1
|
Patel T, Quow K, Cardones AR. Management of Infectious Emergencies for the Inpatient Dermatologist. CURRENT DERMATOLOGY REPORTS 2021; 10:232-242. [PMID: 34642610 PMCID: PMC8493951 DOI: 10.1007/s13671-021-00334-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 12/20/2022]
Abstract
Purpose of Review There are various dermatologic emergencies stemming from bacterial, viral, and fungal etiologies that can present in the inpatient setting. This review summarizes the pathogenesis and diagnosis of infections with cutaneous involvement and highlights new therapies. Recent Findings Clindamycin inhibits toxin formation and can be used as an adjunct therapy for the staphylococcal scalded syndrome. Isavuconazole therapy for mucormycosis infection is a less toxic alternative to amphotericin B. Summary Diagnosis of these infections is primarily guided by high clinical suspicion and early recognition can prevent dangerous sequelae. Treatment mainstays have been well-established, but there are adjunctive therapies that may potentially benefit the patient.
Collapse
Affiliation(s)
- Tulsi Patel
- Duke University School of Medicine, Durham, NC 27710 USA
| | - Krystina Quow
- Department of Dermatology, Duke University, Durham, NC 27710 USA
| | - Adela R Cardones
- Department of Dermatology, Duke University, Durham, NC 27710 USA
- Durham VA Medical Center, Durham, NC 27705 USA
- Durham, USA
| |
Collapse
|
2
|
Hysong AA, Posey SL, Blum DM, Benvenuti MA, Benvenuti TA, Johnson SR, An TJ, Devin JK, Obremskey WT, Martus JE, Moore-Lotridge SN, Schoenecker JG. Necrotizing Fasciitis: Pillaging the Acute Phase Response. J Bone Joint Surg Am 2020; 102:526-537. [PMID: 31977818 PMCID: PMC8590823 DOI: 10.2106/jbjs.19.00591] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
| | - Samuel L Posey
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Deke M Blum
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Michael A Benvenuti
- Department of Orthopaedics and Rehabilitation (M.A.B., T.A.B., S.R.J., T.J.A., W.T.O., J.E.M., S.N.M.-L., and J.G.S.), Division of Diabetes, Endocrinology, and Metabolism (J.K.D.), and Departments of Pediatrics (J.E.M and J.G.S.), Pathology, Microbiology, and Immunology (J.G.S.), and Pharmacology (J.G.S.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Teresa A Benvenuti
- Department of Orthopaedics and Rehabilitation (M.A.B., T.A.B., S.R.J., T.J.A., W.T.O., J.E.M., S.N.M.-L., and J.G.S.), Division of Diabetes, Endocrinology, and Metabolism (J.K.D.), and Departments of Pediatrics (J.E.M and J.G.S.), Pathology, Microbiology, and Immunology (J.G.S.), and Pharmacology (J.G.S.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Samuel R Johnson
- Department of Orthopaedics and Rehabilitation (M.A.B., T.A.B., S.R.J., T.J.A., W.T.O., J.E.M., S.N.M.-L., and J.G.S.), Division of Diabetes, Endocrinology, and Metabolism (J.K.D.), and Departments of Pediatrics (J.E.M and J.G.S.), Pathology, Microbiology, and Immunology (J.G.S.), and Pharmacology (J.G.S.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Thomas J An
- Department of Orthopaedics and Rehabilitation (M.A.B., T.A.B., S.R.J., T.J.A., W.T.O., J.E.M., S.N.M.-L., and J.G.S.), Division of Diabetes, Endocrinology, and Metabolism (J.K.D.), and Departments of Pediatrics (J.E.M and J.G.S.), Pathology, Microbiology, and Immunology (J.G.S.), and Pharmacology (J.G.S.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jessica K Devin
- Department of Orthopaedics and Rehabilitation (M.A.B., T.A.B., S.R.J., T.J.A., W.T.O., J.E.M., S.N.M.-L., and J.G.S.), Division of Diabetes, Endocrinology, and Metabolism (J.K.D.), and Departments of Pediatrics (J.E.M and J.G.S.), Pathology, Microbiology, and Immunology (J.G.S.), and Pharmacology (J.G.S.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - William T Obremskey
- Department of Orthopaedics and Rehabilitation (M.A.B., T.A.B., S.R.J., T.J.A., W.T.O., J.E.M., S.N.M.-L., and J.G.S.), Division of Diabetes, Endocrinology, and Metabolism (J.K.D.), and Departments of Pediatrics (J.E.M and J.G.S.), Pathology, Microbiology, and Immunology (J.G.S.), and Pharmacology (J.G.S.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jeffrey E Martus
- Department of Orthopaedics and Rehabilitation (M.A.B., T.A.B., S.R.J., T.J.A., W.T.O., J.E.M., S.N.M.-L., and J.G.S.), Division of Diabetes, Endocrinology, and Metabolism (J.K.D.), and Departments of Pediatrics (J.E.M and J.G.S.), Pathology, Microbiology, and Immunology (J.G.S.), and Pharmacology (J.G.S.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Stephanie N Moore-Lotridge
- Department of Orthopaedics and Rehabilitation (M.A.B., T.A.B., S.R.J., T.J.A., W.T.O., J.E.M., S.N.M.-L., and J.G.S.), Division of Diabetes, Endocrinology, and Metabolism (J.K.D.), and Departments of Pediatrics (J.E.M and J.G.S.), Pathology, Microbiology, and Immunology (J.G.S.), and Pharmacology (J.G.S.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan G Schoenecker
- Department of Orthopaedics and Rehabilitation (M.A.B., T.A.B., S.R.J., T.J.A., W.T.O., J.E.M., S.N.M.-L., and J.G.S.), Division of Diabetes, Endocrinology, and Metabolism (J.K.D.), and Departments of Pediatrics (J.E.M and J.G.S.), Pathology, Microbiology, and Immunology (J.G.S.), and Pharmacology (J.G.S.), Vanderbilt University Medical Center, Nashville, Tennessee
| |
Collapse
|
3
|
