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Ting KC, Chuang PW, Tsai MJ. Necrotizing fasciitis in a 44-year-old woman caused by Vibrio vulnificus. CMAJ 2024; 196:E446. [PMID: 38589031 PMCID: PMC11001385 DOI: 10.1503/cmaj.231766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Affiliation(s)
- Kuan-Chung Ting
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Pei-Wen Chuang
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan
| | - Ming-Jen Tsai
- Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.
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Allaw F, Wehbe S, Kanj SS. Necrotizing fasciitis: an update on epidemiology, diagnostic methods, and treatment. Curr Opin Infect Dis 2024; 37:105-111. [PMID: 38037890 DOI: 10.1097/qco.0000000000000988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
PURPOSE OF REVIEW The aim of this review is to discuss the latest evidence of epidemiology, diagnostic methods, and treatment of necrotizing soft tissue infections (NSTIs) with a particular focus on necrotizing fasciitis (NF). RECENT FINDINGS NSTIs have been historically referred to as NF but encompass a broader range of infections, with variable rates ranging from 0.86 to 32.64 per 100 000 person-years, influenced by factors such as climate and seasonal variations. They have diverse microbiological profiles categorized into different types based on the involved pathogens, including polymicrobial or monomicrobial infections caused by organisms such as group A streptococcus (GAS), Staphylococcus aureus , some Gram-negative pathogens, and filamentous fungi following trauma and natural disasters. Diagnosis relies on clinical symptoms and signs, laboratory markers, and imaging. However, the gold standard for diagnosis remains intraoperative tissue culture. Treatment involves repeated surgical debridement of necrotic tissues in addition to intravenous antibiotics. Adjuvant therapies with intravenous immunoglobulin (IVIG) and hyperbaric oxygen therapy (HBOT) might have a role. Soft tissue reconstruction may be necessary following surgery. SUMMARY Prompt diagnosis and proper medical and surgical management of NSTI will improve outcomes.
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Affiliation(s)
- Fatima Allaw
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center
| | - Saliba Wehbe
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center
- Center for Infectious Disease Research, American University of Beirut, Beirut, Lebanon
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Bastelica P, Florentin G, Baudouin C, Labbé A. [Hyperbaric oxygen therapy and eye disease: Review of the literature]. J Fr Ophtalmol 2024; 47:104107. [PMID: 38430627 DOI: 10.1016/j.jfo.2024.104107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/28/2023] [Indexed: 03/05/2024]
Abstract
Hyperbaric oxygen therapy consists of breathing 100% oxygen continuously or intermittently in a chamber at a pressure equal to or greater than 1.4 absolute atmospheres. Indicated for the emergency treatment of carbon monoxide poisoning and other medical-surgical pathologies such as gas embolism or necrotizing soft-tissue infections, various studies have shown a beneficial effect of hyperbaric oxygen therapy in certain ocular pathologies, notably of microcirculatory origin, such as central retinal artery occlusion or macular edema linked to retinal vein occlusions. In addition, hyperbaric oxygen might represent an alternative treatment for ocular quinine toxicity and might also be useful as an adjuvant to surgery and antibiotics in cases of periorbital necrotizing fasciitis. On the other hand, oxygen in high concentrations has toxic ocular effects due to the production of reactive oxygen derivatives.
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Affiliation(s)
- P Bastelica
- IHU FOReSIGHT, Service 3, hôpital national de la vision des Quinze-Vingts, 28, rue de Charenton, 75012 Paris 11, France; Institut de la vision, IHU FOReSIGHT, Sorbonne université, 17, rue Moreau, 75012 Paris, France.
| | - G Florentin
- Hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin en Yvelines, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France
| | - C Baudouin
- IHU FOReSIGHT, Service 3, hôpital national de la vision des Quinze-Vingts, 28, rue de Charenton, 75012 Paris 11, France; Institut de la vision, IHU FOReSIGHT, Sorbonne université, 17, rue Moreau, 75012 Paris, France; Hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin en Yvelines, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France
| | - A Labbé
- IHU FOReSIGHT, Service 3, hôpital national de la vision des Quinze-Vingts, 28, rue de Charenton, 75012 Paris 11, France; Institut de la vision, IHU FOReSIGHT, Sorbonne université, 17, rue Moreau, 75012 Paris, France; Hôpital Ambroise-Paré, AP-HP, université de Versailles Saint-Quentin en Yvelines, 9, avenue Charles-De-Gaulle, 92100 Boulogne-Billancourt, France
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Afzal H, Dawson E, Fonseca R, Canas M, Diaz L, Filippis AD, Bochicchio KM, Bochicchio GV. Does Negative Pressure Wound Therapy Impact the Outcome for Patients With Necrotizing Soft Tissue Infection Infected With Anaerobic Bacteria? Surg Infect (Larchmt) 2024; 25:179-184. [PMID: 38381953 DOI: 10.1089/sur.2023.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024] Open
Abstract
Background: A notable improvement in the treatment of necrotizing soft tissue infections (NSTIs) is the development of negative pressure wound therapy (NPWT). Clinicians are still debating whether NPWT is as successful as conventional wet-to-dry dressings at removing bacteria. Recent research has revealed potential oxygen deprivation effects of NPWT in underlying wound tissues, although clinical trials regarding the effects of reduced oxygen on anaerobic bacterial soft tissue infections remain noticeably lacking. Hypothesis: We hypothesized that NPWT-treated patients with NSTIs who were solely infected by anaerobic bacteria would have worse outcomes than those who were infected with other bacterial species. Patients and Methods: Our study included a retrospective examination of the 2008-2022 period of our Acute and Critical Care Surgery database. Patients who had been identified as having necrotizing fasciitis, Fournier gangrene, or gas gangrene and who had their conditions verified by positive wound cultures acquired during the initial debridement and subsequently received NPWT made up the study cohort. Comorbidities, surgical techniques, and clinical results were all covered by the data. Based on their wound infections, patients were divided into two groups: those with exclusively anaerobic NSTIs and those with different bacterial groups (such as polymicrobial and aerobic). Multiple regression, χ2 analysis, and analysis of variance (ANOVA) were among the analytical methods used. Results: One hundred twelve patients with NSTI who had received NPWT comprised the study cohort. Sixteen of these patients (14.3%) had NSTIs that were exclusively anaerobic, whereas the remaining 96 (85.7%) had NSTIs that were mixed aerobic, facultative, or polymicrobial. Between the two groups, there was no difference in the initial wound size. Patients with anaerobic NSTI who underwent NPWT showed a statistically significant increase in the number of debridements (3 [interquartile range {IQR},1-9] vs. 2 [IQR, 1-4]; p = 0.012) and an increased 100-day re-admission rate (37.5% vs. 12.5%; p = 0.012) when compared with patients with non-anaerobic NSTI. The 100-day re-admission rate increased three-fold in NPWT-treated anaerobic NSTIs, according to a logistic regression analysis (odds ratio [OR], 3.63; 95% confidence interval [CI], 1.06-12.44; p = 0.04). Conclusions: In contrast to patients with other bacterial strains, our data show that patients with NSTI treated with NPWT who only have anaerobic bacterial infections have a larger number of debridements and are much more likely to require re-admission within 100 days. We call for additional prospective studies to be conducted to identify additional risk factors and consider alternate treatment options for individuals with exclusively anaerobic NSTIs in light of these findings.
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Affiliation(s)
- Hussain Afzal
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erin Dawson
- Trauma and Surgical Critical Care, Penn Medicine, Philadelphia, Pennsylvania, USA
| | - Ricardo Fonseca
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Melissa Canas
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Leonardo Diaz
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | | | - Kelly M Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grant V Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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Toppen W, Cho NY, Sareh S, Kjellberg A, Medak A, Benharash P, Lindholm P. Contemporary national outcomes of hyperbaric oxygen therapy in necrotizing soft tissue infections. PLoS One 2024; 19:e0300738. [PMID: 38512943 PMCID: PMC10956790 DOI: 10.1371/journal.pone.0300738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The role of hyperbaric oxygen therapy (HBOT) in necrotizing soft tissue infections (NSTI) is mainly based on small retrospective studies. A previous study using the 1998-2009 National Inpatient Sample (NIS) found HBOT to be associated with decreased mortality in NSTI. Given the argument of advancements in critical care, we aimed to investigate the continued role of HBOT in NSTI. METHODS The 2012-2020 National Inpatient Sample (NIS) was queried for NSTI admissions who received surgery. 60,481 patients between 2012-2020 were included, 600 (<1%) underwent HBOT. Primary outcome was in-hospital mortality. Secondary outcomes included amputation, hospital length of stay, and costs. A multivariate model was constructed to account for baseline differences in groups. RESULTS Age, gender, and comorbidities were similar between the two groups. On bivariate comparison, the HBOT group had lower mortality rate (<2% vs 5.9%, p<0.001) and lower amputation rate (11.8% vs 18.3%, p<0.001) however, longer lengths of stay (16.9 days vs 14.6 days, p<0.001) and higher costs ($54,000 vs $46,000, p<0.001). After multivariate analysis, HBOT was associated with decreased mortality (Adjusted Odds Ratio (AOR) 0.22, 95% CI 0.09-0.53, P<0.001) and lower risk of amputation (AOR 0.73, 95% CI 0.55-0.96, P = 0.03). HBO was associated with longer stays by 1.6 days (95% CI 0.4-2.7 days) and increased costs by $7,800 (95% CI $2,200-$13,300), they also had significantly lower risks of non-home discharges (AOR 0.79, 95%CI 0.65-0.96). CONCLUSIONS After correction for differences, HBOT was associated with decreased mortality, amputations, and non-home discharges in NSTI with the tradeoff of increase to costs and length of stay.
