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A case of necrotizing fasciitis due to Streptococcus pneumoniae serotype 5 in Saskatchewan. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 19:69-71. [PMID: 19145265 DOI: 10.1155/2008/246468] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 09/04/2007] [Indexed: 11/17/2022]
Abstract
Necrotizing fasciitis due to Streptococcus pneumoniae is a rare and grave condition, and only a few cases have been reported. Suggested risk factors include minor trauma, systemic lupus erythematosus, immunosuppression secondary to medication, use of intramuscular anti-inflammatories and alcoholism. A fatal case of pneumococcal necrotizing fasciitis that occurred in a 51-year-old woman with a history of alcohol abuse and oral anti-inflammatory use is presented. Her condition was caused by a multi-etiology outbreak of community-acquired pneumonia, from which S pneumoniae serotype 5 was also isolated. The case description outlines the subtle presentation and rapid clinical progression of this condition. Because serotype 5 antigen is included in the polysaccharide 23-valent pneumococcal vaccine, the present case highlights the importance of pneumococcal immunization programs in Canada.
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Fascitis necrosante producida por Streptococcus pneumoniae. Med Clin (Barc) 2011; 136:176-7. [DOI: 10.1016/j.medcli.2009.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Revised: 11/17/2009] [Accepted: 11/19/2009] [Indexed: 11/24/2022]
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Park SY, Park SY, Moon SY, Son JS, Lee MS. Fatal necrotizing fasciitis due to Streptococcus pneumoniae: a case report. J Korean Med Sci 2011; 26:131-4. [PMID: 21218041 PMCID: PMC3012837 DOI: 10.3346/jkms.2011.26.1.131] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Accepted: 08/03/2010] [Indexed: 11/20/2022] Open
Abstract
Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.
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Affiliation(s)
- So-Youn Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - So Young Park
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soo-youn Moon
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jun Seong Son
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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Mylle M, Goubau J, Bourgeois M, Vandecasteele SJ. Necrotizing fasciitis due to Streptococcus pneumoniae in a healthy 68-year old man: case report and review of the literature. Acta Clin Belg 2009; 64:452-4. [PMID: 19999397 DOI: 10.1179/acb.2009.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A case of pneumococcal necrotizing soft-tissue infection (NSTI) is described and 16 cases available in literature are reviewed. Pneumococcal NSTI seems to be the consequence of hematogeneous shedding of pneumococci, with frequent involvement of articulations. Furthermore, pneumococcal NSTI present like other NSTI, with a high mortality and the need for a combined surgical and medical therapy.
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Affiliation(s)
- M Mylle
- Internal Medicine, Leuven University Hospital, Herestraat 49, 3000 Leuven, Belgium
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YAMASHIRO E, ASATO Y, TAIRA K, AWAZAWA R, YAMAMOTO YI, HAGIWARA K, TAMAKI H, UEZATO H. Necrotizing fasciitis caused byStreptococcus pneumoniae. J Dermatol 2009; 36:298-305. [DOI: 10.1111/j.1346-8138.2009.00643.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Garcia-Lechuz JM, Cuevas O, Castellares C, Perez-Fernandez C, Cercenado E, Bouza E. Streptococcus pneumoniae skin and soft tissue infections: characterization of causative strains and clinical illness. Eur J Clin Microbiol Infect Dis 2007; 26:247-53. [PMID: 17372776 DOI: 10.1007/s10096-007-0283-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 01/19/2007] [Indexed: 11/30/2022]
Abstract
Streptococcus pneumoniae is an uncommon cause of skin and soft tissue infections, yet the incidence and clinical significance of its isolation in samples of skin or soft tissues in unselected hospital samples is poorly understood. In the present study, a review was conducted of the records of all patients with skin and soft tissue infections due to S. pneumoniae at a university hospital between January 1994 and December 2005. The isolates were identified by standard methods and were serotyped, and susceptibility testing was performed by the broth microdilution method following the guidelines of the Clinical and Laboratory Standards Institute. During the study period, 3,201 isolates of S. pneumoniae were recovered from several sources. Of these, 69 (2.2%) were from skin and soft tissue samples (69 patients). Complete information could not be obtained for 13 patients. Of the 56 patients remaining, 36 (64.3%) were infected and fulfilled the inclusion criteria. The following types of infections were observed: surgical wound infection (n = 11), burn infection (n = 7), pyomyositis (n = 6), cellulitis (n = 4), perineal or scrotal abscess (n = 3), and other (n = 5). Thirty-one (86%) patients had a favorable outcome, and 5 (13.8%) patients died. Mortality was directly attributable to S. pneumoniae infection in three of the five fatal cases. Of the 39 S. pneumoniae isolates obtained (36 from skin and soft tissues, three from blood cultures), 58.9% were penicillin nonsusceptible, 7.7% were cefotaxime nonsusceptible, and 20.5% were erythromycin resistant. The most frequent serotypes were 3, 19, 11, and 23. Of the overall number of isolates of S. pneumoniae recovered in a general institution, 2.2% involved skin and soft tissues (of which 64% were clinically significant). Mortality due to pneumococcal skin and soft tissue infections was low.
