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Sun Y, Lin YZ, Chen ZG. An Uncommon Case of Necrotizing Fasciitis and Septic Shock Caused by Vibrio vulnificus Infection-Related Freshwater Shrimp Stung. THE INTERNATIONAL JOURNAL OF LOWER EXTREMITY WOUNDS 2023; 22:152-155. [PMID: 33225768 DOI: 10.1177/1534734620973992] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Vibrio vulnificus is a deadly marine pathogen that can cause necrotizing fasciitis, septic shock, and even death in severe cases. The relatively low incidence and atypical early-stage symptoms may hinder many physicians from carrying out surgical intervention effectively, thus leading to an increase of mortality in infected patients. This article reported a patient who developed necrotizing fasciitis and septic shock after the exposure to freshwater shrimp stabbed on the limb. By reviewing and analyzing previous studies, it was found out that the timing of surgery could have a significant impact on the patients for their necrotizing fasciitis caused by Vibrio vulnificus infection. The mortality among patients undergoing early-stage surgical treatment (≤12 hours from the time of admission) was significantly lower than that of patients undergoing late surgical treatment (>12 hours).
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Affiliation(s)
- Yi Sun
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yu-Ze Lin
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Zeng-Gan Chen
- Zhongshan Hospital, Fudan University, Shanghai, China
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2
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Villarreal ME, Jalilvand A, Schubauer K, Kellet W, DiDonato C, Roberts L, Helkin A, Scarlet S, Wisler J. Comorbidities Matter as Distressed Communities Index Fails to Predict Mortality in Necrotizing Soft Tissue Infection. Surg Infect (Larchmt) 2022; 23:801-808. [DOI: 10.1089/sur.2022.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Anahita Jalilvand
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Kathryn Schubauer
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Whitney Kellet
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Courtney DiDonato
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Luke Roberts
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Alex Helkin
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Sara Scarlet
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jonathan Wisler
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Abstract
Necrotizing soft tissue infections of the perineum are rapidly progressing infections associated with significant morbidity and mortality. Prompt diagnosis and management with early surgical debridement is necessary to improve survival from this deadly disease. Repeat debridements are not uncommon. Important adjuncts to surgery include broad-spectrum antibiotics and management in an intensive care unit, as patients frequently develop multisystem organ failure. Once the acute phase is managed, fecal diversion with either an ostomy or fecal management catheter can be considered to decrease soiling of the wound and facilitate healing. Long-term management requires meticulous wound care, often with the assistance of negative pressure wound therapy. Patients may ultimately require skin grafts or tissue flaps for soft tissue coverage following extensive surgical debridements.
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Affiliation(s)
- Bryan P. Kline
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Nimalan A. Jeganathan
- Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania,Address for correspondence Nimalan A. Jeganathan, MD Division of Colon and Rectal Surgery, Department of Surgery, The Pennsylvania State University, College of Medicine500 University Drive, Hershey, PA 17033-0850
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4
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Islam S, Aziz I, Shah J, Naraynsingh V, Harnarayan P. Necrotizing Fasciitis of the Breast Requiring a Life-Saving Mastectomy: A Case Report and Literature Review. Cureus 2021; 13:e19886. [PMID: 34966604 PMCID: PMC8710037 DOI: 10.7759/cureus.19886] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/05/2022] Open
Abstract
Necrotizing soft tissue infection of the breast is an extremely rare event in routine surgical practice. It is the most aggressive form of soft tissue infection and a real surgical emergency. It is associated with a high risk of mortality if not diagnosed promptly. A Literature search has revealed only a few such cases. The exact etiology is variable and very often multifactorial. Early recognition and prompt surgical treatment along with broad-spectrum antibiotic therapy are of paramount importance to prevent mortality. In this report, we present the first case of necrotizing fasciitis of the breast following an insect bite in the literature, in a 57-year-old diabetic patient with a delayed presentation that required a life-saving mastectomy.
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Affiliation(s)
- Shariful Islam
- General Surgery/Oncoplastic Breast Surgery, San Fernando General Hospital, San Fernando, TTO
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
| | - Imran Aziz
- Surgery, San Fernando General Hospital, San Fernando, TTO
| | - Jitendra Shah
- Department of General Surgery/Breast Surgery, San Fernando General Hospital, San Fernando, TTO
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
| | - Vijay Naraynsingh
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
- Surgery, Medical Associates Hospital, St. Joseph, TTO
| | - Patrick Harnarayan
- Department of Clinical Surgical Sciences, University of the West Indies, St. Augustine, TTO
- General Surgery, San Fernando General Hospital, San Fernando, TTO
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Lemsanni M, Najeb Y, Zoukal S, Chafik R, Madhar M, Elhaoury H. Necrotizing fasciitis of the upper extremity: a retrospective analysis of 19 cases. HAND SURGERY & REHABILITATION 2021; 40:505-512. [PMID: 33812083 DOI: 10.1016/j.hansur.2021.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/10/2021] [Accepted: 02/19/2021] [Indexed: 11/24/2022]
Abstract
Necrotizing fasciitis (NF) is both a limb-and life-threatening disease that affects skin, hypodermis as well as superficial fascia and deep fascia by rapidly progressive necrosis. Although this serious infection frequently occurs in the extremities, upper limb NF is a rare clinical presentation. The present study attempted to evaluate the clinical profiles, paraclinical findings, treatment modalities, outcomes and predictors of morbidity and mortality in patients with NF of the upper extremity. The validity of the Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) scoring system was also assessed. Nineteen patients who were treated between January 2010 and December 2019 for NF of the upper extremity were eligible for this study. Data including demographics, clinical signs, paraclinical findings, treatment and outcomes were collected retrospectively from our medical records. Fisher's exact test was used to analyze predictive factors for mortality and morbidity. The mean age was 62 years, with a male predominance. The most common comorbidity was diabetes mellitus (42%). Main clinical manifestations were pain (79%), tense edema (79%) and a large infiltrated swollen erythematous plaque (58%). Severe sepsis and septic shock were identified in 32% and 21% of patients, respectively. Thirteen of our 19 patients (68%) were identified as having a high or intermediate likelihood of NF based of the LRINEC scoring system, while the other 6 (32%) were classified as having low likelihood. All patients received systemic broad spectrum antibiotic therapy in addition to surgical debridement. Two patients (10%) died and one (5%) required amputation. Mortality was associated with septic shock (p = 0.006), delay in surgery >24 h (p = 0.018), creatininemia >141 mmol/l (p = 0.018) and LRINEC score ≥ 8 (p = 0.035). Otherwise, anemia (p = 0.021), hypercreatininemia (p = 0.001) and delayed surgical debridement (p = 0.001) were risk factors for morbidity and mortality. The surviving patients underwent reconstructive surgery (skin grafting after wound preparation by using vacuum therapy) with positive outcome. Early diagnosis coupled with emergent surgical debridement and broad-spectrum empiric antibiotic therapy are the keystones of a successful outcome. The LRINEC score was not strongly correlated to the true diagnosis of NF and was a prognostic tool rather than a diagnostic one.
