"Flesh-eating bacteria": return of an old nemesis

Post-traumatic occipital psoriatic plaque complicated by extensive necrotizing fasciitis of the head and neck: a case report and literature review

Necrotizing fasciitis (NF) is a severe infection involving the superficial fascial layers, subcutaneous cellular tissue, and possibly skin. It usually has a fulminant evolution, rapidly leading to death in the absence of early diagnosis and aggressive surgical treatment. We herein report a rare case of NF secondary to a traumatized occipital psoriatic plaque in an alcoholic 47-year-old woman and compare this case with the published literature. The NF extended to the entire scalp, right face, and posterior and lateral cervical region. Despite the initially guarded prognosis, the patient’s survival emphasizes the importance of aggressive surgical treatment with wide excision of all necrotic structures without any aesthetic compromise.

Cervical Necrotizing Fasciitis Caused by Dental Extraction

Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections.

Necrotizing fasciitis after internal fixation of fracture of femoral trochanteric

Necrotizing fasciitis is a rare and potentially lethal soft tissue infection. We report a case of trochanteric femur fracture in a patient who underwent fracture fixation and developed necrotizing fasciitis. A literature review on the topic will be addressed.

Life-threatening necrotizing fasciitis

Necrotizing fasciitis is characterized by a rapidly progressing necrosis of subcutaneous fat and fascia, which can be life-threatening without prompt recognition, surgical intervention, and immediate antibiotic therapy. Necrotizing fasciitis has been subdivided into type 1, or polymicrobial necrotizing fasciitis, and type 2, or group A streptococcal necrotizing fasciitis. In addition, synonyms, such as streptococcal gangrene and "flesh-eating bacteria syndrome," have been used in the literature.

Streptococcal infection and necrotizing fasciitis—implications for rehabilitation: a report of 5 cases and review of the literature

Five cases are presented of patients who were diagnosed with necrotizing fasciitis secondary to (1) hip disarticulation (in a paraplegic patient); (2) tooth abscess with extensive neck dissection, complicated by sepsis and hypotension with resultant dysphagia and ischemic encephalopathy; (3) below-knee amputation, anoxia, and severe debility; (4) emergent above-knee amputation; and (5) percutaneous endoscopic gastrostomy placement. The latter patient developed abdominal and chest wall necrotizing fasciitis that required skin grafting. Four patients were treated in an acute rehabilitation setting and returned home, and the fifth was rehabilitated in a subacute facility. This report emphasizes the importance of carefully monitoring rehabilitation patients, especially those with impaired sensation.

Fasciíte necrosante: revisão com enfoque nos aspectos dermatológicos

Fasciíte necrosante é infecção bacteriana destrutiva e rapidamente progressiva do tecido subcutâneo e fáscia superficial, associada a altos índices de morbimortalidade, se não tiver tratamento precoce. Recentemente, inúmeros casos publicados têm demonstrado aumento na freqüência e gravidade dessa infecção, particularmente causada pelo Streptococcus do grupo A (GAS) e que acomete até mesmo pessoas jovens e saudáveis. Classifica-se em tipo I, quando causada por flora mista de anaeróbios e outras bactérias, e tipo II, quando causada pelo GAS isolado ou associado ao Staphylococcus aureus. Os fatores predisponentes incluem: doenças crônicas e malignas, abuso de álcool, uso de drogas endovenosas, lesões da pele como varicela, úlceras crônicas, psoríase, cirurgia, traumas abertos e fechados, entre outros. Clinicamente destacam-se: a dor intensa, o edema grave, a rápida progressão e a resposta pobre à antibioticoterapia. É necessário um alto índice de suspeição para o diagnóstico clínico, que é confirmado à intervenção cirúrgica, com a evidência de necrose da fáscia superficial. Os exames radiológicos são úteis, e o diagnóstico diferencial deve ser feito principalmente com celulite em seu estágio inicial. O tratamento, que deve ser precoce, é feito com antibióticos de amplo espectro, debridamento cirúrgico agressivo e medidas de suporte clínico e nutricional.

Infectious disease update

Many newly described or "re-emerging" infectious diseases may present to the dermatologist, often with potentially life-threatening implications. Prompt recognition and early intervention can greatly diminish the morbidity and mortality associated with these diseases.

Bacterial and protozoal infections

The oral cavity is a common site for manifestations of systemic microbial diseases. Oral lesions may be typical of those seen elsewhere on the body, or the lesions may be modified by the local environment. The ease of examination within the oral cavity, however, and any site-specific features facilitates diagnosis of the systemic condition.

Toxin-mediated streptococcal and staphylococcal disease

After several decades of seemingly decreasing virulence, streptococcal and staphylococcal infections have reemerged as a major source of morbidity and mortality. Within the past 2 decades, not only have well-established diseases such as rheumatic fever begun to reappear. but also many new entities, such as toxic shock syndrome, streptococcal toxic shock syndrome, recurrent toxin-mediated perineal erythema, and recalcitrant erythematous desquamating disorder have been described. Central to the renewed importance of these bacteria has been the production of circulating toxins, which often function as superantigens in causing the clinical manifestations, morbidity and mortality associated with these diseases.

Current aspects of bacterial infections of the skin

The practicing dermatologist is faced with an ever-changing epidemiologic spectrum of cutaneous bacterial diseases. Studies have stated that bacterial skin infections may account for up to 17% of clinical visits. It is hoped that the information presented in this article will enable the practicing dermatologist to provide improved patient care in the diagnosis and management of bacterial infections of the skin.