Sin F, Yuen M, Lam K, Wu C, Tung W. A Retrospective Review of Patients with Necrotizing Fasciitis Presenting to an Emergency Department in Hong Kong. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490790200900102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Necrotizing fasciitis is a soft tissue gangrenous infection that require early diagnosis, radical debridement and broad-spectrum antibiotics. Aim To review the clinical spectrum and outcome of necrotizing fasciitis in Kwong Wah Hospital during a period of 18 months. Method Cases of necrotizing fasciitis were identified from discharge statistics for the period January 1999 to June 2000. Accident and Emergency Department (AED) notes and clinical records after admission were reviewed for clinical features, predisposing factors, microbiology, histology, treatment and outcome. Results Fifteen cases of necrotizing fasciitis were found but two of them had wrong diagnosis made. Of the thirteen cases, ten were male and three were female. The average age was 61.7 years old. Most of them presented with different combinations of swelling, pain, erythema and fever. They attended the emergency department with an interval of 3.5 days from the onset of symptoms. Risk factors were identified in 64% of patients, with diabetes mellitis (DM) and hypertension (HT) being the most common. Monomicrobial and polymicrobial infections were equally common in our study. Streptococcus pyogene was the most common pathogen. Only two NF (18%) were diagnosed in AED. Six patients were admitted to either surgical or orthopaedic wards and all of them underwent operations within 24 hours although two of them died. Other five patients were managed in medical ward and four of these patients underwent delayed operations but survived whilst one of them died despite of early surgical intervention. Overall mortality was 23%. Conclusions This condition affects a wide age group and have associated morbidities. It is often a fatal disease. Early recognition, high dose antibiotics and surgical debridement are important in its management.
Collapse
Affiliation(s)
- Fp Sin
- Kwong Wah Hospital, Accident and Emergency Department, 25 Waterloo Road, Kowloon
| | | | | | | | | |
Collapse
|
4
|
Ahlawat S, Corl FM, LaPorte DM, Fishman EK, Fayad LM. MDCT of hand and wrist infections: emphasis on compartmental anatomy. Clin Radiol 2017; 72:338.e1-338.e9. [PMID: 28065641 DOI: 10.1016/j.crad.2016.11.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 11/14/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
Hand and wrist infections can present with a spectrum of manifestations ranging from cellulitis to deep-space collections. The various infectious processes can be categorised as superficial or deep infections based on their respective locations relative to the tendons. Superficial hand infections are located superficial to the tendons and are comprised of cellulitis, lymphangitis, paronychia, pulp-space infections, herpetic whitlow, and include volar as well as dorsal subcutaneous abscesses. Deep hand infections are located deep to the tendon sheaths and include synovial space infections, such as infectious tenosynovitis, deep fascial space infections, septic arthritis, necrotising fasciitis, and osteomyelitis. Knowledge of hand and wrist compartmental anatomy is essential for the accurate diagnosis and management of hand infections. Although early and superficial infections of the hand may respond to non-surgical management, most hand infections are surgical emergencies. Multidetector computed tomography (MDCT), with its muliplanar reformation (MPR) and three-dimensional (3D) capabilities, is a powerful tool in the emergency setting for the evaluation of acute hand and wrist pathology. The clinical and imaging features of hand and wrist infections as evident on MDCT will be reviewed with emphasis on contiguous and closed synovial and deep fascial spaces. Knowledge of hand compartmental anatomy enables accurate characterisation of the infectious process and localise the extent of disease in the acute setting.
Collapse
Affiliation(s)
- S Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD 21287, USA.
| | - F M Corl
- Department of Radiology, Mayo Clinic, 200 1st Street Southwest, Rochester, MN 55902, USA
| | - D M LaPorte
- Johns Hopkins Outpatient Center, 601 N. Caroline Street, Baltimore, MD 21287, USA
| | - E K Fishman
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD 21287, USA
| | - L M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins University School of Medicine, 601 North Wolfe Street, Baltimore, MD 21287, USA
| |
Collapse
|
5
|
Mittapalli D, Velineni R, Rae N, Howd A, Suttie SA. Necrotizing soft tissue infections in intravenous drug users: a vascular surgical emergency. Eur J Vasc Endovasc Surg 2015; 49:593-9. [PMID: 25805328 DOI: 10.1016/j.ejvs.2015.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/01/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess the short and long-term outcomes of necrotizing soft tissue infection (NSTI) in intravenous drug users (IVDU) in a regional vascular centre. METHODS This was a retrospective analysis of all IVDUs with NSTI admitted to the regional vascular surgical unit between January 2009 and July 2014. Clinical outcome measures were interval between admission and surgery, length of ITU/HDU and hospital stays, post-operative complications, in hospital and one year mortality. RESULTS 25 patients were admitted. The median age was 39 years (range 30-53 years) with a female to male ratio of 1:3.3. The median interval between admission and surgery was 23 hours (range 2-195 hours), however, this was significantly less when the admitting specialty was directly to vascular surgery (median 4 hours, range 2-7) compared with other specialties (median 38 hours, range 7-195 hours). Ten patients required HDU/ITU care with a median duration of 4 days (range 1-12 days). Five patients (20%) required amputation, of whom two (40%) had a prosthetic limb fitted. There was one in hospital death (4%). Another patient died while awaiting limb fitting 4 months post discharge, giving a 1 year mortality of 8%. CONCLUSIONS NSTI in IVDUs carries high risk of amputation with a very low rate of limb fitting. Intervention is significantly delayed when the admitting specialty is not vascular surgery, and half of these patients require HDU/ITU care, with significant morbidity and mortality. Early diagnosis and referral to vascular surgery is crucial in management of these patients.