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Affiliation(s)
- M Lemsanni
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000, Marrakesh, Morocco.
| | - Y Najeb
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000, Marrakesh, Morocco
| | - S Zoukal
- Epidemiology Laboratory of the Faculty of Medicine and Pharmacy of Casablanca, Casablanca, Morocco
| | - R Chafik
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000, Marrakesh, Morocco
| | - M Madhar
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000, Marrakesh, Morocco
| | - H Elhaoury
- Department of Orthopedic and Trauma Surgery, Ibn Tofail Hospital, Mohammed VI University Hospital Center, Abdelouahab Derraq Street, PB 40000, Marrakesh, Morocco
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Retracted: Necrotizing Fasciitis: Diagnostic Challenges and Current Practices. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2020. [DOI: 10.1155/2020/4827404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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McCarty AR, Villarreal ME, Tamer R, Strassels SA, Schubauer KM, Paredes AZ, Santry H, Wisler JR. Analyzing Outcomes Among Older Adults With Necrotizing Soft-Tissue Infections in the United States. J Surg Res 2020; 257:107-117. [PMID: 32818779 DOI: 10.1016/j.jss.2020.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Necrotizing soft-tissue infections (NSTIs) encompass a group of severe, life-threatening diseases with high morbidity and mortality. Evidence suggests advanced age is associated with worse outcomes. To date, no large data sets exist describing outcomes in older individuals, and risk factor identification is lacking. METHODS Retrospective data were obtained from the 2015 Medicare 100% sample. Included in the analysis were those aged ≥65 y with a primary diagnosis of an NSTI (gas gangrene, necrotizing fasciitis, cutaneous gangrene, or Fournier's gangrene). Risk factors for in-hospital mortality and discharge disposition were examined. Continuous variables were assessed using central tendency, t-tests, and Wilcoxon rank-sum tests. Categorical variables were assessed using the chi-squared and Fisher's exact tests. Statistical significance was defined as P < 0.05. RESULTS 1427 patient records were reviewed. 59% of patients were male, and the overall mean age was 75.4±8.6 y. 1385 (97.0%) patients required emergency surgery for their NSTI diagnosis. The overall mortality was 5.3%. Several underlying comorbidities were associated with higher rates of mortality including cancer (OR: 3.50, P = 0.0009), liver disease (OR: 2.97, P = 0.03), and kidney disease (OR: 2.15, P = 0.01). While associated with high in-hospital mortality, these diagnoses were not associated with a difference in the rate of discharge to home compared with skilled nursing or rehab. Overall, patients discharged to skilled nursing facilities or rehab had higher rates of underlying comorbidities than patients who were discharged home (3 or more comorbid illness 84.3% versus 68.6%, P < 0.0001); however, no individual comorbid illness was associated with discharge location. CONCLUSIONS In our Medicare data set, we identified several medical comorbidities that are associated with increased rates of in-hospital mortality. Patients with underlying cancers had the highest odds of increased mortality. The effect on outcomes of the potentially immunosuppressive cancer treatments in these patients is unknown. These data suggest that patients with underlying illnesses, especially cancer, kidney disease, or liver disease have higher mortalities and are more likely to be discharged to skilled nursing facilities or rehab. It is unclear why these illnesses were associated with these worse outcomes while others including diabetes and heart disease were not. These data suggest that these particular comorbid illnesses may have special prognostic implications, although further analysis is necessary to identify the causative factors.
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Affiliation(s)
- Adara R McCarty
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio.
| | - Michael E Villarreal
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio
| | - Robert Tamer
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio
| | - Scott A Strassels
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio; Ohio State University, Wexner Medical Center Center For Surgical Health Assessment, Research And Policy (SHARP), Columbus, Ohio
| | - Kathryn M Schubauer
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio
| | - Anghela Z Paredes
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio
| | - Heena Santry
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio; Ohio State University, Wexner Medical Center Center For Surgical Health Assessment, Research And Policy (SHARP), Columbus, Ohio
| | - Jon R Wisler
- Ohio State University, Wexner Medical Center Department of Surgery, Columbus, Ohio
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Juncar M, Juncar RI, Onisor-Gligor F. Ludwig's angina, a rare complication of mandibular fractures. J Int Med Res 2019; 47:2280-2287. [PMID: 30958072 PMCID: PMC6567769 DOI: 10.1177/0300060519840128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 03/06/2019] [Indexed: 11/25/2022] Open
Abstract
Traumas are a major problem worldwide. A considerable proportion of traumas are located in the cephalic extremity. Neglect of these disorders by patients or those responsible for patient management may result in particularly serious consequences. This paper presents the case of a 58-year-old male patient with an intraorally open mandibular fracture, which left untreated for 3 days, was complicated by Ludwig's angina. Following aggressive surgical treatment during which the mandibular fracture was manually reduced and immobilized with a metal splint fixed with circumdental wires and effective antibiotic therapy, the septic process was terminated and the patient's fracture and infected wound were healed. The correct and rapid treatment of open mandibular fractures is mandatory in order to avoid severe septic complications.
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Affiliation(s)
- Mihai Juncar
- Oral and Maxillofacial Surgery, Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Raluca-Iulia Juncar
- Department of Prosthetics, Department of Dental Medicine, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
| | - Florin Onisor-Gligor
- Department of Oral and Maxillofacial Surgery, Iuliu Haţieganu University of Medicine and Pharmacy Cluj-Napoca, Cluj-Napoca, Cluj, Romania
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9
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Nawijn F, Wassenaar ECE, Smeeing DPJ, Vlaminckx BJM, Reinders JSK, Wille J, Leenen LPH, Hietbrink F. Exhaustion of the immune system by Group A Streptococcus necrotizing fasciitis: the occurrence of late secondary infections in a retrospective study. Trauma Surg Acute Care Open 2019; 4:e000272. [PMID: 30899798 PMCID: PMC6407531 DOI: 10.1136/tsaco-2018-000272] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/18/2018] [Accepted: 11/19/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis is a potentially lethal condition for which early and adequate treatment with surgical debridement and broad-spectrum intravenous antibiotics are essential for survival. It is hypothesized that Group A Streptococcus (GAS) necrotizing fasciitis causes exhaustion of the immune system, making these patients more susceptible for late secondary infections. METHODS A retrospective study was conducted of all patients with necrotizing fasciitis between 2002 and 2016. Patients with necrotizing fasciitis based on macroscopic findings, positive Gram staining, culture or fresh frozen section of fascia biopsies were included. Patients with necrotizing fasciitis were divided into two groups based on the presence of GAS. Of both groups, clinical course, outcome and occurrence of late secondary infections were analyzed. For the occurrence of secondary infections, pneumonia was chosen as reference for late secondary infections. RESULTS Eighty-one patients with necrotizing fasciitis were included of which 38 (47%) had GAS necrotizing fasciitis and 43 (53%) had non-GAS necrotizing fasciitis. Patients with GAS necrotizing fasciitis were younger (50 vs. 61 years, p=0.023) and more often classified as ASA I (45% vs. 14%, p=0.002) compared with patients with non-GAS necrotizing fasciitis. In-hospital mortality rate for necrotizing fasciitis was 32%. Patients with comorbidities were more likely to die of necrotizing fasciitis compared with patients without comorbidities (OR 7.41, 95% CI 1.58 to 34.63). Twelve patients (39%) with GAS necrotizing fasciitis developed pneumonia compared with four patients (13%) with non-GAS necrotizing fasciitis (p=0.017; OR 4.42, 95% CI 1.124 to 15.79). Median time from diagnosis to development of pneumonia in patients with GAS necrotizing fasciitis was 10 days (IQR 9). CONCLUSION Patients with GAS necrotizing fasciitis have an increased risk to develop late secondary infections during initial treatment for necrotizing fasciitis compared with patients with necrotizing fasciitis without involvement of GAS. This suggests exhaustion of the immune system after severe GAS infection. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Femke Nawijn
