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Case Reports
. 2022 Dec 22:31:e01667.
doi: 10.1016/j.idcr.2022.e01667. eCollection 2023.

A case of necrotizing fasciitis caused by Bifidobacterium breve

Yuriko Takeda  1 , Koshi Ota  1 , Ayuka Kondo  1 , Tomonobu Nishii  1 , Naoya Onishi  1 , Hiroki Yokoyama  1 , Kazuma Yamakawa  1 , Akira Takasu  1
Affiliations
Case Reports

A case of necrotizing fasciitis caused by Bifidobacterium breve

Yuriko Takeda et al. IDCases. .

Abstract

Background: Bifidobacterium breve is an obligate anaerobic gram-positive bacillus mainly found in the gastrointestinal tract of human infants. Few cases of necrotizing fasciitis caused by B. breve have been reported.

Case presentation: A 42-year-old Japanese man with type 2 diabetes mellitus, obesity, cellulitis of the back, and subcutaneous abscess of the right inguinal region presented with rapidly developing erythema, swelling and severe pain in the right inguinal region. Computed tomography showed widespread gas in the right leg region. Cultures of blood and a swab of the wound abscess grew gram-positive bacilli. Mass spectrography and 16 S rDNA analysis confirmed the gram-positive bacilli as B. breve. The patient recovered following extensive debridement and antibacterial therapy.

Conclusion: Unidentified necrotizing fasciitis can be caused by B. breve, especially in compromised hosts.

Keywords: B. breve, Bifidobacterium breve; Bifidobacterium breve; CT, computed tomography; Mass spectrograph; Necrotizing fasciitis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Results of blood culture. Anaerobic gram-positive bacilli with short and club-shaped rods, often showing bifurcation. Identification of the species from morphological features alone was not possible.
Fig. 2
Fig. 2
Results of 16 S rDNA analysis. A) Base sequence of the sample from the patient. B) Base sequence of the sample shows 98 % concordance with Bifidobacterium breve.
Fig. 3
Fig. 3
Plain CT taken on hospital day 1, (A) Horizontal section of the pelvic CT shows gas in the adipose tissue of the right inguinal region (arrow). CT attenuation value of the subcutaneous adipose tissue is increased around the gas. These findings are consistent with necrotizing fasciitis. (B) Horizontal section of the CT at the level of the femoral head shows widespread gas around the right gluteus medius muscle and the right iliacus muscle (arrows). (C) Coronal section of the CT shows widespread gas from the inside of the right femur to subcutaneous tissue over the superior anterior iliac spine, and from the muscles around the right femur to the right iliopsoas muscle (arrows). (D) Sagittal section of the CT shows widespread gas from front of the right quadriceps femoral muscle to the right iliopsoas muscle (arrows).
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