Collapse
Affiliation(s)
- D Mittapalli
- Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK.
| | - R Velineni
- Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | - N Rae
- Department of Infectious Diseases, Ninewells Hospital and Medical School, Dundee, UK
| | - A Howd
- Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | - S A Suttie
- Department of Vascular Surgery, Ninewells Hospital and Medical School, Dundee, UK
| | | |
Collapse
|
6
|
Hodgins N, Damkat-Thomas L, Shamsian N, Yew P, Lewis H, Khan K. Analysis of the increasing prevalence of necrotising fasciitis referrals to a regional plastic surgery unit: A retrospective case series. J Plast Reconstr Aesthet Surg 2015; 68:304-11. [DOI: 10.1016/j.bjps.2014.11.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Revised: 10/25/2014] [Accepted: 11/09/2014] [Indexed: 12/20/2022]
|
7
|
Gander B, Kaye M, Wollstein R. Limited surgical treatment of suspected necrotizing fasciitis of the upper extremity with a benign clinical presentation. THE CANADIAN JOURNAL OF PLASTIC SURGERY = JOURNAL CANADIEN DE CHIRURGIE PLASTIQUE 2012. [DOI: 10.1177/229255031202000308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Necrotizing fasciitis is a rapidly evolving, potentially fatal infection. Current recommendations advocate antibiotic administration and early aggressive surgical debridement. Aggressive surgery is associated with significant morbidity, leaving patients with substantial tissue loss and complex wounds. A case of suspected necrotizing fasciitis treated with minimal surgery is described. A previously healthy 48-year-old man presented with increased erythema, swelling and blistering of his left upper extremity. Despite a benign systemic clinical presentation, the hand and forearm were suspicious for necrotizing fasciitis, prompting surgical treatment. Surgical exploration found a significant amount of intradermal and subdermal clear fluid. It was decided to limit the amount of debridement. The diagnosis was Wells syndrome, eosinophilic cellulitis. Treated with steroids, the wounds healed uneventfully. It is important to consider the complete clinical picture before aggressive surgical treatment. A negative history for diabetes, atypical clinical presentation and benign operative findings are suggestive of a more benign diagnosis.
Collapse
Affiliation(s)
- Brian Gander
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Marc Kaye
- Department of Orthopedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ronit Wollstein
- Department of Surgery, Division of Plastic and Reconstructive Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
8
|
Purkait R, Samanta T, Basu B, Ganguly S. Unusual associations of necrotizing fascitis: a case series report from a tertiary care hospital. Indian J Dermatol 2011; 55:399-401. [PMID: 21430902 PMCID: PMC3051309 DOI: 10.4103/0019-5154.74571] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Necrotizing fasciitis is a rapidly progressive, potentially fatal infection of the superficial fascia and subcutaneous tissue. It is rare in children. We report three such cases in which differentiating from common soft tissue infection was challenging. High index of suspicion is important as management initiated at an early stage is rewarding.
Collapse
Affiliation(s)
- Radheshyam Purkait
- Department of Pediatric Medicine, NRS Medical College and Hospital, Kolkata, India
| | | | | | | |
Collapse
|
9
|
Modern Concepts of the Diagnosis and Treatment of Necrotizing Fasciitis. J Emerg Med 2010; 39:261-5. [DOI: 10.1016/j.jemermed.2008.06.024] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 05/08/2008] [Accepted: 06/11/2008] [Indexed: 11/18/2022]
|
10
|
Abstract
Necrotizing fasciitis (NF) is a necrotizing soft tissue infection that can cause rapid local tissue destruction, necrosis and life-threatening severe sepsis. Predisposing conditions for NF include diabetes, malignancy, alcohol abuse, and chronic liver and kidney diseases. NF is classified into two categories (types 1 and 2) based on causative microorganisms. The initial clinical picture of NF mimics that of cellulitis or erysipelas, including fever, pain, tenderness, swelling and erythema. The cardinal manifestations of NF are severe pain at onset out of proportion to local findings, hemorrhagic bullae and/or vital sign abnormality. In such cases, NF should be strongly suspected and immediate surgical intervention should be considered, along with broad-spectrum antimicrobials and general supportive measures, regardless of the findings of imaging tests.
Collapse
Affiliation(s)
- Taro Shimizu
- Rollins School of Public Health, Emory University, Georgia, Atlanta, USA.
| | | |
Collapse
|
11
|
Wilharm A, Gras F, Mückley T, Hofmann GO. [Necrotizing fasciitis after "banal" back pain. An unusual course of a retrocoecal appendicitis and its sequellae]. Chirurg 2009; 81:472-6. [PMID: 19812905 DOI: 10.1007/s00104-009-1798-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Necrotizing fasciitis is a life-threatening disease which can only be successfully treated by an interdisciplinary team. An immediate and radical debridement with opening of all compartments and debridement of the affected fascia is the basis for a successful therapy. We report about the treatment of a 21-year-old man who was taken to hospital due to "banal" back pain which was caused by a perforated appendicitis. In only 2 days necrotizing fasciitis developed which spread out over the complete right leg.