- Surgery, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Emma C E Wassenaar
- Surgery, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
- Surgery, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
| | | | | | | | - Jan Wille
- Surgery, Sint Antonius Ziekenhuis, Nieuwegein, Netherlands
| | - Luke P H Leenen
- Surgery, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
| | - Falco Hietbrink
- Surgery, Universitair Medisch Centrum Utrecht, Utrecht, Netherlands
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12
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Kim YH, Ha JH, Kim JT, Kim SW. Managing necrotising fasciitis to reduce mortality and increase limb salvage. J Wound Care 2018; 27:S20-S27. [DOI: 10.12968/jowc.2018.27.sup9a.s20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Youn Hwan Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Jeong Hyun Ha
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, Korea
| | - Jeong Tae Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Hanyang University, Seoul, Korea
| | - Sang Wha Kim
- Department of Plastic and Reconstructive Surgery, College of Medicine, Seoul National University, Seoul National University Hospital, Seoul, Korea
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13
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Agarwal L, Yasin A. Necrotising fasciitis: a fatal case of sepsis and a diagnostic challenge - case report and review of literature. Int J Emerg Med 2018; 11:23. [PMID: 29626314 PMCID: PMC5889371 DOI: 10.1186/s12245-018-0183-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 03/28/2018] [Indexed: 12/04/2022] Open
Abstract
Background Necrotising fasciitis (NF) is a severe, devastating soft tissue infection characterised by rapidly progressing tissue necrosis. This rare condition has a high mortality rate and poses diagnostic and management challenges to the clinician. There is usually a history of trauma, which maybe trivial. Some of the premorbid conditions associated with NF are diabetes and or immunocompromised state. It requires prompt recognition and early treatment with intravenous antibiotics and extensive surgical debridement. Case presentation We describe a 74-year-old lady who presented to our emergency department following 3 days’ history of watery diarrhoea and feeling generally unwell. She had signs of severe sepsis and was started on broad-spectrum intravenous antibiotics and fluids for sepsis with unknown source. She was found to have an area of blackish discolouration on her thigh which was suspected as necrotising fasciitis (NF) and referred to the surgeons. She had no history of trauma or significant comorbidity. She underwent surgical exploration and debridement within few hours of arrival into the emergency department and subsequent further debridement with above-knee amputation of the affected limb. She eventually died after about 48 h of hospital stay despite an early diagnosis and prompt surgical debridement and a multidisciplinary approach. Conclusions Necrotising fasciitis has been previously reported in literature but we would like to highlight through this case the importance of looking for the source of sepsis by thorough clinical examination and the need to have a high threshold of suspicion for this rare condition and urgent involvement of a surgical team for debridement.
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Affiliation(s)
- Lekha Agarwal
- Emergency Medicine Department, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK.
| | - Athar Yasin
- Emergency Medicine Department, Peterborough City Hospital, North West Anglia NHS Foundation Trust, Peterborough, UK
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Gassiep I, Gore L, Dale JL, Playford EG. Ureaplasma urealyticum necrotizing soft tissue infection. J Infect Chemother 2017; 23:830-832. [PMID: 28803865 DOI: 10.1016/j.jiac.2017.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 06/10/2017] [Accepted: 07/17/2017] [Indexed: 11/30/2022]
Abstract
Ureaplasma urealyticum is a urogenital commensal and often associated with localised infection. With the advent of monoclonal immunosuppressive therapy and improved diagnostic methods, reports of non-urogenital infections are accumulating. We report a rare case of U. urealyticum necrotizing soft tissue infection and left hip septic arthritis in a hypogammaglobulinaemic patient. Consideration of this organism as an etiological agent, and potential early use of nucleic-acid diagnostic investigation with empiric therapy including activity against Ureaplasma in this patient population may be warranted.
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Affiliation(s)
- Ian Gassiep
- Department of Infectious Diseases, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia; School of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia.
| | - Letitia Gore
- School of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia; Pathology Queensland Central Laboratory, Royal Brisbane and Women's Hospital, Block 7, Level 9, Herston Road, Herston, QLD, 4006, Australia
| | - Joanne L Dale
- School of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia; Department of Colorectal Surgery, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia
| | - E Geoffrey Playford
- Department of Infectious Diseases, Princess Alexandra Hospital, 199 Ipswich Rd, Woolloongabba, QLD, 4102, Australia; School of Medicine, University of Queensland, St Lucia, QLD, 4072, Australia
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15
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Mammadli T, Kim BS, Rennekampff HO, Pallua N. Necrotizing fasciitis resulting in fatal lung aspergillosis: Uncommon pathogenesis. A case report. J Mycol Med 2017; 27:400-406. [PMID: 28479007 DOI: 10.1016/j.mycmed.2017.04.007] [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: 10/16/2016] [Revised: 02/26/2017] [Accepted: 04/08/2017] [Indexed: 10/19/2022]
Abstract
We present a fatal case of Aspergillus-associated lung failure in a patient with necrotizing fasciitis. The cause of the fasciitis was a retroperitoneal perforation of a colon carcinoma. Being already a rare condition, the fasciitis did not manifest as Fournier's gangrene like similar described cases illustrate, but instead travelled along the fasciae and subcutaneous fat tissue cranially into the thoracic cavity, ultimately leading to a disseminated infection of the lungs. The lethal outcome was thus caused by respiratory failure at a time when the primary focus was already successfully treated, contrary to typical cases of necrotizing fasciitis. This case report depicts the importance of acknowledging opportunistic fungal infections in the practice of emergency surgery. Contributing factors, pathogenesis and possible prevention measures are discussed.
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Affiliation(s)
- T Mammadli
- Department of Plastic Surgery, Hand Surgery and Burn Center, Faculty of Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - B-S Kim
- Department of Plastic and Aesthetic Surgery, Burn Surgery, Klinikum Leverkusen, Am Gesundheitspark, Germany
| | - H-O Rennekampff
- Department of Plastic and Aesthetic Surgery, Burn Surgery, Klinikum Leverkusen, Am Gesundheitspark, Germany
| | - N Pallua
- Department of Plastic Surgery, Hand Surgery and Burn Center, Faculty of Medicine, RWTH Aachen University Hospital, Pauwelsstrasse 30, 52074 Aachen, Germany
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Sukato DC, Ferzli G, Thakkar P, Gordin E. Concurrent external and intraluminal vacuum-assisted closure in head and neck necrotizing fasciitis. Laryngoscope 2017; 127:1361-1364. [DOI: 10.1002/lary.26399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 08/03/2016] [Accepted: 09/14/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Daniel C. Sukato
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - George Ferzli
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Punam Thakkar
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
| | - Eli Gordin
- Department of Otolaryngology; SUNY Downstate Medical Center; Brooklyn New York U.S.A
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17
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Gassiep I, Douglas J, Playford EG. First report of monomicrobial Candida parapsilosis necrotizing fasciitis. Transpl Infect Dis 2016; 18:752-755. [PMID: 27385469 DOI: 10.1111/tid.12571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/04/2016] [Accepted: 04/17/2016] [Indexed: 11/26/2022]
Abstract
Candida parapsilosis is an emerging pathogen worldwide. It commonly causes soft tissue infection; however, to our knowledge there has been no previous report of monomicrobial necrotizing soft tissue infection (NSTI) secondary to C. parapsilosis. We report the first case of NSTI caused by C. parapsilosis in an immunocompromised renal transplant patient, with the diagnosis proven both histologically and microbiologically. Our patient required aggressive surgical intervention and antifungal therapy, with postoperative survival at 90 days.
