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Ling XW, Zhang TT, Ling MM, Chen WH, Huang CH, Shen GL. Th1/Th2 cytokine levels: A potential diagnostic tool for patients with necrotizing fasciitis. Burns 2023; 49:200-208. [PMID: 36195489 DOI: 10.1016/j.burns.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 08/06/2022] [Accepted: 08/29/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Necrotizing fasciitis (NF) has emerged as rare but rapidly progressive, life-threatening severe skin and soft tissue infection. We conducted a study to investigate whether Th1/Th2 cytokines could serve as biomarkers to distinguish NF from class III skin and soft tissue infections (SSTIs). METHODS A retrospective review was performed for 155 patients suffering from serious skin and soft tissue infections from October 2020 to February 2022. Th1/Th2 cytokines were obtained from peripheral blood and wound drainage fluid samples. Data on demographic characteristics, causative microbiological organisms, Th1/Th2 cytokines, c-reactive protein, procalcitonin and white blood cell (WBC) were extracted for analysis. Factors with statistical difference(p < 0.1) were included in the multivariate logistic regression model. The clinical differential diagnostic values of interleukin-2(IL-2), IL-6, IL-10, tumor necrosis factor-α (TNF-α) and interferon-r (IFN-r) were analyzed by receiver operating characteristic (ROC) curve. RESULTS Among the 155 patients, 66(43%) patients were diagnosed as NF. We found no significant difference for sex, age, location of infection, coexisting condition, predisposition, duration of symptoms before admission and micro-organisms, WBC, procalcitonin and c-reactive protein in NF and class III SSTIs group. NF had higher levels of IL-6 in serum (50.46 [24.89, 108.89] vs. 11.87 [5.20, 25.32] pg/ml; p<0.01), IL-10 in serum (3.45 [2.03, 5.12] vs. 2.51 [1.79, 3.29] pg/ml; p<0.01), IL-2 in wound drainage fluid (0.89 [0.49, 1.33] vs. 0.63 [0.14, 1.14] pg/ml; p = 0.02), IL-6 in wound drainage fluid (5000.84 [1392.30, 13287.19] vs. 1927.82 (336.65, 6759.27) pg/ml; p<0.01), TNF-a in wound drainage fluid (5.20 [1.49, 22.97] vs. 0.96 [0.12, 3.21] pg/ml; p<0.01) and IFN-r in wound drainage fluid (1.32 [0.47, 4.62] vs. 0.68 [0.10, 1.88] pg/ml; p = 0.02) as compared to the class III SSTIs. Multivariate logistic regression analyses showed that IL-6 in serum, IL-10 in serum and TNF-a in wound drainage fluid exhibited independently significant associations with diagnosis of NF(p<0.05). In ROC curve analysis of IL-2, IL-6, IL-10, TNF-a and IFN-r for diagnosis of NF, the area under the curve (AUC) of IL-6 in serum could reach to 0.80 (p<0.001). Using 27.62 pg/ml as the cut off value, the sensitivity was 74% and the specificity was 79% in IL-6 in serum. CONCLUSIONS Th1/Th2 cytokines, IL-6 in serum in particular, are potential biomarkers for the diagnosis of NF in the early stage. However, larger patient populations with multiple centers and prospective studies are necessary to ensure the prognostic role of Th1/Th2 cytokines.
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Affiliation(s)
- Xiang-Wei Ling
- Department of Burn, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ting-Ting Zhang
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Meng-Meng Ling
- Department of Information, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Wei-Hao Chen
- Department of Burn, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Chun-Hui Huang
- Department of Burn, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Guo-Liang Shen
- Department of Burn, The First Affiliated Hospital of Soochow University, Suzhou 215006, China.