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Affiliation(s)
- William Toppen
- Division of Hyperbaric Medicine, Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States of America
| | - Nam Yong Cho
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Sohail Sareh
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Anders Kjellberg
- Dept. Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
- Hyperbaric Medicine, Medical Unit Intensive Care and Thoracic Surgery, Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Anthony Medak
- Division of Hyperbaric Medicine, Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States of America
| | - Peyman Benharash
- Cardiovascular Outcomes Research Laboratories, Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States of America
| | - Peter Lindholm
- Division of Hyperbaric Medicine, Department of Emergency Medicine, University of California San Diego, San Diego, CA, United States of America
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Herrera Hidalgo E, Rosa Camacho V, Artacho González L, Camacho Alonso JM. Necrotizing fasciitis and streptococcal toxic shock. An Pediatr (Barc) 2024; 100:220-221. [PMID: 38403536 DOI: 10.1016/j.anpede.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 11/09/2023] [Indexed: 02/27/2024] Open
Affiliation(s)
- Elena Herrera Hidalgo
- UGC Cuidados Críticos y Urgencias Pediátricas, Hospital Regional de Málaga, Málaga, Spain.
| | - Vanessa Rosa Camacho
- UGC Cuidados Críticos y Urgencias Pediátricas, Hospital Regional de Málaga, Málaga, Spain
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Levy M, Blondé R, Naudin J, Dauger S. [Pediatric necrotizing soft-tissue infections]. Rev Prat 2024; 74:311-317. [PMID: 38551879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
PEDIATRIC NECROTIZING SOFT-TISSUE INFECTIONS. Necrotizing soft-tissue infections (NSTI) include necrotizing forms of fasciitis, myositis, and cellulitis. In children, these are extremely rare conditions with an estimated annual incidence of less than 0.1/100,000 patients aged 0-18 years in France. Nevertheless, the evolution can be very serious (6% mortality, higher than the mortality observed in paediatric intensive care units [PICU]), whereas the initial local symptoms are poor and can be falsely reassuring. The monitoring of a skin infection must be close in order not to ignore the evolution towards a NSTI. In this case, prompt transfer to a PICU with all the necessary technical facilities and used to the management of these rare conditions must be done. Early initiation of antibiotic treatment and aggressive haemodynamic resuscitation according to the latest Surviving Sepsis Campaign guidelines should be a priority. The paediatric surgeon should be called upon as soon as clinical suspicion arises and participate in the frequent clinical reassessment to determine the optimal time to perform the surgical treatment.
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Affiliation(s)
- Michaël Levy
- Service de médecine intensive et réanimation pédiatriques, hôpital universitaire Robert-Debré, AP-HP, Paris, France. Université Paris-Cité, Paris, France
| | - Renaud Blondé
- Service de réanimation pédiatrique, centre hospitalouniversitaire de Saint-Denis, La Réunion, France
| | - Jérôme Naudin
- Service de médecine intensive et réanimation pédiatriques, hôpital universitaire Robert-Debré, AP-HP, Paris, France
| | - Stéphane Dauger
- Service de médecine intensive et réanimation pédiatriques, hôpital universitaire Robert-Debré, AP-HP, Paris, France. Université Paris-Cité, Paris, France
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Zhao CYY, Zhang YS, Yang ZJ, Wang MQ, Xue WJ, Huo R, Zhao R. [Analysis of clinical data of necrotizing fasciitis secondary to intestinal fistulas and screening the mortality risk factors]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2024; 40:141-150. [PMID: 38418175 DOI: 10.3760/cma.j.cn501225-20230923-00088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
Objective: To analyze the clinical data and to screen the mortality risk factors of necrotizing fasciitis (NF) secondary to intestinal fistulas (NFsIF). Methods: This study was a retrospective observational study. The data of all NFsIF cases who met the inclusion criteria and were admitted into Shandong Provincial Hospital Affiliated to Shandong First Medical University (hereinafter referred to as our unit) from January 2000 to October 2023, and in PubMed, Web of Science, Scopus, China National Knowledge Infrastructure, and Chinese Medical Journal Network databases from its establishment to October 2023 were retrieved and screened. Based on clinical outcomes, the cases were divided into survival group (47 males and 24 females) and death group (16 males and 7 females), and the mortality rate was calculated. Clinical data of patients in the two groups including age, underlying diseases (most related to NF), symptom duration before presentation, white blood cell count, causes of NF, signs of peritonitis, scope of NF involvement, and intestinal management and wound management measures were compared and analyzed to screen the risk factors of death in 94 patients with NFsIF. Results: A total of 94 valid cases were collected, including 90 patients reported in the literature and 4 patients admitted to our unit, with the mortality rate of patients being 24.5% (23/94). Univariate analysis showed that there were no statistically significant differences in age, underlying diseases, symptom duration before presentation, white blood cell count, causes of NF, signs of peritonitis, scope of NF involvement between patients in the two groups (P>0.05); there were statistically significant differences in intestinal treatment and wound treatment between the two groups (with χ2 values of 17.97 and 8.33, respectively, P<0.05). Multivariate logistic regression analysis showed that both intestinal treatment measures and wound treatments measures were independent risk factors for death in 94 NFsIF patients, among which first-stage colostomy+late-stage reconstruction and negative presssure therapy had higher protective effects (with odds ratios of 0.05 and 0.27, respectively, 95% confidence intervals of 0.01-0.33 and 0.08-0.88, respectively, P<0.05). Conclusions: The mortality risk of patients with NFsIF is high. Based on comprehensive treatments, active intestinal and wound treatment may be the key to avoid death, with first-stage colostomy+late-stage reconstruction and negative pressure therapy having higher protective effects.
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Affiliation(s)
- C Y Y Zhao
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Y S Zhang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Z J Yang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - M Q Wang
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - W J Xue
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - R Huo
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - R Zhao
- Department of Burn and Plastic Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
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Lenoble É, Waitzenegger T. [Hand infections]. Rev Prat 2024; 74:164-168. [PMID: 38415419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
HAND INFECTIONS. Hand and finger infections are very common. They result from the inoculation of a germ through the skin barrier. They can range from simple paronychia to extremely serious necrotizing fasciitis. Certain infections, such as those resulting from bites, have their own specific characteristics, which will determine how they are managed. While management can be medical in the early stages, it is important not to ignore the need for surgical treatment, otherwise serious complications may arise, leading to functional and aesthetic sequelae. Delays in treatment cannot be made up. Any infectious lesion can be potentially serious and must be treated in an appropriate department if there is the slightest doubt.
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Hansen SUB, Jespersen FVB, Markvart M, Hyldegaard O, Plaschke CC, Bjarnsholt T, Nielsen CH, Jensen SS. Characterization of patients with odontogenic necrotizing soft tissue infections in the head and neck area. A retrospective analysis. Acta Odontol Scand 2024; 82:40-47. [PMID: 37688516 DOI: 10.1080/00016357.2023.2254389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 08/13/2023] [Accepted: 08/27/2023] [Indexed: 09/11/2023]
Abstract
OBJECTIVE Necrotizing soft-tissue infection (NSTI) in the head and neck area may develop from odontogenic infections. The aim of this study was to characterize patients with NSTI in the head and neck with odontogenic origin in a well-defined prospectively collected cohort. MATERIAL AND METHODS Patients with NSTI in the head and neck, hospitalized between 2013 and 2017 at Copenhagen University Hospital and registered in the Scandinavian INFECT database were included. Medical records of identified patients and from the INFECT database were screened for a defined set of data including the primary focus of infection, comorbidities, predisposing factors, clinical and radiographic diagnostics, course of treatment, and treatment outcome. RESULTS Thirty-five patients with NSTI in the head and neck area were included in the study. A total of 54% had odontogenic origin, primarily from mandibular molars, and 94% had radiographic signs of infectious oral conditions. Overall, comorbidities were reported in 51% with cardiovascular disease being the most prevalent. In 20%, no comorbidities or predisposing conditions could be identified. The overall 30-day mortality rate was 9%. CONCLUSIONS More than half of NSTI cases in the head and neck region had an odontogenic origin, and special attention should be paid to infections related to mandibular molars.
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Affiliation(s)
| | | | - Merete Markvart
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
| | - Ole Hyldegaard
- Department of Anaesthesia, Centre of Head and Orthopaedics, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christina Caroline Plaschke
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Bjarnsholt
- Department of Clinical Microbiology, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Immunology and Microbiology, Costerton Biofilm Center, University of Copenhagen, Copenhagen, Denmark
| | - Claus Henrik Nielsen
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
- Institute for Inflammation Research, Copenhagen University Hospital, Copenhagen, Denmark
| | - Simon Storgård Jensen
- Department of Odontology, University of Copenhagen, Copenhagen, Denmark
- Deparment of Oral & Maxillofacial Surgery, Copenhagen University Hospital, Copenhagen, Denmark
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Brébant V, Eschenbacher E, Hitzenbichler F, Pemmerl S, Prantl L, Pawlik M. Pathogens and their resistance behavior in necrotizing fasciitis. Clin Hemorheol Microcirc 2024; 86:169-181. [PMID: 37807775 DOI: 10.3233/ch-238119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a rare but life-threatening condition in which extensive soft tissue destruction can occur very quickly if left untreated. Therefore, timely broad-spectrum antibiotic administration is of prognostic importance in addition to radical surgical debridement. AIM This study evaluates the cases of NF in our hospital during the last ten years retrospectively with respect to the pathogens involved and their antimicrobial resistance. This approach aims to provide guidance regarding the most targeted initial antibiotic therapy. METHODS We performed a retrospective microbiological study evaluating pathogen detection and resistance patterns including susceptibility testing of 42 patients with NF. RESULTS Type 1 NF (polymicrobial infection) occurred in 45% of the patients; 31% presented type 2 NF (monomicrobial infection). The most common pathogens detected were E. coli, staphylococci such as Staphylococcus aureus and Staphylococcus epidermidis, Proteus mirabilis, enterococci, and streptococci such as Streptococcus pyogenes. Twelve percent presented an additional fungus infection (type 4). Ten percent showed no cultivation. Two percent (one patient) presented cocci without specification. CONCLUSION Most pathogens were sensitive to antibiotics recommended by guidelines. This confirms the targeting accuracy of the guidelines. Further studies are necessary to identify risk factors associated with multidrug resistant infections requiring early vancomycin/meropenem administration.