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Affiliation(s)
- I Gassiep
- Department of Infectious Diseases, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia. .,School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
| | - J Douglas
- Department of Infectious Diseases, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia
| | - E G Playford
- Department of Infectious Diseases, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Yang B, Connolly S, Ball W. Necrotising fasciitis of the breast: A rare primary case with conservation of the nipple and literature review. JPRAS Open 2015. [DOI: 10.1016/j.jpra.2015.05.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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19
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Siemens N, Kittang BR, Chakrakodi B, Oppegaard O, Johansson L, Bruun T, Mylvaganam H, Svensson M, Skrede S, Norrby-Teglund A. Increased cytotoxicity and streptolysin O activity in group G streptococcal strains causing invasive tissue infections. Sci Rep 2015; 5:16945. [PMID: 26601609 PMCID: PMC4658506 DOI: 10.1038/srep16945] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/22/2015] [Indexed: 11/09/2022] Open
Abstract
Streptococcus dysgalactiae subsp. equisimilis (SDSE) has emerged as an important cause of severe skin and soft tissue infections, but little is known of the pathogenic mechanisms underlying tissue pathology. Patient samples and a collection of invasive and non-invasive group G SDSE strains (n = 69) were analyzed with respect to virulence factor expression and cytotoxic or inflammatory effects on human cells and 3D skin tissue models. SDSE strains efficiently infected the 3D-skin model and severe tissue pathology, inflammatory responses and altered production of host structural framework proteins associated with epithelial barrier integrity were evident already at 8 hours post-infection. Invasive strains were significantly more cytotoxic towards keratinocytes and expressed higher Streptokinase and Streptolysin O (SLO) activities, as compared to non-invasive strains. The opposite was true for Streptolysin S (SLS). Fractionation and proteomic analysis of the cytotoxic fractions implicated SLO as a factor likely contributing to the keratinocyte cytotoxicity and tissue pathology. Analyses of patient tissue biopsies revealed massive bacterial load, high expression of slo, as well as immune cell infiltration and pro-inflammatory markers. Our findings suggest the contribution of SLO to epithelial cytotoxicity and tissue pathology in SDSE tissue infections.
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Affiliation(s)
- Nikolai Siemens
- Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Bård R Kittang
- Haraldsplass Deaconess Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Bhavya Chakrakodi
- Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Oddvar Oppegaard
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Linda Johansson
- Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Trond Bruun
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Haima Mylvaganam
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
| | | | - Mattias Svensson
- Center for Infectious Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Steiner Skrede
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Medicine, Haukeland University Hospital, Bergen, Norway
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20
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Mochizuki T, Ikari K, Hiroshima R, Takaoka H, Kawakami K, Koenuma N, Ishibashi M, Momohara S. Negative pressure wound therapy and skin grafting for necrotizing fasciitis in a patient with rheumatoid arthritis treated with abatacept: A case report. Mod Rheumatol 2015; 28:358-360. [PMID: 26457807 DOI: 10.3109/14397595.2015.1106645] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Herein, we present a case of necrotizing fasciitis (NF) in a patient with rheumatoid arthritis (RA) treated with abatacept. Cultures of the patient's leg effusion revealed group A Streptococcus. Treatment included antibiological drugs, repeat debridement, negative pressure wound therapy (NPWT), and skin grafting. This case highlights the need for suspicion of severe bacterial infection for early diagnosis and effective treatment. NF with RA can be treated effectively with repeat debridement and NPWT.
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Affiliation(s)
- Takeshi Mochizuki
- a Department of Orthopedic Surgery , Kamagaya General Hospital , Chiba , Japan and
| | - Katsunori Ikari
- b Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan
| | - Ryo Hiroshima
- a Department of Orthopedic Surgery , Kamagaya General Hospital , Chiba , Japan and
| | - Hiromitsu Takaoka
- a Department of Orthopedic Surgery , Kamagaya General Hospital , Chiba , Japan and
| | - Kosei Kawakami
- a Department of Orthopedic Surgery , Kamagaya General Hospital , Chiba , Japan and
| | - Naoko Koenuma
- a Department of Orthopedic Surgery , Kamagaya General Hospital , Chiba , Japan and
| | - Mina Ishibashi
- a Department of Orthopedic Surgery , Kamagaya General Hospital , Chiba , Japan and
| | - Shigeki Momohara
- b Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan
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21
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Clinical features and outcome of patients with descending necrotizing mediastinitis: prospective analysis of 34 cases. Infection 2015; 44:77-84. [PMID: 26335892 DOI: 10.1007/s15010-015-0838-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We aimed to investigate clinical features of patients with descending necrotizing mediastinitis (DNM) in order to improve management and outcome. METHODS We prospectively examined all patients with DNM admitted to the Intensive Care Unit (ICU) during the period from April 2007 to December 2013. Demographics, clinical features, microbiology, medical and surgical treatment data were recorded. Survivor and nonsurvivor groups were analyzed to identify factors associated with mortality. RESULTS Overall, 34 patients with DNM have been included. The mean age was 46.8 ± 11.2 years (range 24-70). The male/female ratio was 3.25. DNM arose from odontogenic infection in 22 (65%) patients; from peritonsillar abscess in 9 (26%) patients and from paranasal sinus in 3 (9%) patients. Microbiological cultures revealed a high percentage of aerobic/anaerobic coinfection. Nonsurvivors were statistically more likely to have higher SAPS II score (mean difference 19.1, 95% CI 12.3-25.9 P < 0.01) and more severe disease (P < 0.01) than survivors. Positive correlation was found between time to ICU admission after head or neck infection diagnosis and SAPS II score (ρ = 0.5, P = 0.03). The same was true for ICU length of stay and time to ICU admission (ρ = 0.6, P < 0.01) and time to surgery (ρ = 0.5, P = 0.03). Surgical treatments consisted in: transcervical drainage in 14 cases, (42%); irrigation through subxiphoid and cervical incisions of the anterior mediastinum with additional percutaneous thoracic drainage when necessary in ten cases, (29 %); thoracotomy with radical mediastinal surgical debridement, excision of necrotic tissue and decortication in ten cases, (29%). We have found a mortality rate of 12%. Patients with DNM type IIB were admitted to the ICU later than patients with DNM type I and type IIA (mean difference 3.2 days, 95% CI 1.2-5.1, P 0.02). CONCLUSIONS Prompt ICU admission in order to manage severe sepsis and/or septic shock, along with early and aggressive surgery and adequate antimicrobial therapy, could be key factors in reducing DNM mortality.
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22
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Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Tantraworasin A. Clinical predictors for severe sepsis in patients with necrotizing fasciitis: an observational cohort study in northern Thailand. Infect Drug Resist 2015. [PMID: 26213473 PMCID: PMC4509542 DOI: 10.2147/idr.s85249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background Necrotizing fasciitis (NF) is a life-threatening infection of skin and fascia. Its progress is extremely fast, with extensive necrosis. Delay in treatment, with subsequent huge soft tissue loss and associated severe sepsis, remains a major cause of death in the management of NF. Objective The aim of this study was to explore clinical characteristics that may be used to predict severe sepsis in patients with NF, in the context of routine clinical practice in northern Thailand. Methods A retrospective observational cohort study was conducted. The patient cohort in this study consisted of all patients who were diagnosed with NF by surgical or pathological confirmation. The follow-up period started with the admission date and ended with the discharge date. The clinical variables were collected from patients registered at three provincial hospitals in northern Thailand from 2009 to 2012. The clinical predictors for severe sepsis were analyzed using multivariable risk regression. Results A total of 1,452 patients were diagnosed with NF, either with severe sepsis (n=237 [16.3%]) or without severe sepsis (n=1,215 [83.7%]). From the multivariable analysis, female sex (relative risk [RR] =1.51; 95% confidence interval [CI] =1.04–2.20), diabetes mellitus (RR =1.40; 95% CI =1.25–1.58), chronic heart disease (RR =1.31; 95% CI =1.15–1.49), hemorrhagic bleb (RR =1.47; 95% CI =1.32–1.63), skin necrosis (RR =1.45; 95% CI =1.34–1.57), and serum protein <6 g/dL (RR =2.67; 95% CI =1.60–4.47) were all predictive factors for severe sepsis. Conclusion The clinical predictors for severe sepsis in patients with suspicion of NF included female sex, diabetes mellitus, chronic heart disease, hemorrhagic bleb, skin necrosis, and serum protein <6 d/dL. The risk ratio was much higher in patients with total protein less than 6 g/dL, which is associated with malnutrition. Therefore, provision of sufficient nutritional support and close monitoring for these clinical predictors may be beneficial to reduce morbidity and mortality.
