B群連鎖球菌による壊死性筋膜炎の1救命例  [in Japanese] A case of necrotizing fasciitis caused by Group B Streptococcus  [in Japanese]

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壊死性筋膜炎(necrotizing fasciitis, NF)はA群連鎖球菌によって起こることが多く,致死率の高い重篤な感染症である。今回我々は極めて稀なB群連鎖球菌によるNFの1救命例を経験したので報告する。症例は80歳男性。糖尿病を指摘され加療中であった。下腹部に表皮剥離を伴った有痛性の腫瘤を自覚した。2~3日後,疼痛が増悪し不隠状態となったため当院を受診した。腹部CTでガス像を含む皮下組織の広範な壊死を認めたためガス壊疽を疑い緊急の広範囲の腹壁開放術を行った。術後はICUに収容した。壊死組織からB群連鎖球菌が培養された。ICUでは,十分な鎮静下での創の洗浄,抗生物質,γグロブリン投与などにより第14病日に軽快退室した。B群連鎖球菌によるNFはA群と同様に極めて重篤で,治療には早期の開放洗浄術を含めた集中管理が重要である。

We report a rare case of necrotizing fasciitis not by group A but by group B <i>Streptococcus</i>. An 80-year-old man who had medicated diabetes with hypoglycemic drugs complained of painful erythema in lower abdomen when he arrived at our emergency room. His body temperature was 38°C and CRP was 65.7mg·d<i>l</i><sup>-1</sup>. Subcutaneous gases revealed by computed tomography suggested gas gangrene in the lower abdomen. He immediately underwent extensive debridement of necrotic tissues and put on a ventilator postoperatively in ICU. An open wound was irrigated with acid water everyday and prostaglandin E<sub>1</sub> was infused in expectation of improving wound microcirculation. Skin graft surgery on the 12th day successfully covered the wound and the patient was discharged from ICU on the 14th day. Group B <i>Streptococcus</i> was detected in culture of necrotic tissue. Necrotizing fasciitis caused by group B <i>Streptococcus</i> is as catastrophic as that of group A <i>Streptococcus</i>. Early and extensive debridement, wound irrigation, and administration of appropriate antibiotics and prostaglandin E<sub>1</sub> resulted in good recovery.


  • Journal of the Japanese Society of Intensive Care Medicine

    Journal of the Japanese Society of Intensive Care Medicine 9(2), 121-126, 2002-04-01

    The Japanese Society of Intensive Care Medicine

References:  20

Cited by:  3


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