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Affiliation(s)
- Vanessa Brébant
- University Centre for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Elisabeth Eschenbacher
- University Centre for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Florian Hitzenbichler
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - Sylvia Pemmerl
- Department of Hygiene, Caritas-Hospital St. Josef, Regensburg, Germany
| | - Lukas Prantl
- University Centre for Plastic, Aesthetic, Hand and Reconstructive Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Michael Pawlik
- Department of Anaesthesiology, Intensive Care and Emergency Medicine, Caritas St. Josef Medical Centre, University Medical Centre Regensburg, Regensburg, Germany
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Friederichs J, Gerl B, Schneidmüller D, Hungerer S. Severe necrotizing soft tissue infections-Is wound microbiology a prognostic factor for clinical outcome? Int Wound J 2023; 20:4235-4243. [PMID: 37646330 PMCID: PMC10681420 DOI: 10.1111/iwj.14325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/11/2023] [Indexed: 09/01/2023] Open
Abstract
Necrotizing soft tissue infections (NSTIs) represent similar pathophysiological features, but the clinical course might range from subacute to a rapidly progressive, fulminant sepsis. Initial wound microbiology is the base for the Guiliano classification. The timeline of microbiological colonization has not been described during the clinical course. The role of the different microbiological pathogens on the outcome and mortality is unclear. One hundred eighty patients were included with septic inflammation response syndrome on admission. Initial wound microbiology and the changes in wound microbiology were analysed during the clinical course and correlated with outcome and risk indicators. Overall mortality was 35%. Higher age, a high Charlson Comorbidity Index or ASA score and truncal infections were highly prognostic for a lethal outcome. Microbiological findings revealed significant differences in the persistence of bacteria during the course of disease. Streptococci were only detectable within the first 5 days, whereas other bacteria persisted over a longer period of time. Initial microbiological findings correlated with better prognosis when no causative agent was identified and for gram-negative rods. Varying survival rates were observed for different Streptococci, Staphylococci, Enterococci and other bacteria. The highest odds ratio for a lethal outcome was observed for Enterococci and fungi. Microbiological colonization changes during the clinical course of NSTIs and some microbiologic pathogens are predictive for worsening the outcome and survival. Streptococcus pyogenes is only detectable in the very early phase of NSTI and after 6 days not anymore detectable. Later Enterococci and fungi showed the highest odds ratios for a lethal outcome. Enterococci bacteria and fungi have yet not been considered of clinical relevance in NSTI or even as indicator for worsening the outcome.
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Affiliation(s)
- Jan Friederichs
- Trauma and Orthopedic SurgeryBG Unfallklinik MurnauMurnauGermany
| | - Benedikt Gerl
- Trauma and Orthopedic SurgeryBG Unfallklinik MurnauMurnauGermany
| | - D. Schneidmüller
- Trauma and Orthopedic SurgeryBG Unfallklinik MurnauMurnauGermany
| | - Sven Hungerer
- Trauma and Orthopedic SurgeryBG Unfallklinik MurnauMurnauGermany
- Institute for BiomechanicsParacelsus Medical UniversitySalzburgAustria
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Molasy B, Frydrych M. Necrotizing fasciitis - two case reports and literature review. Pol Przegl Chir 2023; 96:103-108. [PMID: 38348986 DOI: 10.5604/01.3001.0053.9501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
<b><br>Introduction:</b> Necrotizing fasciitis (NF) is a rare, rapidly progressing infection of the skin and subcutaneous tissue. NF can lead to massive tissue necrosis, resulting in sepsis, septic shock and death. In this disease, it is important to quickly diagnose and implement appropriate treatment.</br> <b><br>Aim:</b> Analysis of the diagnostic and therapeutic process in two clinical cases and a review of the literature on the methods of diagnosis and treatment of necrotizing fasciitis.</br> <b><br>Material and methods:</b> The medical data of two patients hospitalized in the St Alexander Hospital in Kielce from December 2022 to June 2023 due to necrotizing fasciitis were analyzed. Also literature search across PubMed, Medline and Research Gate databases from 2000 up to 2023 was performed. We reviewed English literature according to Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The following keywords were used: necrotizing fasciitis, etiopathogenesis, pathophysiology, management.</br> <b><br>Results:</b> The research group consisted of two male patients with NF after trauma, in different parts of the body. Based on the clinical examination, the results of laboratory and imaging tests, a diagnosis was made and appropriate treatment was initiated. Despite the applied treatment, one patient died as a result of progressive multiple organ failure.</br> <b><br>Conclusions:</b> Despite advances in diagnosis and treatment, including universal access to antibiotics, necrotizing fasciitis still cause high mortality. The microbiological complexity of the majority of cases and non-specific symptoms make the diagnostic and therapeutic process difficult. Taking into account necrotizing fasciitis each time in the differential diagnosis of inflammation of the skin and subcutaneous tissue, especially based on trauma, will allow to reduce morbidity and mortality in this disease.</br>.
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Affiliation(s)
- Bartosz Molasy
- Jan Kochanowski University Medical College, Department of General Surgery, St. Alexander Hospital in Kielce, Kielce, Poland
| | - Mateusz Frydrych
- Department of General Surgery, St. Alexander Hospital in Kielce, Kielce, Poland
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Desai V, Vokey S, Vaughan S, Somayaji R. Necrotizing Soft-Tissue Infections: A Case-Based Review. Adv Skin Wound Care 2023; 36:571-577. [PMID: 37861662 DOI: 10.1097/asw.0000000000000060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
GENERAL PURPOSE To review the assessment and management of necrotizing fasciitis. TARGET AUDIENCE This continuing-education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES After participating in this educational activity, the participant will:1. Identify the etiologic pathogens for necrotizing fasciitis.2. Summarize assessment guidelines for patients who present with signs of necrotizing fasciitis.3. Explain recommended treatment protocols for patients who have necrotizing fasciitis.
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Necrotizing Soft-Tissue Infections: A Case-Based Review. Adv Skin Wound Care 2023; 36:1. [PMID: 37861667 DOI: 10.1097/ASW.0000000000000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
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Kozaki T, Minamide A, Taniguchi T, Taniguchi W, Nishiyama D, Tamai H, Yamada H. Life-threatening necrotizing fasciitis after spinal surgery with electromyography monitoring and intravenous access at lower limb: A case report. J Orthop Sci 2023; 28:1505-1507. [PMID: 34625326 DOI: 10.1016/j.jos.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 08/01/2021] [Accepted: 08/16/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Takuhei Kozaki
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan.
| | - Akihito Minamide
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Takaya Taniguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Wataru Taniguchi
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Daisuke Nishiyama
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Hidenobu Tamai
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
| | - Hiroshi Yamada
- Department of Orthopaedic Surgery, Wakayama Medical University, Wakayama City, Wakayama, Japan
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Khan MF, Mistry AA, Usmani AS, Shamim F. Risk factors and outcomes in patients with severe Necrotizing fasciitis admitted to surgical intensive Care unit: a retrospective cohort study from pakistan. J Ayub Med Coll Abbottabad 2023; 35(Suppl 1):S757-S761. [PMID: 38406906 DOI: 10.55519/jamc-s4-12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Background Necrotizing fasciitis (NF) is a debilitating condition that has high mortality and morbidity even in specialized centres. This study aims to determine risk factors in our local population and identify variables that contribute to mortality in the necrotizing fasciitis patients treated in the surgical intensive care unit of a tertiary care hospital. Methods This retrospective cross-sectional study included 39 patients admitted to the surgical ICU from January 1, 2015 to June 30, 2019. They were analyzed for comorbidities, symptoms at presentation, predisposing factors, location of the infection, microbiological analysis and mortality. Results There were 27 (69.2%) males and 12 (30.8%) females while the age was distributed as 47.44±15 years. Pain was the most frequently reported symptom (89.7%), followed by swelling (79.5%) and tenderness (77%). Significant predisposing factors included trauma in 14 (35.9%) and Intramuscular injections (IM) in 10 (25.6%) patients. On univariate and multiple logistic regression, patients with chronic kidney disease (AOR:1.27, 95% CI: 0-691.22) and ischemic heart (AOR: 1.55, 95% CI: 0.02-153.26) disease had higher odds of mortality than those with no comorbidity. The overall mortality was 12/39 (30.8%). Conclusion Intramuscular injections without aseptic measures in our local population are a significant predisposing risk factor for severe necrotizing fasciitis. High laboratory risk Indicators for necrotizing fasciitis and acute physiology and chronic health evaluation II scores at admission were associated with increased mortality.