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Affiliation(s)
- Patcharin Khamnuan
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ; Department of Nursing, Phayao Hospital, Phayao, Thailand
| | - Wilaiwan Chongruksut
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jayanton Patumanond
- Clinical Epidemiology Unit, Clinical Research Center, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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23
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Kim SI, Lim MC, Lee JS, Kim YJ, Seo SS, Kang S, Yoo CW, Nam BH, Kim JY, Chung SH, Park SY. Comparison of Lower Extremity Edema in Locally Advanced Cervical Cancer: Pretreatment Laparoscopic Surgical Staging with Tailored Radiotherapy Versus Primary Radiotherapy. Ann Surg Oncol 2015; 23:203-10. [PMID: 26059654 DOI: 10.1245/s10434-015-4653-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Indexed: 01/11/2023]
Abstract
BACKGROUND This study investigated the clinical manifestations of lower extremity edema (LEE) in locally advanced cervical cancer patients treated with two different strategies. METHODS In total, 79 cervical cancer survivors with International Federation of Gynecology and Obstetrics stage IB2-IIB were included. Six survivors with stage IB1 and who had been suspicious for lymph node metastasis on pretreatment image also were included. Forty-two patients received radiotherapy after pretreatment laparoscopic surgical staging (Group 1), and 43 patients received primary radiotherapy (Group 2). The patients' medical records and survey results of the Korean version of the Gynecologic Cancer Lymphedema Questionnaire (GCLQ-K) were analyzed. RESULTS The incidence of LEE was higher in Group 1 than in Group 2 (69.0 vs. 11.6 %; P < 0.001). The duration of LEE was longer in Group 1 (mean 77.3 vs. 9.4 months). At the time of survey, 47.6 % of the patients in Group 1 were clinically diagnosed with lymphedema compared with no patients in Group 2. In GCLQ-K, the mean symptom cluster scores for general swelling (0.74 vs. 0.09; P < 0.001), limb swelling (0.22 vs. 0.00; P = 0.006), and heaviness (0.45 vs. 0.23; P = 0.033) were significantly higher in Group 1. One patient in Group 1 developed lymphedema-related angiosarcoma that was diagnosed at 7.8 years after surgery. CONCLUSIONS Patients with cervical cancer who underwent radiotherapy after laparoscopic surgical staging more commonly experienced LEE and related symptoms than patients who underwent primary radiotherapy. As LEE decreases patients' quality of life, it should be considered during patient consultation and surveillance.
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Affiliation(s)
- Se Ik Kim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.,Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myong Cheol Lim
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea. .,Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea. .,Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.
| | - Jeong Seon Lee
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yeon-Joo Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Soo Seo
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sokbom Kang
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.,Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Chong Woo Yoo
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Byung-Ho Nam
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea.,Biostatistics Biometric Research Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Joo-Young Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of System Cancer Science, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Seung Hyun Chung
- Rehabilitation Medicine, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Sang-Yoon Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Gynecologic Cancer Branch, Research Institute and Hospital, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
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24
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Lanitis S, Khan MAA, Sgourakis G, Kontovounisios C, Papaconstandinou T, Karaliotas C. Severe monobacterial necrotizing soft tissue infection by group A Streptococcus: A surgical emergency. Asian Pac J Trop Biomed 2015; 2:250-2. [PMID: 23569908 DOI: 10.1016/s2221-1691(12)60052-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 09/05/2011] [Accepted: 09/28/2011] [Indexed: 11/17/2022] Open
Abstract
Eight percent of necrotizing soft tissue infections (NSTI) are attributable to group A Streptococci (GAS), and among these, 50% develop streptococcal toxic shock syndrome. The reported mortality associated with NSTI reaches 32%. We present cases of two healthy individuals with minor GAS skin infection which developed to a rapidly progressed NSTI and sepsis despite of the antibiotic treatment, aiming to discuss the lessons learned from the course and management of these patients.
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Affiliation(s)
- S Lanitis
- Second Surgical Department and Unit of Surgical Oncology "Korgialenio-Benakio", Red Cross Athens General Hospital, Greece 11526
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25
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Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Yodluangfun S, Tantraworasin A. Necrotizing fasciitis: risk factors of mortality. Risk Manag Healthc Policy 2015; 8:1-7. [PMID: 25733938 PMCID: PMC4337692 DOI: 10.2147/rmhp.s77691] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a serious infection of skin and soft tissues that rapidly progresses along the deep fascia. It becomes a fatal soft tissue infection with high mortality rate if treatment is delayed. Early diagnosis for emergency surgical debridement and broad-spectrum antibiotic therapy were the optimal treatments to reduce the mortality rate of NF. OBJECTIVE The aim of this study was to identify risk factors that increased the mortality rate in patients with NF under routine clinical practices. METHODS A retrospective cohort study was performed at three general hospitals located in northern Thailand. All medical records of patients with surgically confirmed NF treated between January 2009 and December 2012 were reviewed. Clinical predictors for mortality were analyzed using multivariable risk regression analysis. RESULTS Of a total of 1,504 patients with a diagnosis of NF, 19.3% (n=290) died in hospital and 80.7% (n=1,214) survived. From multivariable analysis, being female (risk ratio [RR] =1.37, 95% confidence interval [CI] =1.01-1.84); age >60 (RR=1.39, 95% CI =1.25-1.53); having chronic heart disease (RR=1.64, 95% CI=1.18-2.28), cirrhosis (RR =2.36, 95% CI=1.70-3.27), skin necrosis (RR =1.22, 95% CI=1.15-1.28), pulse rate >130/min (RR =2.26, 95% CI=1.79-2.85), systolic BP <90 mmHg (RR =2.05, 95% CI =1.44-2.91), and serum creatinine ≥1.6 mg/dL (RR=3.06, 95% CI=2.08-4.50) were risk factors for mortality. CONCLUSION Prognostic factors for mortality in NF patients included being female; age >60; or having chronic heart disease, cirrhosis, skin necrosis, pulse rate >130/min, systolic BP <90 mmHg, and serum creatinine ≥1.6 mg/dL. Thus, disease progression to mortality may occur in such patients presenting one of these risk factors. Further examination or close monitoring for systemic involvement may be advantageous to reduce morbidity and mortality.
