Clinical characteristics of necrotizing fasciitis caused by group G Streptococcus: case report and review of the literature.

A 52-y-old diabetic male developed severe necrotizing fasciitis due to group G Streptococcus. A review of the English language literature revealed 8 additional cases. The mean age of the total of 9 cases was 65.5 y (range: 49-80 y) and the majority (n = 5; 55.6%) had no comorbid conditions. The duration of symptoms prior to presentation was 1-5 d (mean +/- SD = 2.5 +/- 1.5 d). Presenting manifestations were swelling with redness (6/6 cases; 100%), severe pain (5/6 cases; 83.3%) and blister formation (3/6 cases; 50%); blisters developed eventually in 5/6 (88.3%) patients. Muscle involvement was noted in 2 patients (22.2%). Progression to toxic shock-like syndrome occurred in 3 cases (33.3%). The organism was isolated from the involved sites in all cases. Bacteremia was documented in 1/3 patients. Treatment included antibiotics (n = 9) and varying degrees of surgical debridement (n = 8). The mortality rate was 33.3%; all patients who died developed toxic shock-like syndrome. These findings illustrate that, similar to Streptococcus pyogenes-induced fasciitis, necrotizing fasciitis due to group G Streptococcus can be severe and life-threatening. Early diagnosis, immediate surgical debridement and antibiotic therapy are essential in order to improve the outcome.