A case of streptococcal toxic shock syndrome due to Group G streptococci identified as Streptococcus dysgalactiae subsp. equisimilis.
Identifieur interne : 002277 ( PubMed/Corpus ); précédent : 002276; suivant : 002278A case of streptococcal toxic shock syndrome due to Group G streptococci identified as Streptococcus dysgalactiae subsp. equisimilis.
Auteurs : Takahito Nei ; Koichi Akutsu ; Ayaka Shima ; Ippei Tsuboi ; Hiroomi Suzuki ; Takeshi Yamamoto ; Keiji Tanaka ; Akihiro Shinoyama ; Yoshiko Kojima ; Yohei Washio ; Sakina Okawa ; Kazunari Sonobe ; Yoshihiko Norose ; Ryoichi SaitoSource :
- Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy [ 1437-7780 ] ; 2012.
English descriptors
- KwdEn :
- Aged, Anti-Bacterial Agents (therapeutic use), Antigens, Bacterial (genetics), Bacterial Outer Membrane Proteins (genetics), Carrier Proteins (genetics), Edema (microbiology), Edema (pathology), Fasciitis, Necrotizing (microbiology), Fasciitis, Necrotizing (pathology), Fatal Outcome, Hemodiafiltration, Humans, Leg (microbiology), Leg (pathology), Male, Shock, Septic (microbiology), Shock, Septic (pathology), Streptococcal Infections (microbiology), Streptococcal Infections (pathology), Streptococcus (classification), Streptococcus (genetics), Streptococcus (isolation & purification).
- MESH :
- chemical , genetics : Antigens, Bacterial, Bacterial Outer Membrane Proteins, Carrier Proteins.
- chemical , therapeutic use : Anti-Bacterial Agents.
- classification : Streptococcus.
- genetics : Streptococcus.
- isolation & purification : Streptococcus.
- microbiology : Edema, Fasciitis, Necrotizing, Leg, Shock, Septic, Streptococcal Infections.
- pathology : Edema, Fasciitis, Necrotizing, Leg, Shock, Septic, Streptococcal Infections.
- Aged, Fatal Outcome, Hemodiafiltration, Humans, Male.
Abstract
A 79-year-old man with a 3-month history of lymphedema of the lower limbs, and diabetes mellitus, was admitted to our hospital for suspected deep venous thrombosis. Several hours after admission, leg pain and purpura-like skin color appeared. On the 2nd hospital day, he was referred to our department for possible acute occlusive peripheral artery disease (PAD) and skin necrosis with blisters; however, computed tomography with contrast showed no occlusive lesions. He had already developed shock and necrotizing deep soft-tissue infections of the left lower leg. Laboratory findings revealed renal dysfunction and coagulation system collapse. Soon after PAD was ruled out, clinical findings suggested necrotizing deep soft-tissue infections, shock state, disseminated intravascular coagulation, and multiple organ failure. These symptoms led to a high suspicion of the well-recognized streptococcal toxic shock syndrome (STSS). With a high suspicion of STSS, we detected Group G β-hemolytic streptococci (GGS) from samples aspirated from the leg bullae, and the species was identified as Streptococcus dysgalactiae subsp. equisimilis (SDSE) by 16S-ribosomal RNA sequencing. However, unfortunately, surgical debridement was impossible due to the broad area of skin change. Despite adequate antimicrobial therapy and intensive care, the patient died on the 3rd hospital day. The M-protein gene (emm) typing of the isolated SDSE was revealed to be stG6792. This type of SDSE is the most frequent cause of STSS due to GGS in Japan. We consider it to be crucial to rapidly distinguish STSS from acute occlusive PAD to achieve life-saving interventions in patients with severe soft-tissue infections.