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Affiliation(s)
- Patcharin Khamnuan
- Clinical Epidemiology Program, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ; Department of Nursing, Phayao Hospital, Phayao, Thailand
| | - Wilaiwan Chongruksut
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Jayanton Patumanond
- Clinical Epidemiology Unit, Clinical Research Center, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Suttida Yodluangfun
- Department of Nursing, Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | - Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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26
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Sartelli M, Malangoni MA, May AK, Viale P, Kao LS, Catena F, Ansaloni L, Moore EE, Moore FA, Peitzman AB, Coimbra R, Leppaniemi A, Kluger Y, Biffl W, Koike K, Girardis M, Ordonez CA, Tavola M, Cainzos M, Di Saverio S, Fraga GP, Gerych I, Kelly MD, Taviloglu K, Wani I, Marwah S, Bala M, Ghnnam W, Shaikh N, Chiara O, Faro MP, Pereira GA, Gomes CA, Coccolini F, Tranà C, Corbella D, Brambillasca P, Cui Y, Segovia Lohse HA, Khokha V, Kok KY, Hong SK, Yuan KC. World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections. World J Emerg Surg 2014; 9:57. [PMID: 25422671 PMCID: PMC4242587 DOI: 10.1186/1749-7922-9-57] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 09/26/2014] [Indexed: 12/16/2022] Open
Abstract
Skin and soft tissue infections (SSTIs) encompass a variety of pathological conditions ranging from simple superficial infections to severe necrotizing soft tissue infections. Necrotizing soft tissue infections (NSTIs) are potentially life-threatening infections of any layer of the soft tissue compartment associated with widespread necrosis and systemic toxicity. Successful management of NSTIs involves prompt recognition, timely surgical debridement or drainage, resuscitation and appropriate antibiotic therapy. A worldwide international panel of experts developed evidence-based guidelines for management of soft tissue infections. The multifaceted nature of these infections has led to a collaboration among surgeons, intensive care and infectious diseases specialists, who have shared these guidelines, implementing clinical practice recommendations.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, Macerata, 62019 Italy
| | | | - Addison K May
- Division of Trauma and Surgical Critical Care, Vanderbilt University Medical Center, Nashville, Tennessee USA
| | - Pierluigi Viale
- Clinic of Infectious Diseases, St Orsola-Malpighi University Hospital, Bologna, Italy
| | - Lillian S Kao
- Department of Surgery, The University of Texas Medical School, Houston, USA
| | - Fausto Catena
- Emergency Surgery Department, Maggiore Parma Hospital, Parma, Italy
| | - Luca Ansaloni
- General Surgery I, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Ernest E Moore
- Department of Surgery, Denver Health Medical Center, Denver, USA
| | - Fred A Moore
- Department of Surgery, University of Florida, Gainesville, Florida USA
| | - Andrew B Peitzman
- Department of Surgery, University of Pittsburgh, Medical Center, Pittsburgh, USA
| | - Raul Coimbra
- Department of Surgery, UC San Diego Health System, San Diego, USA
| | - Ari Leppaniemi
- Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Walter Biffl
- Department of Surgery, University of Florida, Gainesville, Florida USA
| | - Kaoru Koike
- Department of Primary Care & Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Carlos A Ordonez
- Department of Surgery, Fundación Valle del Lilí, Universidad del Valle, Cali, Colombia
| | - Mario Tavola
- Department of Anesthesia and ICU, Villa Scazzi Hospital, Genoa, Italy
| | - Miguel Cainzos
- Department of Surgery, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Gustavo P Fraga
- Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Igor Gerych
- Department of Surgery 1, Lviv Regional Hospital, DanyloHalytskyLviv National Medical University, Lviv, Ukraine
| | | | - Korhan Taviloglu
- Department of General Surgery, Istanbul Doctor's Center, Istanbul, Turkey
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | - Sanjay Marwah
- Department of Surgery, Pt BDS Post-graduate Institute of Medical Sciences, Rohtak, India
| | - Miklosh Bala
- General Surgery and Trauma Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Wagih Ghnnam
- Department of Surgery Mansoura, Faculty of medicine, Mansoura University, Mansoura, Egypt
| | - Nissar Shaikh
- Department of Anesthesia and ICU, Hamad Medical Corporation, Doha, Qatar
| | - Osvaldo Chiara
- Emergency Department, Niguarda Ca'Granda Hospital, Milan, Italy
| | - Mario Paulo Faro
- Department of General and Gastrointestinal Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo André, SP Brazil
| | - Gerson Alves Pereira
- Emergency Surgery and trauma Unit, Department of Surgery, Ribeirão, Preto Brazil
| | - Carlos Augusto Gomes
- Hospital Universitário Therezinha de Jesus, Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Universidade Federal de Juiz de Fora (UFJF), Minas Gerais, Brasil
| | | | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, Macerata, 62019 Italy
| | - Davide Corbella
- Department of Anestesiology, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Helmut A Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | | | - Kenneth Yy Kok
- Department of Surgery, Ripas Hospital, Bandar Seri Begawan, Brunei
| | - Suk-Kyung Hong
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Ulsan, Seoul, Republic of Korea
| | - Kuo-Ching Yuan
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan
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27
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Juncar M, Popa AR, Baciuţ MF, Juncar RI, Onisor-Gligor F, Bran S, Băciuţ G. Evolution assessment of head and neck infections in diabetic patients – A case control study. J Craniomaxillofac Surg 2014; 42:498-502. [DOI: 10.1016/j.jcms.2013.06.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Revised: 06/07/2013] [Accepted: 06/10/2013] [Indexed: 01/19/2023] Open
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28
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Hourmozdi JJ, Hawley DA, Hadi CM, Tahir B, Seupaul RA. Streptococcal Necrotizing Myositis: A Case Report and Clinical Review. J Emerg Med 2014; 46:436-42. [DOI: 10.1016/j.jemermed.2013.08.048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 04/28/2013] [Accepted: 08/15/2013] [Indexed: 10/26/2022]
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29
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Carassou-Maillan A, Savary D, Jacquetin B. [Necrotizing fasciitis and double bowel perforation after retropubic sub-urethral sling]. ACTA ACUST UNITED AC 2013; 43:629-32. [PMID: 24332737 DOI: 10.1016/j.jgyn.2013.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/31/2013] [Accepted: 08/13/2013] [Indexed: 11/25/2022]
Abstract
A 60-year-old woman without medical history developed after a Tension-free Vaginal Tape (TVT) procedure a necrotizing fasciitis and an abscess. After unadapted initial treatment, surgical procedure revealed 2 bowel perforations caused by the sling. Treatment was achieved by total mesh removal, bowel repair, necrosis excision and vacuum-assisted closure system. This is the first case report about the association of necrotizing fasciitis and double bowel perforations after TVT procedure. Any critical sepsis or with unsatisfactory evolution after retropubic sub-urethral sling has to make look for a digestive wound.
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Affiliation(s)
- A Carassou-Maillan
- Pôle de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
| | - D Savary
- Pôle de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - B Jacquetin
- Pôle de gynécologie-obstétrique et reproduction humaine, CHU Estaing, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
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Jun YJ, Kang IS, Lee JH, Kim SM, Kim YJ. A Case of Fatal Necrotizing Fasciitis Arising From Chronic Lymphedema. INT J LOW EXTR WOUND 2013; 12:293-6. [DOI: 10.1177/1534734613508648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic lymphedema and lymphangitis are common adverse effects following treatment for gynecological cancer. Because the early symptoms of necrotizing fasciitis are similar to those of lymphangitis, fatal outcome can occur if patients or physicians underestimate this condition. Here, we present a case of necrotizing fasciitis in a patient with chronic lymphedema.