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Affiliation(s)
- J M Garcia-Lechuz
- Department of Clinical Microbiology and Infectious Diseases--HIV, Hospital General Universitario "Gregorio Marañón", Dr. Esquerdo 46, 28007 Madrid, Spain.
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Quintard H, Pène F, Ginsburg C, Goulenok C, Cariou A, Grivois JP, Claessens YE. [A case of association of atypical localisations of Streptococcus pneumoniae]. Rev Med Interne 2004; 25:303-5. [PMID: 15050798 DOI: 10.1016/j.revmed.2003.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2003] [Accepted: 12/06/2003] [Indexed: 11/26/2022]
Abstract
Streptococcus pneumoniae can be responsible for spinal, joints, pulmonary or infrequently cutaneous septic localisations. The association between different septic localisation is extremely rare with this microorganism. We describe the first case of concomitant spinal, joints and cutaneous septic localisations in a critically ill patient with S. pneumoniae septicaemia. This observation illustrates that heterogeneity of clinical features depends on the pathogen characteristic and its interaction with the host.
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Affiliation(s)
- H Quintard
- Service de réanimation médicale, hôpital Cochin, 27, rue du faubourg Saint-Jacques, 75679 Paris cedex 14, France
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Prakash PK, Biswas M, ElBouri K, Braithwaite PA, Hanna FW. Pneumococcal necrotizing fasciitis in a patient with Type 2 diabetes. Diabet Med 2003; 20:899-903. [PMID: 14632714 DOI: 10.1046/j.1464-5491.2003.00984.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Necrotizing fasciitis (NF) is a rare and often fatal soft-tissue infection involving the superficial fascial layers of the extremities, abdomen or perineum. Progression to septic shock can occur very rapidly with its associated high morbidity and mortality. NF is usually caused by beta haemolytic streptococci; less often a poly-microbial isolate is the cause. It typically occurs in patients with some degree of immune dysfunction. We present a case of severe pneumococcal necrotizing fasciitis in an obese patient with Type 2 diabetes. There was no history of trauma or evidence of diabetes-related complications. The initial presentation was with features of septic arthritis of the left knee, which subsequently progressed to NF. Differentiation from cellulitis is often difficult in the early stages. Invasive pneumococcal infections are extremely rare, with only a few reported in the literature. Moreover, our case highlights the need to consider other differential diagnoses (and to look out for complications) in patients with diabetes, especially if there is little clinical response to the initial treatment.
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Affiliation(s)
- P K Prakash
- Department of Diabetes and Endocrinology, Prince Charles Hospital, Merthyr Tydfil, UK.
