Wound: neutrophils, gram positive cocci in chains (group A Streptococcus) – Shipped August 14, 2017


A simulated arm tissue smear collected from 42 year old female IV drug user with an arm wound and a suspected necrotizing fasciitis diagnosis was sent to category A, B, C, and C1 laboratories.
Participants were instructed to consider the sample as a tissue sample, and were expected to observe and report neutrophils and gram positive cocci in chains.


  1. Typically, in cases of group A streptococcal necrotizing fasciitis, the Gram stains of aspirated fluids demonstrate gram positive cocci in chains, and few, if any, white blood cells.
  2. Gram stain results should be reported as soon as they are availa-ble as necrotizing fasciitis is a severe infection; morphological observations, if typical, should be included with the Gram stain report.


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