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You Q, Guan J, Wu B, Du J, Miao Y, Bai X, Ma Y, Zhen S, He Z. Fournier's Gangrene: clinical case review and analysis of risk factors for mortality. BMC Surg 2024; 24:251. [PMID: 39251993 PMCID: PMC11382531 DOI: 10.1186/s12893-024-02547-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/27/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Fournier's Gangrene is a severe surgical infectious disease, and various risk factors can increase its mortality rate. The purpose of this study is to retrospectively analyze the clinical characteristics and laboratory data of Fournier's Gangrene patients, followed by an analysis of mortality-related risk factors. This study has no secondary objectives. METHODS This study included 46 hospitalized patients diagnosed with Fournier's Gangrene at Suzhou Traditional Chinese Medicine Hospital from December 2013 to March 2024. Clinical data for all patients were extracted from the electronic medical records system. The collected data included gender, age, duration of illness, length of hospital stay, sites of infection involvement, comorbidities, white blood cell count, hematocrit, albumin, blood glucose, creatinine, serum sodium, serum potassium upon admission, microbial culture results, and patient outcomes (survival/death). The Simplified Fournier Gangrene Severe Index (SFGSI) was used to score all patients. Patients were categorized into survival and death groups based on clinical outcomes. Differences between categorical variables were compared using the χ² test or Fisher's exact test. Differences between numerical variables were compared using Student's t-test or the Mann-Whitney U test. Binary logistic regression was employed to analyze the risk factors for mortality in Fournier's Gangrene. RESULTS Among the 46 Fournier's Gangrene patients, 39 were male (84.8%) and 7 were female (15.2%). The age ranged from 17 to 86 years, with a median age of 61 years. Fourteen cases (30.4%) were confined to the perianal area, 26 cases (56.5%) had fascial necrosis involving the perianal, perineal, and genital regions, while 6 cases (13.0%) extended to the abdominal wall. At a 3-month postoperative follow-up, 43 patients (93.5%) survived, while 3 patients (6.5%) died shortly after admission due to severe illness. Based on the outcome, patients were divided into survival and death groups with 43 and 3 cases, respectively. Significant differences were observed between the two groups in terms of age (P<0.05), extension to the abdominal wall (P<0.01), hematocrit (P<0.01), albumin (P<0.01), SFGSI (P<0.01), and SFGSI>2 (P<0.01). Binary logistic regression analysis indicated that decreased hematocrit was an independent risk factor for mortality in Fournier's Gangrene patients. CONCLUSION This study provides a detailed analysis of the clinical characteristics and risk factors for mortality in Fournier's Gangrene patients. The primary outcome of this study is that a decreased hematocrit is an independent risk factor for predicting mortality in FG patients. These findings offer valuable prognostic insights for clinicians, underscoring the importance of early identification and correction of reduced hematocrit to improve patient outcomes and survival rates.
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Affiliation(s)
- Qingyun You
- Nanjing University of Chinese Medicine, Nanjing, 210046, Jiangsu, PR China
| | - Jing Guan
- Nanjing University of Chinese Medicine, Nanjing, 210046, Jiangsu, PR China
| | - Bensheng Wu
- Department of Anorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, Jiangsu Province, PR China
| | - Jun Du
- Department of Anorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, Jiangsu Province, PR China
| | - Yangyang Miao
- Clinical Laboratory, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, PR China
| | - Xinxin Bai
- Nanjing University of Chinese Medicine, Nanjing, 210046, Jiangsu, PR China
| | - Yuhua Ma
- Nanjing University of Chinese Medicine, Nanjing, 210046, Jiangsu, PR China
| | - Shuguang Zhen
- Department of Anorectal Surgery, Suzhou TCM Hospital Affiliated to Nanjing University of Chinese Medicine, Suzhou, 215009, Jiangsu Province, PR China.
| | - Zongqi He
- Department of Anorectal Surgery, Kunshan Hospital Affiliated to Nanjing University of Chinese Medicine, Kunshan, 215300, Jiangsu Province, PR China.
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Bedini A, Medioli F, Gallerani A, Venturelli I, Franceschi G, Meschiari M, Franceschini E, Maria Lima G, Sarti M, Mussini C. A rare case of necrotizing fasciitis of the leg in an intravenous drug user caused by Prevotella denticola. J Oral Microbiol 2024; 16:2334545. [PMID: 38562513 PMCID: PMC10984238 DOI: 10.1080/20002297.2024.2334545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Background Intravenous drug users (IDUs) have a high risk of developing skin and soft tissue infections such as erysipelas, abscesses, and less frequently necrotizing fasciitis (NF) or gas gangrene. Rarely, the cause of the infection is microorganisms residing in the oral cavity and can lead to life-threatening infections. Methods We describe the case of a 43-year-old man intravenous drug user (IDU) who was admitted for intense leg pain following an injection of cocaine at that site. Results A clinical and radiological diagnosis of NF was made, so the patient was started on empirical antibiotic therapy and underwent surgical fasciotomy (after 8 hours from admission). Prevotella denticola was isolated from multiple intraoperative specimens and was resistant to initial antimicrobial therapy. The man, suffering from periodontal disease, reported sucking the syringe several times to unblock it. Both fasciotomy surgery and adjustment of antimicrobial therapy enabled therapeutic success. Conclusions In IDUs the risk of deep skin and soft tissue infections is high and may be aggravated by contamination with oral microorganisms. The choice of empirical antibiotic treatment should include agents active against oral cavity anaerobes, such as P. denticola.
