A New Bacteria, Lactobacillus Acidophilus, Causing Necrotizing Fasciitis: A Case Report And Review Of The Literature

Author(s):
Jennifer Hubbard; Walid Saad; Inam Shaikh; Bhavik Jariwala; Ashley Hill; Arjet Gega; Alexander Palesty

Background:First described by Hippocrates in 500BC and popularized by Joseph Jones in 1871, Necrotizing Fasciitis (NF) is a severe necrotizing infection of the soft tissue.

Hypothesis:Spreading along the fascial planes, the disease is rapidly progressive and can involve any part of the body^1,2,3,4,5. Type I and type II are the most common types of NF^2,3,5,6,7. Type I is usually multi-microbial and includes at least one streptococci facultative anaerobe and one or more enterobacteriacae organism^2,3,5,6,7. Type II necrotizing fasciitis is most commonly monomirobial caused by group A streptococcus with or without a staphylococcal aureus infection^2,3,4,5,6,7.

Methods:The diagnosis is clinical and alarming physical exam findings include sloughing of skin, skin discoloration, crepitus, blistering, intense pain with palpation, and easy separation of the fascial planes^3,4,5,7.

Results:The gold standard of treatment for NF is early surgical debridement plus or minus a planned second look operation^3,4,5. Broad spectrum antibiotics while awaiting cultures and intensive care admission for close hemodynamic monitoring is extremely beneficial for the patient^3,4,5,7.

Conclusions:We present a case of a 59-year old female, found to be in diabetic ketoacidosis, with a left labial abscess which progressed to an abdominopelvic NF requiring multiple debridements and prolonged hospitalization. Interestingly, the causative organism for our patient’s NF was lactobacillus acidophilus, which has not been reported as a species to cause NF. This is followed by a review of the literature.