Community-Acquired Mecithillin-Resistant Staphylococcus Aureus : A Case Report on Necrotizing Fasciitis And Deep Vein Thrombosis In Adolescent Boy

Abdullah Alanazi, J. Alenazi, Suliman Alola, E. Banyan, M. Shalaan
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引用次数: 1

Abstract

Staphylococcus aureus (S. Aureus) is the most common species of staphylococci to cause Staph infections. The infections caused by S. aureus were not difficult to manage. However, in recent past, S. aureus is transformed to its variant forms, including, Methicillin-resistant S. aureus (MRSA) by acquiring methicillin resistant gene (mec A gene). Previously, the MRSA was known for its origin from hospitals, but more recently, it is known to be acquired, from the communities too. Here we report the case presentation of a male adolescent with complicated fibular osteomyelitis, necrotizing fasciitis and deep vein thrombosis caused by Community acquired (CA) MRSA. The preliminary complaint of the patient was swelling in right foot and leg associated with high fever, pain, dyspnea and cough. The clinical presentation fit him as acute respiratory distress syndrome and hence antibiotics (ceftixone and vancomycin) were started. Doppler ultrasound revealed deep vein thrombosis (DVT). Analysis of blood culture showed the presence of MRSA. Hence rifampin and gentamicin were added and ceftrixon was discontinued. MRI revealed ostiomyelitis in the distal part of fibula. The bone infection was so severe that despite of using the three antibiotics, the patient remained febrile with increased leukocytes and neutrophills, the ankle redness became confined with malleollus on each side and the sepsis remained uncontrollable. Repeated MRI showed inflammatory findings, including cellulitis, pyogenic myositis, deep fasciitis and fibular periosteal reactions, suggestive of necrotizing fasciitis. Upon confirmation of fasciitis, fasciotomy with debridement and irrigations was done in multiple sessions and a high dose intravenous immunoglobulin was administered as an adjuvant therapy, resulting in reversal of the disease progression. In light of reports in the literature, we replaced antibiotics with immunoglobulins as a post surgery treatment, which worked well.
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社区获得性耐甲氧西林金黄色葡萄球菌:青少年男孩坏死性筋膜炎及深静脉血栓1例报告
金黄色葡萄球菌(S. aureus)是引起葡萄球菌感染的最常见葡萄球菌。金黄色葡萄球菌引起的感染并不难控制。然而,近年来,金黄色葡萄球菌通过获得耐甲氧西林基因(mec A基因)转化为其变体形式,包括耐甲氧西林金黄色葡萄球菌(MRSA)。以前,人们知道MRSA起源于医院,但最近,人们知道它也可以从社区获得。在此,我们报告一例男性青少年由社区获得性(CA) MRSA引起的并发腓骨骨髓炎、坏死性筋膜炎和深静脉血栓形成的病例。患者的初步主诉为右脚和腿部肿胀并伴有高热、疼痛、呼吸困难和咳嗽。临床表现符合急性呼吸窘迫综合征,因此开始使用头孢替酮和万古霉素。多普勒超声示深静脉血栓形成。血培养分析显示存在MRSA。因此加入利福平和庆大霉素,停用头孢曲松。MRI显示腓骨远端骨脊髓炎。骨感染非常严重,尽管使用了三种抗生素,患者仍然发热,白细胞和中性粒细胞增加,脚踝红肿受限,两侧有内踝,脓毒症仍然无法控制。反复MRI显示炎症表现,包括蜂窝织炎、化脓性肌炎、深筋膜炎和腓骨骨膜反应,提示坏死性筋膜炎。确诊为筋膜炎后,进行了多次筋膜切开、清创和冲洗,并给予高剂量静脉注射免疫球蛋白作为辅助治疗,导致疾病进展逆转。根据文献报道,我们用免疫球蛋白代替抗生素作为术后治疗,效果很好。
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