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JMD 2005, Vol. 7, No. 5
Copyright © 2005 American Society for Investigative Pathology & Association for Molecular Pathology

Molecular Diagnosis of Necrotizing Fasciitis by 16S rRNA Gene Sequencing and Superantigen Gene Detection

Kenneth L. Muldrew*, Jean F. Simpson*, Charles W. Stratton*{dagger} and Yi-Wei Tang*{dagger}

From the Departments of Pathology * and Medicine, {dagger} Vanderbilt University Medical Center, Nashville, Tennessee

We report the use of molecular techniques in the diagnosis of a case of culture-negative necrotizing fasciitis occurring in a 32-year-old female with no significant past medical history and who died within 36 hours of admission. Paraffin-embedded tissue sections from the popliteal fossa region obtained at autopsy showed hemorrhage, necrosis, and mild inflammation by hematoxylin and eosin staining. Tissue gram stain showed numerous gram-positive organisms arranged in clusters. The sequences of the first 500 bp of bacterial 16S rRNA gene amplified from the lesion were identical to a Lancefield group A ß-hemolytic Streptococcus pyogenes. Streptococcal pyrogenic exotoxin A and B superantigen genes were detected and an emm type 1 was determined by polymerase chain reaction and sequencing from the lesion. This confirmed the etiology of the patient’s rapid deterioration with multisystem organ failure.




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K. L. Muldrew, R. R. Miller, M. Kressin, Y.-W. Tang, and C. Stratton
Necrotizing Fasciitis from Vibrio vulnificus in a Patient with Undiagnosed Hepatitis and Cirrhosis
J. Clin. Microbiol., March 1, 2007; 45(3): 1058 - 1062.
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