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Al-Wageeh S, Ahmed F, Alyhari Q, Mohammed F. Synchronous cervical necrotizing fasciitis and pharyngocutaneous fistula: A case report. Int J Surg Case Rep 2022; 93:106988. [PMID: 35367953 PMCID: PMC8976119 DOI: 10.1016/j.ijscr.2022.106988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/28/2022] [Accepted: 03/26/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction and importance Necrotizing fasciitis is a fulminant infection that spreads along the fascial planes. It is a rare entity with potentially fatal outcomes. The head and neck involvement is infrequent, with primary source either odontogenic or pharyngeal infection by single or mixed bacterial flora. To our knowledge, synchronous cervical necrotizing fasciitis (CNF) and pharyngocutaneous fistula is rarely reported in pieces of literature. Case presentation We present a 38-years-old female patient who presented with CNF and pharyngocutaneous fistula. Diabetes mellitus was accidentally discovered during the investigation. The patient was successfully treated with broad-spectrum antibiotics, serial surgical debridement sessions, wound irrigation, and multiple muscular and myocutaneous skin flaps. Clinical discussion Rapid diagnosis, radical surgical debridement of all necrotic tissue, intravenous broad-spectrum antibiotics, and close monitoring of patients with CNF are crucial to avoid critical complications and better patient survival. Due to the poor healing process in the neck area, the pharyngocutaneous fistula should be repaired with good musculocutaneous flaps such as the pectoralis major myocutaneous flap. Meticulous suturing of the flap to the mucosa, reinforcement of the repair with muscle, and suturing of the skin without tension are essential to obtaining a successful outcome. Conclusion Synchronous CNF and pharyngocutaneous fistula are rare events. Initial diagnosis and serial surgical debridement, along with aggressive broad-spectrum antibiotics and adequate resuscitation with great attention to the poor healing process in the diabetic patients' neck area, are critical for a beneficial result. In our case, the reconstruction was performed successfully using multiple muscular and skin flaps. Cervical necrotizing fasciitis (CNF) is a fetal infection with a high mortality rate even under ideal medical conditions. Synchronous CNF and pharyngocutaneous fistula are rare occurrence. In CNF with pharyngocutaneous fistula, initial diagnosis, surgical debridement, broad-spectrum antibiotics and resuscitation with attention to poor healing process, are critical for a beneficial result.
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Affiliation(s)
- Saleh Al-Wageeh
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb, Yemen.
| | - Qasem Alyhari
- Department of General Surgery, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
| | - Fawaz Mohammed
- Department of Orthopedy, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
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Tosi M, Al‐Awa A, Raeymaeckers S, De Mey J. Subcutaneous emphysema of the extremities: Be wary of necrotizing fasciitis, but also consider occult rupture or perforation. Clin Case Rep 2021; 9:e04831. [PMID: 34584708 PMCID: PMC8455963 DOI: 10.1002/ccr3.4831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 08/18/2021] [Accepted: 08/30/2021] [Indexed: 11/24/2022] Open
Abstract
Not all causes of subcutaneous emphysema are attributable to necrotizing fasciitis. Consider other causes of subcutaneous emphysema in the differential diagnosis.
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Affiliation(s)
- Maurizio Tosi
- Department of AnesthesiologyUZ BrusselBrusselBelgium
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Rosén A, Arnell P, Madsen MB, Nedrebø BG, Norrby-Teglund A, Hyldegaard O, Dos Santos VM, Bergey F, Saccenti E, Skrede S. Diabetes and necrotizing soft tissue infections-A prospective observational cohort study: Statistical analysis plan. Acta Anaesthesiol Scand 2018; 62:1171-1177. [PMID: 29671865 DOI: 10.1111/aas.13130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Necrotizing soft tissue infections (NSTIs) are rare but carry a high morbidity and mortality. The multicenter INFECT project aims to improve the understanding of the pathogenesis, clinical characteristics, diagnosis, and prognosis of NSTIs. This article describes the study outline and statistical analyses that will be used. METHODS Within the framework of INFECT project, patients with NSTI at 5 Scandinavian hospitals are enrolled in a prospective observational cohort study. The goal is to evaluate outcome and characteristics for patients with NSTI and diabetes compared to patients with NSTI without diabetes. The primary outcome is mortality at 90 days after inclusion. Secondary outcomes include days alive and out of ICU and hospital, SAPS II, SOFA score, infectious etiology, amputation, affected body area, and renal replacement therapy. Comparison in mortality between patients with diabetes type 1 and 2 as well as between insulin-treated and non-insulin-treated diabetes patients will be made. Clinical data for diabetic patients with NSTI will be reported. CONCLUSION The study will provide important data on patients with NSTI and diabetes.
