Salmonella typhimurium necrotizing fasciitis: a case report.
Bacteremia
Case report
Fusarium
Immunodeficiency
Necrotizing fasciitis
Salmonella
Salmonella non-typhi
Salmonella typhimurium
Salmonellosis
Journal
Journal of medical case reports
ISSN: 1752-1947
Titre abrégé: J Med Case Rep
Pays: England
ID NLM: 101293382
Informations de publication
Date de publication:
13 Aug 2023
13 Aug 2023
Historique:
received:
29
11
2022
accepted:
20
07
2023
medline:
14
8
2023
pubmed:
13
8
2023
entrez:
12
8
2023
Statut:
epublish
Résumé
Necrotizing fasciitis is an aggressive disease that causes necrosis in the muscular fascia and subcutaneous tissues. The infection spreads rapidly along the fascia and perifascial planes, followed by extension of the infection to nearby soft tissues and muscles. Necrotizing fasciitis can be attributed to different pathogens, namely Staphylococcus aureus, group A streptococci, and Clostridium perfringes. Only a few cases of skin and soft tissue infections from Salmonella species have been reported to date. Herein we report a case of Salmonella non-typhi necrotizing fasciitis, an exceedingly rare entity. This case report may serve as a potential management plan in similar cases in light of the scarcity of evidence. A 20-year-old Caucasian male patient with congenital cardiac anomaly presented with diarrhea and unilateral lower extremity cellulitis causing septic shock. Cultures from blood and the bullae associated with the lower extremity cellulitis grew Salmonella typhimurium. Surgical debridement was performed. Intraoperative tissue cultures were positive for Salmonella typhimurium, and surgical pathology confirmed the diagnosis of necrotizing fasciitis. After a total of 6 weeks of appropriate antimicrobial therapy, another surgical debridement was executed for poor wound healing. New intraoperative cultures grew Fusarium species, and the patient received voriconazole with an adequate response. Immunologic studies showed humoral and cellular immunodeficiency. It is important to maintain a high index of suspicion for rare entities that can cause skin and soft tissue infections, such as Salmonella non-typhi, in particular in immunosuppressed patients where a delay in diagnosis and management may have significant morbidity and mortality.
Sections du résumé
BACKGROUND
BACKGROUND
Necrotizing fasciitis is an aggressive disease that causes necrosis in the muscular fascia and subcutaneous tissues. The infection spreads rapidly along the fascia and perifascial planes, followed by extension of the infection to nearby soft tissues and muscles. Necrotizing fasciitis can be attributed to different pathogens, namely Staphylococcus aureus, group A streptococci, and Clostridium perfringes. Only a few cases of skin and soft tissue infections from Salmonella species have been reported to date. Herein we report a case of Salmonella non-typhi necrotizing fasciitis, an exceedingly rare entity. This case report may serve as a potential management plan in similar cases in light of the scarcity of evidence.
CASE PRESENTATION
METHODS
A 20-year-old Caucasian male patient with congenital cardiac anomaly presented with diarrhea and unilateral lower extremity cellulitis causing septic shock. Cultures from blood and the bullae associated with the lower extremity cellulitis grew Salmonella typhimurium. Surgical debridement was performed. Intraoperative tissue cultures were positive for Salmonella typhimurium, and surgical pathology confirmed the diagnosis of necrotizing fasciitis. After a total of 6 weeks of appropriate antimicrobial therapy, another surgical debridement was executed for poor wound healing. New intraoperative cultures grew Fusarium species, and the patient received voriconazole with an adequate response. Immunologic studies showed humoral and cellular immunodeficiency.
CONCLUSION
CONCLUSIONS
It is important to maintain a high index of suspicion for rare entities that can cause skin and soft tissue infections, such as Salmonella non-typhi, in particular in immunosuppressed patients where a delay in diagnosis and management may have significant morbidity and mortality.
Identifiants
pubmed: 37573427
doi: 10.1186/s13256-023-04090-x
pii: 10.1186/s13256-023-04090-x
pmc: PMC10423414
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
345Informations de copyright
© 2023. BioMed Central Ltd., part of Springer Nature.