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Affiliation(s)
- Andrea Bedini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Filippo Medioli
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Altea Gallerani
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Irene Venturelli
- Clinical Microbiology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Giacomo Franceschi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Marianna Meschiari
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Erica Franceschini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Giacomo Maria Lima
- Nuclear Medicine Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | - Cristina Mussini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
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Warli SM, Pakpahan KA, Nasution R, Kadar DD, Adhyatma KP. Role of SFGSI, microbial culture and qSOFA as predictive factors in determining the survival rate in Fournier Gangrene patient. Saudi Med J 2024; 45:230-234. [PMID: 38438215 PMCID: PMC11115395 DOI: 10.15537/smj.2024.45.3.20230036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/04/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES To examine the simplified Fournier Gangrene Severe Index Score (SFGSI) and the number of species in culture findings for predicting death in Fournier Gangrene (FG) patients in terms of their predictive power. METHODS From January 2017 to July 2022, the medical records of individuals undergoing emergency surgery for FG were obtained. A total of 80 patients were examined for clinical data such as age, gender, laboratory parameters, etiology, isolated bacteria, and mortality rate. RESULTS We identified a statistically significant mean difference between SFGSI (p<0.0001) and quickSOFA (qSOFA) scores (p=0.002) in determining the survival rate of FG patients. The sensitivity and specificity of the SFGSI score in predicting mortality were 90.1% and 88.3% respectively, whereas the sensitivity and specificity of the qSOFA score were 88.2% and 86.2%. E. Coli comprised 56.2% of the bacteria, followed by S. Haemolyticus, S. Aureus, P. Aeruginosa, and K. Pneumoniae. On the basis of bacterial culture results, P. Aeruginosa had the highest fatality rate (100%) followed by S. Aureus (75%), S. Haemolyticus (30%), and E. Coli (20%), in that order. CONCLUSION The survival rate of FG patients can be predicted using the sensitivity and specificity of the SFGSI and qSOFA scores together. P. Aeruginosa-infected patients have the greatest mortality rate (100%) compared to the other groups.
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Affiliation(s)
- Syah M. Warli
- From the Division of Urology (Warli, Nasution, Kadar, Adhyatma, Pakpahan), Department of Surgery, Faculty of Medicine, from the Department of Urology (Warli), Universitas Sumatera Utara, and from the Department of Urology (Pakpahan), Faculty of Medicine, Universitas Indonesia, Haji Adam Malik General Hospital, Medan, Indonesia.
| | - Karimul A. Pakpahan
- From the Division of Urology (Warli, Nasution, Kadar, Adhyatma, Pakpahan), Department of Surgery, Faculty of Medicine, from the Department of Urology (Warli), Universitas Sumatera Utara, and from the Department of Urology (Pakpahan), Faculty of Medicine, Universitas Indonesia, Haji Adam Malik General Hospital, Medan, Indonesia.
| | - Ramlan Nasution
- From the Division of Urology (Warli, Nasution, Kadar, Adhyatma, Pakpahan), Department of Surgery, Faculty of Medicine, from the Department of Urology (Warli), Universitas Sumatera Utara, and from the Department of Urology (Pakpahan), Faculty of Medicine, Universitas Indonesia, Haji Adam Malik General Hospital, Medan, Indonesia.
| | - Dhirajaya D. Kadar
- From the Division of Urology (Warli, Nasution, Kadar, Adhyatma, Pakpahan), Department of Surgery, Faculty of Medicine, from the Department of Urology (Warli), Universitas Sumatera Utara, and from the Department of Urology (Pakpahan), Faculty of Medicine, Universitas Indonesia, Haji Adam Malik General Hospital, Medan, Indonesia.
| | - Kharisma P. Adhyatma
- From the Division of Urology (Warli, Nasution, Kadar, Adhyatma, Pakpahan), Department of Surgery, Faculty of Medicine, from the Department of Urology (Warli), Universitas Sumatera Utara, and from the Department of Urology (Pakpahan), Faculty of Medicine, Universitas Indonesia, Haji Adam Malik General Hospital, Medan, Indonesia.
