Bacterial diseases; Biological and medical sciences; Clindamycin - therapeutic use; Combined Modality Therapy; Debridement; Diabetes Complications; Drug Therapy, Combination - therapeutic use; Fasciitis, Necrotizing - complications; Fasciitis, Necrotizing - microbiology; Fasciitis, Necrotizing - therapy; Female; Gentamicins - therapeutic use; Human bacterial diseases; Humans; Hyperbaric Oxygenation; Infectious diseases; Medical sciences; Middle Aged; Shock, Septic - complications; Shock, Septic - microbiology; Shock, Septic - therapy; Staphylococcal infections, streptococcal infections, pneumococcal infections; Streptococcus agalactiae - isolation & purification; Endocrinopathy; Skin disease; Intravenous administration; Clindamycin; Microbiological investigation; Necrotizing fasciitis; Streptococcus B; Bacteria; Micrococcales; Adult; Female; Diagnosis; Hyperbaric oxygenotherapy; Human; Connective tissue disease; Diabetes mellitus; Treatment efficiency; Etiopathogenesis; Exploration; Bacteriological investigation; Infection; Case study; Streptococcaceae; Antibiotic; Concomitant disease; Chemotherapy; Treatment; Debridment; Bacteriosis; Age 50-59
• ISSN: 0038-4348; 1541-8243
• DOI: 10.1097/00007611-200011000-00011

A recent increase in reports of necrotizing fasciitis resulting from group B streptococcus has alerted physicians to a possible concomitant increase of toxic shock-like syndrome. We report the second case of group B streptococcus causing necrotizing fasciitis and toxic shock-like syndrome. A black woman, aged 52 years, with newly diagnosed diabetes mellitus had necrotizing fasciitis type II of the left groin. Hypotension, elevated bilirubin and liver enzymes, and adult respiratory distress syndrome rapidly developed. Because group B streptococcus was isolated from a normally sterile site, the patient's condition met the criteria for toxic shock-like syndrome. Extensive surgical debridement, hyperbaric oxygen therapy, and intravenous antibiotic therapy (including clindamycin) were required for complete recovery. The antitoxin effects of hyperbaric oxygen therapy and clindamycin should be further investigated for the treatment of such patients.