Références
Wallace HA, Perera TB. Necrotizing fasciitis. In: StatPearls. Treasure Island: StatPearls Publishing; 2022. http://www.ncbi.nlm.nih.gov/books/NBK430756/ . Accessed 17 Spet 2022.
Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44(5):705–10.
doi: 10.1086/511638
pubmed: 17278065
Stevens DL, Bryant AE. Necrotizing soft-tissue infections. N Engl J Med. 2017;377(23):2253–65.
doi: 10.1056/NEJMra1600673
pubmed: 29211672
Zmora N, Shrestha S, Neuberger A, Paran Y, Tamrakar R, Shrestha A, et al. Open label comparative trial of mono versus dual antibiotic therapy for Typhoid Fever in adults. PLoS Negl Trop Dis. 2018;12(4): e0006380.
doi: 10.1371/journal.pntd.0006380
pubmed: 29684022
pmcid: 5912710
Cherubin CE, Neu HC, Imperato PJ, Harvey RP, Bellen N. Septicemia with non-typhoid salmonella. Medicine (Baltimore). 1974;53(5):365–76.
doi: 10.1097/00005792-197409000-00003
pubmed: 4605105
Cohen JI, Bartlett JA, Corey GR. Extra-intestinal manifestations of salmonella infections. Medicine (Baltimore). 1987;66(5):349–88.
doi: 10.1097/00005792-198709000-00003
pubmed: 3306260
Fernández Guerrero ML, Ramos JM, Núñez A, Cuenca M, de Górgolas M. Focal infections due to non-typhi Salmonella in patients with AIDS: report of 10 cases and review. Clin Infect Dis. 1997;25(3):690–7.
doi: 10.1086/513747
pubmed: 9314463
Canut Blasco A, Brezmes Valdivieso MF, Antolín Ayala MI, Yagüe Muñoz A, Arribas JA. Focal infections caused by non-typhi Salmonella: a review of our case series and comparison with other series. Rev Clin Esp. 1992;191(2):71–5.
pubmed: 1386936
Javaloyas M, García MD, Sierra E, Domingo J. A case of cellulitis, thrombophlebitis and bacteremia caused by Salmonella group E. Eur J Clin Microbiol Infect Dis. 1992;11(2):200–1.
doi: 10.1007/BF01967081
pubmed: 1396740
Marzano AV, Mercogliano M, Borghi A, Facchetti M, Caputo R. Cutaneous infection caused by Salmonella typhi. J Eur Acad Dermatol Venereol. 2003;17(5):575–7.
doi: 10.1046/j.1468-3083.2003.00797.x
pubmed: 12941099
Simeon-Aznar CP, Cuenca-Luque R, Solans-Laque R, Fernandez-Cortijo J, Bosch-Gil JA, Vilardell-Tarres M. Fulminant soft tissue infection by Salmonella enteritidis in SLE. J Rheumatol. 1990;17(11):1570–1.
pubmed: 2273512
Khalid M, Dattani M, Bowley D. Necrotizing fasciitis: expect the unexpected. Int J Surg Case Rep. 2020;76:199–201.
doi: 10.1016/j.ijscr.2020.09.132
pubmed: 33039782
pmcid: 7560614
Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51(8):344–62.
doi: 10.1067/j.cpsurg.2014.06.001
pubmed: 25069713
pmcid: 4199388
Itsiopoulos I, Vasiliadis AV, Tsitouras D, Goulas P, Malliou P, Ktenidis K. Amputation in necrotizing fasciitis—dilemma or reality: a case report and literature review. J Orthop Case Rep. 2020;10(4):54–8.
pubmed: 33623768
pmcid: 7885656
Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJC, Gorbach SL, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases Society of America. Clin Infect Dis. 2014;59(2):e10-52.
doi: 10.1093/cid/ciu296
pubmed: 24973422
Khawcharoenporn T, Apisarnthanarak A, Kiratisin P, Mundy LM. Salmonella group C necrotizing fasciitis: a case report and review of the literature. Diagn Microbiol Infect Dis. 2006;54(4):319–22.
doi: 10.1016/j.diagmicrobio.2005.10.015
pubmed: 16466893