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Fatal case of necrotizing fasciitis due to Myroides odoratus.pdf

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Fatal case of necrotizing fasciitis due to Myroides odoratus

CASE REPORT Fatal case of necrotizing fasciitis due to Myroides odoratus N. F. Crum-Cianflone ? R. W. Matson ? G. Ballon-Landa Received: 9 April 2014 / Accepted: 21 April 2014 / Published online: 8 May 2014 Springer-Verlag Berlin Heidelberg 2014 Abstract Myroides sp., previously known as Flavobac- terium odoratum, is a relatively unknown organism with unclear human pathogenicity. While Myroides sp. has been implicated in human infections, many reports have descri- bed the organism as a relatively avirulent opportunistic pathogen. We present an unusual case of rapidly fatal necrotizing fasciitis and septic shock due to Myroides od- oratus. Our case demonstrates the pathogenicity of Myro- ides, 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. Keywords Myroides Life-threatening infection Necrotizing fasciitis Septic shock Cirrhosis Introduction Severe skin and soft tissue infections (SSTIs), including necrotizing forms, that are monomicrobial in nature are most commonly caused by a Staphylococcus and Streptococcus species [1]. Among those with underlying conditions, including cirrhosis, Gram-negative bacteria such as Vibrio and Aeromonas species may occasionally cause necrotizing infections [2, 3]. Other organisms are less commonly implicated in severe SSTIs, but their rec- ognition is important, especially when these organisms are associated with unique antimicrobial susceptibilities and potentially fatal outcomes. Flavobacterium odaratum, reclassified in 1996 based on genotypic and phenotypic data as Myroides odoratus [4], was described nearly a century ago as an avirulent organ- ism of unclear human significanc