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Affiliation(s)
| | - In Sook Kang
- Catholic University of Korea, Gyeonggi-do, South Korea
| | - Jung Ho Lee
- Catholic University of Korea, Gyeonggi-do, South Korea
| | - Sue Min Kim
- Catholic University of Korea, Gyeonggi-do, South Korea
| | - Young Jin Kim
- Catholic University of Korea, Gyeonggi-do, South Korea
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Yoshii Y, Ishii T, Sakai S. Necrotising soft tissue infection of bilateral upper limb caused by the injection of oral bacteria: a case report. ACTA ACUST UNITED AC 2013; 18:243-6. [PMID: 24164130 DOI: 10.1142/s021881041372012x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Necrotising soft tissue infection is a rare and rapid process with devastating consequence. We report one case of necrotising soft tissue infection in a bilateral upper limb with uncommon oral bacteria. Radiological imaging revealed the presence of gas in upper limb soft tissues, and an MRI showed the localised signal changes in the biceps muscle of the right upper arm, and the subcutaneous tissue of the left elbow. The patient was treated with surgical resection of the infected muscle and wide debridement of the subcutaneous tissue. Antibiotics were initiated. The patient recovered immediately without functional deficit. The unique features of this patient were possible to observe in the progression of the necrotising soft tissue infection in the bilateral upper limb with intentional injection of oral bacteria, and the effect of biceps brachii resection in a prime age worker.
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Affiliation(s)
- Yuichi Yoshii
- Department of Orthopaedic Surgery, Tokyo Medical University, Ibaraki Medical Center, Ibaraki 300-0395, Japan , Endowed Department of Human Resources Development for Community Medicine, Tokyo Medical University, Ibaraki Medical Center, Ibaraki 300-0395, Japan
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Chao WN, Tsai CF, Chang HR, Chan KS, Su CH, Lee YT, Ueng KC, Chen CC, Chen SC, Lee MC. Impact of timing of surgery on outcome of Vibrio vulnificus–related necrotizing fasciitis. Am J Surg 2013; 206:32-9. [DOI: 10.1016/j.amjsurg.2012.08.008] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 05/31/2012] [Accepted: 08/28/2012] [Indexed: 12/14/2022]
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Rana M, Sturdevant M, Patel G, Huprikar S. Klebsiellanecrotizing soft tissue infections in liver transplant recipients: a case series. Transpl Infect Dis 2013; 15:E157-63. [DOI: 10.1111/tid.12103] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2012] [Revised: 02/28/2013] [Accepted: 04/02/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M.M. Rana
- Department of Medicine; Mount Sinai School of Medicine; New York; New York; USA
| | - M. Sturdevant
- Department of Surgery; University of Pittsburgh Medical Center; Pittsburgh; Pennsylvania; USA
| | - G. Patel
- Department of Medicine; Mount Sinai School of Medicine; New York; New York; USA
| | - S. Huprikar
- Department of Medicine; Mount Sinai School of Medicine; New York; New York; USA
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Fatal Necrotizing Fasciitis in a Child following a Blunt Chest Trauma. Case Rep Pediatr 2013; 2013:373712. [PMID: 23607028 PMCID: PMC3623462 DOI: 10.1155/2013/373712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 03/11/2013] [Indexed: 11/17/2022] Open
Abstract
Necrotizing fasciitis is a serious soft tissue infection rarely occurring in children after blunt trauma. Due to its high morbidity and mortality rates, a high index of suspicion is necessary for prompt diagnosis and treatment. We describe a 6-year-old Costa Rican girl who died secondary to multiple complications following a posttraumatic necrotizing fasciitis.
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Abstract
Necrotising soft tissue infection (NSTI) presents unique challenges in diagnosis and management. The key to a successful outcome is a high index of suspicion in appropriate clinical settings. Type II NSTI tends to occur on an extremity in younger, healthier patients with a history of known trauma, and to be monomicrobial. Type I NSTI tends to occur on the trunk of older, less healthy patients without an obvious history of trauma, and tends to be polymicrobial. Other, rarer types exist as well. The pathophysiology of both types involves superantigen acticivty, as well as a number of microbial byproducts which collectively decrease the viscosity of pus, facilitating its spread along deep tissue planes and ultimately causing diffuse deep thrombosis and aggressive systemic sepsis. The most important physical finding is tenderness to palpation beyond the area of redness, and the lack of crepitus should not be seen as a reassuring sign. Suspected cases should undergo early surgical exploration for diagnosis, which may be performed at bedside through a small incision. Most imaging techniques are not sufficiently specific to warrant a delay in surgical exploration. The Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) shows promise as a tool for excluding suspected cases. Successful outcomes in cases of NSTI require early and aggressive serial debridement and a multidisciplinary critical care approach.
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Affiliation(s)
- Adam M Shiroff
- Division of Acute Care Surgery, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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36
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Necrotizing fasciitis: is the bacterial spectrum changing? Langenbecks Arch Surg 2012; 398:153-9. [DOI: 10.1007/s00423-012-0983-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 07/17/2012] [Indexed: 11/25/2022]
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Martinschek A, Evers B, Lampl L, Gerngroß H, Schmidt R, Sparwasser C. Prognostic aspects, survival rate, and predisposing risk factors in patients with Fournier's gangrene and necrotizing soft tissue infections: evaluation of clinical outcome of 55 patients. Urol Int 2012; 89:173-9. [PMID: 22759538 DOI: 10.1159/000339161] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 04/23/2012] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To determine predisposing or prognostic factors and mortality rates of patients with Fournier's gangrene compared to other necrotizing soft tissue infections (NSTI). MATERIAL AND METHODS Data of 55 intensive care patients (1981-2010) with NSTI were evaluated. Data were collected prospectively. RESULTS 43.4% of the patients were in septic condition and 27.3% were hemodynamically unstable. Half of the patients showed predisposing factors (52.7%). The lower extremity (63.2%), abdomen (30.9%), and perineum (14.5%) were most affected. Polymicrobial infections were frequent (65.5%, mean 2.8, range: 1-4). The mortality rate was 16.4% (n = 9). An increase was shown for diabetes mellitus (20%), cardiac insufficiency (22.3%), septic condition at presentation (33.3%), abdominal affection (47.1%), and hemodynamic instability (46.7%). Comparing survivors and nonsurvivors, statistical significance was seen with age (p < 0.001), septic condition at admission (p < 0.001), hemodynamic instability (p < 0.001), low blood pressure (p < 0.001), and abdominal affection (p < 0.001). In laboratory findings, an increase of creatine kinase (p < 0.001) and lactate (p < 0.001) and a decrease of antithrombin III (p < 0.007) and the Quick value (p < 0.01) proved to be significant. CONCLUSION Patients with Fournier's gangrene do not differ in all aspects from those with other NSTI. Successful treatment consists of immediate surgical debridement, broad-spectrum antibiotic treatment, and critical care management. Supportive hyperbaric oxygen therapy should be considered.
