A Case of Necrotizing Fasciitis Due to Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a Dog-bitten Patient with Diabetes

Sungsil Lee; Kyoung Ho Roh; Chang Ki Kim; Dongeun Yong; Jun Yong Choi; Jin Woo Lee; Kyungwon Lee; Yunsop Chong

doi:10.3343/kjlm.2008.28.3.191

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Lee, Roh, Kim, Yong, Choi, Lee, Lee, and Chong: A Case of Necrotizing Fasciitis Due to Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a Dog-bitten Patient with Diabetes

Original Article

Korean J Leg Med 2008;28(3):191-195.

Published online: 14 February 2008

DOI: https://doi.org/10.3343/kjlm.2008.28.3.191

A Case of Necrotizing Fasciitis Due to Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a Dog-bitten Patient with Diabetes

Sungsil Lee, M.D.¹, Kyoung Ho Roh, M.D.², Chang Ki Kim, M.D.¹, Dongeun Yong, M.D.^1,³, Jun Yong Choi, M.D.⁴, Jin Woo Lee, M.D.⁵, Kyungwon Lee, M.D.^1,³, Yunsop Chong, Ph.D.¹

¹Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, Korea

²Department of Laboratory Medicine, Korea University College of Medicine, Seoul, Korea

³Department of BK21 Project for Medical Sciences, Yonsei University College of Medicine, Seoul, Korea

⁴Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea

⁵Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea

Received 8 January 200821 March 2008 Accepted 21 March 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of necrotizing fasciitis involving Streptococcus agalactiae, Arcanobacterium haemolyticum, and Finegoldia magna in a 36-yr-old female diabetic patient, which started after a minor dog bite to the toe of the patient. This case suggested that a trivial infection after a minor dog bite in an immunocompromised patient such as diabetes patient could result in a significant complication such as necrotizing fasciitis. The life-threatening infection was cured by timely above-the-knee amputation, as well as penicillin G and clindamycin therapy.

Keywords: Necrotizing fasciitis, Streptococcus agalactiae, Arcanobacterium haemolyticum, Finegoldia magna, Diabetic patient

REFERENCES

1.Brook I., Frazier EH. Clinical and microbiological features of necrotizing fasciitis. J Clin Microbiol. 1995. 33:2382–7.

2.Gardam MA., Low DE., Saginur R., Miller MA. Group B streptococcal necrotizing fasciitis and streptococcal toxic shock-like syndrome in adults. Arch Intern Med. 1998. 158:1704–8.

3.Kihiczak GG., Schwartz RA., Kapila R. Necrotizing fasciitis: a deadly infection. J Eur Acad Dermatol Venereol. 2006. 20:365–9.

4.Ceilley RI. Foot ulceration and vertebral osteomyelitis with Corynebacterium haemolyticum. Arch Dermatol. 1977. 113:646–7.

5.Chang K., Siu LK., Chen YH., Lu PL., Chen TC., Hsieh HC, et al. Fatal Pasteurella multocida septicemia and necrotizing fasciitis related with wound licked by a domestic dog. Scand J Infect Dis. 2007. 39:167–70.

6.Lipsky BA., Berendt AR., Deery HG., Embil JM., Joseph WS., Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2004. 39:885–910.

7.Griego RD., Rosen T., Orengo IF., Wolf JE. Dog, cat, and human bites: a review. J Am Acad Dermatol. 1995. 33:1019–29.

8.Douglas AK., Allen BK. Postoperative infections and antimicrobial prophylaxis. Gerald LM, John EB, editors. Principles and practice of infectious diseases. 4th ed.New York: Churchill Livingstone;1995. p. 2746.

9.Crum NF., Wallace MR. Group B streptococcal necrotizing fasciitis and toxic shock-like syndrome: a case report and review of the literature. Scand J Infect Dis. 2003. 35:878–81.