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Condell L, Doolan N, McMonagle M. The novel use of a vacuum-assisted closure dressing in the management of Fournier's gangrene. Ann R Coll Surg Engl 2024. [PMID: 38362891 DOI: 10.1308/rcsann.2023.0102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Affiliation(s)
- L Condell
- St Vincent's University Hospital, Dublin, Ireland
| | - N Doolan
- Beaumont Hospital, Dublin, Ireland
| | - M McMonagle
- University Hospital Waterford, Ireland
- Imperial College Healthcare NHS Trust, UK
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Theodorou DJ, Theodorou SJ, Kakitsubata Y. Pneumatosis: Appearances on CT Imaging. Cureus 2023; 15:e41927. [PMID: 37583727 PMCID: PMC10424766 DOI: 10.7759/cureus.41927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Pneumatosis is a general term used to designate the presence of spontaneous air or gas leaks into the body's compartments. PURPOSE In this paper, we provide an overview of gas originating from different sites and present the most common routes by which air may escape free to surrounding or distant tissues. METHODS On the basis of 45 interesting clinical cases, we discuss the CT imaging characteristics of thoracic and spinal pneumatosis, better known as pneumomediastinum and pneumorrhachis. In addition, we present craniocervical pneumatosis manifesting as subcutaneous emphysema. RESULTS Isolated pneumatosis was diagnosed in 12 (27%) of the 45 patients, manifesting as craniocervical free air or pneumoperitoneum. In 28 (62%) patients with pneumomediastinum, 12 (43%) had concomitant pneumothorax. Soft tissue emphysema was seen in 24 (52%) patients. One of the patients with generalized pneumatosis had craniocervical and extensive soft tissue emphysema, in conjunction with pneumomediastinum, pneumothorax, and pneumoperitoneum. Intraspinal pneumatosis was always coupled with pneumomediastinum. CONCLUSION Pneumatosis may not be as uncommon as it seems, and indeed, this condition may need to be recognized early as it can be an alarming sign of serious pathology.
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Zhang JY, Xiao CF, Wang C, Yao YB. Bibliometric insights in fournier's gangrene: Research landscapes, turning points, and global trends. Front Surg 2023; 10:1057486. [PMID: 36874468 PMCID: PMC9978006 DOI: 10.3389/fsurg.2023.1057486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023] Open
Abstract
Study Design Bibliometric and visualization analysis. Objective To analyze the research landscapes and hotspots of Fournier's gangrene, and reveal the dynamic changes and development trend of research hotspots for the purpose of providing ideas and a basis for clinical and basic research in this field. Methods Research datasets were acquired from the Web of Science. The publication years were limited from January 1, 1900 to August 5, 2022. The bibliometric tools CiteSpace (v5.8) and VOSviewer (v1.6) were used to analyze the data and generate visualization knowledge maps. Trends in annual publications, distribution, H-index status, coauthorships status and research hotspots were analyzed. Results According to the search strategy, we identified and enrolled 688 publications regarding to Fournier's gangrene. The number of published papers showed an overall upwards trend. The USA was the largest contributor, ranking first in total publications, citations and the H-index. The top 10 most productive institutions were all from the USA. De Simone B and Sartelli M were the most productive authors. There was close cooperation among countries, but the cooperation among institutions and authors had little contact and poor interactivity. The research hotspots included the pathogenesis factors and treatment. All the identified keywords were divided into 14 clusters, and the label of the latest cluster was "empagliflozin". Prognosis and risk factors, emerging treatment methods, and pathogenesis were at the forefront of the Fournier's gangrene field and were predicted to be the next hot topics. Conclusion The research of Fournier's gangrene has made some achievements, but the overall research level is still in the primary stage. The academic cooperation between different institutions and authors needs to be strengthened. At the early stage, the mainstream of research was the infected tissue and site, pathogenesis, and diagnosis of disease, while research on newly discovered sodium-glucose cotransporter 2 inhibitor, adjuvant therapy and prognostic factors may be the main directions in the future.
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Affiliation(s)
- Jia-Yuan Zhang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chang-Fang Xiao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Wang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yi-Bo Yao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Dalili A, Hamidi Alamdari D, Dalili A, Sarkardeh M, Rezapanah A, Tafazoli N. Autologous Platelet-Rich Plasma Injection and Platelet-Rich Fibrin Glue Insertion for the Treatment of Extensive Supralevator Anorectal Fistula: A Case Report. World J Plast Surg 2023; 12:58-62. [PMID: 37220581 PMCID: PMC10200087 DOI: 10.52547/wjps.12.1.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/02/2023] [Indexed: 05/25/2023] Open
Abstract
Supralevator fistula stays a challenge in general surgery. We present a case with supralevator anorectal fistula and subsequent retroperitoneal necrotizing fasciitis in which autologous platelet-rich plasma and platelet-rich fibrin glue were used for fistula closure. A 59-year-old man was admitted with pelvic pain and fever. Abdominopelvic sonography and CT scan reported a deep horseshoe-shaped anorectal abscess with extension to the pelvic floor, supralevator, psoas, retroperitoneal muscles, and kidneys. He was managed with antibiotics, abscess drainage, repeated radical surgical debridement, and necrosectomy. After 30 days, he was discharged, but he returned to the office with the complaint of purulent discharge from the hypogastric region and a diagnosis of fistula formation. Platelet-rich plasma was injected around the fistula into the tissue, and platelet-rich fibrin glue was introduced to the fistula tract. At the 11-month follow-up, the patient did not have voiding dysfunction, constipation, diarrhea, or fistula tract infection. Autologous platelet-rich plasma injection and platelet-rich fibrin glue insertion suggest a secure and effective approach for treating supralevator anorectal fistula.
