A case of neonatal necrotizing fasciitis caused by Panton-Valentine leukocidin producing, METHICILLIN-SUSCEPTIBLE Staphylococcus aureu

Key words: Neonatal sepsis, Neonatal surgery, Staphylococcus aureus, Necrotizing fasciitis, Panton-Valentine leukocidin

Necrotizing fasciitis is an infection of the skin and soft tissues that diffuses rapidly to the connective tissue with necrosis of the subcutaneous fat and underlying layers that extends to the muscular fasciae. It is more frequent in adults and is typically associated with immune deficiencies or comorbidities. In neonates, it is a very rare condition and its mortality reaches 59%. Less than 100 neonatal cases have been described, most of which secondary to omphalitis, mastitis or infection of post-operative wounds. Actually, only 7 cases of idiopathic necrotizing fasciitis have been described. The causative organism is usually Streptococcus, Escherichia coli, Clostridium perfringens, Bacteroides fragilis, and Staphylococcus aureus. The paper presents the case of a previously healthy 6-day-old infant with rapidly progressive community-acquired necrotizing fasciitis caused by methicillinsusceptible Staphylococcus aureus infection. The isolate harboured the genes encoding for the Panton-Valentine leukocidin. Although therapy usually involves early surgery, especially if the arms and legs are involved, the described case was treated with a conservative therapy, awaiting spontaneous colliquation and demarcation of the necrotic regions with excellent results, thus avoiding the risks of surgery.