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Necrotizing fascitis located in deep fascia
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Necrotizing fascitis is a progressive, rapidly spreading, inflammatory infection located in deep fascia. It may cause necrosis of skin and subcutaneous tissues. Spreading of it may lead to shock, organ failure and even death.
In this study, we evaluated prevalence of variables including predisposing factors, clinical and paraclinical findings, dist...
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Necrotizing fasciitis (NF) is a rare, rapidly progressive and potentially fatal soft-tissue infection characterized by widespread severe infection of the deep soft tissue, including fascia. Predisposing conditions for NF include diabetes, malignancy, obesity, and chronic liver disease. Patients with suspected NF should be empirically and immediatel...
To describe clinical, laboratory, microbiological features, and outcomes of necrotizing fasciitis.
From January 1, 2004 to December 31, 2011, 115 patients (79 males, 36 females) diagnosed with necrotizing fasciitis were admitted to Mackay Memorial Hospital in Taitung. Demographic data, clinical features, location of infection, type of comorbidities...
Fournier's gangrene (FG) is a rare and often fulminant necrotizing fasciitis of the perineum and genital region frequently due to polymicrobial infection. This truly emergent condition is typically seen in elderly, diabetic and immune compromised patients. Here, we report an unusual case of FG with isolated glans penis necrosis in a diabetic 77-yea...
Citations
... The presence of poorly controlled diabetes as a comorbidity in this patient is significant, as evidence suggests that diabetes can predispose to necrotising fasciitis. [7] The typical symptomatic triad of necrotising fasciitis is erythema, fever and pain all of which were present in our patient. [8] The presence of soft tissue gas is a classic sign, and was present both radiologically ( Figure 2) and clinically in theatre on debridement. ...
Necrotising fasciitis is a rapidly progressing soft tissue infection associated with significant morbidity and mortality. We present a case of cervical necrotising fasciitis with mediastinal extension in a diabetic young male who was COVID-19 positive. He presented with a five-day history of left-sided neck swelling which was fluctuant, red and painful. Subsequent debridement and management of the wound were complicated by the comorbid SARS-CoV2 infection due to potential need for proning. This case highlights the complex interplay between the management of two significant conditions; the surgical approach to necrotising fasciitis and the concern of deterioration due to COVID-19.
... 7,8 It is also associated with cancer, alcoholism, chronic liver, chronic renal and peripheral vascular disease. 9 It may occur as a complication of cardiac catheterization, sclerotherapy, diagnostic laparoscopy or may be idiopathic. 3,10 A minor insect bite may start such disease in immuno compromised patients. ...
... Investigations were mandatory to know the liver, renal and immunological functions of the body. 9 In present study we found that 65.42% of patients had diabetes. Others were post trauma-27.90%. ...
Background: Necrotizing fasciitis is a severe flesh-eating disease of soft tissue infection. It is characterized by widespread infection of the fascia with necrosis. It may lead to MODS and shock in a very short period of time. In this study we have evaluated the predisposing factors, clinical manifestation and different modalities of investigation which helps in management of this near fatal disease.Methods: This study was conducted in Department of Surgery, Gandhi Medical College, Bhopal, Madhya Pradesh, India for 3 years (October 2013-September 2016). A total of 107 patients having necrotising fasciitis were admitted in this period. The diagnosis was confirmed by detailed history and physical examination followed by haematological, microbiological and radiological investigations priority wise. After initial resuscitation patients were taken to OT where debridement of dead necrotic tissue was done, laying open of deeper planes with proper and effective drainage of pus. Most of the dressings used were silver sulfadiazine or iodine depending upon the sensitivity to sulpha group.Results: Diabetes mellitus was the most common predisposing factor (65.4%) followed by trauma (28%). Perineum and thigh were the most commonly affected site (70%). Most of the patients (84%) presented with skin erythema and blistering. Fever and tachycardia were seen in almost all the patients (95%). Leukocytosis and neutrophilia were seen in 91.5%. Most common organisms isolated were E. coli and proteus. Mortality rate was 24.29%.Conclusions: Necrotizing fasciitis is a flesh eating, highly lethal disease. Early diagnosis, early and radical surgical debridement supported by appropriate antibiotic and correction of metabolic disorder are the cornerstones of successful management.