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Affiliation(s)
- A Rosén
- Department of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
| | - P Arnell
- Department of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden
| | - M B Madsen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - B G Nedrebø
- Department of Medicine, Haugesund County Hospital, Haugesund, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - A Norrby-Teglund
- Centre for Infectious Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - O Hyldegaard
- Department of Anaesthesia, Center of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - V M Dos Santos
- LifeGlimmer GmbH, Berlin, Germany
- Laboratory of Systems and Synthetic Biology, Wageningen University & Research, Wageningen, The Netherlands
| | - F Bergey
- LifeGlimmer GmbH, Berlin, Germany
| | - E Saccenti
- Laboratory of Systems and Synthetic Biology, Wageningen University & Research, Wageningen, The Netherlands
| | - S Skrede
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
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Taneja V, Walker RJ, Tedla M. Necrotising fasciitis of the neck: Unusual presentation with aggressive management – case report with review of literature. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2017. [DOI: 10.1080/23772484.2016.1266636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Virangna Taneja
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Rachel J. Walker
- ENT Department, University Hospitals Coventry and Warwickshire, Coventry, UK
| | - Miroslav Tedla
- Otorhinolaryngology Department, Warwick University and University Hospital Coventry, Coventry, UK
- Department of ORL-HNS, Faculty of Medicine, Comenius University Bratislava, Slovakia
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Heigh EG, Maletta-Bailey A, Haight J, Landis GS. Necrotizing Fasciitis of the Lower Extremity Caused by Serratia marcescens A Case Report. J Am Podiatr Med Assoc 2016; 106:144-6. [PMID: 27031553 DOI: 10.7547/15-042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Necrotizing fasciitis is a rare and potentially fatal infection, with mortality of up to 30%. This case report describes a patient recovering from a laryngectomy for laryngeal squamous cell cancer who developed nosocomial necrotizing fasciitis of the lower extremity due to Serratia marcescens . Only eight cases of necrotizing fasciitis exclusive to the lower extremity due to S marcescens have been previously reported. Patients with S marcescens necrotizing fasciitis of the lower extremity often have multiple comorbidities, are frequently immunosuppressed, and have a strikingly high mortality rate.
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Affiliation(s)
- Evelyn G. Heigh
- Department of Podiatric Medicine and Surgery, North Shore–Long Island Jewish Medical Center, New Hyde Park, NY
| | - April Maletta-Bailey
- Department of Podiatric Medicine and Surgery, North Shore–Long Island Jewish Medical Center, New Hyde Park, NY
| | - John Haight
- Department of Podiatric Medicine and Surgery, North Shore–Long Island Jewish Medical Center, New Hyde Park, NY
| | - Gregg S. Landis
- Department of Vascular and Endovascular Surgery, North Shore–Long Island Jewish Medical Center, New Hyde Park, NY
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Necrotizing soft tissue infection caused by Serratia marcescens: A case report and literature review. J Infect Chemother 2016; 22:335-8. [PMID: 26778253 DOI: 10.1016/j.jiac.2015.11.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 11/11/2015] [Accepted: 11/24/2015] [Indexed: 12/17/2022]
Abstract
A 64-year-old man with advanced liver cirrhosis was transferred to an emergency center due to septic shock and markedly inflamed left leg. Under a clinical diagnosis of necrotizing soft tissue infection (NSTI), the patient undertook intensive therapy but died 25 h after arrival. The pathogenic organism, Serratia marcescens, was later isolated from blood and soft tissue cultures. NSTI is very rarely associated with S. marcescens. A literature review showed that only 16 such cases, including our case, have been reported to date. Our case is the first evidence of an S. marcescens NSTI in a patient with liver cirrhosis. S. marcescens NSTI has an extremely high mortality rate; total mortality and mortality in cases involving the extremities were 75% (12 of 16 cases) and 83.3% (10 of 12 cases), respectively. Physicians need to be aware that S. marcescens can induce fatal infections in community patients.
