Bacteremia due to Granulicatella adiacens has been rarely reported in the medical literature. A middleaged gentleman developed necrotizing fasciitis on his left second toe after stepping on a nail. A ray amputation was performed and ceftazidime-susceptible Pseudomonas aeruginosa was isolated from his bone culture. However, while receiving ceftazidime for the necrotizing fasciitis, his blood culture vial was positive for gram-positive cocci-shaped bacteria in short chains which grew as tiny non-lytic colonies on sheep blood agar only following extended incubation. There was no culture evidence of P. aeruginosa in the same blood specimen. The gram-positive organism was conclusively identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry as G. adiacens. The patient was treated with benzylpenicillin (to which the organism tested susceptible) for 14 days before he was discharged home.
Necrotising fasciitis is a life-threatening infection of the soft tissue which can be caused by different microorganisms, but infection caused by Aeromonas spp. or Vibrio spp. is frequently associated with higher mortality rate. Necrotising fasciitis progresses rapidly and often need aggressive surgical intervention. We present a rare case of necrotising fasciitis cause by Aeromonas sobria which mortality was successfully prevented by swift diagnosis and aggressive surgery.
Acupuncture is used for some conditions as an alternative to medication or surgical intervention. Several complications had been reported, and they are generally due to physical injury by the needle or transmission of diseases. We report a case of life-threatening necrotising fasciitis that developed after acupuncture treatment for osteoarthritis of the knee in a 55-year-old diabetic woman. She presented with multiple discharging sinuses over the right knee. As the patient did not respond to intravenous antibiotics, extensive debridement was performed. She made a good recovery. Since many old diabetic patients with degenerative joint diseases may consider this mode of treatment, guidelines on cleanliness and sterility of this procedure should be developed and practiced.