Abstract
BackgroundStreptococcus 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 presentationThe 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.ConclusionThis 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.
Highlights
Streptococcus equi subsp. zooepidemicus is a beta-hemolytic group C streptococcus mainly causing infections in domesticated animals
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
necrotizing soft tissue infections (NSTI) caused by S. zooepidemicus was recently documented in a Kittang et al BMC Infectious Diseases (2017) 17:147 dog shortly after subcutaneous vaccination [18], but to our knowledge, human NSTI caused by S. zooepidemicus has not been reported previously
Summary
This first case report on necrotizing myositis caused by S. equi subsp. zooepidemicus illustrates the zoonotic potential and clinical versatility of this betahaemolytic streptococcus. Zooepidemicus illustrates the zoonotic potential and clinical versatility of this betahaemolytic streptococcus. This first case report on necrotizing myositis caused by S. equi subsp. It is a reminder of the fulminant course streptococcal NSTI can pursue, requiring prompt recognition, extensive surgery, appropriate antibiotics and supportive treatment in the intensive care unit. The strain ST 364 belonged to a new sequence type closely related to S. zooepidemicus-strains previously identified in horses, and expressed S. pyogenes-like putative virulence determinants
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