... In the neurosurgical field, although rare, it can cause brain abscess, subdural empyema, discitis, osteomyelitis, and SEA 2,5,11,16,18,20) . They are one of the pathogens of gas-containing infections in the extremities, such as non-clostridial gas gangrene and necrotizing fascitis 6) . However, gas-containing SEA due to E. faecalis was rarely reported. ...
... Gas-containing infection can occur in many regions and organs in the body. Gas-containing infections of the abdomen, pelvis, and extremities are well-known 6,8) . Gas-formation infections can occur with both aerobic and anaerobic microorganisms 15) . ...
... Other gases, except carbon dioxide, accumulate in tissues because of their reduced solubility in water 1,15) . The most common predisposing factor for gas-containing infections is reported to be DM 6) . High blood glucose from poorly controlled DM and poor glycolysis at the tissue level in diabetic patients may contribute to increased glucose concentrations within the interstitial fluid 1,8) . ...
Gas-containing (emphysematous) infections of the abdomen, pelvis, and extremities are well-known disease entities, which can potentially be life-threatening. They require aggressive medical and often surgical treatment. In the neurosurgical field, some cases of gas-containing brain abscess and subdural empyema have been reported. Sometimes they progress rapidly and even can cause fatal outcome. However, gas-containing spinal epidural abscess has been rarely reported and clinical course is unknown. We report on a case of rapidly progressive gas-containing lumbar spinal epidural abscess due to Enterococcus faecalis in a 72-year-old male patient with diabetes mellitus.
... According to some studies, mortality rate is higher in cases with involvement of head and neck, thorax or abdomen. 13 As a result of high mortality rate in patients suffering from this disease and lack of enough statistical researches in this field, we decided to evaluate the prevalence of clinical and paraclinical findings in addition to predisposing factors in these patients. ...
: Necrotizing fascitis is a progressive, rapidly spreading infection affecting mainly deep
fascia and may cause necrosis of skin and subcutaneous tissues. Spreading of it may lead to shock,
multi organ failure and eventually death. METHODS: In this study, we have evaluated prevalence of
predisposing factors, clinical, distribution of tissue involvement and mortality rate in 100 patients of
necrotizing fascitis at our Hospital between 2008 and 2010. RESULTS: Prevalence of this disease was
higher in males than females with the rate of 2.6:1. Diabetes mellitus 44.0% was the most common
predisposing disease followed by trauma and acquired immunodeficiency disease. Genital region was
the most common site of involvement followed by lower limbs. Nonspecific erythema was the main
dermatological manifestation. The most common organism was Enterococcus faecalis and mortality
rate was 35.0%. CONCLUSION: Necrotizing fascitis is an infectious disease with high mortality rate
and frequently with non-specific skin and general manifestations. High suspicion, surgical
debridement and judicious use of 3rd generation cephalsporins can be effective in decreasing the rate
of morbidity and mortality.
... Rapid progression is characteristic of necrotizing fasciitis so rapid treatment is imperative. In the same study, the muscles were involved in 26 patients, and extensive surgical debridement was required in 90 patients [2]. Infection by Vibrio vulnificus is related to poor hygiene mainly presented in the middle-age adult, and is rapidly progressive. ...
... According to regions, the genital and extremities were the most commonly affected. [3] Although rare, it carries a high mortality if not recognized early in the course of the disease. A high index of suspicion is required based on a variety of nonspecific physical signs that add to the diagnostic difficulties. ...
... Necrotizing fasciitis is a rare entity. [3] It was documented initially by Fournier in 1883. [1] In 1920, Meleny identify 20 patients in China with the single organism; group A-hemolytic streptococci (GAS). ...
Necrotizing fasciitis (NF) is not uncommon but in the era of therapeutic and prophylactic antimicrobial, it is considered to be a rare entity. The diagnosis requires a prerequisite high index of suspicion. Many classifications of such a entity do exist depending mainly on the causative agent. Others have classified it according to the immune‑competent status or the anatomical location. The causative agent varies depending on the patients’ risk factors. We report a case of a 28‑year‑old female who developed NF in the postcesarean section period. She was managed by surgical debridement, and made a full recovery. The recovered pathogen was Providencia stuartii. The patient made a full and uneventful recovery. Such a report will increase the awareness of the existence of nontypical sole agents. This would initiate empirical therapy in timely fashion.