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Clad A, Orlowska-Volk M, Karck U. Fatal puerperal sepsis with necrotising fasciitis due to Streptococcus pneumoniae. BJOG 2003. [DOI: 10.1046/j.1471-0528.2003.01187.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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10
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Frick S, Cerny A. Necrotizing fasciitis due to Streptococcus pneumoniae after intramuscular injection of nonsteroidal anti-inflammatory drugs: report of 2 cases and review. Clin Infect Dis 2001; 33:740-4. [PMID: 11486297 DOI: 10.1086/322592] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2000] [Revised: 02/08/2001] [Indexed: 11/03/2022] Open
Abstract
Two cases of pneumococcal necrotizing fasciitis (NF) occurred after intramuscular injections of nonsteroidal anti-inflammatory drugs; another 5 cases reported in the literature fulfilled the criteria for NF involving Streptococcus pneumoniae. Conditions associated with alterations of immune function could be identified in 6 of the 7 cases; 2 patients died despite surgical and antimicrobial treatment.
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Affiliation(s)
- S Frick
- Department of Internal Medicine, University Hospital, Bern, Switzerland
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11
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Baghai M, Osmon DR, Wolk DM, Wold LE, Haidukewych GJ, Matteson EL. Fatal sepsis in a patient with rheumatoid arthritis treated with etanercept. Mayo Clin Proc 2001; 76:653-6. [PMID: 11393506 DOI: 10.4065/76.6.653] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Patients with long-standing, severe, erosive rheumatoid arthritis who have extra-articular manifestations and have undergone joint replacement surgery are at increased risk for serious infection and premature mortality. New therapies, including cytokine antagonists, hold great promise for improving the course of rheumatoid arthritis. However, they have powerful anti-inflammatory effects that may mask symptoms of serious infection. We report a case of fatal pneumococcal sepsis occurring in a 37-year-old woman with rheumatoid arthritis treated with the tumor necrosis factor antagonist etanercept and suggest management strategies for early detection and management of this complication.
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MESH Headings
- Adult
- Anti-Inflammatory Agents/therapeutic use
- Antirheumatic Agents/adverse effects
- Arthritis, Infectious/chemically induced
- Arthritis, Infectious/diagnosis
- Arthritis, Infectious/drug therapy
- Arthritis, Rheumatoid/drug therapy
- Arthritis, Rheumatoid/immunology
- Arthritis, Rheumatoid/surgery
- Bacteremia/chemically induced
- Bacteremia/diagnosis
- Bacteremia/drug therapy
- Drug Therapy, Combination
- Etanercept
- Fasciitis, Necrotizing/chemically induced
- Fasciitis, Necrotizing/diagnosis
- Fasciitis, Necrotizing/drug therapy
- Fatal Outcome
- Female
- Humans
- Immunoglobulin G/adverse effects
- Pneumococcal Infections/chemically induced
- Pneumococcal Infections/diagnosis
- Pneumococcal Infections/drug therapy
- Prednisone/therapeutic use
- Receptors, Tumor Necrosis Factor
- Severity of Illness Index
- Streptococcus pneumoniae
- Tumor Necrosis Factor-alpha/antagonists & inhibitors
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Affiliation(s)
- M Baghai
- Department of Surgery, Mayo Clinic, Rochester, Minn 55905, USA
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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.
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Affiliation(s)
- G R Ballon-Landa
- Department of Medicine, Scripps Mercy Hospital, San Diego, CA, USA
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Abstract
We describe the rare complication of necrotizing pneumonia and invasive pneumococcal infection in 3 previously healthy pediatric patients. Lobar consolidation and pleural effusions appeared initially, followed within several days by the appearance of multiple small lucencies in the area of consolidation. In one case, necrosis progressed to a large abscess cavity. Surgical intervention was limited to treatment of pleural space complications. There were no deaths. Pulmonary parenchymal residual was limited to a thin-walled cavity in one case.
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Affiliation(s)
- V P McCarthy
- Department of Pediatrics, University of Tennessee Medical Center-Knoxville 37920-6999, USA.