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Affiliation(s)
| | | | | | - Faisal Shamim
- Department of Anaesthesiology, Aga Khan University Karachi, Pakistan
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Hara H, Mihara M, Todokoro T. Necrotizing Fasciitis Occurred in the Lymphedematous leg. INT J LOW EXTR WOUND 2023; 22:599-604. [PMID: 34057385 DOI: 10.1177/15347346211023030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lymphedema is a chronic edema that sometimes occurs after treatment of gynecologic cancer, and cellulitis often occurs concomitantly with lymphedema. On the other hand, necrotizing fasciitis (NF) is a relatively rare, but life-threatening disease. The symptoms in cellulitis and NF are very similar. In this case report, we describe a case in which the diagnosis of NF in a lymphedematous limb was difficult. A 70-year-old woman had secondary lymphedema in bilateral legs and consulted our department. On the first day of lymphedema therapy, the patient complained of vomiting, diarrhea, and fever (37.7 °C) without local fever in the legs. She was diagnosed with acute gastroenteritis. On the next day, swelling and pain in her left leg occurred and her blood pressure was 59/44 mmHg. She was diagnosed with cellulitis accompanied by lower limb lymphedema and septic shock. On the second day, blisters appeared on the left leg, and computed tomography showed NF. We performed debridement under general anesthesia and her vital signs improved postoperatively. Streptococcus agalactiae (B) was detected in blood culture, and we administered bixillin and clindamycin. Postoperatively, necrosis in the skin and fat around the left ankle gradually spread, and it took 5 months to complete epithelialization. The diagnosis was more difficult than usual NF because patients with lymphedema often experience cellulitis. Clinicians should always think of NF to avoid mortality due to delayed treatment. This case report was approved by the institutional ethics committee.
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Spector CL, Hernandez J, Kiffin C, Lee S. Fulminant Overwhelming Necrotizing Vibrio vulnificus Sepsis Secondary to Oyster Consumption. Am Surg 2023; 89:3896-3897. [PMID: 37170537 DOI: 10.1177/00031348231174013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Vibrio vulnificus is an opportunistic gram-negative rod-shaped bacteria found in warm, low salinity waters. Transmission through open wounds or consumption of contaminated seafood can lead to wound infections, sepsis, and potentially death. A 44-year-old man with a history of poly-substance abuse, cirrhosis, and recent oyster consumption presented to the emergency department in June with acute onset bilateral leg pain associated with rash and fever. Within 6 hours of his arrival, the rash rapidly progressed to large bullae with extensive necrosis ascending to the level of the abdomen, and he developed septic shock. Despite prompt surgical intervention and appropriate antibiotic and resuscitative therapies, the patient had progressive multi-system organ failure and died 7 days after admission. Concurrent necrotizing fasciitis with sepsis secondary to V. vulnificus infection is rare and potentially fatal, as demonstrated in this case.
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Affiliation(s)
- Chelsea L Spector
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Jennifer Hernandez
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Chauniqua Kiffin
- Trauma Critical Care Surgery, Memorial Healthcare System, Hollywood, FL, USA
| | - Seong Lee
- Trauma Critical Care Surgery, Memorial Healthcare System, Hollywood, FL, USA
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Ture Z, Unuvar GK, Esmaoglu A, Ulu-Kilic A, Coruh A, Doganay M. Severe and complicated soft tissue infections: a single-centre case series. J Wound Care 2023; 32:492-499. [PMID: 37572342 DOI: 10.12968/jowc.2023.32.8.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/14/2023]
Abstract
OBJECTIVE To assess the demographic and clinical characteristics, laboratory findings, and economic burden of patients with a diagnosis of complicated skin and soft tissue infection (cSSTI). METHOD The demographic and clinical characteristics, laboratory findings, surgical interventions, cost of treatment, and outcome of patients diagnosed with cSSTIs between January 2017 and December 2019 were retrospectively analysed. RESULTS A total of 24 patients with cSSTIs were included in the study. The median age was 53 (22-85) years, and 14 (58%) were female. The most common comorbidity was diabetes (54%). On admission, 75% of patients presented with sepsis, and 70% had a high-grade Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score. The causative microorganism was isolated from 21 (87%) patients, and the multidrug resistance rate of Gram-negative bacteria was 50%. The median number of debridements was 3 (1-12). In all, 11 patients were followed up in the intensive care unit, and the mortality rate was 29%. The presence of confusion (p=0.025), causative Gram-negative microorganisms (p=0.009), hyponatraemia (p=0.034), the need for intensive care (p=0.001), anti-meticillin-resistant Staphylococcus aureus antibiotics (p=0.023) and the rate of antibiotic changes during treatment (p=0.019) were significantly higher in the non-survival patient group. Hyponatraemia was a significant independent risk factor for mortality (p=0.048). The median cost of per-patient treatment was $9453 USD in the non-surviving and $1536 in the surviving group. CONCLUSION It is important to know possible factors and local resistance rates at the beginning of empirical antibacterial and surgical treatment. The presence of hyponatraemia, sepsis and a high LRINEC score can be considered to be the mortality predictors.
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Affiliation(s)
- Zeynep Ture
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Gamze Kalin Unuvar
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Aliye Esmaoglu
- Department of Anesthesiology and Reanimation, Erciyes University Medical Faculty, Kayseri, Turkey
| | - Aysegul Ulu-Kilic
- Department of Infectious Diseases, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Atilla Coruh
- Department of Plastic & Reconstructive Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey
| | - Mehmet Doganay
- Department of Infectious Diseases, Faculty of Medicine, Lokman Hekim University, Ankara, Turkey
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Abstract
BACKGROUNDS Necrotizing fasciitis is a severe bacterial infection characterized by involvement of all skin's layers, including the superficial fascia. Diagnosis and treatment must be as quick as possible. Once suspected, extensive surgical debridement is required. METHODS All necrotizing fasciitis, managed in our hospital in Dijon, during the period from January 2011 to May 2021, were retrospectively analyzed. Demographics characteristics of patients, biological parameters, and type of bacteria were collected. Statistical analysis was performed on the cost of hospitalization, as well as on the death rate between type I and II NF and the speed of management. Student's t-test and Chi2 test were performed with a significant level P<0.05. FINDINGS A total of 65 patients were included over the period. The mean age was 68.8 years. The average length of stay was 32.4 days, with an average cost of 79,305 €. The main locations were the lower limbs (57%) and the perineum (35%). Cost of hospitalization did not differ between type I and II (P=0.21), unlike mortality rate (P=0.003). Furthermore, the mortality rate according to the speed of management did not vary in our series (P=0.45). CONCLUSION Necrotizing fasciitis is quickly fatal if left untreated. Early diagnosis, combined with surgical debridement and probabilistic antibiotic therapy are required. Our study shows the impact of necrotizing fasciitis in terms of cost to society and the importance of prevention of certain risk factors. A global management of the patient is necessary to increase the survival rate.
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Affiliation(s)
- V Rabuel
- Department of maxillofacial and plastic surgery, University Hospital of Burgundy, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon cedex, France.
| | - D Guillier
- Department of maxillofacial and plastic surgery, University Hospital of Burgundy, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon cedex, France.
| | - N Zwetyenga
- Department of maxillofacial and plastic surgery, University Hospital of Burgundy, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon cedex, France.
| | - V Moris
- Department of maxillofacial and plastic surgery, University Hospital of Burgundy, 2, boulevard du Maréchal-de-Lattre-de-Tassigny, BP 77908, 21079 Dijon cedex, France.
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22
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Sakkab R, MacRae T, Nguyen QG, Ballon-Landa G. Serratia marcescens Necrotizing Fasciitis of the Ankle: A Case Report. J Am Podiatr Med Assoc 2023; 113:22-113. [PMID: 37467259 DOI: 10.7547/22-113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Necrotizing fasciitis is a devastating inflammatory infection requiring emergent medical treatment and surgical intervention. Even with timely management, the mortality rate of necrotizing fasciitis approaches 25%. The causative bacteria invade fascial planes and express toxins that advance rapidly. Here, we document a rare case of necrotizing fasciitis from Serratia marcescens infection. Serratia marcescens is capable of inducing a necrotizing inflammatory cascade mediated by extracellular cytotoxin and lipase. In this case report, a 90-year-old man presented to our emergency department from a long-term care facility with a relatively benign-appearing ulcer with surrounding cellulitis on the right ankle. Blood cultures and wound cultures confirmed the organism to be S marcescens. A multidisciplinary team was consulted for management. The patient received antibiotic therapy and medical support, but because of his comorbid conditions and social situation, the designated medical decision maker opted for comfort care rather than aggressive surgical debridement. The patient progressed through the clinical stages of necrotizing fasciitis. Within 36 hours, the patient died as result of sepsis-induced organ failure.
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24
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Boyd S, Dorairaj J, Burke C, Hayes-Ryan D. Vulval Necrotising Cellulitis: An Unusual Presentation to the Emergency Room. Ir Med J 2022; 115:662. [PMID: 36327993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Affiliation(s)
- S Boyd
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork
| | - J Dorairaj
- Department of Plastic Surgery, Cork University Hospital, Cork
| | - C Burke
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork
| | - D Hayes-Ryan
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, Cork
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Ahmadzada S, Rao A, Ghazavi H. Necrotizing fasciitis of the face: current concepts in cause, diagnosis and management. Curr Opin Otolaryngol Head Neck Surg 2022; 30:270-275. [PMID: 35906981 DOI: 10.1097/moo.0000000000000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Necrotizing fasciitis of the face is uncommon but potentially life threatening. With adequate multidisciplinary treatment, mortality and has significantly improved. This article highlights current concepts and supporting literature in the management of facial necrotizing fasciitis. RECENT FINDINGS Management of necrotizing fasciitis involving the face requires a multisciplinary team approach, including early medical and surgical intervention. With early haemodynamic support, broad spectrum antibiotics and aggressive surgical debridement, mortality has reduced significantly. Soft-tissue reconstruction can be effectively utilized once the infection has been adequately treated. Although some adjunctive treatment such as vacuum assisted closure dressing has shown to be of benefit, other treatments such as hyperbaric oxygen remains controversial. SUMMARY Necrotizing fasciitis is an aggressive soft tissue involving that rapidly spreads along fascial planes. Necrotizing fasciitis involving the face is rare owing to its rich blood supply but is also difficult to manage due to the complex regional anatomy. Common sources are odontogenic, sinugenic, peritonsillar or salivary gland infections and often polymicrobial. The principles of treatment include early and aggressive haemodynamic support, broad spectrum antibiotics and aggressive surgical debridement. Often times repeat debridements following close monitoring is required. Reconstructive options are viable only after the infection has been adequately treated. Although mortality has significantly improved, mediastinal involvement, multiple comorbidities and delayed treatment confers a worse prognosis.
