A case report of necrotizing fasciitis with a sole causative agent: Actinotignum schaalii: Necrotizing fasciitis due to Actinotignum schaalii

Mateusz Michalczak; Jakub Michalczak; Aldona Olechowska-Jarząb; Justyna Rymarowicz

doi:10.28982/josam.8231

Authors

Mateusz Michalczak 2nd Department of General Surgery, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Kraków, Poland. https://orcid.org/0009-0000-9133-4935
Jakub Michalczak 2nd Department of General Surgery, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Kraków, Poland. https://orcid.org/0009-0006-9072-3385
Aldona Olechowska-Jarząb Department of Microbiology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Kraków, Poland. & Department of Pharmaceutical Microbiology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Kraków, Poland. https://orcid.org/0009-0007-8149-7424
Justyna Rymarowicz 2nd Department of General Surgery, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Kraków, Poland. https://orcid.org/0000-0002-6713-5255

DOI:

https://doi.org/10.28982/josam.8231

Keywords:

Necrotizing Fasciitis, Actinotignum schaalii, Soft Tissue Infections, Anaerobic Bacteria, Infectious Disease Diagnostics, Clinical Case Report, Advanced Diagnostic Techniques, Rare Pathogens, MALDI-TOF, Diabetes and Infections

Abstract

Actinotignum schaalii (A. schaalii) is a Gram-positive, anaerobic bacterium. While primarily associated with urinary tract infections in elderly and immunocompromised individuals, it has also been implicated in soft tissue infections such as necrotizing fasciitis. However, its role as a primary pathogen in necrotizing fasciitis outside the genitourinary region remains underreported. We present a case of necrotizing fasciitis of the axilla caused by A. schaalii in an elderly diabetic female. This case is unique in that it highlights the bacterium’s role as the sole causative agent in a severe soft tissue infection, diverging from its typical polymicrobial involvement. This case emphasizes the pathogenic potential of A. schaalii in severe soft tissue infections and highlights the importance of advanced microbiological techniques for its accurate identification.

Downloads

Download data is not yet available.

References

Maraki S, Evangelou G, Stafylaki D, Scoulica E. Actinotignum schaalii subcutaneous abscesses in a patient with hidradenitis suppurativa: case report and literature review. Anaerobe. 2017;43:43–6. doi:10.1016/j.anaerobe.2016.11.010. Epub 2016 Nov 29. PMID: 27913316. DOI: https://doi.org/10.1016/j.anaerobe.2016.11.010

Könönen E, Wade WG. Actinomyces and related organisms in human infections. Clin Microbiol Rev. 2015;28(2):419–42. doi:10.1128/cmr.00100-14. PMID: 25788515; PMCID: PMC4402957. DOI: https://doi.org/10.1128/CMR.00100-14

Bank S, Jensen A, Hansen TM, Søby M, Prag J, Kemp M. Actinobaculum schaalii, a common uropathogen in elderly patients, Denmark. Emerg Infect Dis. 2013;19(7):1123–9. doi:10.3201/eid1601.090761. PMID: 20031046; PMCID: PMC2874361. DOI: https://doi.org/10.3201/eid1601.090761

Tena D, Fernández C, Lago MR, Arias M, Medina MJ, Sáez-Nieto JA. Skin and soft-tissue infections caused by Actinobaculum schaalii: report of two cases and literature review. Anaerobe. 2014 Aug;28:95-7. doi: 10.1016/j.anaerobe.2014.05.009. Epub 2014 Jun 9. PMID: 24923266. DOI: https://doi.org/10.1016/j.anaerobe.2014.05.009

Panganiban CM, Gupta S. Actinotignum schaalii Abscess in a Patient with Common Variable Immunodeficiency. Pathogens. 2020 Jun 22;9(6):494. doi: 10.3390/pathogens9060494. PMID: 32580346; PMCID: PMC7350303. DOI: https://doi.org/10.3390/pathogens9060494

Tschudin-Sutter S, Frei R, Weisser M, Goldenberger D, Widmer AF. Actinobaculum schaalii - invasive pathogen or innocent bystander? A retrospective observational study. BMC Infect Dis. 2011 Oct 26;11:289. doi: 10.1186/1471-2334-11-289. PMID: 22029906; PMCID: PMC3252262. DOI: https://doi.org/10.1186/1471-2334-11-289

Lotte R, Lotte L, Ruimy R. Actinotignum schaalii (formerly Actinobaculum schaalii): a newly recognized pathogen-review of the literature. Clin Microbiol Infect. 2016 Jan;22(1):28-36. doi: 10.1016/j.cmi.2015.10.038. Epub 2015 Nov 11. PMID: 26577137. DOI: https://doi.org/10.1016/j.cmi.2015.10.038