Collapse
Affiliation(s)
- A Wilharm
- Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universitätsklinikum der Friedrich-Schiller-Universität, Erlanger Alle 101, 07747 Jena.
| | | | | | | |
Collapse
|
12
|
Abstract
Necrotizing fasciitis is an uncommon, rapidly spreading infection, affecting primarily the deep fascia, which may result in secondary necrosis of the subcutaneous tissue, fascia and muscle. We report a patient that had the cardinal features; namely, excruciatingly painful lesions, demonstration of gas in the tissue and an obnoxious foul odor, prominent erythema, induration, patchy necrosis, and loss of sensation in the left buttock and thigh. Its onset probably followed inadvertent trauma/injury of the left buttock. Corroborative microscopic pathology confirmed the diagnosis. Debridement and intensive supportive therapy comprising antibiotics, analgesics and fluids were given. The outcome of the therapy was gratifying.
Collapse
Affiliation(s)
- Virendra N Sehgal
- Dermato-Venereology (Skin/VD) Centre, Sehgal Nursing Home, Panchwati, Azadpur, Delhi, India.
| | | | | | | | | |
Collapse
|
13
|
|
14
|
|
15
|
Baker JR, McEneaney PA, Prezioso JL, Adajar MA, Goldflies ML, Zambrano CH. Aggressive management of necrotizing fasciitis through a multidisciplinary approach using minimal surgical procedures: a case report. Foot Ankle Spec 2008; 1:160-7. [PMID: 19825711 DOI: 10.1177/1938640008318966] [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: 11/17/2022]
Abstract
Necrotizing fasciitis is an aggressive, destructive infection of the soft tissue and fascia and is a life-threatening surgical emergency. A case study is presented of necrotizing fasciitis in the right lower extremity of a 53-year-old male resident of a long-term skilled nursing facility. Limb salvage was achieved through a multidisciplinary approach with early surgical management and aggressive postoperative management. Through 3 surgical procedures, the combined efforts of podiatric surgery, orthopaedic surgery, general/trauma surgery, and infectious disease provided early wound closure and limb salvage. An aggressive multidisciplinary approach to the management of necrotizing fasciitis in the lower extremity is necessary for limb salvage. Use of this multidisciplinary approach will minimize the number of surgical procedures and decrease the potential morbidity and mortality seen in patients with this infection.
Collapse
Affiliation(s)
- Jeffrey R Baker
- Weil Foot and Ankle Institute, Des Plaines, Illinois 60610, USA.
| | | | | | | | | | | |
Collapse
|
16
|
Hemorrhagic bullae are not only skin deep. Am J Emerg Med 2008; 26:316-9. [PMID: 18358943 DOI: 10.1016/j.ajem.2007.07.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 06/30/2007] [Accepted: 07/04/2007] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Dermatologic complaints are common presentations in the ED. Hemorrhagic bullae are an example of dermatologic manifestation caused by variable etiologies. The life-threatening skin lesion usually is an external sign of a systemic or immune response stimulated by an infection, toxin, medication, or disease process. Although most patient with life-threatening skin lesion, such as hemorrhagic bullae, may appear ill, patients who present in the early course of illness may appear well but deteriorate rapidly. For greater comprehension of hemorrhagic bullae, we prospectively followed 42 patients who presented with hemorrhagic bullae at the ED and analyzed their clinical characteristics and their confirmative diagnoses. METHODS This is a prospective, observational cohort study conducted at a university-affiliated community hospital. Data were collected from January 2002 to January 2007. Patients presenting to the ED with hemorrhagic bullae were enrolled prospectively. RESULTS All of our patients with hemorrhagic bullae had evidence of a serious disease: necrotizing fasciitis (42 case, 100%). The most common comorbidity was diabetes mellitus (18 cases; 42.9%). Vibrio species was the most common organism from blood culture (8/16 cases) and wound culture (17/27 cases). Streptococcal species was found in only 1 patient via blood culture and 4 patients via wound culture. The yield of positive wound culture with Vibrio species was significantly greater than with streptococcal species (P < .05). Fourteen (33.3%) patients came to the ED for help 48 hours later after the onset of hemorrhagic bullae. None of these 14 patients died. In our total of 42 patients, 8 (19%) died. CONCLUSION In our study, the most common causative disease of hemorrhagic bullae was necrotizing fasciitis. Hemorrhagic bullae are a more common clinical feature in Vibrio infection than in streptococcal infection. Hemorrhagic bullae may occur in the early stage of necrotizing fasciitis. Necrotizing fasciitis may be the first sign that emergency physicians come across in patients with hemorrhagic bullae that are not in the oral, genital, anal, ocular area, and high index of suspicion of Vibrio infection should be considered. More aggressive treatment may be needed as hemorrhagic bullae may occur in the early stage of a serious disease. Further multi-institution study may be required to support these findings.
Collapse
|
17
|
Hsiao CT, Weng HH, Yuan YD, Chen CT, Chen IC. Predictors of mortality in patients with necrotizing fasciitis. Am J Emerg Med 2008; 26:170-5. [PMID: 18272096 DOI: 10.1016/j.ajem.2007.04.023] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 04/19/2007] [Accepted: 04/20/2007] [Indexed: 12/17/2022] Open
Affiliation(s)
- Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Puzih City, Chiayi County 613, Taiwan
| | | | | | | | | |
Collapse
|
18
|
Necrotizing fasciitis due to acute perforated appendicitis: case report. J Emerg Med 2008; 39:178-80. [PMID: 18226875 DOI: 10.1016/j.jemermed.2007.09.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2006] [Revised: 05/07/2007] [Accepted: 09/28/2007] [Indexed: 11/23/2022]
Abstract
Acute appendicitis is one of the most common surgical emergencies. Accurate diagnosis is often hindered due to various presentations that differ from the typical signs of appendicitis, especially the position of the appendix. A delay in treatment increases the likelihood of complications such as perforation, which is associated with an increase in morbidity and mortality rates. We herein present the case of a 76-year-old woman presenting with necrotizing fasciitis of the abdominal wall and right flank regions due to a perforated appendix. Such complication is extremely rare but life-threatening. It may be confused with cellulitis, causing a delay in aggressive treatment. This case represents an unusual complication of a common disease. Also, acute appendicitis or intra-abdominal pathologies should be taken into consideration in determining the cause of necrotizing fasciitis presenting over abdominal, flank, or perineal regions.
