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Vongsachang H, Chiou CA, Azad AD, Lin LY, Yoon MK, Lefebvre DR, Stagner AM. Periorbital necrotizing sweet syndrome: A report of two cases mimicking necrotizing soft tissue infections. Am J Ophthalmol Case Rep 2024; 34:102033. [PMID: 38487334 PMCID: PMC10937104 DOI: 10.1016/j.ajoc.2024.102033] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/08/2024] [Accepted: 02/20/2024] [Indexed: 03/17/2024] Open
Abstract
Purpose Two cases are described of necrotizing Sweet syndrome (nSS), a rare variant of acute febrile neutrophilic dermatosis that mimics necrotizing soft tissue infections. Observation A 74-year-old female with myelodysplastic syndrome (MDS) presented with isolated periorbital nSS that closely mimicked necrotizing fasciitis (NF); she displayed pathergy to debridement, was exquisitely responsive to corticosteroids, and underwent successful first-stage reconstruction of the eyelid with full-thickness skin grafting. A second 40-year-old female patient with relapsed acute myelogenous leukemia (AML) presented with multifocal nSS most prominently involving the eyelid. Positive herpes zoster virus (HSV) PCR and bacterial superinfection complicated the diagnosis. She improved with chemotherapy for AML and corticosteroid therapy. Conclusion nSS is rare and a high level of clinical suspicion as well as an understanding of its distinguishing features is necessary to avoid undue morbidity. Identification of pathergy, histopathology, microbiology, and clinical context are critical to avoid misdiagnosis of infection.
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Affiliation(s)
- Hursuong Vongsachang
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Carolina A. Chiou
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Amee D. Azad
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Lisa Y. Lin
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Michael K. Yoon
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Daniel R. Lefebvre
- Department of Ophthalmology, Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Anna M. Stagner
- David G. Cogan Laboratory of Ophthalmic Pathology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
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Setiawan F, Sibarani J. A rare case of Fournier's gangrene developing from colon perforation in an infant: A case report. Urol Case Rep 2024; 54:102721. [PMID: 38601087 PMCID: PMC11004081 DOI: 10.1016/j.eucr.2024.102721] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/12/2024] Open
Abstract
Fournier's gangrene, a rare and life-threatening soft tissue infection affecting the genitalia and perineum, results from various microorganisms. This rapidly progressing necrotizing fasciitis yields higher mortality and morbidity rates. We report a case of a 1-month-old male infant with Fournier's gangrene due to perforation transverse colon complicated with septic shock and pneumonia also accompanied by patent processus vaginalis. Radiological findings of pneumonia and pneumoperitoneum were exhibited. Early diagnosis and management are demanded to mitigate life-threatening and improve the prognosis. The patient underwent incision drainage, peritoneal lavage, exploratory laparotomy, colostomy, necrotomy debridement, and patent processus vaginalis ligation after hemodynamic status stabilization.
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Affiliation(s)
- Fiki Setiawan
- Department of Urology, Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
| | - Jupiter Sibarani
- Department of Urology, Faculty of Medicine University of Padjadjaran, Bandung, Indonesia
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Yu KQ, Li HX, Wu J. Suspected coexistence of perianal necrotizing sweet syndrome in chronic myelomonocytic leukemia: A case report. World J Gastrointest Surg 2024; 16:1176-1183. [DOI: 10.4240/wjgs.v16.i4.1176] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 02/02/2024] [Accepted: 03/11/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Chronic myelomonocytic leukemia (CMML) complicated with Sweet syndrome (SS) is a rare hematological neoplasm. However, cases of concomitant development of perianal necrotizing SS (NSS) have not been reported.
CASE SUMMARY We report a case of a 49-year-old male patient who underwent sequential procedures for hemorrhoids and perianal abscess. He developed postoperative incision infection and was referred to the department where the authors work. Initially, perianal necrotizing fasciitis secondary to incision infection after perianal abscess surgery was suspected. Despite receiving antibiotic therapy and undergoing surgical debridement, deeper necrotic areas formed in the patient’s perianal wounds, accompanied by persistent high fever. Blood and fungal cultures yielded negative results. The final diagnosis was corrected to be CMML with suspected concomitant perianal NSS.
CONCLUSION CMML with perianal NSS is a rare condition, often misdiagnosed as perianal abscess or perianal necrotizing fasciitis. Conventional antibiotic therapy and surgical debridement are ineffective in managing this condition.