DOI: 10.1007/s10156-012-0375-x
PubMed: 22327489
Links to Exploration step
pubmed:22327489Le document en format XML
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first="Hiroomi" last="Suzuki">Hiroomi Suzuki</name></author><author><name sortKey="Yamamoto, Takeshi" sort="Yamamoto, Takeshi" uniqKey="Yamamoto T" first="Takeshi" last="Yamamoto">Takeshi Yamamoto</name></author><author><name sortKey="Tanaka, Keiji" sort="Tanaka, Keiji" uniqKey="Tanaka K" first="Keiji" last="Tanaka">Keiji Tanaka</name></author><author><name sortKey="Shinoyama, Akihiro" sort="Shinoyama, Akihiro" uniqKey="Shinoyama A" first="Akihiro" last="Shinoyama">Akihiro Shinoyama</name></author><author><name sortKey="Kojima, Yoshiko" sort="Kojima, Yoshiko" uniqKey="Kojima Y" first="Yoshiko" last="Kojima">Yoshiko Kojima</name></author><author><name sortKey="Washio, Yohei" sort="Washio, Yohei" uniqKey="Washio Y" first="Yohei" last="Washio">Yohei Washio</name></author><author><name sortKey="Okawa, Sakina" sort="Okawa, Sakina" uniqKey="Okawa S" first="Sakina" last="Okawa">Sakina Okawa</name></author><author><name sortKey="Sonobe, Kazunari" sort="Sonobe, Kazunari" uniqKey="Sonobe K" first="Kazunari" last="Sonobe">Kazunari Sonobe</name></author><author><name sortKey="Norose, Yoshihiko" sort="Norose, Yoshihiko" uniqKey="Norose Y" first="Yoshihiko" last="Norose">Yoshihiko Norose</name></author><author><name sortKey="Saito, Ryoichi" sort="Saito, Ryoichi" uniqKey="Saito R" first="Ryoichi" last="Saito">Ryoichi Saito</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2012">2012</date><idno type="RBID">pubmed:22327489</idno><idno type="pmid">22327489</idno><idno type="doi">10.1007/s10156-012-0375-x</idno><idno type="wicri:Area/PubMed/Corpus">002277</idno><idno type="wicri:explorRef" wicri:stream="PubMed" wicri:step="Corpus" wicri:corpus="PubMed">002277</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">A case of streptococcal toxic shock syndrome due to Group G streptococci identified as Streptococcus dysgalactiae subsp. equisimilis.</title><author><name sortKey="Nei, Takahito" sort="Nei, Takahito" uniqKey="Nei T" first="Takahito" last="Nei">Takahito Nei</name><affiliation><nlm:affiliation>Division of Intensive Care Unit and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan. takahitonei@gmail.com</nlm:affiliation></affiliation></author><author><name sortKey="Akutsu, Koichi" sort="Akutsu, Koichi" uniqKey="Akutsu K" first="Koichi" last="Akutsu">Koichi Akutsu</name></author><author><name sortKey="Shima, Ayaka" sort="Shima, Ayaka" uniqKey="Shima A" first="Ayaka" last="Shima">Ayaka Shima</name></author><author><name sortKey="Tsuboi, Ippei" sort="Tsuboi, Ippei" uniqKey="Tsuboi I" first="Ippei" last="Tsuboi">Ippei Tsuboi</name></author><author><name sortKey="Suzuki, Hiroomi" sort="Suzuki, Hiroomi" uniqKey="Suzuki H" first="Hiroomi" last="Suzuki">Hiroomi Suzuki</name></author><author><name sortKey="Yamamoto, Takeshi" sort="Yamamoto, Takeshi" uniqKey="Yamamoto T" first="Takeshi" last="Yamamoto">Takeshi Yamamoto</name></author><author><name sortKey="Tanaka, Keiji" sort="Tanaka, Keiji" uniqKey="Tanaka K" first="Keiji" last="Tanaka">Keiji Tanaka</name></author><author><name sortKey="Shinoyama, Akihiro" sort="Shinoyama, Akihiro" uniqKey="Shinoyama A" first="Akihiro" last="Shinoyama">Akihiro Shinoyama</name></author><author><name sortKey="Kojima, Yoshiko" sort="Kojima, Yoshiko" uniqKey="Kojima Y" first="Yoshiko" last="Kojima">Yoshiko Kojima</name></author><author><name sortKey="Washio, Yohei" sort="Washio, Yohei" uniqKey="Washio Y" first="Yohei" last="Washio">Yohei Washio</name></author><author><name sortKey="Okawa, Sakina" sort="Okawa, Sakina" uniqKey="Okawa S" first="Sakina" last="Okawa">Sakina Okawa</name></author><author><name sortKey="Sonobe, Kazunari" sort="Sonobe, Kazunari" uniqKey="Sonobe K" first="Kazunari" last="Sonobe">Kazunari Sonobe</name></author><author><name sortKey="Norose, Yoshihiko" sort="Norose, Yoshihiko" uniqKey="Norose Y" first="Yoshihiko" last="Norose">Yoshihiko Norose</name></author><author><name sortKey="Saito, Ryoichi" sort="Saito, Ryoichi" uniqKey="Saito R" first="Ryoichi" last="Saito">Ryoichi Saito</name></author></analytic><series><title level="j">Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy</title><idno type="eISSN">1437-7780</idno><imprint><date when="2012" type="published">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged</term><term>Anti-Bacterial Agents (therapeutic use)</term><term>Antigens, Bacterial (genetics)</term><term>Bacterial Outer Membrane Proteins (genetics)</term><term>Carrier Proteins (genetics)</term><term>Edema (microbiology)</term><term>Edema (pathology)</term><term>Fasciitis, Necrotizing (microbiology)</term><term>Fasciitis, Necrotizing (pathology)</term><term>Fatal Outcome</term><term>Hemodiafiltration</term><term>Humans</term><term>Leg (microbiology)</term><term>Leg (pathology)</term><term>Male</term><term>Shock, Septic (microbiology)</term><term>Shock, Septic (pathology)</term><term>Streptococcal Infections (microbiology)</term><term>Streptococcal Infections (pathology)</term><term>Streptococcus (classification)</term><term>Streptococcus (genetics)</term><term>Streptococcus (isolation & purification)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="genetics" xml:lang="en"><term>Antigens, Bacterial</term><term>Bacterial Outer Membrane Proteins</term><term>Carrier Proteins</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Anti-Bacterial Agents</term></keywords><keywords scheme="MESH" qualifier="classification" xml:lang="en"><term>Streptococcus</term></keywords><keywords scheme="MESH" qualifier="genetics" xml:lang="en"><term>Streptococcus</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Streptococcus</term></keywords><keywords scheme="MESH" qualifier="microbiology" xml:lang="en"><term>Edema</term><term>Fasciitis, Necrotizing</term><term>Leg</term><term>Shock, Septic</term><term>Streptococcal Infections</term></keywords><keywords scheme="MESH" qualifier="pathology" xml:lang="en"><term>Edema</term><term>Fasciitis, Necrotizing</term><term>Leg</term><term>Shock, Septic</term><term>Streptococcal Infections</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Fatal Outcome</term><term>Hemodiafiltration</term><term>Humans</term><term>Male</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">A 79-year-old man with a 3-month history of lymphedema of the lower limbs, and diabetes mellitus, was admitted to our hospital for suspected deep venous thrombosis. Several hours after admission, leg pain and purpura-like skin color appeared. On the 2nd hospital day, he was referred to our department for possible acute occlusive peripheral artery disease (PAD) and skin necrosis with blisters; however, computed tomography with contrast showed no occlusive lesions. He had already developed shock and necrotizing deep soft-tissue infections of the left lower leg. Laboratory findings revealed renal dysfunction and coagulation system collapse. Soon after PAD was ruled out, clinical findings suggested necrotizing deep soft-tissue infections, shock state, disseminated intravascular coagulation, and multiple organ failure. These symptoms led to a high suspicion of the well-recognized streptococcal toxic shock syndrome (STSS). With a high suspicion of STSS, we detected Group G β-hemolytic streptococci (GGS) from samples aspirated from the leg bullae, and the species was identified as Streptococcus dysgalactiae subsp. equisimilis (SDSE) by 16S-ribosomal RNA sequencing. However, unfortunately, surgical debridement was impossible due to the broad area of skin change. Despite adequate antimicrobial therapy and intensive care, the patient died on the 3rd hospital day. The M-protein gene (emm) typing of the isolated SDSE was revealed to be stG6792. This type of SDSE is the most frequent cause of STSS due to GGS in Japan. We consider it to be crucial to rapidly distinguish STSS from acute occlusive PAD to achieve life-saving interventions in patients with severe soft-tissue infections.</div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">22327489</PMID><DateCreated><Year>2012</Year><Month>12</Month><Day>24</Day></DateCreated><DateCompleted><Year>2013</Year><Month>07</Month><Day>23</Day></DateCompleted><DateRevised><Year>2012</Year><Month>12</Month><Day>24</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1437-7780</ISSN><JournalIssue CitedMedium="Internet"><Volume>18</Volume><Issue>6</Issue><PubDate><Year>2012</Year><Month>Dec</Month></PubDate></JournalIssue><Title>Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy</Title><ISOAbbreviation>J. Infect. Chemother.</ISOAbbreviation></Journal><ArticleTitle>A case of streptococcal toxic shock syndrome due to Group G streptococci identified as Streptococcus dysgalactiae subsp. equisimilis.</ArticleTitle><Pagination><MedlinePgn>919-24</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s10156-012-0375-x</ELocationID><Abstract><AbstractText>A 79-year-old man with a 3-month history of lymphedema of the lower limbs, and diabetes mellitus, was admitted to our hospital for suspected deep venous thrombosis. Several hours after admission, leg pain and purpura-like skin color appeared. On the 2nd hospital day, he was referred to our department for possible acute occlusive peripheral artery disease (PAD) and skin necrosis with blisters; however, computed tomography with contrast showed no occlusive lesions. He had already developed shock and necrotizing deep soft-tissue infections of the left lower leg. Laboratory findings revealed renal dysfunction and coagulation system collapse. Soon after PAD was ruled out, clinical findings suggested necrotizing deep soft-tissue infections, shock state, disseminated intravascular coagulation, and multiple organ failure. These symptoms led to a high suspicion of the well-recognized streptococcal toxic shock syndrome (STSS). With a high suspicion of STSS, we detected Group G β-hemolytic streptococci (GGS) from samples aspirated from the leg bullae, and the species was identified as Streptococcus dysgalactiae subsp. equisimilis (SDSE) by 16S-ribosomal RNA sequencing. However, unfortunately, surgical debridement was impossible due to the broad area of skin change. Despite adequate antimicrobial therapy and intensive care, the patient died on the 3rd hospital day. The M-protein gene (emm) typing of the isolated SDSE was revealed to be stG6792. This type of SDSE is the most frequent cause of STSS due to GGS in Japan. We consider it to be crucial to rapidly distinguish STSS from acute occlusive PAD to achieve life-saving interventions in patients with severe soft-tissue infections.