Collapse
|
19
|
Adam EN, Southwood LL. Primary and secondary limb cellulitis in horses: 44 cases (2000–2006). J Am Vet Med Assoc 2007; 231:1696-703. [DOI: 10.2460/javma.231.11.1696] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
20
|
Abstract
PURPOSE To update the practitioner with causes, diagnosis, and treatment options for necrotizing fasciitis. TARGET AUDIENCE This continuing education activity is intended for physicians and nurses with an interest in better understanding the pathophysiology, diagnosis, and treatment of necrotizing fasciitis. OBJECTIVES After reading this article and taking this test, the reader should be able to: 1. Identify the risk factors and causes of necrotizing fasciitis (NF). 2. Describe the clinical presentation and diagnosis of NF. 3. Explain the treatment options for NF.
Collapse
Affiliation(s)
- Richard Sal Salcido
- Department of Rehabilitation Medicine, Institute of Medicine and Bioengineering, University of Pennsylvania Health System, Philadelphia, PA, USA
| |
Collapse
|
21
|
Affiliation(s)
- Rajat Varma
- Oceana Medical Clinic, Naval Air Station Oceana, Virginia Beach, Virginia, USA.
| | | |
Collapse
|
22
|
De Decker K, Van Poucke S, Wojciechowski M, Ieven M, Colpaert C, Vogelaers D, Jorens PG. Successful use of posaconazole in a pediatric case of fungal necrotizing fasciitis. Pediatr Crit Care Med 2006; 7:482-5. [PMID: 16878050 DOI: 10.1097/01.pcc.0000235255.68759.05] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To report a pediatric case of posttraumatic fungal fasciitis treated successfully with a combination including posaconazole. DESIGN Case report. SETTING Pediatric critical care unit at Antwerp University Hospital. PATIENT A 12-yr-old female polytrauma patient, suffering from extensive skin and muscle injuries, developed fasciitis. Two fungi (Mucor and Trichosporon species) were isolated. The necrotic tissues were aggressively excised, hyperbaric oxygen therapy was applied, and oral posaconazole was added to the initial amphotericin B treatment. The patient made an excellent recovery. CONCLUSIONS A combination of a high index of suspicion, early aggressive surgery, hyperbaric oxygen, and the association of amphotericin B and posaconazole led to a successful outcome in a case of fungal necrotizing fasciitis. After decades of disappointing amphotericin B treatment in spite of acceptable in vitro activity, the combination with the new triazole posaconazole seems promising.
Collapse
Affiliation(s)
- Koen De Decker
- Departments of Critical Care Medicine, Antwerp University Hospital, Belgium
| | | | | | | | | | | | | |
Collapse
|
23
|
Lassalle S, Hofman V, Butori C, Sicard D, Hofman P. [Histological diagnosis of lung bacterial necrotizing infections: a study of four fulminant cases]. Ann Pathol 2006; 25:349-56. [PMID: 16498288 PMCID: PMC7133755 DOI: 10.1016/s0242-6498(05)80143-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Nous rapportons les aspects anatomo-cliniques et histologiques de 4 observations d’infection bactérienne pulmonaire associée à des lésions de nécrose extensive, dont l’évolution a été foudroyante en quelques heures (2 cas d’infections à streptocoque béta hémolytique du groupe A, 1 cas d’infection à Staphylococcus aureus et un cas d’infection à Haemophilus influenzae). Ces infections bactériennes nécrosantes extensives (IBNE) sont gravissimes compte tenu de la production de toxines nécrosantes. Les aspects histologiques sont stéréotypés, combinant une nécrose hémorragique extensive et diffuse, des nappes de bactéries et une réaction inflammatoire cellulaire quasi inexistante. Ces infections sont extrêmement rares et elles surviennent sans cause apparente, chez le sujet immunodéficient ou immunocompétent. Elles posent des problèmes de diagnostic différentiel parfois difficile à résoudre en histologie faisant discuter une infection virale associée. Le diagnostic positif repose sur une confontation anatomopathologique et microbiologique.
Collapse
Affiliation(s)
- Sandra Lassalle
- Laboratoire de Pathologie Clinique et Expérimentale, Hôpital Pasteur, BP 69, 06002 Nice Cedex
| | - Véronique Hofman
- Laboratoire de Pathologie Clinique et Expérimentale, Hôpital Pasteur, BP 69, 06002 Nice Cedex
| | - Catherine Butori
- Laboratoire de Pathologie Clinique et Expérimentale, Hôpital Pasteur, BP 69, 06002 Nice Cedex
| | - Dominique Sicard
- Laboratoire de Bactériologie, Hôpital de l’Archet II, route Saint Antoine de Ginestière, 06200, Nice Cedex
| | - Paul Hofman
- Laboratoire de Pathologie Clinique et Expérimentale, Hôpital Pasteur, BP 69, 06002 Nice Cedex
- Tirés à part : P. Hofman, voir adresse en début d’article.
| |
Collapse
|
24
|
Abstract
Necrotizing fasciitis is characterized by a rapidly progressing necrosis of subcutaneous fat and fascia, which can be life-threatening without prompt recognition, surgical intervention, and immediate antibiotic therapy. Necrotizing fasciitis has been subdivided into type 1, or polymicrobial necrotizing fasciitis, and type 2, or group A streptococcal necrotizing fasciitis. In addition, synonyms, such as streptococcal gangrene and "flesh-eating bacteria syndrome," have been used in the literature.