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Affiliation(s)
- Ke-Qiang Yu
- Clinical Medicine School, Chengdu University of Chinese Medicine, Chengdu 610072, Sichuan Province, China
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hui-Xiang Li
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Jing Wu
- Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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Joshi A, Alomar T, Kaune DF, Bourgeois J, Solomon D. A case of necrotizing fasciitis initially misdiagnosed as cellulitis. Int J Surg Case Rep 2024; 118:109701. [PMID: 38669802 DOI: 10.1016/j.ijscr.2024.109701] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/15/2024] [Accepted: 04/20/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Necrotizing Fasciitis (NF) is a life-threatening, rapidly progressive infection of the skin and underlying soft tissues. Bacterial pathogens induce a toxic-shock reaction that reduces vascular flow, causing thrombosis, sepsis, and tissue necrosis. Treatment consists of immediate IV antibiotics and oftentimes surgical intervention. We present a case of acute NF that was misdiagnosed as cellulitis. CASE PRESENTATION A 17-year-old male was transferred to an emergency department from a rural hospital for further management of right lower extremity cellulitis and suspected sepsis. On examination, there was an ulcerated lesion on his right lower leg. Within 4 h, the patient underwent fasciotomy and debridement. The patient was hospitalized for 10 days, received a 3-week-course of Cefazolin, and underwent a meshed split-thickness skin graft. By the end of his hospital stay, he showed significant clinical improvement. CLINICAL DISCUSSION Misdiagnosis of NF will almost always lead to a poorer prognosis. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is used to differentiate NF from other soft tissue infections. Yet, other diagnostic clues such as presentation or pain out of proportion to physical findings may be more relevant clinical indicators for a NF diagnosis. Moreover, though imaging findings of NF may be relevant, surgical fascial examination must not be delayed for the purpose of imaging. It is also important to note that cellulitis and NF do share a disease spectrum. CONCLUSION A life-threatening NF infection may seem to be a benign-appearing case of cellulitis, and thus early detection is vital.
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Affiliation(s)
- Aditya Joshi
- Creighton University School of Medicine, Phoenix, AZ, United States of America.
| | - Talal Alomar
- Creighton University School of Medicine, Phoenix, AZ, United States of America
| | - Diego F Kaune
- Johns Hopkins University, Baltimore, MD, United States of America
| | - Julien Bourgeois
- Creighton University School of Medicine, Phoenix, AZ, United States of America
| | - David Solomon
- Phoenix Children's Hospital Department of Hospital Medicine, Phoenix, AZ, United States of America
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Needleman A, Sheaff M, Pepper RJ, Evans RDR. Immunoglobulin G4-related disease presenting with nephrotic syndrome due to minimal change disease: a case report. J Med Case Rep 2024; 18:192. [PMID: 38641649 PMCID: PMC11031906 DOI: 10.1186/s13256-024-04494-3] [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: 11/07/2023] [Accepted: 03/06/2024] [Indexed: 04/21/2024] Open
Abstract
BACKGROUND Immunoglobulin G4-related disease is an inflammatory disease affecting multiple organs including the kidney. Immunoglobulin G4-related kidney disease most commonly manifests as a tubulointerstitial nephritis and is associated with glomerular disease in a proportion of cases. Membranous nephropathy is the most frequent glomerular lesion. Herein, we report the first documented case of immunoglobulin G4-related disease presenting with nephrotic syndrome owing to minimal change disease. CASE PRESENTATION A 67-year-old South Asian male presented to our service with systemic upset and leg swelling. He had heavy proteinuria (urine protein:creatinine ratio 1042 mg/mmol) and was hypoalbuminemic (17 g/L) and hypercholersterolemic (9.3 mmol/L), consistent with the nephrotic syndrome. His serum creatinine was 140 μmol/L, and he was hypocomplementemic (C3 0.59 g/L, C4 < 0.02 g/L) with raised immunoglobulin G4 subclass levels (5.29 g/L). Kidney biopsy demonstrated minimal change disease alongside a plasma-cell-rich tubulointerstitial nephritis with strong positive staining for immunoglobulin G4. A diagnosis of minimal change disease in the setting of immunoglobulin G4-related disease was made. He was commenced on oral prednisolone at 60 mg daily but suffered infectious complications, including necrotizing fasciitis within 3 weeks of starting treatment, ultimately resulting in his death 52 days after initial presentation. CONCLUSION This case highlights the potential for immunoglobulin G4-related disease to be associated with a spectrum of glomerular pathologies including minimal change disease. It adds to the differential diagnosis of secondary causes of minimal change disease, and moreover, aids as an important reminder of the potential complications of high-dose steroids used in its treatment.
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Affiliation(s)
- Amy Needleman
- UCL Centre for Kidney and Bladder Health, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
| | - Michael Sheaff
- Department of Histopathology, Bart's Health NHS Trust, London, UK
| | - Ruth J Pepper
- UCL Centre for Kidney and Bladder Health, Royal Free Hospital, Pond Street, London, NW3 2QG, UK
| | - Rhys D R Evans
- UCL Centre for Kidney and Bladder Health, Royal Free Hospital, Pond Street, London, NW3 2QG, UK.