10.Holmstrom B., Grimsley EW. Necrotizing fasciitis and toxic shock-like syndrome caused by group B Streptococcus. South Med J. 2000. 93:1096–8.

11.Carlson P., Korpela J., Walder M., Nyman M. Antimicrobial susceptibilities and biotypes of Arcanobacterium haemolyticum blood isolates. Eur J Clin Microbiol Infect Dis. 1999. 18:915–7.

12.Linder R. Rhodococcus equi and Arcanobacterium haemolyticum: two “coryneform” bacteria increasingly recognized as agents of human infection. Emerg Infect Dis. 1997. 3:145–53.

13.Yuli S., Sydney MF. Peptostreptococcus, Finegoldia, Anaerococcus, Peptoniphilus, Veillonella, and other anaerobic cocci. Murray PR, Baron EJ, editors. Manual of clinical microbiology. 9th ed.Washington: ASM Press;2007. p. 863.

14.Brook I. Aerobic and anaerobic microbiology of necrotizing fasciitis in children. Pediatr Dermatol. 1996. 13:281–4.

15.Ge Y., MacDonald D., Henry MM., Hait HI., Nelson KA., Lipsky BA, et al. In vitro susceptibility to pexiganan of bacteria isolated from infected diabetic foot ulcers. Diagn Microbiol Infect Dis. 1999. 35:45–53.

16.Yildirim AO., Lammler C., Weiss R., Kopp P. Pheno- and genotypic properties of streptococci of serological group B of canine and feline origin. FEMS Microbiol Lett. 2002. 212:187–92.

17.Jobanputra RS., Swain CP. Septicaemia due to Corynebacterium haemolyticum. J Clin Pathol. 1975. 28:798–800.

18.Batty A., Wren MW. Prevalence of Fusobacterium necrophorum and other upper respiratory tract pathogens isolated from throat swabs. Br J Biomed Sci. 2005. 62:66–70.

19.DiPersio LP., DiPersio JR. High rates of erythromycin and clindamycin resistance among OBGYN isolates of group B Streptococcus. Diagn Microbiol Infect Dis. 2006. 54:79–82.

Table 1.

Characteristics of bacterial isolates from the patient with necrotizing fasciitis

Specimens	Characteristics of isolates	Identification	MIC (μg/mL)^‡
Specimens	Characteristics of isolates	Identification	Penicillin G	Clindamycin
Wound^∗	Heavy growth of small, pleomorphic, gram-positive bacilli after 24 hr aerobic culture	Arcanobacterium haemolyticum by API Coryne strip^†	0.008	0.06
	Colonies were small in size with a narrow zone of hemolysis
	Positive CAMP-inhibition reaction with S. aureus
	Heavy growth of gram-positive cocci in chain after 24 hr aerobic culture	Streptococcus agalactiae by Vitek GPI card^†	0.064	0.06
	Colonies were small with incomplete hemolysis
	Positive latex-agglutination test with group B reagent of Streptex test (Remel, Lenexa, KS)
	Heavy growth of gram-positive cocci in clusters after 48-hr anaerobic culture	Finegoldia magna by ATB rapid ID 32A strip^†	Not tested	Not tested
	Small nonhemolytic colonies
Blood	All three aerobic blood cultures (BacT/ALERT 3D^†) yielded S. agalactiae. Anaerobic blood cultures using thioglycollate broth (Micromedia, Busan, Korea) did not yield any anaerobe	S. agalactiae by Vitek GPI card^†	0.064	0.06

^∗ , Both of the two wound specimens taken at the time of hospitalization and operation yielded the same organisms;

^† , The culture and identification systems were from bioMerieux (Marcy l'Etoile, France);

^‡ , MIC determination: penicillin G by the Etest and clindamycin by the agar dilution method of Clinical and Laboratory Standards Institute using 5% blood supplemented Mueller-Hinton agar.

Abbreviation: MIC, minimum inhibitory concentration

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