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Affiliation(s)
- Amin Dalili
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Surgery, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Daryoush Hamidi Alamdari
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Surgery, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alimohamad Dalili
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Surgery, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sarkardeh
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Surgery, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Rezapanah
- Surgical Oncology Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Surgery, Imam Reza hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nooshin Tafazoli
- MD, Faculty of Medicine, Mashhad University of medical sciences, Mashhad, Iran
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Paladini A, Cochetti G, Tancredi A, Mearini M, Vitale A, Pastore F, Mangione P, Mearini E. Management of Fournier's gangrene during the Covid-19 pandemic era: make a virtue out of necessity. Basic Clin Androl 2022; 32:12. [PMID: 35850577 PMCID: PMC9294754 DOI: 10.1186/s12610-022-00162-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022] Open
Abstract
Background Fournier’s gangrene (FG) is a necrotizing fasciitis caused by aerobic and anaerobic bacterial infection that involves genitalia and perineum. Males, in their 60 s, are more affected with 1.6 new cases/100.000/year. Main risk factors are diabetes, malignancy, inflammatory bowel disease. FG is a potentially lethal disease with a rapid and progressive involvement of subcutaneous and fascial plane. A multimodal approach with surgical debridement, antibiotic therapy, intensive support care, and hyperbaric oxygen therapy (HBOT) is often needed. We present the inpatient management of an FG case during the Covid-19 pandemic period. A narrative review of the Literature searching “Fournier’s gangrene”, “necrotizing fasciitis” on PubMed and Scopus was performed. Case presentation A 60 years old man affected by diabetes mellitus, with ileostomy after colectomy for ulcerative colitis, was admitted to our Emergency Department with fever and acute pain, edema, dyschromia of right hemiscrotum, penis, and perineal region. Computed tomography revealed air-gas content and fluid-edematous thickening of these regions. Fournier’s Gangrene Severity Index was 9. A prompt broad-spectrum antibiotic therapy with Piperacillin/Tazobactam, Imipenem and Daptomycin, surgical debridement of genitalia and perineal region with vital tissue exposure, were performed. Bedside daily surgical wound medications with fibrine debridement, normal saline and povidone-iodine solutions irrigation, iodoform and fatty gauze application, were performed until discharge on the 40th postoperative day. Every 3 days office-based medication with silver dressing, after normal saline and povidone-iodine irrigation and fibrinous tissue debridement, was performed until complete re-epithelialization of the scrotum on the 60th postoperative day. Conclusions FG is burdened by a high mortality rate, up to 30%. In the literature, HBOT could improve wound restoration and disease-specific survival. Unfortunately, in our center, we do not have HBOT. Moreover, one of the pandemic period problems was the patient’s displacement and outpatient hospital management. For all these reasons we decided for a conservative inpatient management. Daily cleaning of the surgical wound allowed to obtain its complete restoration avoiding surgical graft and hyperbaric oxygen chamber therapy, without foregoing optimal outcomes.
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Affiliation(s)
- Alessio Paladini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Giovanni Cochetti
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy.
| | - Angelica Tancredi
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Matteo Mearini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Andrea Vitale
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Francesca Pastore
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Paolo Mangione
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
| | - Ettore Mearini
- Department of Medicine and Surgery, Urology Clinic, University of Perugia, 06129, Perugia, Italy
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Öcük Ö, Yağın FH, Dinç OG, Fırat C. Effectiveness of Fasciocutaneous Superomedial Thigh Flap in Reconstruction of Fournier Gangrene Defects. EPLASTY 2022; 22:e26. [PMID: 36000012 PMCID: PMC9361348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Fournier gangrene (FG) is a necrotizing fasciitis involving perianal and abdominal regions. It progresses quickly and requires urgent intervention. With the use of vacuum-assisted closure (VAC) treatment applied during clinical follow-up and the use of superomedial thigh flap in the region, the treatment is completed with an effective, functional, and rapid approach. This study examines the clinical details of this method for reconstruction. METHODS The study included 15 patients who underwent superomedial thigh flap in VAC treatment reconstruction for tissue defect after FG debridement from 2016 to 2020. The patients were examined in the form of clinical evaluation with hospital admission and surgical evaluation in the postop process. RESULTS In patients with wound maturation and sufficient granulation, superomedial thigh flap application followed by VAC treatment soon after shortened the operation time, shortened the postop drain time, and provided effective treatment of dead space. An aesthetic and functional result was obtained with the proximity of the flap to the area. In addition, due to the sensory branches present in the flap, a sensory result was obtained according to the ratio of flap size. CONCLUSIONS Superomedial thigh flap provides a practical, effective, and fast solution to the tissue defect that occurs after FG debridement. Effective results can be obtained when combined with VAC therapy.
