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01.12.2017 | Case report | Ausgabe 1/2017 Open Access

BMC Infectious Diseases 1/2017

Zoonotic necrotizing myositis caused by Streptococcus equi subsp. zooepidemicus in a farmer

Zeitschrift:
BMC Infectious Diseases > Ausgabe 1/2017
Autoren:
Bård Reiakvam Kittang, Veronika Kuchařová Pettersen, Oddvar Oppegaard, Dag Harald Skutlaberg, Håvard Dale, Harald G. Wiker, Steinar Skrede
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s12879-017-2262-7) contains supplementary material, which is available to authorized users.

Abstract

Background

Streptococcus equi subsp. zooepidemicus is a beta-hemolytic group C streptococcus mainly causing infections in domesticated animals. Here we describe the first case of zoonotic necrotizing myositis caused by this bacterium.

Case presentation

The patient was a 73-year-old, previously healthy farmer with two asymptomatic Shetland ponies in his stable. After close contact with the ponies while feeding them, he rapidly developed erythema of his left thigh and sepsis with multiple organ failure. The clinical course was severe and complicated, requiring repetitive surgical excision of necrotic muscle, treatment with vasopressors, mechanical ventilation and continuous venovenous hemofiltration, along with adjunctive hyperbaric oxygen therapy. The patient was discharged from hospital at day 30, without obvious sequelae.
The streptococcal isolate was identified as Streptococcus equi by MALDI-ToF MS, and was later assigned subspecies identification as S. equi subsp. zooepidemicus. Multilocus sequence typing identified the strain as a novel sequence type (ST 364), closely related to types previously identified in horses and cattle. A focused proteomic analysis revealed that the ST 364 expressed putative virulence factors similar to that of Streptococcus pyogenes, including homologues of the M protein, streptodornases, interleukin 8-protease and proteins involved in the biosynthesis of streptolysin S.

Conclusion

This case illustrates the zoonotic potential of S. equi subsp. zooepidemicus and the importance of early clinical recognition, rapid and radical surgical therapy, appropriate antibiotics and adequate supportive measures when necrotizing soft tissue infection is suspected. The expression of Streptococcus pyogenes-like putative virulence determinants in ST 364 might partially explain the fulminant clinical picture.
Zusatzmaterial
Additional file 1: Proteomic analysis – materials and methods. Methodology of sample preparation for LC-MS/MS analysis and the MS/MS data analysis. (DOC 40 kb)
12879_2017_2262_MOESM1_ESM.doc
Additional file 2: Data sheets – Proteins and Peptides. Results from the proteomic analysis; Streptococcus equi subsp. zooepidemicus proteins detected at 1% FDR and corresponding peptide sequences detected at 1% FDR. (XLSX 45 kb)
12879_2017_2262_MOESM2_ESM.xlsx
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