Collapse
Affiliation(s)
- Erika Gaines Levine
- Division of Dermatology, Robert Wood Johnson Medical School at Camden, University of Medicine & Dentistry of New Jersey, Camden, NJ 08103, USA
| | | |
Collapse
|
25
|
Chau CLF, Griffith JF. Musculoskeletal infections: ultrasound appearances. Clin Radiol 2005; 60:149-59. [PMID: 15664569 DOI: 10.1016/j.crad.2004.02.005] [Citation(s) in RCA: 131] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2003] [Revised: 02/02/2004] [Accepted: 02/06/2004] [Indexed: 12/19/2022]
Abstract
Musculoskeletal infections are commonly encountered in clinical practice. This review will discuss the ultrasound appearances of a variety of musculoskeletal infections such as cellulitis, infective tenosynovitis, pyomyositis, soft-tissue abscesses, septic arthritis, acute and chronic osteomyelitis, and post-operative infection. The peculiar sonographic features of less common musculoskeletal infections, such as necrotizing fasciitis, and rice body formation in atypical mycobacterial tenosynovitis, and bursitis will also be presented.
Collapse
Affiliation(s)
- C L F Chau
- Department of Radiology, North District Hospital, NTEC, Fanling, Hong Kong, Republic of China.
| | | |
Collapse
|
26
|
Thami GP, Kaur S, Bawa AS, Chander J, Mohan H, Bedi MS. Post-surgical zygomycotic necrotizing subcutaneous infection caused by Absidia corymbifera. Clin Exp Dermatol 2003; 28:251-3. [PMID: 12780704 DOI: 10.1046/j.1365-2230.2003.01244.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Necrotizing infections of the skin and subcutaneous tissue are usually bacterial in origin. Rarely, fungi of the class Zygomycetes, which cause deep mycoses, may be responsible for acute necrotizing infections of these areas. Several local and systemic predisposing factors have been associated with such acute necrotizing infections. Surgical debridement and amphotericin B remain the mainstay of treatment. In this report we describe a patient with post-surgical necrotizing subcutaneous infection caused by Absidia corymbifera, 2 weeks following appendectomy. Successful management with surgical debridement, topical amphotericin B and oral potassium iodide is reported.
Collapse
Affiliation(s)
- G P Thami
- Department of Dermatology and Venereology, Government Medical College Hospital, Chandigarh, India.
| | | | | | | | | | | |
Collapse
|
27
|
Singh G, Chawla S. Aggressiveness - The key to a Successful Outcome in Necrotizing Soft Tissue Infection. Med J Armed Forces India 2003; 59:21-4. [PMID: 27407451 PMCID: PMC4925751 DOI: 10.1016/s0377-1237(03)80098-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
16 patients with necrotizing soft tissue infections were managed during last three years in various service hospitals. The experience indicates that there is considerable overlap in clinical findings and bacteriology. The infections seem to be variations of the same disease process, a spreading necrotizing infection. The number of these patients suggests that there is an increasing incidence of this entity. Staphylococcus and coliforms were the commonest organisms cultured in most of these patients. Because of the high mortality rate upto 50% as reported, we advocate aggressive and early treatment of this condition. Urgent radical exploration, excision of all necrotic tissue and adequate drainage of the deep fascial planes was done in all patients until healthy tissue planes were reached. A strong index of suspicion aids early diagnosis which ensures a favourable outcome. Our study indicates that the lower gastrointestinal tract should be considered as a possible cause of infection in all patients with synergistic gangrene. The involvement of the perineum and scrotum was most common. All these patients were treated with a common approach of resuscitation, broad spectrum antibiotics, immediate surgical excision of all necrotic tissue, aggressive nutritional therapy and early skin coverage with 20% mortality. The infection was primary in 8, postsurgical in 4 and following trauma in 4 cases. In majority of patients, Staphylococcus with beta haemolytic streptococci and E coli were the organisms isolated initially. Mortality was highest in intensive infections extending the abdomen and chest. Aggressive, effective and early treatment of necrotizing soft tissue infections is imperative to prevent a fatal outcome. Urgent radical exploration by the most experienced surgeon available is essential and includes wide excision of all necrotic tissue and adequate drainage of the deep fascial planes until indubitably healthy tissue is experienced. The surgeon must be prepared to proceed to a laparotomy, diverting colostomy or a suprapubic cystotomy where there exists any element of doubt. Aggression is also of significance in resuscitation, early institution of empirical broad spectrum antibiotic therapy, elaborate repeated daily dressings with hydrogen peroxide and to allow further debridement till the process is controlled.