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Affiliation(s)
- Özcan Öcük
- Department of Plastic Reconstructive and Aesthetic Surgery, İnönü University, Medical Faculty, Malatya, Turkey
| | - Fatma Hilal Yağın
- Department of Biostatistics and Medical İnformatics, İnönü University, Medical Faculty, Malatya, Turkey
| | - Orhan Gazi Dinç
- Department of Plastic Reconstructive and Aesthetic Surgery, İnönü University, Medical Faculty, Malatya, Turkey
| | - Cemal Fırat
- Department of Plastic Reconstructive and Aesthetic Surgery, İnönü University, Medical Faculty, Malatya, Turkey
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Practical Review of the Current Management of Fournier’s Gangrene. Plast Reconstr Surg Glob Open 2022; 10:e4191. [PMID: 35295879 PMCID: PMC8920302 DOI: 10.1097/gox.0000000000004191] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/18/2022] [Indexed: 12/18/2022]
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Larsen K, Paige A, Mutyala M, Weber B, Slim J. Fournier's gangrene mimicking an acute epididymitis. SAGE Open Med Case Rep 2021; 9:2050313X211059297. [PMID: 34820131 PMCID: PMC8606724 DOI: 10.1177/2050313x211059297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/25/2021] [Indexed: 12/17/2022] Open
Abstract
Fournier's gangrene is a urologic emergency secondary to a necrotizing soft tissue infection. Fournier's gangrene is characterized by severe pain and features of Fournier's gangrene may include edema, blisters and bullae, crepitus, subcutaneous gas, and systemic symptoms. Risk factors include male gender, alcohol abuse, immunocompromised state, uncontrolled diabetes mellitus, obesity, and malignancy. The diagnosis is made clinically but is often supported by radiography, ultrasound, computed tomography, and magnetic resonance imaging. Treatment consists of emergent hospitalization and surgery to debride the necrotic tissues. Morbidity and mortality for Fournier's gangrene are very high if left untreated. Early surgical intervention is key to the successful treatment of Fournier's gangrene. This case report presents a case of Fournier's gangrene mimicking acute epididymitis and highlights the importance of a thorough physical examination with high clinical suspicion for Fournier's gangrene.
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Affiliation(s)
- Kalee Larsen
- Saint Michael's Medical Center, New York Medical College, Newark, NJ, USA
| | - Amy Paige
- Saint Michael's Medical Center, New York Medical College, Newark, NJ, USA
| | - Monica Mutyala
- Saint Michael's Medical Center, New York Medical College, Newark, NJ, USA
| | - Benjamin Weber
- Saint Michael's Medical Center, New York Medical College, Newark, NJ, USA
| | - Jihad Slim
- Saint Michael's Medical Center, New York Medical College, Newark, NJ, USA
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Alyanak A, Cakici OU, Turkmen YA. Skin-sparing approach in the management of Fournier's gangrene: the initial histological evidence and results of a tertiary health-care center. ANZ J Surg 2021; 92:128-131. [PMID: 34825439 DOI: 10.1111/ans.17387] [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: 09/07/2021] [Accepted: 11/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To report the initial histological evidence on the feasibility of the skin-sparing approach in the treatment of Fournier's gangrene. METHODS We retrospectively reviewed the clinical data and the tissue blocks obtained from patients who had undergone debridement in a tertiary healthcare center by a urologist and a general surgeon. RESULTS The histological review revealed the prevalence of the intact epidermal layers in the debrided tissues involving necrosed subcutaneous parts. Clinical results of our cohort were compatible with the contemporary series. CONCLUSION We can propose that the skin parts without macroscopic necrosis can be spared in the initial debridement in the treatment of Fournier's gangrene, at least in the first debridement. The skin-sparing approach may provide easier and primary closure of the wound without compromising surgical safety in Fournier's gangrene treatment.
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Affiliation(s)
- Ahmet Alyanak
- Department of General Surgery, Yuksek Ihtisas University Affiliated Medical Park Ankara Private Hospital, Ankara, Turkey
| | - Ozer Ural Cakici
- Department of Urology. Ankara, Yuksek Ihtisas University Affiliated Medical Park Ankara Private Hospital, Ankara, Turkey
| | - Yesim Atak Turkmen
- Department of Pathology, Yenimahalle Training and Research Hospital, Yildirim Beyazit University, Ankara, Turkey
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13
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Lewis GD, Majeed M, Olang CA, Patel A, Gorantla VR, Davis N, Gluschitz S. Fournier's Gangrene Diagnosis and Treatment: A Systematic Review. Cureus 2021; 13:e18948. [PMID: 34815897 PMCID: PMC8605831 DOI: 10.7759/cureus.18948] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2021] [Indexed: 12/15/2022] Open
Abstract
Fournier's gangrene (FG) is a perineal and abdominal necrotizing infection. It is most commonly found in middle-aged men with comorbidities such as diabetes mellitus. Initial symptoms are often indistinct and can rapidly progress to overwhelming infections with a relatively high mortality rate. It is crucial to make a prompt diagnosis so that the patient receives appropriate treatment. Given the importance of the identification of FG, we explored what were the most common signs and symptoms associated with FG, as well as distinguished the gold standard treatment. This systematic review utilized articles identified exclusively through PubMed using key terms such as Fournier's gangrene, signs, symptoms, and treatment. A total of 37 studies, including a total of 3,224 patients (3,093 males and 131 females), fit our inclusion parameters for relevance that included either the most identifiable presentation of FG or the most effective treatment. From our search, the most common clinical presentation was scrotal and labial pain, fever, abscesses, crepitus, erythema, and cellulitis. Diagnosis is made from clinical findings in conjunction with imaging. The gold standard for treatment was found to be a combination of surgical debridement, broad-spectrum antibiotics, and the administration of intravenous fluids. Further, patient survival was found to be directly related to the time from diagnosis to treatment when they underwent surgical debridement. The importance of early identification for improved outcomes or survival highlights the need for further studies or measures to enhance the identification of the signs and symptoms of FG.