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Nei</LastName><ForeName>Takahito</ForeName><Initials>T</Initials><AffiliationInfo><Affiliation>Division of Intensive Care Unit and Cardiac Care Unit, Nippon Medical School, Tokyo, Japan. takahitonei@gmail.com</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Akutsu</LastName><ForeName>Koichi</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Shima</LastName><ForeName>Ayaka</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Tsuboi</LastName><ForeName>Ippei</ForeName><Initials>I</Initials></Author><Author ValidYN="Y"><LastName>Suzuki</LastName><ForeName>Hiroomi</ForeName><Initials>H</Initials></Author><Author ValidYN="Y"><LastName>Yamamoto</LastName><ForeName>Takeshi</ForeName><Initials>T</Initials></Author><Author ValidYN="Y"><LastName>Tanaka</LastName><ForeName>Keiji</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Shinoyama</LastName><ForeName>Akihiro</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Kojima</LastName><ForeName>Yoshiko</ForeName><Initials>Y</Initials></Author><Author ValidYN="Y"><LastName>Washio</LastName><ForeName>Yohei</ForeName><Initials>Y</Initials></Author><Author ValidYN="Y"><LastName>Okawa</LastName><ForeName>Sakina</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Sonobe</LastName><ForeName>Kazunari</ForeName><Initials>K</Initials></Author><Author ValidYN="Y"><LastName>Norose</LastName><ForeName>Yoshihiko</ForeName><Initials>Y</Initials></Author><Author ValidYN="Y"><LastName>Saito</LastName><ForeName>Ryoichi</ForeName><Initials>R</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2012</Year><Month>02</Month><Day>11</Day></ArticleDate></Article><MedlineJournalInfo><Country>Netherlands</Country><MedlineTA>J Infect Chemother</MedlineTA><NlmUniqueID>9608375</NlmUniqueID><ISSNLinking>1341-321X</ISSNLinking></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000900">Anti-Bacterial Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D000942">Antigens, Bacterial</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D001425">Bacterial Outer Membrane Proteins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D002352">Carrier Proteins</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="C014689">streptococcal M protein</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000900" MajorTopicYN="N">Anti-Bacterial Agents</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000942" MajorTopicYN="N">Antigens, Bacterial</DescriptorName><QualifierName UI="Q000235" MajorTopicYN="N">genetics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D001425" MajorTopicYN="N">Bacterial Outer Membrane Proteins</DescriptorName><QualifierName UI="Q000235" MajorTopicYN="N">genetics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002352" MajorTopicYN="N">Carrier Proteins</DescriptorName><QualifierName UI="Q000235" MajorTopicYN="N">genetics</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D004487" MajorTopicYN="N">Edema</DescriptorName><QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D019115" MajorTopicYN="N">Fasciitis, Necrotizing</DescriptorName><QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D017809" MajorTopicYN="N">Fatal Outcome</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D017583" MajorTopicYN="N">Hemodiafiltration</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D007866" MajorTopicYN="N">Leg</DescriptorName><QualifierName UI="Q000382" MajorTopicYN="N">microbiology</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D012772" MajorTopicYN="N">Shock, Septic</DescriptorName><QualifierName UI="Q000382" MajorTopicYN="Y">microbiology</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013290" MajorTopicYN="N">Streptococcal Infections</DescriptorName><QualifierName UI="Q000382" MajorTopicYN="Y">microbiology</QualifierName><QualifierName UI="Q000473" MajorTopicYN="N">pathology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D013291" MajorTopicYN="N">Streptococcus</DescriptorName><QualifierName UI="Q000145" MajorTopicYN="N">classification</QualifierName><QualifierName UI="Q000235" MajorTopicYN="N">genetics</QualifierName><QualifierName UI="Q000302" MajorTopicYN="Y">isolation & purification</QualifierName></MeshHeading></MeshHeadingList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2011</Year><Month>11</Month><Day>21</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2012</Year><Month>01</Month><Day>18</Day></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2012</Year><Month>2</Month><Day>14</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2012</Year><Month>2</Month><Day>14</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2013</Year><Month>7</Month><Day>24</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">22327489</ArticleId><ArticleId 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