Document Detail

Unusual "flesh-eating" strains of Escherichia coli.
MedLine Citation:
PMID:  23035196     Owner:  NLM     Status:  MEDLINE    
Monomicrobial necrotizing fasciitis (type II) is typically caused by group A streptococcus alone or in combination with Staphylococcus aureus. Escherichia coli has been isolated from polymicrobial or Fournier's gangrene but has rarely been reported in monomicrobial necrotizing fasciitis. We describe the clinical characteristics and outcomes of seven cases of monomicrobial E. coli necrotizing fasciitis and/or severe soft tissue infection diagnosed at a single institution during an 18-month period. Four isolates from three patients and two isolates from two patients with type I polymicrobial severe soft tissue infection (controls) were assayed by the randomly amplified polymorphic DNA (RAPD) analysis for fingerprinting and PCR amplification of primers in order to detect cytotoxic necrotizing factor 1 and 2 (cnf1 and cnf2) genes. All patients had some type of immune suppression. The limb was the most commonly involved organ. In all cases, E. coli was isolated as a monomicrobial pathogen from blood, fascia, or both. All patients died during hospitalization, three within the first 48 h. The RAPD amplification assay showed a high degree of genetic diversity among the "flesh-eating" strains and controls. The cnf1 toxin gene was identified in two out of three cases, but not in the controls. cnf2 was not detected in any of the patients. E. coli may be responsible for life-threatening necrotizing fasciitis. Further research is needed to reveal relevant risk factors, reservoirs, and modes of transmission of cnf1 E. coli.
Hila Shaked; Zmira Samra; Michal Paul; Liora Madar-Shapiro; Jonathan Cohen; Silvio Pitlik; Jihad Bishara
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2012-10-03
Journal Detail:
Title:  Journal of clinical microbiology     Volume:  50     ISSN:  1098-660X     ISO Abbreviation:  J. Clin. Microbiol.     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-19     Completed Date:  2013-04-17     Revised Date:  2013-07-11    
Medline Journal Info:
Nlm Unique ID:  7505564     Medline TA:  J Clin Microbiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  4008-11     Citation Subset:  IM    
Unit of Infectious Diseases, Rabin Medical Center, Beilinson Campus, Petah Tikva, Israel.
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MeSH Terms
Aged, 80 and over
Bacterial Toxins / genetics
DNA Fingerprinting
Escherichia coli / classification,  genetics,  isolation & purification*,  pathogenicity
Escherichia coli Infections / microbiology*,  mortality,  pathology*
Escherichia coli Proteins / genetics
Fasciitis, Necrotizing / microbiology*,  mortality,  pathology*
Fatal Outcome
Middle Aged
Random Amplified Polymorphic DNA Technique
Streptococcus pyogenes / classification,  genetics,  isolation & purification*,  pathogenicity
Reg. No./Substance:
0/Bacterial Toxins; 0/Escherichia coli Proteins; 0/cytotoxic necrotizing factor type 2; 106803-33-2/cytotoxic necrotizing factor type 1

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