A case of necrotizing fasciitis caused by coagulase-negative staphylococcus: utility of magnetic resonance imaging for the preoperative diagnosis of necrotizing fasciitis

Surgical considerations in pediatric necrotizing fasciitis

BACKGROUND

Necrotizing fasciitis (NF) is a serious infection of soft tissues. This paper presents experience with pediatric NF and suitability of conservative surgery in its management.

MATERIALS AND METHODS

In this retrospective study, 70 patients of NF were managed during the study period of eight years. The study was divided into two time periods- first period (June 1998 to June 2001- group 1) and second period (June 2001 to June 2006- group 2). The parameters studied were age, sex, site of involvement and treatment. The treatment included intravenous antibiotics, supportive therapy and either aggressive (group 1) or conservative surgery (group 2).

RESULTS

Age of presentation ranged from 10 days to 11 years. Male to female ratio was 1.69:1. Back was the commonest site to be involved. Culture reports were polymicrobial in 70% with predominance of Staphylococcus species. Predisposing factors included malnourishment, boils, scratch injury, intravenous cannulation and injections. Conservative surgery had better outcome in terms of hospital stay, complications and cost of treatment.

CONCLUSION

NF is a serious and disease which requires immediate and all out attention. Early diagnosis, aggressive supportive treatment and conservative surgery improve survival.

Necrotizing fasciitis in a woman with a diabetic foot infection and peripheral neuropathy

We report the case of a 62-year-old African American woman with poorly controlled diabetes who presented with the complaint of not being able to remove her stockings from her left foot. The patient had long-standing peripheral neuropathy from diabetes. Her physical examination in the emergency department was challenging because of extensive infection in her left lower extremity. Careful removal of the stockings resulted in the debridement of the lower third of her left leg and entire foot. Her laboratory findings were notable for a white blood cell count of 11.7 x 10(3) cells/mm(3) with 18% bands, an erythrocyte sedimentation rate of 100 mm/hour, and glycated hemoglobin of 11.5%. This case is unique in that the patient presented with both wet and dry gangrene of her lower extremities. We discuss the spectrum of infectious processes in diabetic foot infections and discuss the management of patients with necrotizing fasciitis.

Neonatal necrotising fasciitis--Varanasi experience

Neonatal necrotising fasciitis (NNF) is a rare and fatal disorder. Successful outcome depends on timely intervention. This paper presents single-centre experience of presentation, management and outcome of the condition. Fifteen patients of NNF were managed during the study period of 5 years. Parameters studied were age, sex, site of involvement and treatment. Treatment included intravenous (i.v.) antibiotics and conservative surgery. Age of presentation was 10-28 days. Male to female ratio was 2:1. Neck and scalp were the commonest site (53.3%). Culture reports were unimicrobial in 66% with predominance of Staphylococcus species. Predisposing factors included rural environment (100%), malnourishment (60%), boils (40%) and scratch injury (13%). Forty per cent had idiopathic NNF. Wound healing was by secondary intention in 46.6% and skin grafting in 53.3%. Overall survival was 80%, while the premature had poorer outcome. NNF is a serious disorder. Early treatment with i.v. antibiotics and supportive measures followed by debridement improves survival.