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Affiliation(s)
- Sejad Ahmadzada
- University of Sydney, Sydney
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Amshuman Rao
- University of Sydney, Sydney
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Hossein Ghazavi
- Department of Otolaryngology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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Pozzi M, Cuomo R, Giardino FR, Brandi C, Nisi G, Grimaldi L. A case of necrotizing fasciitis from a pedicure: when beauty centers become life-threatening. Acta Biomed 2022; 93:e2022126. [PMID: 35671116 PMCID: PMC10510979 DOI: 10.23750/abm.v93is1.9492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 04/07/2020] [Indexed: 06/15/2023]
Abstract
INTRODUCTION in a historical moment where there is an increasing use of beauty center, we report a case of necrotizing fasciitis occurred after a pedicure, with the aim of clarifying the safety of these aesthetic treatments. CASE REPORT we discuss a case of left foot necrotizing fasciitis as consequence of removing a plantar callus. The patient is a 49 years old man; he is hypertensive, and diabetic not controlled. We report our experience showing the clinical manifestation and the tricky profile of the patient; then we reflect on the safety profiles of these aesthetic treatments. DISCUSSION some bacterial infections of soft tissue after pedicure and manicure are reported in Literature. Mycobacteria seems to play a prevalent role, mostly after a peculiar practice of "fish pedicure". Our experience shows how the combination between a patient with complicated profile and poor hygienic measures can have catastrophic consequences. CONCLUSION the aim of this article is to raise awareness on the serious consequences that can arise from banal aesthetic procedures. Furthermore, we want to recommend more control over these treatments performed in Beauty Salon, considering the large turnout of people, even clinically sensitive.
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Agarwal SS, Ansari HMN, Rao S, Galhotra V. Extrapulmonary tuberculosis and COVID-19 infection coexisting in concurrent necrotising fasciitis with deep space infection of neck: an unusual presentation. BMJ Case Rep 2022; 15:15/6/e250382. [PMID: 35725284 PMCID: PMC9214398 DOI: 10.1136/bcr-2022-250382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Ludwig’s angina is a rapidly spreading, potentially fatal infection of deep fascial spaces of the neck leading to airway oedema and death. This, in recent times when associated with COVID-19 infection, possess treatment challenges making the patient susceptible to opportunistic infections with reduced healing potential. Owing to the multifactorial aetiology in our case and addressing them at the earliest, it is important to achieve favourable outcomes. The space infection that seeded with untreated trivial dental caries progressed to necrotising fasciitis of neck with mycobacterial growth on cartridge-based nucleic acid amplification test for tuberculosis testing. The presence of Mycobacterium organisms should be speculated in patients with pulmonary signs of tuberculosis (TB) because a suppurative TB lymphadenitis of neck could also have the same presentation. The decisive moment in successful outcome was identification of mycobacteria in COVID-19 infected patient, thereby allowing to initiate the antitubercular therapy along with surgical debridement. Thus, medical management of patient with cohabiting infections is difficult task and needs appropriate addressal.
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Affiliation(s)
- Subham S Agarwal
- Dentistry-Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Hafiz Md Nasimuddin Ansari
- Dentistry-Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Santhosh Rao
- Dentistry-Oral & Maxillofacial Surgery, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Virat Galhotra
- Dentistry, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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Kim MJ, Yang KM, Lim H. Paraspinal Necrotizing Fasciitis Associated with Pressure Injury: An Unusual Case Report. Adv Skin Wound Care 2022; 35:234-237. [PMID: 35311768 PMCID: PMC8925866 DOI: 10.1097/01.asw.0000820256.91723.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/01/2021] [Indexed: 02/02/2023]
Abstract
ABSTRACT Necrotizing fasciitis is a type of soft tissue infection that destroys subcutaneous tissue. It is particularly dangerous for patients with chronic diseases and those who are bedridden while recuperating. Although necrotizing fasciitis is often caused by trauma or postoperative infection, in rare cases, it can be attributed to pressure injury (PI). The disease progression is very aggressive and can be lethal for patients who are bedridden or immunocompromised.This case report describes a 47-year-old man with a history of diabetes and hypertension who became bedridden after a sudden status decline caused by nephrotic syndrome. He gradually developed an infection and rare deterioration of a PI on his upper back. After radiologic evaluation with magnetic resonance imaging and computed tomography, surgical intervention was performed and necrotizing fasciitis was confirmed. In this case of necrotizing fasciitis derived from a PI on the upper back, the infected area spread to the periphery at a rapid rate. The infection spread over his back and across the T1-T9 levels.In this report, the authors describe the integrated system of the thoracolumbar fascia and the very aggressive spread of necrotizing fasciitis. Because of the anatomic structure of the back and the characteristics of this infection, only aggressive surgical debridement could prevent the spread of infection and reduce the systemic effects of the infection. Physicians should be aware of the possibility of PIs in bedridden patients and, in cases of exacerbation of the wound, consider rapid surgical intervention after prompt examination and diagnosis to reduce mortality.
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Affiliation(s)
- Min Ji Kim
- In the Department of Plastic and Reconstructive Surgery, Ajou University School of Medicine, Suwon, Korea, Min Ji Kim, MD, PhD, is Assistant Professor; Kyung Min Yang, MD, is Resident; and Hyoseob Lim, MD, PhD, is Associate Professor
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29
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Deschaumes O, Hubert M, Hardy PY. [Soft tissue necrotizing infection]. Rev Med Liege 2022; 77:77-79. [PMID: 35143125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Necrotizing fasciitis and gas gangrene represent a rapidly progressive and fatal tissue infection in the absence of early multidisciplinary treatment. There are multiple risk factors, but diabetes remains the main one. The presence of crackles or extensive lesions are an indication for exploration and surgical treatment. Conservative management is associated with zero survival. Iconography, biology or bacteriology can help in the diagnosis, but the latter is only made during surgery. The associated mortality is high, despite appropriate management. We report here the case of a diabetic patient requiring insulin, having presented this pathology, the starting point of which is a traumatic wound, with an extensive acute course, contra-indicating any surgical procedure.
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Affiliation(s)
| | - M Hubert
- Service d'Anesthésie-Réanimation, CHU, Liège, Belgique
| | - P Y Hardy
- Service d'Anesthésie-Réanimation, CHU, Liège, Belgique
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30
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Simsek A. Thigh Abscess Secondary to Intra-abdominal Pathologic Conditions: Three Cases Progressing to Necrotizing Fasciitis. Wounds 2021; 33:226-230. [PMID: 34734841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Necrotizing fasciitis results in progressive destruction of the fascia and overlying tissue. Mortality primarily depends upon the timing of medical care and the extent of infection. OBJECTIVE This article presents a case series of thigh abscesses originating from intra-abdominal pathologic conditions and progressing to necrotizing fasciitis due to delayed diagnosis. MATERIALS AND METHODS The data concerning 3 patients with thigh abscess originating from an intra-abdominal pathologic condition and progressing to necrotizing fasciitis are presented. RESULTS All patients had undergone previous colorectal surgery for malignancy and were admitted to the hospital with pain concentrated in the lower back and spreading down to the buttock, sacrum and coccyx, and leg. Patients had received symptomatic therapy, including nonsteroidal anti-inflammatory drugs, and 1 patient had undergone diskectomy for a herniated disk in the lumbar region. All 3 patients subsequently developed thigh abscesses (initially treated by percutaneous and/or surgical drainage) and received antibiotic therapy. One patient underwent percutaneous drainage, and 2 patients underwent abdominal surgery to address the abdominal abscess. During the course of treatment, thigh abscesses progressed to necrotizing fasciitis, which was treated by surgical debridement with or without negative pressure wound therapy. All patients died of overwhelming sepsis. CONCLUSIONS Thigh abscess may spontaneously arise from surrounding soft tissues, or it may be a sign of intraperitoneal, retroperitoneal, or pelvic pathologic conditions. Deep, vague pain in the back or hip area that spreads downward to the buttock and leg may be an early symptom of these pathologic conditions. Clinical suspicion may be effective in reducing mortality by enabling early surgical intervention, especially in the patient with a previous history of abdominal surgery, radiotherapy, or inflammatory or malignant disease.