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Affiliation(s)
- A Martinschek
- Department of Urology, Federal Armed Forces Hospital of Ulm, Ulm, Germany. Martinschek @ web.de
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TeBockhorst S, Gurunluoglu R. Four Extremity Necrotizing Fasciitis without Involvement of the Trunk or Head. Am Surg 2012. [DOI: 10.1177/000313481207800406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Seth TeBockhorst
- Rocky Mountain Regional Trauma Center at Denver Health Medical Center University of Colorado Denver, Colorado
| | - Raffi Gurunluoglu
- Rocky Mountain Regional Trauma Center at Denver Health Medical Center University of Colorado Denver, Colorado
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Fanfarillo F, Pace F, Maida R, Pignata D, Cerqua G. Necrotizing fasciitis following intra-articular steroid injection: case report and review of the literature. Geriatr Gerontol Int 2012; 12:353-5. [PMID: 22449057 DOI: 10.1111/j.1447-0594.2011.00752.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Surgical treatment of 19 cases with vibrio necrotising fasciitis. Burns 2012; 38:290-5. [DOI: 10.1016/j.burns.2011.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 04/21/2011] [Accepted: 04/27/2011] [Indexed: 12/17/2022]
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Microbiology and surgical indicators of necrotizing fasciitis in a tertiary hospital of southwest Taiwan. Int J Infect Dis 2012; 16:e159-65. [DOI: 10.1016/j.ijid.2011.11.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 10/12/2011] [Accepted: 08/26/2011] [Indexed: 11/19/2022] Open
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Choi SH, Choi SH, Kwak YG, Chung JW, Choo EJ, Kim KH, Yun NR, Lee S, Kwon KT, Cho JH, Kim NJ. Clinical Characteristics and Causative Organisms of Community-acquired Necrotizing Fasciitis. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.3.180] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Seong-Ho Choi
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Sang-Ho Choi
- Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea
| | - Yee Gyung Kwak
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Jin-Won Chung
- Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Joo Choo
- Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Kye-Hyung Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Na Ra Yun
- Department of Internal Medicine, School of Medicine, Chosun University, Gwangju, Korea
| | - Shinwon Lee
- Division of Infectious Diseases, Daegu Fatima Hospital, Daegu, Korea
| | - Ki Tae Kwon
- Division of Infectious Diseases, Daegu Fatima Hospital, Daegu, Korea
| | - Jae-Hyun Cho
- Department of Internal Medicine, National Police Hospital, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Abstract
Necrotizing fasciitis (NF) is a rare, rapidly progressive bacterial soft tissue infection with a high risk for morbidity and mortality. Although more common in adults, NF also affects the pediatric population. Many bacterial organisms can cause NF, but group A Streptococcus is the most common monomicrobial cause of disease. Necrotizing fasciitis remains principally a clinical diagnosis, and it is often missed early in its presentation because of the difficulty in differentiating it from more common soft tissue infections. The criterion standard for diagnosis and the mainstay of therapy are surgical debridement. Time to initiation and completion of therapy remains the most important factor in patient outcome, highlighting the importance of early recognition and intervention in this potentially devastating disease.
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Abstract
Necrotizing fasciitis belongs to a group of complicated soft tissue infections that can be even life threatening. Despite growing knowledge about its etiology, predictors, and the clinical progression, the mortality remains at a high level with 20%. A relevant reduction can be achieved only by an early diagnosis followed by consistent therapy. The clinical findings in about 75% of the cases are pain out of proportion, edema and tenderness, blisters, and erythema. It is elementary to differentiate a necrotizing or a non-necrotizing soft tissue infection early. In uncertain cases it can be necessary to perform a surgical exploration to confirm the diagnosis. The histopathologic characteristics are the fascial necrosis, vasculitis, thrombosis of perforating veins, the presence of the disease-causing bacteria as well as inflammatory cells like macrophages and polymorphonuclear granulocytes. Secondly, both the cutis and the muscle can be affected. In many cases there is a disproportion of the degree of local and systemic symptoms. Depending on the infectious agents there are two main types: type I is a polymicrobial infection and type II is a more invasive, serious, and fulminant monomicrobial infection mostly caused by group A Streptococcus pyogenes.Invasive, severe forms of streptococcal infections seem to occur more often in recent years. Multimodal and interdisciplinary therapy should be based on radical surgical débridement, systemic antibiotic therapy as well as enhanced intensive care therapy, which is sometimes combined with immunoglobulins (in streptococcal or staphylococcal infections) or hyperbaric oxygen therapy (HBOT, in clostridial infections). For wound care of extensive soft tissue defects vacuum-assisted closure has shown its benefit.
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Development of a computed tomography-based scoring system for necrotizing soft-tissue infections. ACTA ACUST UNITED AC 2011; 70:894-9. [PMID: 21610394 DOI: 10.1097/ta.0b013e3182134a76] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Necrotizing soft-tissue infections (NSTIs) are associated with significant morbidity and mortality, but a definitive nonsurgical diagnostic test remains elusive. Despite the widespread use of computed tomography (CT) as a diagnostic adjunct, there is little data that definitively correlate CT findings with the presence of NSTI. Our goal was the development of a CT-based scoring system to discriminate non-NSTI from NSTI. METHODS Patients older than 17 years undergoing CT for evaluation of soft-tissue infection at a tertiary care medical center over a 10-year period (2000-2009) were included. Abstracted data included comorbidities and social history, physical examination, laboratory findings, and operative and pathologic findings. NSTI was defined as soft-tissue necrosis in the dictated operative note or the accompanying pathology report. CT scans were reviewed by a radiologist blinded to clinical and laboratory data. A scoring system was developed and the area under the receiver operating characteristic curve was calculated. RESULTS During the study period, 305 patients underwent CT scanning (57% men; mean age, 47.4 years). Forty-four patients (14.4%) evaluated had an NSTI. A scoring system was retrospectively developed (table). A score >6 points was 86.3% sensitive and 91.5% specific for the diagnosis of NSTI (positive predictive value, 63.3%; negative predictive value, 85.5%). The area under the receiver operating characteristic curve was 0.928 (95% confidence interval, 0.893-0.964). The mean score of the non-NSTI group was 2.74. CONCLUSIONS We have developed a CT scoring system that is both sensitive and specific for the diagnosis of NSTIs. This system may allow clinicians to more accurately diagnose NSTIs. Prospective validation of this scoring system is planned.
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Affiliation(s)
- Gina M. Howell
- Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
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48
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Seminar Review: A Review of the Basis of Surgical Treatment of Diabetic Foot Infections. INT J LOW EXTR WOUND 2011; 10:33-65. [DOI: 10.1177/1534734611400259] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Infection is an extremely challenging complication of foot ulcers in patients with diabetes. Surgery as part of a multidisciplinary approach is key in the management of many types of diabetic foot infections (DFIs). Unfortunately, the surgical treatment of DFIs is based more on clinical judgment and less on structured evidence, which leaves unresolved doubts. The clinical presentation of DFIs is varied. This review examines the basis of nonvascular surgical treatment of DFIs, emphasizing the importance of the anatomic concepts of the foot, the variety of its clinical presentations, and the concepts of timing surgery. Recent evidence and case reports based on the author’s experience are presented in 2 parts. The first part examines clinical presentation of infections, whereas the second part deals with imaging, foot anatomy, and some case reports.
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[Necrotizing fasciitis of the thoracoabdominal wall complicating Dujarier's bandage: a case report]. ANN CHIR PLAST ESTH 2011; 58:362-6. [PMID: 21420776 DOI: 10.1016/j.anplas.2010.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 12/10/2010] [Indexed: 11/20/2022]
Abstract
The necrotizing fasciitis (NF) means a serious infection of the subcutis, the fascia and superficial dermis secondarily. We report the case of a patient with cellulitis NF of the thoracoabdominal wall complicating Dujarier's bandage. It was monobacterial NF caused by β hemolytic streptococcus, whose development was supported through an appropriate medical and surgical care. The situation mentioned is the occurrence of secondary infection of skin necrosis occurred in the bandage too tight opposite the support zone of the elbow on the trunk. We point out, through this case, the importance of the medicosurgical and also the importance of making any thoracoabdominal bandage, which could lead, if it is tight, a pressure sore can be a door entry for any NF plus a late diagnosis.
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Marshall JC, al Naqbi A. Principles of Source Control in the Management of Sepsis. Crit Care Nurs Clin North Am 2011; 23:99-114. [DOI: 10.1016/j.ccell.2010.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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