Necrotizing Fasciitis in a Dog

Retrospective case series: Necrotising fasciitis in 23 dogs

BACKGROUND

Necrotising fasciitis (NF) is a rare, rapidly progressive subcutaneous bacterial infection. Few studies have characterised NF in dogs.

HYPOTHESIS/OBJECTIVES

To retrospectively describe clinical and laboratory findings, with treatments and outcomes, in dogs with NF.

ANIMALS

Twenty-three client-owned dogs treated at a veterinary teaching hospital between 1998 and 2021.

MATERIALS AND METHODS

Medical records and laboratory data from 23 dogs diagnosed with NF were reviewed.

RESULTS

Male dogs were significantly over-represented (p = 0.003). The most common presenting complaint was sudden lameness. Infection occurred in one or two limbs in 19 of 23 dogs, with right hindlimbs most often affected (13 of 23). Pitting oedema was evident in 14 of 23 dogs. Antibiotic and nonsteroidal anti-inflammatory drugs were administered before presentation in nine and 13 of 23 dogs, respectively. Common clinicopathological abnormalities included hypoalbuminemia, hyponatremia, elevated liver enzymes, elevated creatine kinase, increased bands and lymphopenia. Streptococcus canis was isolated from 18 of 23 dogs. Histopathological features included acute necrosis and severe neutrophilic inflammation. Fifteen dogs were euthanised or died, while surgical intervention led to survival in eight of 23 dogs.

CONCLUSIONS AND CLINICAL RELEVANCE

Dogs presenting for acute swelling of a limb with oedema should have the diagnosis of NF considered and early surgical intervention might increase survival.

Safety and Tolerability of Hyperbaric Oxygen Therapy in Cats and Dogs

This prospective clinical trial was designed to evaluate the safety of hyperbaric oxygen therapy (HBOT) in a population of cats and dogs with a variety of naturally occurring diseases. Seventy-eight dogs and twelve cats with various naturally occurring disease conditions, who had the potential to benefit from HBOT, were enrolled in the study. These patients were treated with HBOT in a monoplace hyperbaric oxygen chamber at 2 air pressure absolute for a treatment length of either 45 min or 60 min. There were 230 hyperbaric oxygen treatments performed during the study period. No major adverse effects were observed. There were 76 minor adverse effects recorded, which were not considered to be of clinical significance. Hyperbaric oxygen therapy was well tolerated and there were no major adverse effects recorded during treatment.

The Successful Use of Negative-Pressure Wound Therapy in Two Cases of Canine Necrotizing Fasciitis

A 5 mo old female Akita and a 1 yr, 5 mo old male German shorthaired pointer were both evaluated for soft-tissue lesions characterized by rapidly expanding edema, erythema, and pain. Ultrasound was utilized to locate and sample fluid accumulations, and β-hemolytic Streptococcus was isolated from the wounds. Development of systemic symptoms including fever, tachycardia, and tachypnea as well as a lack of response to medical management prompted surgical intervention in both cases. During surgical exploration and debridement, disruption of intermuscular tissue planes was appreciated and necrotizing fasciitis (NF) was suspected. Negative-pressure wound therapy systems utilizing 120 mm Hg of continual negative pressure were applied to wounds for 5 and 4 days for the Akita and German shorthaired pointer, respectively. Resolution of infection was achieved and although the lesions were associated with limbs, amputation was avoided. In both cases, the results of histopathology were consistent with NF. NF is recognized as a rapidly progressive infection associated with high rates of morbidity and mortality. Timely use of negative-pressure wound therapy appears to be a viable management tool to accompany surgical debridement, appropriate antibiotics, and analgesics.

Necrotising fasciitis associated withEscherichia coliin a dog

CASE HISTORY

Lameness and limb pain associated with a laceration in the inner thigh of a Border Collie dog progressed over 4 days to extensive necrosis of the full-thickness of skin and subcutaneous (S/C) tissue. A successful outcome was achieved using surgical debridement and intensive supportive care, followed by limited local closure, axial pattern flap development, and free skin grafting.

CLINICAL FINDINGS

Clinical findings included severe pain, depression, pyrexia and hypoalbuminaemia, and full-thickness loss of skin from the caudal thigh to the hock. Histopathologically, debrided tissue showed extensive necrosis of the dermis, adipose and muscle tissues, and the presence of numerous Gram-negative rods. Escherichia coli was cultured from deep tissue samples.

DIAGNOSIS

Necrotising fasciitis (NF) associated with E. coli infection.

CLINICAL RELEVANCE

NF associated with E. coli has not been previously reported in dogs. The importance of early diagnosis and surgical debridement is noted and the relevant medical literature is reviewed.