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Affiliation(s)
- Arife Simsek
- Inonu University, School of Medicine, Department of General Surgery, Malatya, Turkey
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Brakenridge SC, Wilfret DA, Maislin G, Andrade KE, Walker V, May AK, Dankner WM, Bulger EM. Resolution of organ dysfunction as a predictor of long-term survival in necrotizing soft tissue infections: Analysis of the AB103 Clinical Composite Endpoint Study in Necrotizing Soft Tissue Infections trial and a retrospective claims database-linked chart study. J Trauma Acute Care Surg 2021; 91:384-392. [PMID: 33797490 DOI: 10.1097/ta.0000000000003183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Necrotizing soft tissue infections (NSTIs) are an acute surgical condition with high morbidity and mortality. Timely identification, resuscitation, and aggressive surgical management have significantly decreased inpatient mortality. However, reduced inpatient mortality has shifted the burden of disease to long-term mortality associated with persistent organ dysfunction. METHODS We performed a combined analysis of NSTI patients from the AB103 Clinical Composite Endpoint Study in Necrotizing Soft Tissue Infections randomized-controlled interventional trial (ATB-202) and comprehensive administrative database (ATB-204) to determine the association of persistent organ dysfunction on inpatient and long-term outcomes. Persistent organ dysfunction was defined as a modified Sequential Organ Failure Assessment (mSOFA) score of 2 or greater at Day 14 (D14) after NSTI diagnosis, and resolution of organ dysfunction defined as mSOFA score of 1 or less. RESULTS The analysis included 506 hospitalized NSTI patients requiring surgical debridement, including 247 from ATB-202, and 259 from ATB-204. In both study cohorts, age and comorbidity burden were higher in the D14 mSOFA ≥2 group. Patients with D14 mSOFA score of 1 or less had significantly lower 90-day mortality than those with mSOFA score of 2 or higher in both ATB-202 (2.4% vs. 21.5%; p < 0.001) and ATB-204 (6% vs. 16%: p = 0.008) studies. In addition, in an adjusted covariate analysis of the combined study data sets D14 mSOFA score of 1 or lesss was an independent predictor of lower 90-day mortality (odds ratio, 0.26; 95% confidence interval, 0.13-0.53; p = 0.001). In both studies, D14 mSOFA score of 1 or less was associated with more favorable discharge status and decreased resource utilization. CONCLUSION For patients with NSTI undergoing surgical management, persistent organ dysfunction at 14 days, strongly predicts higher resource utilization, poor discharge disposition, and higher long-term mortality. Promoting the resolution of acute organ dysfunction after NSTI should be considered as a target for investigational therapies to improve long-term outcomes after NSTI. LEVEL OF EVIDENCE Prognostic/epidemiology study, level III.
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Affiliation(s)
- Scott C Brakenridge
- From the Department of Surgery (S.C.B.), University of Florida College of Medicine, Gainesville, Florida; Atox Bio, Ltd (D.A.W., W.M.D.), Durham, North Carolina; Biomedical Statistical Consulting (G.M.), Wynnewood, Pennsylvania; Health Economics and Outcomes Research, Optum (K.E.A., V.W.), Eden Prairie, Minnesota; Division of Acute Care Surgery (A.K.M.), Atrium Health, Charlotte, North Carolina; Department of Surgery (E.M.B.) University of Washington, Harborview Medical Center, Seattle, Washington
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Daniels M, Oberländer H, Schiefer J, Sonnenberg P, Jörres A, Lefering R, Fuchs PC, Seyhan H. Lactate based Scoring System in the diagnosis of necrotizing fasciitis. J Burn Care Res 2021; 43:625-631. [PMID: 34324681 DOI: 10.1093/jbcr/irab148] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a rare and quickly progressing infection and leads to 100% mortality if untreated. Quick diagnosis and an early and radical surgical treatment are essential for stopping bacterial progression. Unfortunately, the absence of clear clinical signs makes the diagnosis often challenging. Therefore, we searched for easy determinable predictive laboratory markers for NF. This is the first study which includes lactate values in a new score. MATERIAL AND METHODS A retrospective analysis of patients with NF (n = 44) and patients with erysipelas (n = 150) was performed. Lactate values, patients` demographics, clinical presentations, site of infection, comorbidities, microbiological and laboratory findings, antibiotic therapies and LRINEC and modified LRINEC Scores were analyzed. Logistic regression analysis was used to derive adjusted weights, and final simple point score was assessed with a ROC curve analysis. RESULTS Patients with NF had a mean age of 57 years, patients with erysipelas 65 years. The median hospital length of stay was 8 and 49 days in patients with erysipelas and NF, respectively. While only one patient (0.7 %) in the group of erysipelas died, the mortality rate of patients with NF was 9/44 (20.5 %). The lactate values were statistically significant higher in the NF group 4.1 vs. 2.0 mmol/l (p < 0.001). The new created CologNe-FaDe-Score shows the highest AUC-value with 0.907. CONCLUSION With the help of lactate values the CologNe-FaDe-Score consists of easily practicable and highly available parameters, which could sensitize diagnosis.
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Affiliation(s)
- Marc Daniels
- Department of Plastic, Reconstructive, Hand and Burn Surgery, University of Witten-Herdecke, Cologne, Germany
| | - Henrik Oberländer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, University of Witten-Herdecke, Cologne, Germany
| | - Jennifer Schiefer
- Department of Plastic, Reconstructive, Hand and Burn Surgery, University of Witten-Herdecke, Cologne, Germany
| | - Philipp Sonnenberg
- Department of Medicine I, Cologne Merheim Medical Center, University of Witten-Herdecke, Cologne, Germany
| | - Achim Jörres
- Department of Medicine I, Cologne Merheim Medical Center, University of Witten-Herdecke, Cologne, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Paul Christian Fuchs
- Department of Plastic, Reconstructive, Hand and Burn Surgery, University of Witten-Herdecke, Cologne, Germany
| | - Harun Seyhan
- Department of Plastic, Reconstructive, Hand and Burn Surgery, University of Witten-Herdecke, Cologne, Germany
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Wei Z, Wang Q, Wang Y, Fang X, Zhu Y, Cheng J. Necrotizing Fasciitis Shock Syndrome by Group A Hemolytic Streptococcus: Report of 6 Cases and Clinical Management. Clin Lab 2021; 67. [PMID: 33739051 DOI: 10.7754/clin.lab.2020.200801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND To explore the comprehensive treatment of group A streptococcus haemolyticus complicated with streptococcal toxic shock syndrome (STSS) in surgery. METHODS Six patients with Type II necrotizing fasciitis complicated with STSS were enrolled from September 2018 to October 2019 in the Burn Department at Quanzhou First Hospital. The patients were treated with early incision and reduction of tension, anti-shock, anti-infection, primary debridement and vacuum suction, maintenance of organ function, and adjustment of internal environment, secondary autologous skin graft, and early rehabilitation. RESULTS Five patients were healed, while one elderly patient refused treatment. CONCLUSIONS We should be alert to necrotizing fasciitis caused by group A hemolytic streptococcus (GAS) infection and effectively avoid the occurrence of STSS. By making an incision to reduce tension, adopting the principle of anti-infection, and actively anti-shock, maintaining the function of internal organs and the stability of internal environment, debridement and vacuum suction in early and effective stage, followed by selfskin graft to seal the wound and early rehabilitation the treatment of Type II NF and STSS can be effectively improved.
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Jauregui JE, Seward KD. Necrotizing fasciitis: The bounce-back patient case report. J Am Assoc Nurse Pract 2021; 34:397-399. [PMID: 34014890 DOI: 10.1097/jxx.0000000000000612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/13/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Necrotizing fasciitis (NF) is a complicated skin and soft tissue infection that has a high mortality rate and often requires surgical debridement, intravenous antibiotics, and wound care. The nurse practitioner needs to be aware of the common characteristics of NF and depending on their clinical environment, know when to refer the patient to a local emergency department (ED) for further evaluation and treatment and/or consult for hospital admission from an ED.
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Affiliation(s)
- Jean E Jauregui
- Emergency Department, University of Maryland Shore Regional Medical Center at Chestertown, Chestertown, Maryland
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Hutchinson LE, Franke JD, Mailey BA. Necrotizing fasciitis secondary to lake water inoculation with Aeromonas sobria: A case report. Medicine (Baltimore) 2021; 100:e24981. [PMID: 33725868 PMCID: PMC7969264 DOI: 10.1097/md.0000000000024981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Necrotizing fasciitis (NF) is a rapidly progressing bacterial soft tissue infection with a high mortality rate. It is characterized by significant soft tissue destruction with associated sepsis. The mainstay of treatment is coverage with appropriate broad-spectrum antibiotic therapy and emergent surgical debridement. PATIENT CONCERNS A previously healthy 66-year-old female presented with a deep laceration to her right, posterior calf with subsequent contamination with lake water. After the wound was irrigated and closed, the patient developed NF. DIAGNOSIS Laceration of the right lower extremity complicated by NF secondary to Aeromonas sobria. INTERVENTIONS The patient underwent emergent surgical debridements with intravenous broad-spectrum antibiotics and negative pressure wound therapy. The lower extremity was reconstructed with split-thickness skin grafts. OUTCOMES The patient's initial penetrating trauma was closed in the emergency room, and the patient was discharged home with antibiotics. She returned the next day with unstable vitals and was admitted to the intensive care unit. Her condition continued to deteriorate, and she underwent serial surgical debridements. Her condition improved and was discharged home after 13 days in the hospital. LESSONS LEARNED Close monitoring for NF is important for tissue infections sustained in aquatic environments. Timely identification and surgical management of NF increases overall survival.