Objective: In this study, we seek to identify patient characteristics associated with limb loss and mortality while exploring the potential impact a multidisciplinary care team may have. Approach: This was a 10-year retrospective review of patients presenting to our tertiary care center for limb salvage with a diagnosis of lower extremity (LE) necrotizing fasciitis (NF). Patient demographics, clinical history, and outcomes were compared between survivors and nonsurvivors and between those who underwent LE amputation and those who did not. The article adheres to the strengthening the reporting of observational studies in epidemiology statement. Results: Sixty-two patients presented to our tertiary care center for limb salvage with LE NF. Forty-two patients underwent LE amputation: 27 (43.5%) underwent below-knee amputation, 1 (1.6%) underwent above-knee amputation, 8 (12.9%) underwent transmetatarsal amputation and 2 (3.2%) underwent calcanectomy. The overall mortality rate was 16.1% (n = 10). Risk factors for mortality included increased age (p = 0.034), higher Charlson Comorbidity Index (p = 0.011), thrombocytopenia (p = 0.002), hypotension (p = 0.015), erythema (p = 0.010), pain (p = 0.027), diabetes mellitus (p = 0.012), and malignancy (p < 0.001). Risk factors for LE amputation included DM (p = 0.017), peripheral vascular disease (p = 0.033), and an elevated laboratory risk indicator for necrotizing fasciitis (LRINC) (p = 0.033). Innovation: To identify outcomes after admission to a tertiary hospital with a dedicated limb salvage team with LE NF and to analyze risk factors for mortality and amputation. Conclusions: This is a comprehensive analysis of risk factors for mortality and amputation after LE NF. Our institution's experience highlights the importance of a multidisciplinary approach in the care of these patients.
Sub-Saharan Africa bears the greatest burden of paediatric HIV disease. This atlas is the first of its kind with photographs of varying skin, systemic conditions and opportunistic infections in the HIV-infected paediatric patient. The aim of the atlas is to illustrate conditions which were captured among paediatric patients presenting to HIV clinics and wards in an African setting. Some of the conditions are commonly seen in HIV-infected children while some are not specific to HIV.
Necrotising Soft Tissue Infection is a rapidly progressing fatal
disorder, the prognosis of which depends on early diagnosis
and management.
Objective: In this study, our objective was to assess the factors
contributing to mortality due to NSTI.
Methods: A retrospective review of the records of all patients
with NSTI involving fascia, skin or muscle between January 2007
and December 2011, was performed. The atiology, predisposing
factors, risk factors, causative microbiological organisms and
the clinical outcomes associated with mortality were studied.
Statistical Data: Descriptive statistics comprising of proportion(%) presented. Chi–square test was employed to assess the
statistical significance in the distribution of various known risk
factors between the survivors and non–survivors. A ‘p’ value
less than 0.05 was considered significant.
Results: Sixty patients records were reviewed. Fifty-one patients
(85%) were males and nine (15%) were females. Mean age was
46.57 years (+/- 20.60) ranging from 15–83 years. All the patients
were treated by debridement & wide spectrum antibiotics.
Mono-microbial atiology being found in 27 patients (63.3%) and
polymicrobial culture was isolated in 13 patients (36.7%), with
E-coli and staphylococci being the most common organisms
to be isolated. In most patients, multiple debridements were
done. The overall mortality rate was estimated to be 25%. Age,
aatiology, diabetes mellitus, hypoalbuminemia, alcohol, site of
infection, bacteriology etc. were the risk factors associated with
mortality, that were evaluated. Diabetes mellitus was the most
common associated risk factor found in 32 patients (53.3%),
though not statistically significant. Increasing age (>50 years,
p value = 0.016), raised Serum Creatinine (>1.2mg/dl, p-value
= 0.023) and delayed surgical intervention(>24 hours p value=
0.006) were the risk factors associated with Mortality in NSTI
that were statistically significant.
Conclusion: Despite the use of appropriate antibiotic treatment,
aggressive debridement & resuscitation, NSTI still leads to a
high mortality & morbidity. In this series, there is high mortality
associated with increasing age, raised serum creatinine and
delayed surgical intervention. The mortality rate (25%) is
comparable with other studies.
We report a rare case of periorbital necrotizing fasciitis following a dacryocystorhinostomy procedure. We describe the common features of this rare infection of the skin and subcutaneous tissues and discuss the different management strategies as well as the controversial role of anti-inflammatory medication in treating this condition.
