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Bernik R, Horvat Ledinek A, Brecl Jakob G. Local immunosuppression in ofatumumab: a series of three cases with bacterial infections near the injection sites. Neurol Sci 2024:10.1007/s10072-024-07714-2. [PMID: 39069593 DOI: 10.1007/s10072-024-07714-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024]
Affiliation(s)
- Rok Bernik
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2a, Ljubljana, 1000, Slovenia.
| | - Alenka Horvat Ledinek
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2a, Ljubljana, 1000, Slovenia
| | - Gregor Brecl Jakob
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2a, Ljubljana, 1000, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Sears SJ, Menendez K, Cobo Dominguez B, Chernicki B, Caushi J, Cherner R. Fournier's Gangrene in an Elderly Male: A Case Report. Cureus 2024; 16:e64019. [PMID: 39114218 PMCID: PMC11304407 DOI: 10.7759/cureus.64019] [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: 05/02/2024] [Accepted: 06/24/2024] [Indexed: 08/10/2024] Open
Abstract
Fournier's gangrene (FG) is a rapidly progressing necrotizing soft tissue infection of the perineum with potential multiorgan involvement, posing significant mortality risks. This case report highlights the clinical presentation, potential risk factors, and emphasizes the critical necessity of immediate antibiotic therapy and surgical debridement, regardless of the causative agents involved. We also aim to provide new images to better visualize a diagnosis of Fournier's gangrene. We present the case of a 65-year-old male with a history of self-care neglect, hypertension, and extensive tobacco use. The patient presented to the emergency department exhibiting classical symptoms of systemic illness, necessitating a collaborative diagnostic and therapeutic approach involving various medical specialties including family medicine, urology, general surgery, interventional radiology, infectious disease, pharmacy, intensive care, social service, and palliative care teams. Despite aggressive interventions during his 24-day hospitalization, the patient's clinical condition progressively deteriorated. This case underscores the significance of early detection, timely intervention, and interdisciplinary cooperation in optimizing outcomes for patients with Fournier's gangrene.
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Affiliation(s)
- Shalondria J Sears
- Family Medicine, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | | | - Beatriz Cobo Dominguez
- Family Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine Nova Southeastern University, Clearwater, USA
| | - Brendan Chernicki
- Family Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine Nova Southeastern University, Fort Lauderdale, USA
| | - Jessica Caushi
- Family Medicine, Dr. Kiran C. Patel College of Osteopathic Medicine Nova Southeastern University, Fort Lauderdale, USA
| | - Rebecca Cherner
- Family Medicine, Broward Health Medical Center, Fort Lauderdale, USA
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Shet P, Mustafa AD, Varshney K, Rao L, Sawdagar S, McLennan F, Ansari S, Shet D, Sivathamboo N, Campbell S. Risk Factors for Mortality Among Patients With Fournier Gangrene: A Systematic Review. Surg Infect (Larchmt) 2024; 25:261-271. [PMID: 38625013 DOI: 10.1089/sur.2023.372] [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] [Indexed: 04/17/2024] Open
Abstract
Background: Fournier gangrene (FG) is a form of necrotizing fasciitis involving the perineal, peri-anal, and genital structures, and has exceptionally high mortality rates. To help in early detection of high-risk patients, we aimed to systematically review factors associated with mortality from FG. Patients and Methods: Searches were conducted in PubMed, Embase and Scopus. In our review, a minimum of five patients were required and this was to exclude studies with exceedingly small sample sizes, such as case reports and small case series, with minimal relevance in comparison to larger scale studies. Patient characteristics, causative microbes, anatomic areas of infection, presence of comorbidities, severity scores, causes of FG, and complications were extracted and compared to identify factors related to mortality. Results: A total of 57 studies were included in the review. Across 3,646 study participants, the mortality rate of FG was 20.41%. The mean age of non-survivors was 61.27 years. There were more total male deaths, however, the mortality rate was higher in females. Diabetes mellitus was the most common comorbidity in those who died, but the highest mortality rate was seen in HIV patients (54.17%). Mortality rates did not differ widely among antibiotic agents. Regarding causative organisms, fungal infections had the highest rates of mortality (68.18%) and the most common microbe leading to death was Escherichia coli. Conclusions: Female gender, comorbidities, anatomic distribution, development of sepsis, and fungal infection all increased risk for mortality. Early identification of risk factors, and provision of appropriate treatment are crucial in reducing mortality rates of high-risk patients with FG.
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Affiliation(s)
- Pavan Shet
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | | | - Karan Varshney
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Lavina Rao
- School of Medicine, Monash University, Clayton, Victoria, Australia
| | - Sameen Sawdagar
- Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Florence McLennan
- School of Medicine, Deakin University, Waurn Ponds, Victoria, Australia
| | - Siraaj Ansari
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Darshan Shet
- Central Pharmacy Logistics, Coburg North, Victoria, Australia
| | | | - Sian Campbell
- The Royal Melbourne Hospital, Parkville, Victoria, Australia
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Matias MJR, Guimarães D, Vilela M, Sousa J, Bexiga J. Fournier gangrene - would you KISS it? GMS INTERDISCIPLINARY PLASTIC AND RECONSTRUCTIVE SURGERY DGPW 2023; 12:Doc12. [PMID: 38111841 PMCID: PMC10726960 DOI: 10.3205/iprs000182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Fournier gangrene is a disease characterized by necrotizing fasciitis of the perineal and genital region, resulting from synergistic polymicrobiotic infection. Most infections can be localized to a cutaneous, urethral, or rectal source and can culminate in a fulminant sepsis. Current state of the art is systemic broad-spectrum antibiotics and serial aggressive debridement which result in superficial perineal defect of wide dimensions. We compiled all the cases of Fournier gangrene that required reconstruction after debridement in Centro Hospitalar Universitário Lisboa Central from 2018 to 2022. Inclusion criteria were reconstruction for Fournier defects and patients' age 18 to 90 years old. Exclusion criteria were patients who didn't require reconstruction or didn't complete it due to death or transfer to another healthcare institution. Reconstructive procedures and complication rates are reported as whole numbers and percentages of total. The initial search yielded 32 patients. There were 2 (6.2%) patients with defects that healed by secondary intention, 6 (18.7%) with delayed primary closure, 4 (12.5%) with implantation of the testicle in a medial thigh pocket, 12 (37.5%) with skin grafts, 4 (12.5%) with scrotal advancement flaps, 2 (6.2%) with flaps, and 2 (6.2%) with flaps and skin grafts in combination. Four outcomes were evaluated: number of patients, defect size, method of reconstruction, and wound-healing complications. Most reconstructive techniques provide reliable coverage and protection of testicular function with an acceptable cosmetic result. The reconstructive options need to be patient tailored in order to achieve long lasting results with a minimum of postoperative morbidity.
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Affiliation(s)
| | - Diogo Guimarães
- Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Manuel Vilela
- Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Juliana Sousa
- Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
| | - Joaquim Bexiga
- Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal
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