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Abstract
Unusual pneumococcal infections occurred frequently in the preantibiotic age but rapidly declined with the advent of the antibiotic era. Unfortunately, the morbidity and mortality associated with invasive pneumococcal disease remain high despite antibiotic therapy and monumental advances in medical technology. The incidence of invasive pneumococcal disease has increased recently because of the onset of the human immunodeficiency virus (HIV) epidemic and the emergence of antibiotic-resistant pneumococcus. Robert Austrian described the clinical triad of pneumococcal pneumonia, meningitis, and endocarditis, a syndrome that now bears his name. Although seen infrequently today, unusual manifestations of pneumococcal infection such as those Austrian reported still occur. A review of these cases is warranted because, as drug-resistant organisms continue to emerge worldwide, more unusual pneumococcal infections will be seen. Streptococcus pneumoniae is responsible for a remarkable array of disease processes; our literature review uncovered 95 different types of unusual pneumococcal infections representing 2,064 cases. Examples of these infections included pancreatic and liver abscesses, aortitis, gingival lesions, phlegmonous gastritis, inguinal adenitis, testicular and tubo-ovarian abscesses, and necrotizing fasciitis. We also reviewed predisposing underlying illnesses and conditions. Alcoholism, HIV infection, splenectomy, connective tissue disease, steroid use, diabetes mellitus, and intravenous drug use remain common risk factors for invasive pneumococcal infections. Currently, multidrug-resistant S. pneumoniae remains susceptible to vancomycin and several new third-generation fluoroquinolones. As what some fear will be a possible postantibiotic era approaches, clinicians must be able to recognize and manage unusual pneumococcal infections.
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Affiliation(s)
- S N Taylor
- Louisiana State University Medical Center, Department of Medicine, New Orleans 70112, USA
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15
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Réflexions sur la fasciite nécrosante. Med Mal Infect 1998. [DOI: 10.1016/s0399-077x(98)80136-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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16
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Abstract
The association of necrotizing fasciitis, often due to group A streptococcus and primary varicella (chicken pox), is unusual but recognized in children. The association in adults is rare but one report in the literature describes a previously healthy man with the two disorders. We now describe a case of disseminated cutaneous herpes zoster complicated by subacute necrotizing fasciitis in an elderly woman taking low dose methotrexate and prednisone for rheumatoid arthritis. Staphylococcus aureus was isolated. Localized debridement and split skin grafting were required.
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Affiliation(s)
- P Jarrett
- Department of Dermatology, Auckland Hospital, New Zealand
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HSIAO GUANGHSIANG, CHANG CHUNHSIANG, HSIAO CHENGWEI, FANCHIANG JUNGHSIANG, JEE SHIOUHWA. Necrotizing Soft Tissue Infections. Dermatol Surg 1998. [DOI: 10.1111/j.1524-4725.1998.tb04143.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jarrett P, Rademaker M, Duffill M. The clinical spectrum of necrotising fasciitis. A review of 15 cases. AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE 1997; 27:29-34. [PMID: 9079250 DOI: 10.1111/j.1445-5994.1997.tb00910.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Necrotising fasciitis represents a spectrum of disease which ranges from fulminant through acute to subacute varieties. While fulminating necrotising fasciitis is a well recognised entity the subacute variety is not. AIM To assess six years' experience of necrotising fasciitis at Waikato Hospital. METHOD Cases of necrotising fasciitis were identified from discharge statistics for the period 1990-1995. Records were reviewed for clinical features, predisposing factors, microbiology, histology, treatment and outcome. RESULTS Fifteen cases were identified of which ten were female. The average age was 55 years (range of 15-92 years). One patient presented with fulminant, eight with acute and six with subacute necrotising fasciitis. Significant blister formation was noted in eight cases. Risk factors were identified in 14 patients including trauma, renal impairment, diabetes mellitus, and various drugs including diclofenac (four patients), naproxen (one patient) and prednisone (two patients). Group A beta haemolytic streptococcus (GABHS) was identified in ten cases. Swab or tissue cultures had the highest yield for isolating the organism. Blood cultures grew GABHS in only three of 12 cases. Eight patients (53%) died. Of the survivors all but one patient required debridement and skin grafting. CONCLUSIONS Necrotising fasciitis is a clinical spectrum of disease. It affects a wide age group and can have associated morbidities. It is often a fatal disease. Early recognition, high dose antibiotics and surgical debridement are important in the management of the entire spectrum of necrotising fasciitis.
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Affiliation(s)
- P Jarrett
- Department of Dermatology, Health Waikato, Hamilton, New Zealand
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