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Affiliation(s)
- Gregory D Lewis
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Maliha Majeed
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Catherine A Olang
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Arjun Patel
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Vasavi Rakesh Gorantla
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Nelson Davis
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Sarah Gluschitz
- Department of Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
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Trama F, Illiano E, Bertuzzi G, Chiummariello S, Costantini E. Multimodal approach in a patient with Fournier's gangrene during the coronavirus pandemic. Urol Case Rep 2021; 39:101825. [PMID: 34485089 PMCID: PMC8408631 DOI: 10.1016/j.eucr.2021.101825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022] Open
Abstract
Fournier's gangrene (FG) is a polymicrobial necrotizing fasciitis involving the external genitalia and perineal region. It preferentially affects men, with a mortality rate of approximately 40%. Early diagnosis, surgical debridement, appropriate antibiotic therapy, and hyperbaric chamber treatment increase the therapeutic success. The purpose of this clinical report was to emphasize how a multimodal treatment and the tenacity of the health professionals involved in the era of the coronavirus pandemic with considerable health and logistical difficulties can lead to the complete recovery of patients suffering from FG.
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Affiliation(s)
- Francesco Trama
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Italy
| | - Ester Illiano
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Italy
| | - Giancarlo Bertuzzi
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Italy
| | | | - Elisabetta Costantini
- Andrology and Urogynecology Clinic, Santa Maria Terni Hospital, University of Perugia, Italy
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15
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Nepal P, Ojili V, Kumar S, Kumar D, Nagar A. Imaging spectrum of common and rare infections affecting the lower genitourinary tract. Abdom Radiol (NY) 2021; 46:2665-2682. [PMID: 33388810 DOI: 10.1007/s00261-020-02889-6] [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: 07/21/2020] [Revised: 11/24/2020] [Accepted: 11/27/2020] [Indexed: 10/22/2022]
Abstract
In this review, we will discuss the imaging findings of common as well as uncommon lower genitourinary tract infections. For both clinicians and radiologists, it is imperative to understand etiopathogenesis, epidemiological information, clinical presentation, imaging findings and management options of such conditions. Knowledge of salient imaging features of these infections is of utmost importance because prompt recognition enables appropriate management.
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16
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Gas Where It Shouldn't Be! Imaging Spectrum of Emphysematous Infections in the Abdomen and Pelvis. AJR Am J Roentgenol 2021; 216:812-823. [DOI: 10.2214/ajr.20.23545] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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17
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Rampal S, Maniam S, Lim PY, Ramachandran R, Tan EK, Halim MAHA, Shamsudin Z, Singh SSS, Narayanan P, Neela VK. Necrotizing fasciitis, causative agents and management: a five-year retrospective study in two tertiary care hospitals in Central Malaysia. INTERNATIONAL ORTHOPAEDICS 2021; 45:1399-1405. [PMID: 33484294 DOI: 10.1007/s00264-020-04905-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Necrotizing fasciitis (NF) is a rapidly progressive inflammatory infection of the fascia, with secondary necrosis of the subcutaneous tissues. The severity of the disease depends on the virulence of the organism and host immunity. There is a paucity of reports on the prevalence of NF causing pathogens and management. METHODS Retrospective data of patients treated for NF were collected from two tertiary care hospitals in Central Malaysia between January 2014 and December 2018. RESULTS A total of 469 NF patients were identified. More than half of the NF patients were males (n = 278; 59.28%). The highest number of cases was found among age groups between 30 and 79, with mean age of 56.17. The majority of the NF cases (n = 402; 85.72%) were monomicrobial. Streptococcus spp. (n = 89; 18.98%), Pseudomonas aeruginosa (n = 63; 13.44%) and Staphylococcus spp. (n = 61; 13.01%) were identified as the top three microorganisms isolated. Among the 469 NF cases, 173 (36.8%) were amputated or dead while 296 (63.1%) recovered. Proteus spp. (n = 19; 12.93%), Klebsiella pneumoniae (n = 18; 12.24%) and Escherichia coli (n = 14; 9.52%) were associated with all types of amputations. The most common antibiotic prescribed was unasyn (n = 284; 60.56%), followed by clindamycin (n = 56; 11.94%) and ceftazidime (n = 41; 8.74%). A total of 239 (61.8%) recovered while 148 (38.2%) were either amputated or dead when managed with the unasyn, clindamycin or ceftazidime. CONCLUSION This study represents the largest NF cases series in Malaysia highlighting the causative agents and management.
