Candida albicans necrotizing fasciitis following elective surgery

Lethal soft-tissue necrosis early after organ transplantation: a case report

Introduction and importance

Necrotizing soft tissue infection (NSTI) is a rapidly spreading infection which affects subcutaneous tissue, extending to a muscular level. Early and aggressive surgical exploration is frequently necessary, especially in patients with significant comorbidities or advanced age. NSTIs are commonly caused by Streptococcus pyogenes or methicillin resistant Staphylococcus aureus, though monomicrobial infections with Candida species have been reported.

Case presentation

A 64-year-old developed an NSTI of the upper left leg following bilateral lung transplantation. The patient presented with atypical clinical and radiographical symptoms, leading to initial management with antimicrobial therapy. Cultures taken preoperatively and intraoperatively were positive for Candida albicans without the presence of other microorganisms. Surgical exploration revealed extensive necrosis of the upper left leg and groin, resulting in deep sepsis which ultimately led to the patient's death.

Clinical discussion

NSTI should be monitored with extra vigilance in immunocompromised or otherwise at risk patients, especially when exhibiting atypical symptoms or disease course. Extensive surgical exploration remains the cornerstone of adequate treatment.

Conclusion

NSTIs caused by monomicrobial infections with C. albicans are rare and typically progress rapidly. We report a case of monomicrobial NSTI in an immunocompromised patient following bilateral lung transplantation characterized by atypical presentation and course, with C. albicans as the main pathogen.

Necrotizing Soft Tissue Infections

Necrotizing soft tissue infections are a diverse group of severe infections of the skin, fascia, and musculature. These infections are characterized by the rapid and progressive destruction of soft tissue, as well as high incidence of morbidity and mortality. Prompt diagnosis, appropriate antimicrobial choice, and aggressive surgical interventions are essential in effecting a clinical cure and optimal outcomes for patients. Despite advances in medical care since necrotizing soft tissue infections were first described, the morbidity and mortality associated with them remains high. The etiology, pathophysiology, clinical presentation, diagnostic options, and treatment approach will be reviewed in this article.

Candida albicans necrotizing fasciitis following cosmetic tourism: A case report

BACKGROUND

Necrotizing fasciitis is a rare and potentially life-threatening soft tissue infection, even more so when associated with fungal causative agents. Onset has been identified in nosocomial settings following elective surgery, but not in esthetic surgery.

CASE PRESENTATION

We here present a case of necrotizing fasciitis related to Candida albicans infection which occurred in an immunocompetent patient who received a cosmetic breast augmentation mastopexy combined with a Brazilian Butt Lift using autologous fat grafting. The case was managed with aggressive wound exploration and debridement. Treatment was delayed by the diagnostic challenge and the difficulty in identifying the causative agent, but the patient fully healed and recovered once the C. albicans was isolated in culture tests and appropriate antimycotic treatment was implemented.

CONCLUSION

Considerations should be made regarding the possibility of implementing an antimycotic option for first-line empirical treatment despite the rarity of fungal etiology because of the threat of diagnostic delay and worse outcome.

Oral vaccination with recombinant Lactobacillus casei expressing Aeromonas hydrophila Aha1 against A. hydrophila infections in common carps

The immunogenicity of Aha1, an OMP of Aeromonas hydrophila mediating the adhesion of bacteria onto the mucosal surface of hosts has been established. In this study, recombinant vectors, pPG1 and pPG2, carrying a 1366 bp DNA fragment that was responsible for encoding the 49 kDa Aha1 from A. hydrophila were constructed, respectively, then electroporated into a probiotic strain Lactobacillus casei CC16 separately to generate two types of recombinants, L. casei-pPG1-Aha1 (Lc-pPG1-Aha1) and L. casei-pPG2-Aha1 (Lc-pPG2-Aha1). Subsequently, these were orally administered into common carps to examine their immunogenicity. The expression and localization of the expressed Aha1 protein relative to the carrier L. casei was validated via Western blotting, flow cytometry, and immune fluorescence separately. The recombinant vaccines produced were shown high efficacies, stimulated higher level of antibodies and AKP, ACP, SOD, LZM, C3, C4 in serum in hosts. Immune-related gene expressions of cytokines including IL-10, IL-1β, TNF-α, IFN-γ in the livers, spleens, HK, and intestines were up-regulated significantly. Besides, a more potent phagocytosis response was observed in immunized fish, and higher survival rates were presented in common carps immunized with Lc-pPG1-Aha1 (60%) and Lc-pPG2-Aha1 (50%) after re-infection with virulent strain A. hydrophila. Moreover, the recombinant L. casei were shown a stronger propensity for survivability in the intestine in immunized fish. Taken together, the recombinant L. casei strains might be promising candidates for oral vaccination against A. hydrophila infections in common carps.

Necrotizing Fasciitis: a Clinical Case and a Review of the Literature

Necrotizing fasciitis is a soft tissue, life-threatening infection with a fulminant and often fatal course. Early diagnosis is usually delayed as the onset of the disease is often masked in the form of erysipelas or cellulite. The condition is characterized by necrosis of the skin, subcutaneous tissue and underlying fascia. We describe a case of a 42-year-old man with a complaint of erythema, fever and severe pain in his right leg 4 days before hospitalization. The patient was admitted and treated with a diagnosis of erysipelas. A few hours after admission, in connection with a drastic deterioration in the general condition and dermatological status, he was transferred to a purulentseptic ward with a fulminant picture of necrotizing fasciitis. Debridement and fasciotomy were performed successfully and timely. Good prognosis and survival in patients with NF correlate directly with the complex of measures. Appropriate antibiotics and intensive general support avoid massive systemic diffusion. Early and adequate surgical debridement and fasciotomy are associated with improved survival.