scholarly journals Septic Arthritis of the Knee and Necrotizing Fasciitis in a Young Immunocompetent Adult: A Case Report

2018 ◽  
Vol 3 (2) ◽  
pp. 56
Author(s):  
Hayatul Najaa Miptah ◽  
Siti Fatimah Badlishah-Sham ◽  
Selvyn LLyod ◽  
Anis Safura Ramli
Keyword(s):  
Risk Factors ◽  
Knee Joint ◽  
Septic Arthritis ◽  
Necrotizing Fasciitis ◽  
Knee Pain ◽  
Group A Streptococcus ◽  
Immunocompetent Adult ◽  
Group A ◽  
Left Calf ◽  
Underlying Risk

Septic arthritis is uncommon in immunocompetent young adults. It typically presents in individuals with underlying risk factors. Isolation of Group A Streptococcus (GAS) as the causative agent of septic arthritis is usually associated with autoimmune diseases, chronic skin infections or trauma. Here we report a case of a young lady who is immunocompetent without any prior history of trauma, who presented with an abrupt onset of left knee pain and swelling to the emergency department. An initial diagnosis of acute gout was made and she was treated with non-steroidal anti-inflammatory drug (NSAID). She presented again two days later to a primary care clinic with worsening knee pain and severe left calf pain. A clinical diagnosis of septic arthritis was suspected and the patient was urgently referred to the Orthopaedic team. Synovial fluid from the knee joint aspiration showed growth of GAS. A diagnosis of necrotizing fasciitis was also made as the culture taken from the left calf during incision and drainage (I&D) procedure showed a mixed growth. She eventually underwent surgical debridement twice, together with the administration of several courses of intravenous antibiotics leading to her full recovery after 45 days. This case demonstrates the challenge in making a prompt diagnosis of septic arthritis and probable Type II necrotizing fasciitis in an immunocompetent adult without underlying risk factors. Any delay in diagnosis and treatment would have increased the risk of damage to her knee joint and this may be fatal even in a previously healthy young adult. KEYWORDS: septic arthritis, immunocompetent, Group A streptococcus, necrotizing fasciitis

scholarly journals Dermo-Hipodermites Bacterianas Agudas Não Necrotizantes: Erisipela e Celulite Infeciosa

2021 ◽  
Vol 34 (3) ◽  
pp. 217
Author(s):  
Maria Alexandra Rodrigues ◽  
Mónica Caetano ◽  
Isabel Amorim ◽  
Manuela Selores
Keyword(s):  
Risk Factors ◽  
Necrotizing Fasciitis ◽  
Lower Limbs ◽  
First Line ◽  
Correct Treatment ◽  
Vein Thrombosis ◽  
Group A ◽  
Low Sensitivity ◽  
Atypical Presentations ◽  
Main Complication

Non-necrotizing acute dermo-hypodermal infections are infectious processes that include erysipela and infectious cellulitis, and are mainly caused by group A β-haemolytic streptococcus. The lower limbs are affected in more than 80% of cases and the risk factors are disruption of cutaneous barrier, lymphoedema and obesity. Diagnosis is clinical and in a typical setting we observe an acute inflammatory plaque with fever, lymphangitis, adenopathy and leucocytosis. Bacteriology is usually not helpful because of low sensitivity or delayed positivity. In case of atypical presentations, erysipela must be distinguished from necrotizing fasciitis and acute vein thrombosis. Flucloxacillin and cefradine remain the first line of treatment. Recurrence is the main complication, so correct treatment of the risk factors is crucial.

Group A Streptococcus Carriage in an Alabama Child-Care Center Following a Fatal Invasive Case

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 1030-1030
Author(s):  
Michael M. Engelgau ◽  
John M. Horan ◽  
Charles H. Woernle ◽  
Banjamin Schwartz ◽  
Richard R. Facklam ◽  
...  
Keyword(s):  
Risk Factors ◽  
Child Care ◽  
Group A Streptococcus ◽  
Care Center ◽  
Fatal Case ◽  
Prophylactic Antibiotic ◽  
Child Care Center ◽  
Antibiotic Administration ◽  
Group A

Carriage of the GAS strain was common and widespread following a single fatal case of invasive GAS disease at the child-care center. Risk factors for GAS T-1 carriage did not identify all carriers. Our findings suggest that widespread culturing is needed to identify all potential carriers. The role of prophylactic antibiotic administration in preventing secondary cases could not be determined.

scholarly journals The Majority of 9,729 Group A Streptococcus Strains Causing Disease Secrete SpeB Cysteine Protease: Pathogenesis Implications

2015 ◽  
Vol 83 (12) ◽  
pp. 4750-4758 ◽  
Author(s):  
Randall J. Olsen ◽  
Anjali Raghuram ◽  
Concepcion Cantu ◽  
Meredith H. Hartman ◽  
Francisco E. Jimenez ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Cysteine Protease ◽  
Protease Activity ◽  
Sequence Data ◽  
Group A Streptococcus ◽  
Whole Genome Sequence ◽  
Wild Type ◽  
Tissue Destruction ◽  
Lethal Challenge ◽  
Group A

Group A streptococcus (GAS), the causative agent of pharyngitis and necrotizing fasciitis, secretes the potent cysteine protease SpeB. Several lines of evidence suggest that SpeB is an important virulence factor. SpeB is expressed in human infections, protects mice from lethal challenge when used as a vaccine, and contributes significantly to tissue destruction and dissemination in animal models. However, recent descriptions of mutations in genes implicated in SpeB production have led to the idea that GAS may be under selective pressure to decrease secreted SpeB protease activity during infection. Thus, two divergent hypotheses have been proposed. One postulates that SpeB is a key contributor to pathogenesis; the other, that GAS is under selection to decrease SpeB during infection. In order to distinguish between these alternative hypotheses, we performed casein hydrolysis assays to measure the SpeB protease activity secreted by 6,775 GAS strains recovered from infected humans. The results demonstrated that 84.3% of the strains have a wild-type SpeB protease phenotype. The availability of whole-genome sequence data allowed us to determine the relative frequencies of mutations in genes implicated in SpeB production. The most abundantly mutated genes were direct transcription regulators. We also sequenced the genomes of 2,954 GAS isolates recovered from nonhuman primates with experimental necrotizing fasciitis. No mutations that would result in a SpeB-deficient phenotype were identified. Taken together, these data unambiguously demonstrate that the great majority of GAS strains recovered from infected humans secrete wild-type levels of SpeB protease activity. Our data confirm the important role of SpeB in GAS pathogenesis and help end a long-standing controversy.

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