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Affiliation(s)
- Sanjiv Rampal
- Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Sandra Maniam
- Department of Human Anatomy, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Poh Ying Lim
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Rubenandran Ramachandran
- Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Eng Kee Tan
- Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Mohd Asyraf Hafizuddin Ab Halim
- Department of Orthopaedic, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor Darul Ehsan, Malaysia
| | - Zulfahrizzat Shamsudin
- Orthopaedic Department, Hospital Tuanku Ja'afar, Jalan Rasah, Bukit Rasah, 70300, Seremban, Negeri Sembilan, Malaysia
| | - Sandeep Singh Sarawan Singh
- Orthopaedic Department, Hospital Ampang, Jalan Mewah Utara, Pandan Mewah, 68000, Ampang, Selangor Darul Ehsan, Malaysia
| | - Pravind Narayanan
- Department of Internal Medicine, Hospital Sarikei, Jalan Rentap, 96100, Sarikei, Sarawak, Malaysia
| | - Vasantha Kumari Neela
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
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Olivieri V, Ruggiero G, Abate D, Serra N, Fortunati V, Griffa D, Forte F, Corongiu E. Fatal infections in andrology. Atypical clinical presentation of a Fournier's disease. Arch Ital Urol Androl 2020; 92. [PMID: 33016049 DOI: 10.4081/aiua.2020.3.213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Fournier disease (FD) is a worrisome infection of genital area caused by a polimicrobial infection and characterized by a rapid progression to necrosis. Scrotum, perineum and lower abdomen represent the primary sites of origin. Clinical presentation and laboratory strongly suggest FD, but if not precociously diagnosed, it may quickly evolve into septic syndrome and patient's death. CASE REPORT A 62 years old Caucasian male presented for fever and penile gross oedema recently occurred. No history of previous urinary tract infection, hematuria or genital trauma was referred. He did not complain any storage or voiding low urinary tract symptom (LUTS); no foci of infection in genitoperineal area was observed nor urethral discharge. The ultrasound (US) revealed a disomogeneous broad thickening of subcutaneous tissues with increased vascularity on Color-Doppler. When the penis was manipulated in order to reduce oedema, retract foreskin and evaluate the glans, clinical parametres rapidly worsened and the patient developed a septic shock with blood pressure falling down, dyspnoea and tachyarrhythmia, and he was fastly sent to Intensive Care Unit where it has been hemodynamically stabilized and subjected to antibiotic therapy. Considering the clinical absence of gangrene's foci, we opted for a conservative treatment by maintaining bladder catheter and drug therapy.
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Affiliation(s)
- Valerio Olivieri
- Division of Urology, Ivrea civil Hospital (ASL TO4), Ivrea (Turin).
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19
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Mann AJ, Reinoso DB, Genuit T, Jimenez J. Fournier's Gangrene in the Setting of Underlying Carcinoma: A Case Report and Review of the Literature. Cureus 2020; 12:e10317. [PMID: 33052278 PMCID: PMC7544611 DOI: 10.7759/cureus.10317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Most case series of Fournier's gangrene (FG) do not list malignancy as a cause; however, isolated cases with underlying malignancy of the soft tissue, genitourinary, and gastrointestinal systems have been described. After a review of recently published literature, 20 case reports and 15 case series or review articles included relevant information and were included in this literature review. Malignancy is overlooked in 10% (2/20) of patients, resulting in a delayed diagnosis and initiation of cancer treatment. All patients with FG should have a thorough cancer history, digital rectal examination, appropriate local and systemic imaging, as well as tissue biopsies, to reduce the likelihood of a missed cancer diagnosis. Delay in management of the local malignancy may lead to persistence or recurrence of the infection and significantly worsens overall outcome and survival.
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Affiliation(s)
- Adam J Mann
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | | | - Thomas Genuit
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Jesus Jimenez
- General Surgery, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
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20
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Papanikolaou A, Brugger J, Sendi P, Olariu R. An unusual clinical presentation of necrotizing fasciitis. Infection 2020; 48:655-656. [PMID: 32125681 DOI: 10.1007/s15010-020-01405-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 02/19/2020] [Indexed: 12/29/2022]
Affiliation(s)
- Athanasios Papanikolaou
- Department of Plastic, Reconstructive and Aesthetic Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jon Brugger
- Institute of Pathology, University of Bern, Bern, Switzerland
| | - Parham Sendi
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Radu Olariu
- Department of Plastic, Reconstructive and Aesthetic Surgery, Inselspital Bern University Hospital, University of Bern, Bern, Switzerland.
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21
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Salamon D, Ochońska D, Wojak I, Mikołajczyk E, Bulanda M, Brzychczy-Włoch M. Evidence for Infections by the Same Strain of Beta 2-toxigenic Clostridium perfringens Type A Acquired in One Hospital Ward. Pol J Microbiol 2019; 68:323-329. [PMID: 31880878 PMCID: PMC7256698 DOI: 10.33073/pjm-2019-035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/30/2019] [Accepted: 05/21/2019] [Indexed: 11/05/2022] Open
Abstract
This study conducts a comparative phenotypic and genetic analysis of C. perfringens strains isolated from two patients hospitalized at the same time in 2017 in the surgical ward of the Provincial Specialist Hospital in Włocławek (Kujawsko-Pomorskie Province) who developed necrotizing soft tissue infections (NSTI). To explain the recurring cases of this infection, a comparative analysis was performed for these strains and the ones originating from infections recorded at the same hospital in three patients with gas gangrene in 2015. The two C. perfringens isolates studied in 2017 (8554/M/17 from patient No. 1 and 8567/M/17 from patient No. 2) had identical biochemical profiles. A comparison of research results using multiplex PCR from 2017 with a genetic analysis of strains from 2015 enabled us to demonstrate that the strains currently studied have the genes encoding the same toxins (α and β2) as the two strains analyzed in 2015: no. 7143 (patient No. 3) and no. 7149 (patient No. 2). A comparative analysis of the strain profiles obtained with pulsed-field gel electrophoresis (PFGE) in 2017 with the results from 2015 has found one identical and genetically unique restriction profile, corresponding to one clone of C. perfringens comprising of two strains: no. 8567/M/17 (patient No. 2 in 2017) and no. 7143 (patient No. 3 in 2015). The epidemiological data and detailed analysis of the course of both events suggest that this clone of C. perfringens possibly survived in adverse conditions of the external environment in the operating block of this hospital for many months.