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Cruz Toro P, Callejo Castillo À, Tornero Saltó J, González Compta X, Farré A, Maños M. Cervical necrotizing fasciitis: Report of 6 cases and review of literature. Eur Ann Otorhinolaryngol Head Neck Dis 2014; 131:357-359. [DOI: 10.1016/j.anorl.2013.08.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 08/02/2013] [Accepted: 08/08/2013] [Indexed: 10/25/2022]
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Magala J, Makobore P, Makumbi T, Kaggwa S, Kalanzi E, Galukande M. The clinical presentation and early outcomes of necrotizing fasciitis in a Ugandan Tertiary Hospital--a prospective study. BMC Res Notes 2014; 7:476. [PMID: 25069415 PMCID: PMC4119938 DOI: 10.1186/1756-0500-7-476] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 07/21/2014] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis is an infectious process characterized by rapidly progressing necrosis of superficial fascia and subcutaneous tissue with subsequent necrosis of overlying skin.Necrotizing fasciitis is a rare but fatal infection. The worldwide incidence is at 0.4 per 100,000. Mortality is up to 80% with no intervention, and 30-50% with intervention. Delay in intervention is associated with poor outcome. The risk factors for necrotizing fasciitis are diabetes mellitus, HIV, malignancy, illicit drug use, malnutrition among others.The aim of this study was to describe the clinical presentation and early outcomes of necrotizing fasciitis amongst Ugandan patients. METHODS A prospective descriptive case series study conducted at Mulago National Referral and Teaching hospital from 5th January to 30th April 2011. Patients with necrotizing fasciitis were consecutively recruited after clinical evaluation, laboratory and microbiological tests were performed. Aggressive debridement was done and broad-spectrum antibiotics administered. Patients were followed up on surgical wards. Ethical approval was obtained. RESULTS Thirty five patients were recruited over a 4 months period. More males were affected with, M: F 3:1. The 20-40 years age group was most affected. Attainment of healthy granulation tissue took 19 days on average. Mortality rate was 14% (5/35). Limbs were the most affected body parts 20/35 (57%), the scrotum and perineum (23%). Among infants the scalp was the most affected. Co-morbidities included HIV 8/35 (17%), and DM (5%) among others. The commonest organisms were gram negative. Split skin grafting was necessary in 74% (26/35) of patients. CONCLUSION There were a high number of patients with necrotizing fasciitis; it was associated with low mortality but high morbidity (long hospital stay). There was a high preponderance to males and limbs were the more affected body parts.
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Affiliation(s)
| | | | | | | | | | - Moses Galukande
- Department of Surgery, Makerere University College of Health Sciences, Kampala, Uganda.
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Raised serum lactate: A marker of necrotizing fasciitis? J Plast Reconstr Aesthet Surg 2013; 66:1712-6. [DOI: 10.1016/j.bjps.2013.07.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 07/08/2013] [Accepted: 07/09/2013] [Indexed: 11/19/2022]
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Tu GW, Hwabejire JO, Ju MJ, Yang YF, Zhang GJ, Xu JW, Xue ZG, Jiang C, Luo Z. Multidisciplinary intensive care in extensive necrotizing fasciitis. Infection 2013; 41:583-7. [PMID: 23104255 DOI: 10.1007/s15010-012-0346-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 09/24/2012] [Indexed: 02/07/2023]
Abstract
This is a case report of extensive necrotizing fasciitis (NF). A 65-year-old man presented with high fever, pain, swelling, and redness of the perineum, scrotum, and right lower limb. Based on the clinical symptoms and an imaging examination, a diagnosis of NF was made. The patient underwent an extensive exploration followed by daily bedside debridement. A diversion colostomy and six additional debridement procedures on the right thigh and perineum were subsequently performed. Although the patient had an eventful course, he recovered well under a multidisciplinary treatment regimen. The treatment and hospital course of the patient are described.
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Affiliation(s)
- Guo-Wei Tu
- Department of Anesthesiology and Surgical Intensive Care Unit, Zhongshan Hospital, Fudan University, 180 Fenglin Rd, 200032, Shanghai, China
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Vano-Galvan S, Álvarez-Twose I, Moreno-Martín P, Jaén P. Fulminant necrotizing fasciitis caused bySerratia marcescensin an immunosuppressed host. Int J Dermatol 2012; 53:e57-8. [DOI: 10.1111/j.1365-4632.2011.05440.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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