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An Unusual Cause of Tenosynovitis by Group B Streptococcus in the Immunocompromised Patient: A Case Report

AbdulRahman Muthanna, Nur Afiza Aziz, Mohd Nasir Mohd Desa, Nurul Diana Dzaraly, Nurul Hana Zainal Baharin, Mohammad Noor Amal Azmai and Syafinaz Amin-Nordin

Pertanika Journal of Science & Technology, Volume 30, Issue 3, July 2022

DOI: https://doi.org/10.47836/pjst.30.3.17

Keywords: Group B Streptococcus, human, immunocompromised, tenosynovitis

Published on: 25 May 2022

This case report describes a 49-year-old immunocompromised woman with tenosynovitis of the left middle finger caused by Group B Streptococcus (GBS). She claimed that a fishbone picked over her left middle finger. An orthopaedic surgeon operated for incision and drainage of pus discharge, wound debridement of the left middle finger and A1 and A2 pulley release. Treatment was initiated with parenteral cefepime three times per day given the growth of mixed Enterobacter species on the culture media and continued with oral cefuroxime twice daily upon discharge for one week. Unfortunately, during the orthopaedic clinic follow-up, the wound was unclean with a slough and skin necrotic patch. Therefore, Ray’s amputation of the left middle finger proceeded. This case contributes to further investigation of the GBS tenosynovitis due to the rise in GBS invasive infections and shows the importance of early diagnosing and initiating treatment with antibiotics that are effective against this pathogen.

  • Chang, B., Wada, A., Hosoya, M., Oishi, T., Ishiwada, N., Oda, M., Sato, T., Terauchi, Y., Okada, K., Nishi, J., Akeda, H., Kamiya, H., Ohnishi, M., Ihara, T., & Japanese Invasive Disease Study Group. (2014). Characteristics of group B Streptococcus isolated from infants with invasive infections: A population-based study in Japan. Japanese Journal of Infectious Diseases, 67(5), 356-360. http://dx.doi.org/10.7883/yoken.67.356

  • CLSI. (2020). Performance standards for antimicrobial susceptibility testing (30th Ed.). Clinical and Laboratory Standards Institute.

  • Eskandarian, N., Ismail, Z., Neela, V., Van Belkum, A., Desa, M. N. M., & Nordin, S. A. (2015). Antimicrobial susceptibility profiles, serotype distribution and virulence determinants among invasive, non-invasive and colonizing Streptococcus agalactiae (group B streptococcus) from Malaysian patients. European Journal of Clinical Microbiology & Infectious Diseases, 34(3), 579-584. https://doi.org/10.1007/s10096-014-2265-x

  • Ezhumalai, M., Muthanna, A., Suhaili, Z., Dzaraly, N. D., Amin-Nordin, S., Amal, M. N. A., & Desa, M. N. M. (2020). Multilocus sequence typing analysis of invasive and non-invasive Group B Streptococcus of hospital origin in Malaysia. The Malaysian Journal of Medical Sciences: MJMS, 27(1), 134-138. https://doi.org/10.21315/mjms2020.27.1.14

  • Franko, O. I., & Abrams, R. A. (2013). Hand infections. Orthopedic Clinics, 44(4), 625-634.

  • Graux, E., Hites, M., Martiny, D., Maillart, E., Delforge, M., Melin, P., & Dauby, N. (2021). Invasive group B Streptococcus among non-pregnant adults in Brussels-Capital Region, 2005–2019. European Journal of Clinical Microbiology & Infectious Diseases, 40(3), 515-523. https://doi.org/10.1007/s10096-020-04041-0

  • Hyatt, B. T., & Bagg, M. R. (2017). Flexor tenosynovitis. Orthopedic Clinics, 48(2), 217-227. http://dx.doi.org/10.1016/j.ocl.2016.12.010

  • Imperi, M., Pataracchia, M., Alfarone, G., Baldassarri, L., Orefici, G., & Creti, R. (2010). A multiplex PCR assay for the direct identification of the capsular type (Ia to IX) of Streptococcus agalactiae. Journal of Microbiological Methods, 80(2), 212-214. https://doi.org/10.1016/j.mimet.2009.11.010

  • Jones, N., Bohnsack, J. F., Takahashi, S., Oliver, K. A., Chan, M. S., Kunst, F., Glaser, P., Rusniok, C., Crook, D. W. M., Harding, R. M., Bisharat, N., & Spratt, B. G. (2003). Multilocus sequence typing system for group B streptococcus. Journal of Clinical Microbiology, 41(6), 2530-2536. https://doi.org/10.1128/JCM.41.6.2530-2536.2003

  • Kanavel, A. B. (1933). The symptoms, signs, and diagnosis of tenosynovitis and major fascial-space abscesses. Infections of the Hand (6th Ed.). Lea and Febiger Publisher.

  • Karunakaran, R., Raja, N. S., Hafeez, A., & Puthucheary, S. D. (2009). Group B streptococcus infection: Epidemiology, serotypes, and antimicrobial susceptibility of selected isolates in the population beyond infancy (excluding females with genital tract-and pregnancy-related isolates) at the University Malaya Medical Centre, Kuala Lumpur. Japanese Journal of Infectious Diseases, 62(3), 192-194.

  • Pang, H. N., Teoh, L. C., Yam, A. K., Lee, J. Y. L., Puhaindran, M. E., & Tan, A. B. H. (2007). Factors affecting the prognosis of pyogenic flexor tenosynovitis. The Journal of Bone & Joint Surgery, 89(8), 1742-1748. http://dx.doi.org/10.2106/JBJS.F.01356

  • Pattnaik, S., Syed, A., & Siddhardha, B. (2020). Pathogenesis, virulence factors, and antibiotic resistance of group B streptococcus. In Model Organisms for Microbial Pathogenesis, Biofilm Formation and Antimicrobial Drug Discovery (pp. 117-130). Springer. https://doi.org/10.1007/978-981-15-1695-5

  • Stewart, C. N., & Ward, C. M. (2020). Infectious flexor tenosynovitis following trigger finger release: Incidence and risk factors. Hand, 2020. https://doi.org/10.1177/1558944720930298

  • Vuillemin, X., Hays, C., Plainvert, C., Dmytruk, N., Louis, M., Touak, G., Saint-Pierre, B., Adoux, L., Letourneur, F., Frigo, A., Poyart, C., & Tazi, A. (2021). Invasive group B streptococcus infections in non-pregnant adults: A retrospective study, France, 2007–2019. Clinical Microbiology and Infection, 27(1), 129-e1-129-e4. https://doi.org/10.1016/j.cmi.2020.09.037

  • Wang, R., Li, L., Huang, Y., Huang, T., Tang, J., Xie, T., Lei, A., Luo, F., Li, J., Huang, Y., Shi, Y., Wang, D., Chen, M., Mi, Q., & Huang, W. (2017). Pathogenicity of human ST23 Streptococcus agalactiae to fish and genomic comparison of pathogenic and non-pathogenic isolates. Frontiers in Microbiology, 8, Article 1933. https://doi.org/10.3389/fmicb.2017.01933

ISSN 0128-7680

e-ISSN 2231-8526

Article ID

JST-3378-2021

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