Successful treatment of necrotizing fasciitis in the hind limb of a great dane

A 5-month-old, intact female Great Dane was presented for an acute onset of rapidly progressive lameness, severe pain, and diffuse swelling of the right hind limb. Ultrasound evaluation revealed echogenic fluid pockets extending along fascial planes of the right hind limb, from the proximal femur to the hock. Necrotic soft tissues were debrided, and closed-suction drains were placed. No foreign material was identified at surgery. Fluid culture identified a beta-hemolytic Streptococcus sp., and affected fascial histopathology was consistent with necrotizing fasciitis. Postoperatively, the puppy was managed with intravenous broad-spectrum antibiotics, local infusions of amikacin, and daily physical rehabilitation. Oral pentoxifylline was administered to treat bronchopneumonia and streptococcal toxic shock syndrome that developed secondary to necrotizing fasciitis. To our knowledge, this is the first report of a successfully managed case of beta-hemolytic, streptococcal, necrotizing fasciitis successfully managed after a single surgical debridement in combination with systemic broad-spectrum antibiotics, local amikacin infusion, active closed-suction drainage, daily cytology, massage, and passive range-of-motion exercises to maintain limb function.

Necrotising fasciitis in a bull due to infection with Arcanobacterium haemolyticum

CASE HISTORY

A 2-year-old Hereford bull was lame for one week before becoming recumbent.

CLINICAL AND PATHOLOGICAL FINDINGS

The scrotum and ventral perineal region were cold and blackened caudally. The semimembranosus and semitendinosus muscles were firm on palpation. The bull was subject to euthanasia, and necropsy revealed that the skin and S/C tissues of the caudal half of the scrotum were grey and necrotic. The caudal and distal aspects of the semimembranosus and semitendinosus muscles were grey and necrotic to a depth of approximately 15 cm, and these changes appeared to track along fascial planes. The tissue had an offensive smell, and large amounts of flocculent, watery, brown fluid and some gas were present. Histology of affected muscle and S/C tissues revealed coagulative necrosis, with oedema and large numbers of bacteria that were predominantly Gram-positive rods. Adjacent blood vessels contained thrombi while the epidermis overlying the affected areas appeared diffusely necrotic, suggesting infarction. Culture of the fluid yielded a pure growth of Arcanobacterium spp., which was identified as Arcanobacterium haemolyticum, using an API Coryne biochemical test strip.

DIAGNOSIS

Necrotising fasciitis and myositis due to Arcanobacterium haemolyticum.

CLINICAL RELEVANCE

Arcanobacterium haemolyticum has not previously been reported as a cause of necrotising fasciitis in any species. Necrotising fasciitis is probably an under-reported condition in cattle due to its clinical similarity to clostridial disease.

Fournier's gangrene in a cat

OBJECTIVE

To describe the clinical course of a cat diagnosed with Fournier's gangrene.

CASE SUMMARY

A 2-year-old castrated male cat was presented to an emergency hospital for evaluation of acute onset of lethargy, mucoid anal discharge, and fever. During hospitalization, with provision of supportive care, an area of necrotizing fasciitis around the prepuce and anus developed and surgical debridement was performed. Severe sepsis developed secondary to the necrotizing fasciitis and the cat was eventually euthanized.

NEW INFORMATION PROVIDED

The purpose of this report is to document the first case of Fournier's gangrene in a cat that presented for mucoid anal discharge, lethargy, and mild ataxia, and to alert emergency clinicians to this disease process. Early detection of the disease with prompt, aggressive supportive care and surgical debridement is necessary for successful treatment.

Streptococcal infection in dogs: a retrospective study of 393 cases

Streptococcus spp are opportunistic pathogens that normally reside in the upper respiratory, intestinal, lower urinary, and genital tracts but can cause localized infection or septicemia in dogs of all ages. A retrospective study of streptococcal infection in 393 dogs was conducted to identify the species of Streptococcus isolated, determine demographics of affected dogs, and characterize the disease processes associated with infection. The major streptococcal species isolated were S canis (88 cases, 22.4%), S dysgalactiae ssp equisimilis (13, 3.3%), and S equi ssp zooepidemicus (4, 1.0%). Sex was not a risk factor (P > .30). Fetuses and neonates were more likely to have streptococcal infection than were other age groups (P < .001). Streptococcal septicemia was considered an important cause of abortion and neonatal death and was isolated from all samples submitted for aerobic culture from dogs in that age group. There was a seasonal trend, with dogs more likely to have streptococcal infection in summer months. In dogs for which a disease process was identified, streptococcal infection was associated with dermatitis (29 dogs), pneumonia (24 dogs), adult septicemia (13 dogs), and fetal/neonatal septicemia leading to abortion or neonatal death (16 dogs). Identification of other clinically significant bacterial, viral, fungal, and parasitic organisms was common (267 of 393 dogs, 68%), especially in dogs with dermatitis or pneumonia. Infection with Streptococcus spp should be considered in the differential diagnosis in cases of abortion, septicemia, dermatitis, and pneumonia in dogs. Clinical significance of isolation of streptococcal organisms should be interpreted in context of clinical signs and pathologic findings.

Necrotizing Fasciitis: A Review

Necrotizing fasciitis is a rapidly spreading, bacterial, soft-tissue infection reported in both humans and dogs. A review of the pathophysiology, clinical findings, diagnosis, and treatment of necrotizing fasciitis is presented, with the goal of familiarizing veterinarians with this uncommon but potentially fatal condition. A case report highlighting the fulminant course of this disease is also included.