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Affiliation(s)
| | - Jacob D. Franke
- Southern Illinois University School of Medicine, Springfield, IL
| | - Brian A. Mailey
- Institute for Plastic Surgery, Southern Illinois University School of Medicine
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Omahsan L, Bouziane M, Dikhaye S, Zizi N. [Necrotizing fasciitis]. Rev Prat 2020; 70:1105. [PMID: 33739654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Loubab Omahsan
- Service de dermatologie-vénérélogie, CHU Mohammed Ier, faculté de médecine et de pharmacie, université Mohammed-Ier, Oujda, Maroc
| | - Mohammed Bouziane
- Service de chirurgie viscérale B, CHU Mohammed-Ier, faculté de médecine et de pharmacie, université Mohammed-Ier, Oujda, Maroc
| | - Siham Dikhaye
- Service de dermatologie-vénérélogie, CHU Mohammed Ier, faculté de médecine et de pharmacie, université Mohammed-Ier, Oujda, Maroc
- Laboratoire d'épidémiologie, de recherche clinique et de santé publique, faculté de médecine et de pharmacie, université Mohammed-Ier, Oujda, Maroc
| | - Nada Zizi
- Service de dermatologie-vénérélogie, CHU Mohammed Ier, faculté de médecine et de pharmacie, université Mohammed-Ier, Oujda, Maroc
- Laboratoire d'épidémiologie, de recherche clinique et de santé publique, faculté de médecine et de pharmacie, université Mohammed-Ier, Oujda, Maroc
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Abstract
Systemic conditions are associated with higher rates of hand and upper extremity infections, leading to more severe and atypical presentations. Understanding the unique problems associated with some of the most common systemic conditions, including human immunodeficiency virus, diabetes mellitus, and rheumatoid arthritis, can assist the hand surgeon in diagnosing and treating infection in these patients. This article reviews the most common presentation of hand infections for these patients and summarizes current approaches to the management of hand infections for patients with common immunocompromising conditions.
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Affiliation(s)
- Zachary J Finley
- Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Gleb Medvedev
- Department of Orthopaedic Surgery, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA.
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Albasanz-Puig A, Rodríguez-Pardo D, Pigrau C, Lung M, Roldan E, Corona PS, Almirante B, Ruiz-Camps I. Necrotizing fasciitis in haematological patients: a different scenario. Ann Hematol 2020; 99:1741-1747. [PMID: 32399706 DOI: 10.1007/s00277-020-04061-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/27/2020] [Indexed: 12/19/2022]
Abstract
To describe and compare the characteristics of necrotizing fasciitis (NF) in patients with and without haematological malignancy. All adult patients diagnosed with NF and treated at our hospital were included (January 2010-March 2019). Diagnosis was based on intraoperative findings or consistent clinical/radiological characteristics, and patients were classified as group A (with haematological malignancy) or group B (without haematological malignancy). Student's t (quantitative), Fisher's exact (qualitative), and Kaplan-Meyer tests were used for the statistical analysis. The study included 29 patients: 8 in group A and 21 in group B. All haematological patients had severe neutropenia (0.2 [0.02-0.5] ×109 cells/L; p < 0.001) and positive blood cultures (100% vs. 61.9%; p = 0.04) at diagnosis. Gram-negative bacilli NF was more common in group A (87.5% vs. 9.5%; p = 0.001), predominantly due to Escherichia coli (50% vs. 9.5%; p = 0.056). Surgical treatment was less common in haematological patients (5 [62.5%] vs. 21 [100%]; p = 0.015). Overall, 9 (31%) patients died: 4 (50%) in group A and 5 (23.8%) in group B (p = 0.17). The univariate analysis showed that mortality tended to be higher (OR 3.2; 95%CI 0.57-17.7; p = 0.17) and to occur earlier (2.2 ± 2.6 vs. 14.2 ± 19.9 days; p = 0.13) in haematological patients. The LRINEC index > 6 did not predict mortality in either group. In our study, NF in patients with haematological malignancies was mainly due to Gram-negative bacilli, associated to high and early mortality rates. In our experience, the LRINEC scale was not useful for predicting mortality.
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Affiliation(s)
- A Albasanz-Puig
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - D Rodríguez-Pardo
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain.
| | - C Pigrau
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - M Lung
- Microbiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Roldan
- Haematology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - P S Corona
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
- Reconstructive and Septic Surgery Division, Department of Orthopedic Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - B Almirante
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - I Ruiz-Camps
- Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Department of Medicine, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain
- Spanish Network for Research in Infectious Pathology (REIPI), Instituto de Salud Carlos III, Madrid, Spain
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Affiliation(s)
- Jason Diab
- Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Aiveen Bannan
- Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Timothy Pollitt
- Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
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Johnson O, Pouncey AL, Gardiner S, Ross D. A woman with spreading erythema after caesarean section. BMJ 2020; 368:m445. [PMID: 32107271 DOI: 10.1136/bmj.m445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | | | - David Ross
- Guy's and St Thomas' Hospital, London, UK
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Miike T, Sakamoto Y, Sakamoto Y, Matsuoka A, Shinada K, Nakayama K, Sakurai R, Asahi M, Yoshitake K, Narumi S, Koba M, Nagashima F, Inoue S. Influence of hyperbaric oxygen therapy on thrombus formation ability in humans. Undersea Hyperb Med 2020; 47:591-595. [PMID: 33227835 DOI: 10.22462/10.12.2020.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
BACKGROUND Hyperbaric oxygen (HBO2) therapy was introduced nearly 300 years ago. However, its effect on thrombus formation is unclear. This may be because platelet and coagulation functions are unstable, yielding variable results; hence, accurate measurement is difficult. Our study aimed to analyze changes in thrombus formation before and after HBO2 therapy by using a total thrombus formation analysis system (TTAS). METHODS Six patients were prescribed HBO2 therapy for skin and soft tissue ulcers, and necrotic fasciitis. Blood samples were collected immediately before and after treatment. Then samples were put into a reservoir that connected to AR-chip to assess changes in the thrombus formation ability of both platelets and coagulation factors. We examined the differences in the thrombus formation ability using T-TAS. Time until the onset of white thrombus formation (T10) and complete occlusion of the capillary (T80) were analyzed by a two-way repeated measure analysis of variance (ANOVA). RESULTS The duration to pressure increase of samples after HBO2 therapy was longer than the duration before HBO2 therapy (p<0.05). This suggests decreased clot adhesiveness to the inner surface of the simulated blood vessel and reduced clot formation ability. CONCLUSIONS The results for T10 and T80 suggest that HBO2 therapy reduced thrombus formation ability in the enrolled patients. We believe that T-TAS is a promising method to predict the efficacy of HBO2 therapy.
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Affiliation(s)
- Toru Miike
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Yuichiro Sakamoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Yuichiro Sakamoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Ayaka Matsuoka
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Kouta Shinada
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Kento Nakayama
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Ryouta Sakurai
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Miho Asahi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Kunimasa Yoshitake
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Shougo Narumi
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Mayuko Koba
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Futoshi Nagashima
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
| | - Satoshi Inoue
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga City, Saga Prefecture, Japan
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Tsujimoto Y, Kanzawa Y, Seto H, Nakajima T, Ishimaru N, Waki T, Kinami S. Necrotizing fasciitis and sepsis caused by Aeromonas hydrophila. Infez Med 2019; 27:429-435. [PMID: 31846994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Aeromonas hydrophila (A. hydrophila) occasionally causes necrotizing fasciitis (NF) and sepsis in immunocompromised hosts. NF is associated with high mortality. In cases of septic shock due to A. hydrophila, mortality is nearly 100%. Our 47-year-old male patient was diagnosed with NF and septic shock due to A. hydrophila. He had not been exposed to fresh or slightly salty water, which is where the bacterium is typically found, so its origin in this case is unclear. This is the first known case in which the patient was able to be completely cured without amputation. NF was suspected from his sepsis, medical history including alcoholic cirrhosis, and a severely poor general condition, but his skin lesions were mild. We promptly made an exploratory incision and debrided his legs. NF could then be diagnosed. At an early stage, A. hydrophila was recognized as a possible pathogen of NF because of the patient's medical background and the Gram stain findings of intraoperative exudate. Minocycline in addition to carbapenem and vancomycin plus clindamycin were administered as empiric therapy. When A. hydrophila was detected in the blood culture, ciprofloxacin was administered as definitive therapy. Successful treatment of NF requires early diagnosis, prompt debridement from onset and adequate empirical antibiotic therapy.
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Affiliation(s)
| | - Yohei Kanzawa
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Hiroyuki Seto
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Takahiro Nakajima
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Naoto Ishimaru
- Department of General Internal Medicine, Akashi Medical Center, Japan
| | - Takahiro Waki
- Department of Orthopedics, Akashi Medical Center, Japan
| | - Saori Kinami
- Department of General Internal Medicine, Akashi Medical Center, Japan
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Ichisawa A, Jin H, Hagiwara Y, Hara Y, Kimura T, Yonaiyama S, Yoshikawa T, Nakai M, Tokura T, Aoki K, Kawashima H, Toyoki Y, Endoh M. [Successful Treatment of Necrotizing Fasciitis Due to Ascending Colon Cancer-A Case Report]. Gan To Kagaku Ryoho 2019; 46:2574-2576. [PMID: 32157003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A 70-year-old woman was brought to our hospital by ambulance because of severe groin pain on the right side. Computed tomography scan revealed a tumor in the ascending colon, intraperitoneal abscess spread to the subcutaneous tissues, and a large amount of pneumoderma. She was diagnosed with necrotizing fasciitis caused by penetration of ascending colon cancer and underwent lavage and drainage, right hemicolectomy, end ileostomy, and debridement of necrotic tissues on emergency. Postoperatively, she underwent debridement and irrigation at the bedside every day, but the necrotizing tissues spread. Debridement under general anesthesia was repeated on postoperative day 8. On postoperative day 20, negative pressure wound therapy(NPWT)was initiated to manage the exudates and wound condition, and healthy granulation tissues formed gradually. After 4 weeks, she underwent split-thickness skin graft implantation. The postoperative course was uneventful, and she was discharged from the hospital. She is currently on chemotherapy and has been alive for 1 year and 3 months after the first operation.