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Affiliation(s)
- Dominika Salamon
- Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College , Krakow , Poland
| | - Dorota Ochońska
- Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College , Krakow , Poland
| | - Ilona Wojak
- Department of Microbiological Diagnostics, Blessed Father Jerzy Popieluszko Provincial Specialist Hospital , Wloclawek , Poland
| | - Ewa Mikołajczyk
- Department of Microbiological Diagnostics, Blessed Father Jerzy Popieluszko Provincial Specialist Hospital , Wloclawek , Poland
| | - Małgorzata Bulanda
- Department of Epidemiology of Infections, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College , Krakow , Poland
| | - Monika Brzychczy-Włoch
- Department of Molecular Medical Microbiology, Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College , Krakow , Poland
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Zingaro MD, Boni A, Vermandois JARD, Paladini A, Lepri E, Ursi P, Cirocchi R, Turco M, Gaudio G, Nogara A, Mearini E. Fournier's Gangrene and Intravenous Drug Abuse: an Unusual Case Report and Review of The Literature. Open Med (Wars) 2019; 14:694-710. [PMID: 31934634 PMCID: PMC6947763 DOI: 10.1515/med-2019-0114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/09/2019] [Indexed: 12/29/2022] Open
Abstract
Fournier's gangrene is a potentially fatal emergency condition characterized by necrotizing fasciitis and supported by an infection of the external genital, perineal and perianal region, with a rapid and progressive spread from subcutaneous fat tissue to fascial planes. In this case report, a 52-year-old man, with a history of hepatitis C-virus (HCV)-related chronic liver disease and cocaine use disorder for which he was receiving methadone maintenance therapy, was admitted to the Emergency Department with necrotic tissue involving the external genitalia. Fournier's gangrene is usually due to compromised host immunity, without a precise cause of bacterial infection; here it is linked to a loco-regional intravenous injection of cocaine. A multimodal approach, including a wide surgical debridement and a postponed skin graft, was needed. Here we report this case, with a narrative review of the literature.
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Affiliation(s)
- Michele Del Zingaro
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Andrea Boni
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | | | - Alessio Paladini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Emanuele Lepri
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Pietro Ursi
- Department of General Surgery and Surgical Specialties “Paride Stefanini”;, Sapienza University of Rome, Rome, Italy
| | - Roberto Cirocchi
- Division of General Surgery, Department of Surgical and Biochemical Sciences, University of Perugia, Perugia, Italy
| | - Morena Turco
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Gianluca Gaudio
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Andrea Nogara
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- Department of Surgical and Biomedical Sciences, University of Perugia, Perugia, Italy
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Khan A, Sultan M, Ul Haq U, Shahid Habib S. Impact of radiological diagnostics in the survivor of disseminated Fournier gangrene patient with septic pulmonary embolism. BMJ Case Rep 2019; 12:12/12/e231468. [PMID: 31852690 DOI: 10.1136/bcr-2019-231468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 51-year-old diabetic man diagnosed with prostatic abscess underwent its drainage twice. Following surgery he developed fever and right-sided painless visual loss due to endophthalmitis. To rule out its endogenous source CT scan was done which showed multisystem aetiology and complications. His pelvic CT and CT cystogram revealed postsurgical urethral injury along with urinary extravasation, perineal and pelvic soft tissues air densities with fat stranding ascribed to Fournier gangrene, air in distended urinary bladder due to emphysematous cystitis and right common iliac vein air containing septic thrombus. CT chest spotted bilateral multiple septic pulmonary emboli. These radiological findings were promptly handled by uro-surgical team followed by alliance with other relevant departments. With hasty surgical drainage/debridement, urological restoration of urinary obstruction, aggressive broad spectrum antibiotics, anticoagulation and radiological follow-ups the patient withstood multisystem lethal complications and come up with excellent outcome except evisceration.
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Affiliation(s)
- Adeena Khan
- Radiology and Medical imaging, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
| | - Mamoona Sultan
- Internal Medicine, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
| | - Usman Ul Haq
- Orthopaedic Surgery, Jarir Medical Centre, Riyadh, Saudi Arabia
| | - Syed Shahid Habib
- Clinical Physiology, King Saud University, Riyadh, Riyadh Province, Saudi Arabia
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