Familial Transmission of Necrotizing Fasciitis Caused by Group A Streptococcus pyogenes

Hoh M1 , Bollinger T2 , Kelly JL3 , Itzek A4 and Dolderer JH1*

1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Medical Center, Bayreuth, Germany 2Department of Laboratory Medicine, Microbiology and Hospital Hygiene, Medical Center, Bayreuth, Germany 3Department of Plastic and Reconstructive Surgery, Galway University Hospital, Galway, Ireland 4 Department of Medical Microbiology, German National Reference Center on Streptococcal Diseases, University Hospital RWTH Aachen, Aachen, Germany

^*Correspondance to: Dolderer JH 

 PDF  Full Text DOI: 10.25107/2474-1647.3010

Abstract

Necrotizing fasciitis is an invasive, life-threatening disease, frequently caused by Streptococcus pyogenes (Group A Streptococcus: GAS). Cases are already documented but the worldwide incidence has increased in recent years. Here we propose two unusual cases of a potential intrafamilial transmission of necrotizing fasciitis and describe the clinical course in each patient. A 66-year-old man was admitted to our hospital with a necrotizing soft tissue infection of the lower leg and five days later his partner was hospitalized with a necrotizing fasciitis of the neck and chest. After multiple surgical interventions and extensive intensive medical care, the male patient was discharged but his partner developed a multiple organ failure and died 27 h after hospitalization. Isolates of GAS from both patients were analyzed at the reference laboratory applying M?protein (emm) gene typing and multiplex PCR screening for superantigen genes. The results of the microbiological examination support the hypothesis of intrafamilial transmission of a S. pyogenes emm89.0 strain. This clinical presentation shows a case of rapid onset necrotizing fasciitis with lethal outcome despite aggressive multimodal treatment. Both patients lived in the same house but were separately admitted a few days apart. Person-to-person transmission of necrotizing fasciitis caused by Streptococcus pyogenes is rare, but should be considered.

Keywords

Necrotizing fasciitis; Streptococcus pyogenes; Familial transmission

Cite the article

Hoh M, Bollinger T, Kelly JL, Itzek A, Dolderer JH. Familial Transmission of Necrotizing Fasciitis Caused by Group a Streptococcus pyogenes. Clin Surg. 2020; 5: 3010..