Collapse
Affiliation(s)
- Gurjit Singh
- Commandant, Artificial Limb Centre, Pune - 411 040
| | - S Chawla
- Classified Specialist (Surgery), Military Hospital, Bhopal - 462 031
| |
Collapse
|
28
|
Ndukwe KC, Fatusi OA, Ugboko VI. Craniocervical necrotizing fasciitis in Ile-Ife, Nigeria. Br J Oral Maxillofac Surg 2002; 40:64-7. [PMID: 11883974 DOI: 10.1054/bjom.2001.0715] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Sixteen cases of necrotizing fasciitis were seen at the Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria from 1990 to 2000. Primary craniocervical involvement was recorded in seven patients (five men and two women). The clinical records of five patients were sufficiently detailed to allow us to report their age, aetiology, predisposing illness, clinical features, complications, management regimen and outcome. The patients were aged 30-75 years and in four of them odontogenic infections were the cause of the condition. Hypertension, diabetes mellitus and obesity were the underlying systemic diseases in three cases and the body/angle region of the mandible was the predominant site of the infection on the face. All five cases had involvement of the neck. Mediastinal extension was recorded in three cases. Two patients had complications: one had septicaemia and renal failure and the other developed bone necrosis. Pre-existing ill health, old age, late surgical intervention, and mediastinal and thoracic extension of infection were responsible for the only death. Treatment involved frequent and multiple surgical debridement, aggressive antimicrobial treatment and control of systemic disease. Early recognition, prompt surgical intervention, and aggressive antimicrobial treatment are essential to minimize morbidity and mortality. Rapid progression of infection, financial constraints, delayed referrals from rural clinics and distance to the tertiary hospital caused problems.
Collapse
Affiliation(s)
- K C Ndukwe
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria
| | | | | |
Collapse
|
29
|
Abstract
Many newly described or "re-emerging" infectious diseases may present to the dermatologist, often with potentially life-threatening implications. Prompt recognition and early intervention can greatly diminish the morbidity and mortality associated with these diseases.
Collapse
Affiliation(s)
- S M Manders
- Division of Dermatology, University of Medicine and Dentistry, New Jersey-Robert Wood Johnson Medical School at Camden, Camden, New Jersey, USA.
| |
Collapse
|
30
|
|
31
|
Chen JL, Fullerton KE, Flynn NM. Necrotizing fasciitis associated with injection drug use. Clin Infect Dis 2001; 33:6-15. [PMID: 11389488 DOI: 10.1086/320874] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2000] [Revised: 11/02/2000] [Indexed: 11/03/2022] Open
Abstract
We studied cases of necrotizing fasciitis among injection drug users (IDUs) and non-IDUs who presented at the University of California Davis Medical Center from 1984 through 1999. Of 107 patients, 59 (55%) were IDUs and 48 (45%) non-IDUs. Among IDUs, 32 (54%) recently injected at the site of infection, and 17 patients (29%) presented with an abscess. Among non-IDUs, 17 (35%) reported a recent insect bite and 9 (19%) reported a wound or abrasion at the site of infection. Overall, seventy cases (65%) had > or = 3 debridements, and 31 patients (29%) had > 5% of their total body surface area debrided. Of all patients with necrotizing fasciitis, 16 (15%) did not survive. Among the 59 IDUs, 6 (10%) did not survive, while among non-IDUs, 10 (21%) did not survive. Our results indicate the need for a high index of suspicion for necrotizing fasciitis among patients presenting with cellulitis, a recent insect bite, wound, or recent injection drug use. Preventive interventions for necrotizing fasciitis among IDUs should include street-based education and treatment for abscesses and cellulitis.
Collapse
Affiliation(s)
- J L Chen
- Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, USA.
| | | | | |
Collapse
|
32
|
Lin C, Yeh FL, Lin JT, Ma H, Hwang CH, Shen BH, Fang RH. Necrotizing fasciitis of the head and neck: an analysis of 47 cases. Plast Reconstr Surg 2001; 107:1684-93. [PMID: 11391186 DOI: 10.1097/00006534-200106000-00008] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Necrotizing fasciitis is an overwhelming infection common to the perineum, abdominal wall, and extremities. It is a surgical emergency related to a high mortality rate that is more often seen in elderly and immunocompromised patients. Necrotizing fasciitis occurs uncommonly in the head and neck region. Over a 12-year period, 47 cases of necrotizing fasciitis of the head and neck region were collected at this hospital. The demographics, predisposing factors, clinical presentation and courses, management, complications, and outcomes were analyzed. The cases were divided into two groups: survivors and nonsurvivors. Statistical comparisons were made of the parameters age, gender, smoking or drinking habit, underlying medical problems, laboratory data, and treatments used. Forty-two patients (89.4 percent) had associated systemic disease; most of these patients had diabetes (72.3 percent). The clinical manifestations are nonspecific but are often typical for diagnosis. The necessity of computed tomographic scans is not conclusive in this study. Presentation of septic shock (p = 0.004) and association with underlying malignancy (p = 0.03) were the only statistically significant factors that led to a poor prognosis. The cornerstones of proper management include early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and intensive supportive care.
Collapse
Affiliation(s)
- C Lin
- Division of Plastic and Reconstructive Surgery, Veterans General Hospital-Taipei and the National Yang-Ming University, Taiwan, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
33
|
Ballon-Landa GR, Gherardi G, Beall B, Krosner S, Nizet V. Necrotizing fasciitis due to penicillin-resistant Streptococcus pneumoniae: case report and review of the literature. J Infect 2001; 42:272-7. [PMID: 11545571 DOI: 10.1053/jinf.2000.0801] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Necrotizing fasciitis (NF) is a life-threatening infection involving rapid necrosis of subcutaneous and fascial tissues. Streptococcus pneumoniae (SPN) soft tissue infection is exceedingly uncommon, reported primarily in patients with immunosuppression or other underlying conditions. We report a case of NF and septic shock in a healthy 32-year-old man, whose only predisposing factor was antecedent blunt trauma. Pathological examination and culture of the extensive tissue debridement were positive only for SPN. The serotype 9V isolate was penicillin (PCN)-resistant (MIC=2.0), and closely-related by pulse field gel electrophoresis and multilocus fingerprinting to clone France 9V-3, an important genetic reservoir for increasing PCN-resistance worldwide. This unique case has implications for our pathogenic under-standing and empiric management of NF.