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Goggins CA, Khachemoune A. The use of hyperbaric oxygen therapy in the treatment of necrotizing soft tissue infections, compromised grafts and flaps, hidradenitis suppurativa, and pyoderma gangrenosum. Acta Dermatovenerol Alp Pannonica Adriat 2019; 28:81-84. [PMID: 31233172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Hyperbaric oxygen therapy (HBOT) is used in the management of a wide array of disease states, including acute thermal burn injuries, carbon monoxide poisoning, and decompression sickness, to name a few. Although HBOT is approved by the Undersea and Hyperbaric Medical Society for the treatment of only 14 conditions, it has been used "off-label" in the management of a variety of dermatological diseases. This review investigates the utilization of HBOT in dermatology and appraises the evidence behind its use. We focus on the role of HBOT in treating necrotizing soft tissue infections, compromised grafts and flaps, hidradenitis suppurativa, and pyoderma gangrenosum.
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Affiliation(s)
- Clare A Goggins
- Georgetown University School of Medicine, Washington DC, USA
| | - Amor Khachemoune
- Veterans Affairs Hospital and SUNY Downstate University, New York, NY, USA
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Placinta IA, España-Gregori E, Rodrigo-Hernández A, Martínez-Rubio C, Safont-Albert J, Bort-Martí MÁ. Periorbital necrotising fasciitis secondary to scratching. Arch Soc Esp Oftalmol (Engl Ed) 2019; 94:242-247. [PMID: 30733068 DOI: 10.1016/j.oftal.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/07/2019] [Accepted: 01/08/2019] [Indexed: 06/09/2023]
Abstract
An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained.
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Affiliation(s)
- I A Placinta
- Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España.
| | - E España-Gregori
- Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España
| | - A Rodrigo-Hernández
- Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España
| | - C Martínez-Rubio
- Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España
| | - J Safont-Albert
- Servicio de Cirugía Plástica, Estética y Reparadora, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España
| | - M Á Bort-Martí
- Servicio de Oftalmología, Hospital Universitari i Politècnic La Fe, Avinguda de Fernando Abril Martorell 106, 46026, Valencia, España
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Morkos M, Nensey NK, Bindal A. Micafungin-Induced Hypoglycemia in a Patient With Type 1 Diabetes: A Case Report and Review of Literature. J Clin Endocrinol Metab 2019; 104:981-984. [PMID: 30398618 DOI: 10.1210/jc.2018-02017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 10/31/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Patients with type 1 diabetes mellitus (T1DM) are insulin dependent. Infection increases insulin resistance and subsequently increases insulin needs. We are reporting a case of a patient with T1DM and severe infection who has reduced insulin needs after starting micafungin therapy. PARTICIPANT A 29-year-old Hispanic woman with known history of long-standing, uncontrolled T1DM presented for evaluation of worsening dysphagia and dyspnea. She was found to have cervical necrotizing fasciitis extending into the mediastinum and required several debridement surgeries along with broad-spectrum antibiotics and antifungal therapy. She had uncontrolled diabetes with a glycosylated hemoglobin of 13.4% (18.8 mM) on admission. Her insulin requirements progressively increased as a result of worsening infection, continuous tube feeds, and multiple debridement surgeries. She was started on micafungin, a potent 1,3-β-D glucan synthase inhibitor, to broaden antimicrobial coverage when her insulin requirement decreased to zero for >48 hours. Right after discontinuation of micafungin and her switch to a different antifungal, insulin requirements increased back to her baseline needs. RESULTS This is a report of decreased insulin requirements in a patient with T1DM correlating with micafungin administration. The mechanism of micafungin-induced hypoglycemia is not yet established. Oral administration of linear 1,3-β-D glucan has been documented to decrease blood glucose levels significantly by inhibition of expression of sodium-glucose transporter 1 (SGLT1) in intestinal mucosa. CONCLUSION We hypothesize that micafungin may inhibit SGLT-1 function and decrease insulin requirements in patient with T1DM.
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Affiliation(s)
- Michael Morkos
- Division of Endocrinology and Diabetes, Rush University Medical Center, Chicago, Illinois
- Division of Endocrinology and Diabetes, Indiana University, Avon, Indiana
| | - Nasha K Nensey
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Anila Bindal
- Division of Endocrinology and Diabetes, Rush University Medical Center, Chicago, Illinois
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Paula FM, Pinheiro EA, de Oliveira VM, Ferreira CM, Monreal MTFD, Rolan MD, de Matos VTG. A case report of successful treatment of necrotizing fasciitis using negative pressure wound therapy. Medicine (Baltimore) 2019; 98:e13283. [PMID: 30633151 PMCID: PMC6336608 DOI: 10.1097/md.0000000000013283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Necrotizing fasciitis is a destructive tissue infection with rapid progression and high mortality. Thus, it is necessary that high-performance dressings be introduced as possibilities of treatment. PATIENT CONCERNS Female patient, 44 years of age, admitted to hospital unit complaining of lesion in the gluteal region and drainage of purulent secretion in large quantity followed by necrosis. DIAGNOSES The diagnosis of necrotizing fasciitis was carried out with the computerized tomography examination result and its association with the patient's clinical condition. INTERVENTIONS Initially, successive debridements were carried out in lower limbs as well as primary dressing with enzymatic debriding action until indication of negative pressure wound therapy, for the period of 2 weeks in the right lower limb and for 5 weeks in the left lower limb, with changes every 72 h. Dressing with saline gauze was used at the end of this therapy until hospital discharge. OUTCOMES After the use of negative pressure wound therapy, we observed the presence of granulation tissue, superficialization and reduction of lesion extension. The patient presented good tolerance and absence of complications. LESSONS Negative pressure wound therapy constituted a good option for the treatment of necrotizing fasciitis, despite the scarcity of protocols published on the subject.
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Affiliation(s)
| | | | | | | | | | - Marisa Dias Rolan
- Instituto Integrado de Saúde, Universidade Federal de Mato Grosso do Sul, Campo Grande – MS, Brasil
| | - Vanessa Terezinha Gubert de Matos
- Residência Multiprofissional em Cuidados Continuados Integrados
- Faculdade de Faculdade de Ciências Farmacêuticas, Alimentos e Nutrição
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Boinpally H, Howell RS, Ram B, Donovan V, Castellano M, Woods JS, Gorenstein S. Necrotizing Myositis: A Rare Necrotizing Soft Tissue Infection Involving Muscle. Wounds 2018; 30:E116-E120. [PMID: 30561371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Necrotizing myositis (NM) is an extremely rare necrotizing soft tissue infection involving muscle. Unlike similar infections (eg, necrotizing fasciitis, clostridial myonecrosis) that can be more readily diagnosed, NM can have a benign presentation then rapidly progress into a life-threatening condition with a mortality rate of 100% without surgical intervention. CASE REPORT A 74-year-old man with a history of prostate cancer with radiation therapy, seed implants, and 2 transurethral resection procedures presented to the emergency department after a fall. He was initially diagnosed and treated for urosepsis. Sixteen hours after presentation, he complained of pain and swelling of his right groin. Computed tomography of the abdomen and pelvis showed gas findings suspicious for necrotizing infection of the bilateral thighs. Surgical exploration revealed NM. Separate cultures from the left thigh and bladder grew Streptococcus intermedius, Clostridium clostridioforme, and Peptostreptococcus, suggesting a possible common source of infection from the prostate gland or the osteomyelitic pubic symphysis, which subsequently spread to the bilateral thighs. CONCLUSIONS To the best of the authors' knowledge, this is the first reported case of S intermedius and C clostridioforme causing NM. A high index of suspicion is required for extremely rare conditions like NM, because early diagnosis and surgical intervention significantly reduce mortality.
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Affiliation(s)
| | | | - Bebu Ram
- Department of Pathology, NYU Winthrop Hospital, Mineola, NY
| | | | | | - John S Woods
- Department of Surgery, NYU Winthrop Hospital, Mineola, NY
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Bağli BS, Durgut O. Hyperbaric oxygen therapy as adjuvant therapy in necrotizing fasciitis of the face: case report. Undersea Hyperb Med 2018; 45:695-699. [PMID: 31158939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Facial necrotizing fasciitis is a rare bacterial infectious disease. Rapid necrosis of the tissues and suppurative fasciitis is pathognomonic. It can be seen following odontogenic infection. Early aggressive debridements and wide-spectrum antibiotic therapy are currently accepted treatments. A 60-year-old man was admitted to the otolaryngology clinic for facial pain and swelling after odontogenic infection. Inflamed left maxilla and orbit were seen, and abscess contents spontaneously drained into the mouth. It was determined that infectious markers were increased in the blood. On MRI, a broad abscess with edema and gas formation was seen. Debridement of the necrotic tissue was performed immediately and wide-spectrum antibiotic therapy was started. Infection was stopped and wound was closed, with four weeks of antibiotic therapy, three sessions of debridement, and 30 sessions of hyperbaric oxygen (HBO2) therapy. HBO2 therapy must not replace the combination of early aggressive debridements and wide-spectrum antibiotic therapy, but rather must be considered as an important adjuvant treatment.
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Affiliation(s)
- Bekir Selim Bağli
- Department of Underwater and Hyperbaric Medicine, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Osman Durgut
- Department of Otorhinolaryngology, Bursa Yüksek Ihtisas Training and Research Hospital, Bursa, Turkey
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