Fatal case of necrotizing fasciitis due to Myroides odoratus.

Myroides sp., previously known as Flavobacterium odoratum, is a relatively unknown organism with unclear human pathogenicity. While Myroides sp. has been implicated in human infections, many reports have described the organism as a relatively avirulent opportunistic pathogen. We present an unusual case of rapidly fatal necrotizing fasciitis and septic shock due to Myroides odoratus. Our case demonstrates the pathogenicity of Myroides, and highlights potential risk factors for infection including underlying liver disease and open wounds. The recognition of Myroides is of particular importance given its resistance to multiple antibiotics. We review the literature on Myroides sp. skin and soft tissue infections, including necrotizing forms, and discuss the clinical presentation and management of this potentially emerging pathogen.

Necrotizing fasciitis due to penicillin-resistant Streptococcus pneumoniae: case report and review of the literature.

Necrotizing fasciitis (NF) is a life-threatening infection involving rapid necrosis of subcutaneous and fascial tissues. Streptococcus pneumoniae (SPN) soft tissue infection is exceedingly uncommon, reported primarily in patients with immunosuppression or other underlying conditions. We report a case of NF and septic shock in a healthy 32-year-old man, whose only predisposing factor was antecedent blunt trauma. Pathological examination and culture of the extensive tissue debridement were positive only for SPN. The serotype 9V isolate was penicillin (PCN)-resistant (MIC=2.0), and closely-related by pulse field gel electrophoresis and multilocus fingerprinting to clone France 9V-3, an important genetic reservoir for increasing PCN-resistance worldwide. This unique case has implications for our pathogenic under-standing and empiric management of NF.

Growth and antigenic variation of Trypanosoma brucei, T. rhodesiense and T. gambiense in subcutaneous millipore chambers.

The inability to cultivate infective bloodstream forms of the African trypanosomes in cell-free media has complicated studies of the biology of trypanosomes and the pathogenesis of trypanosomiasis. We attempted to overcome this problem by subcutaneous implantation in mice of Millipore chambers that isolate trypanosomes from cells but permit diffusion of soluble substances across their membranes. Chambers were inoculated with 5 X 10(4) to 5 X 10(5) per ml Trypanosoma brucei, T. rhodesiense or T. gambiense; the trypanosomes multiplied rapidly, persisted for as long as five weeks, and remained infective, even when the original inocula were freed of donor cells by ion-exchange. The presence of anti-trypanosomal IgG and IgM in the sera and chambers of recipient mice proved that trypanosomal and mammalian products crossed the membranes. Chamber trypanosomes also expressed two important aspects of normal in vivo biological behaviour: (i) differentiation from long slender to short stumpy bloodstream forms and (ii) antigenic variation. Death of trypanosomes was associated with the presence of IgM antibody in the chambers. This model provides a system for study of an entire population of trypanosomes in an extravascular, cell-free environment.