Collapse
Affiliation(s)
- G R Ballon-Landa
- Department of Medicine, Scripps Mercy Hospital, San Diego, CA, USA
| | | | | | | | | |
Collapse
|
34
|
Affiliation(s)
- S L DeBoer
- University of Chicago Aeromedical Network, University of Chicago Hospitals, Chicago, USA
| | | |
Collapse
|
35
|
Abstract
Ultrasound is able to play a key role in the management of musculoskeletal soft tissue infections. It is an easily accessible imaging modality that can be used immediately after plain radiographs have been obtained. Quick diagnosis is essential in the clinical setting of musculoskeletal infection because delay can lead to significant morbidity. In addition to its diagnostic capabilities, US offers a safe, real-time, and convenient technique to perform immediately a guided-needle aspiration of any suspicious fluid collection. US provides the most efficient way to document quickly an infection of the musculoskeletal soft tissues and to identify the offending micro-organism.
Collapse
Affiliation(s)
- E Cardinal
- Department of Radiology, Centre Hospitalier de l'Université de Montréal, H pital Saint-Luc, Québec, Canada.
| | | | | | | |
Collapse
|
36
|
Abrahamian FM. Update: Clostridium novyi and unexplained illness among injecting-drug users--Scotland, Ireland, and England, April-June 2000. Ann Emerg Med 2001; 37:107-9. [PMID: 11145782 DOI: 10.1067/mem.2001.112097] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- F M Abrahamian
- Olive View-UCLA Medical Center, University of California Los Angeles, Sylmar, CA, USA
| |
Collapse
|
37
|
De quelles données a-t-on besoin aujourd'hui pour prendre en charge les cellulites et fasciites nécrosantes? Med Mal Infect 2000. [DOI: 10.1016/s0399-077x(01)80040-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
38
|
|
39
|
|
40
|
|
41
|
Minnaganti VR, Patel PJ, Iancu D, Schoch PE, Cunha BA. Necrotizing fasciitis caused by Aeromonas hydrophila. Heart Lung 2000; 29:306-8. [PMID: 10900069 DOI: 10.1067/mhl.2000.106723] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Aeromonas Hydrophila is a gram-negative bacillus commonly found in soil, sewage, and fresh or brackish water in many parts of the United States. In healthy people, the most common clinical manifestations attributed to Aeromonas are diarrhea and soft tissue infections. In people with suppressed immune systems or liver disease, A hydrophila can cause meningitis, endocarditis, peritonitis, hemolytic-uremic syndrome, or septicemia. We present the first known case of fulminant necrotizing fasciitis from A hydrophila that is not associated with trauma, liver disease, or immunosuppression.
Collapse
Affiliation(s)
- V R Minnaganti
- Infectious Disease Division and the Department of Pathology, Winthrop-University Hospital, Mineola, NY 11501, USA
| | | | | | | | | |
Collapse
|
42
|
Abstract
Cutaneous infections continue to represent a large proportion of inpatient dermatology. Though most infectious skin diseases do not warrant hospitalization, some do and can rapidly become fatal if not treated promptly. A selected group of infections are reviewed--primary cutaneous infections, exotoxin-mediated syndromes, and systemic infections--that warrant hospitalization. Dermatologists play a critical role in the synthesis of patient history and appreciation of morphologic skin disease, which, when coupled with appropriate lab tests, may help to establish a diagnosis allowing for the timely implementation of effective and targeted therapy.
Collapse
Affiliation(s)
- E F Callahan
- Department of Dermatology, Cleveland Clinic Foundation, Ohio, USA
| | | | | |
Collapse
|
43
|
Abstract
The oral cavity is a common site for manifestations of systemic microbial diseases. Oral lesions may be typical of those seen elsewhere on the body, or the lesions may be modified by the local environment. The ease of examination within the oral cavity, however, and any site-specific features facilitates diagnosis of the systemic condition.
Collapse
Affiliation(s)
- G S Schuster
- Department of Oral Biology and Maxillofacial Pathology, Medical College of Georgia, School of Dentistry, Augusta, USA
| |
Collapse
|
44
|
Abstract
Necrotizing fasciitis, although rare, is one of the more serious, life-threatening complications of missed acute appendicitis. Patients who are predisposed to developing necrotizing fasciitis, regardless of the cause, are typically immunocompromised. We present a case of a 49-year-old immunocompetent female whose diagnosis of acute appendicitis was missed and who subsequently developed necrotizing fasciitis of the abdominal wall and flank. She recovered 1 month after admission due to aggressive surgical and medical therapy.
Collapse
Affiliation(s)
- D Groth
- University of Southern California School of Medicine, Los Angeles, USA
| | | |
Collapse
|
45
|
|
46
|
Abstract
After several decades of seemingly decreasing virulence, streptococcal and staphylococcal infections have reemerged as a major source of morbidity and mortality. Within the past 2 decades, not only have well-established diseases such as rheumatic fever begun to reappear. but also many new entities, such as toxic shock syndrome, streptococcal toxic shock syndrome, recurrent toxin-mediated perineal erythema, and recalcitrant erythematous desquamating disorder have been described. Central to the renewed importance of these bacteria has been the production of circulating toxins, which often function as superantigens in causing the clinical manifestations, morbidity and mortality associated with these diseases.
Collapse
Affiliation(s)
- S M Manders
- Department of Medicine, University of Medicine and Dentistry of New Jersey--Robert Wood Johnson Medical School at Camden, USA
| |
Collapse
|