Vanden Bempt I, Van Trappen S, Cleenwerck I, De Vos P, Camps K, Celens A, Van De Vyvere M. Actinobaculum schaalii causing Fournier's gangrene. J Clin Microbiol. 2011 Jun;49(6):2369-71. doi: 10.1128/JCM.00272-11. Epub 2011 Apr 20. PMID: 21508151; PMCID: PMC3122759. DOI: https://doi.org/10.1128/JCM.00272-11

Cattoir V. Actinobaculum schaalii: review of an emerging uropathogen. J Infect. 2012 Mar;64(3):260-7. doi: 10.1016/j.jinf.2011.12.009. Epub 2011 Dec 21. PMID: 22209960. DOI: https://doi.org/10.1016/j.jinf.2011.12.009

Clarke TM, Citron DM, Towfigh S. The conundrum of the gram-positive rod: are we missing important pathogens in complicated skin and soft-tissue infections? A case report and review of the literature. Surg Infect (Larchmt). 2010 Feb;11(1):65-72. doi: 10.1089/sur.2008.085. PMID: 19803730. DOI: https://doi.org/10.1089/sur.2008.085

Kus NJ, Kim BJ, Ross HM. A case report of necrotizing fasciitis with growth of Actinomyces europaeus and Actinotignum schaalii. J Surg Case Rep. 2019 Oct 17;2019(10):rjz286. doi: 10.1093/jscr/rjz286. PMID: 31636892; PMCID: PMC6796188. DOI: https://doi.org/10.1093/jscr/rjz286

Bank S, Søby KM, Kristensen LH, Voldstedlund M, Prag J. A validation of the Danish microbiology database (MiBa) and incidence rate of Actinotignum schaalii (Actinobaculum schaalii) bacteraemia in Denmark. Clin Microbiol Infect. 2015 Dec;21(12):1097.e1-4. doi: 10.1016/j.cmi.2015.08.006. Epub 2015 Aug 28. PMID: 26319901. DOI: https://doi.org/10.1016/j.cmi.2015.08.006

Olsen AB, Andersen PK, Bank S, Søby KM, Lund L, Prag J. Actinobaculum schaalii, a commensal of the urogenital area. BJU Int. 2013 Aug;112(3):394-7. doi: 10.1111/j.1464-410X.2012.11739.x. Epub 2013 Jan 25. PMID: 23350855. DOI: https://doi.org/10.1111/j.1464-410X.2012.11739.x

Sahuquillo-Arce JM, Suárez-Urquiza P, Hernández-Cabezas A, Tofan L, Chouman-Arcas R, García-Hita M, Sabalza-Baztán O, Sellés-Sánchez A, Lozano-Rodríguez N, Martí-Cuñat J, López-Hontangas JL. Actinotignum schaalii infection: Challenges in diagnosis and treatment. Heliyon. 2024 Mar 22;10(7):e28589. doi: 10.1016/j.heliyon.2024.e28589. PMID: 38590897; PMCID: PMC10999919. DOI: https://doi.org/10.1016/j.heliyon.2024.e28589

Ioannou P, Karakonstantis S, Tavlas E, Kontopodis N, Maraki S, Chamilos G, Kofteridis DP. Actinotignum schaalii infection - a case series from a tertiary hospital in Greece. Germs. 2022 Sep 30;12(3):394-9. doi: 10.18683/germs.2022.1343. PMID: 37680677; PMCID: PMC10482473. DOI: https://doi.org/10.18683/germs.2022.1343

Pedersen H, Senneby E, Rasmussen M. Clinical and microbiological features of Actinotignum bacteremia: a retrospective observational study of 57 cases. Eur J Clin Microbiol Infect Dis. 2017 May;36(5):791-6. doi: 10.1007/s10096-016-2862-y. Epub 2016 Dec 12. PMID: 27957598; PMCID: PMC5395584. DOI: https://doi.org/10.1007/s10096-016-2862-y

Gomez E, Gustafson DR, Rosenblatt JE, Patel R. Actinobaculum bacteremia: a report of 12 cases. J Clin Microbiol. 2011 Dec;49(12):4311-3. doi: 10.1128/JCM.00798-11. Epub 2011 Oct 5. PMID: 21976754; PMCID: PMC3232933. DOI: https://doi.org/10.1128/JCM.00798-11

Sandlund J, Glimåker M, Svahn A, Brauner A. Bacteraemia caused by Actinobaculum schaalii: An overlooked pathogen? Scand J Infect Dis. 2014 Aug;46(8):605-8. doi: 10.3109/00365548.2014.913306. Epub 2014 May 20. PMID: 24840345. DOI: https://doi.org/10.3109/00365548.2014.913306