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Sakhri S, Krimi O, Khessairi N, Abidi F, Slimane M, Bouaziz H, Dhiab TB. A case study of abdominal wall and limb necrotizing fasciitis: an extremely rare post -operative complication. BMC Womens Health 2024; 24:243. [PMID: 38622699 PMCID: PMC11017621 DOI: 10.1186/s12905-024-03084-1] [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: 12/17/2023] [Accepted: 04/08/2024] [Indexed: 04/17/2024] Open
Abstract
INTRODUCTION Infectious affections are the most frequent post-operative complications, the rate have been reducing due to the administration of perioperative antibiotics and they are rarely serious. They are usually associated to pelvic collections, fistulas, urinary tract stenosis and, exceptionally, necrotizing fasciitis (FN) and pelvic organ necrosis. There is no well-codified treatment. CASE PRESENTATION A 42-year-old female patient, was referred to our department for a stage IIIC2 adenocarcinoma of the uterine cervix. Two months after surgery, the patient presented with fever. Abdominal CT scan revealed a recto-vaginal fistula. The patient underwent a surgical evacuation of the collection and a bypass colostomy. Post-operative period was marked by the occurrence of an extensive necrosis to pelvic organs and medial left leg's thigh compartments muscles. She also presented a thrombosis of the left external iliac vein and artery. Given the septic conditions, a revascularization procedure was not feasible. A bilateral ureterostomy was required and a ligature of the left external iliac vessels. Then she received palliative treatment.she died one month after surgery because of multivisceral failure due to sepsis. CONCLUSION Necrotizing fasciitis is extremely rare and serious condition, the diagnosis is clinical and radiological, CT scan is helpful for the. There are predisposing factors such as diabetes, neoadjuvant radiotherapy or chemotherapy. The prognosis can be improved with rapid management and appropriate medical and surgical excisions of necrotic tissue, and antibiotic therapy adapted to the suspected germs, essentially anaerobic ones.
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Affiliation(s)
- Saida Sakhri
- Department of Surgical Oncology, Faculty of Medicine of Tunis, University of Tunis El Manar, Salah Azaiez Institute, Boulevard 9 Avril 1938, Tunis, Tunisia.
| | - Ons Krimi
- Department of Surgical Oncology, Faculty of Medicine of Tunis, University of Tunis El Manar, Salah Azaiez Institute, Boulevard 9 Avril 1938, Tunis, Tunisia
| | - Nayssem Khessairi
- Department of Surgical Oncology, Faculty of Medicine of Tunis, University of Tunis El Manar, Salah Azaiez Institute, Boulevard 9 Avril 1938, Tunis, Tunisia
| | - Fethia Abidi
- Department of Radiology, Faculty of Medicine, Salah Azaïz Institute, University Tunis El Manar, Tunis, Tunisia
| | - Maher Slimane
- Department of Surgical Oncology, Faculty of Medicine of Tunis, University of Tunis El Manar, Salah Azaiez Institute, Boulevard 9 Avril 1938, Tunis, Tunisia
| | - Hanen Bouaziz
- Department of Surgical Oncology, Faculty of Medicine of Tunis, University of Tunis El Manar, Salah Azaiez Institute, Boulevard 9 Avril 1938, Tunis, Tunisia
| | - Tarek Ben Dhiab
- Department of Surgical Oncology, Faculty of Medicine of Tunis, University of Tunis El Manar, Salah Azaiez Institute, Boulevard 9 Avril 1938, Tunis, Tunisia
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Zhang LY, Zheng WJ, Li K, JianPing-Ye, Qiu ZM, Zhao GJ, Jin PP, Chen LW, Tang YH, Hong GL, Lu ZQ. Risk model for predicting mortality in patients with necrotizing soft tissue infections in the intensive care unit. Burns 2024; 50:578-584. [PMID: 38238240 DOI: 10.1016/j.burns.2023.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 12/07/2022] [Revised: 11/10/2023] [Accepted: 11/17/2023] [Indexed: 04/08/2024]
Abstract
BACKGROUND The goal of this study is to look into the factors that lead to death in patients with necrotizing soft tissue infections(NSTIs) in the intensive care unit and create a mortality risk model. METHODS The clinical data of 106 patients with necrotizing soft tissue infections admitted to intensive care unit(ICU) of the First Affiliated Hospital of Wenzhou Medical University between January 2008 and December 2021 were retrospectively analyzed. Univariate analysis and multivariate analysis were performed to evaluate the risk factors impacting patient mortality. The regression coefficient in binary logistic regression analysis was converted into the item score in the model, and then the model score of each patient was calculated. Finally, an ROC curve was constructed to evaluate the efficiency of the model for predicting mortality. Thirteen patients with NSTIs admitted to ICU between January 2022 and November 2022 were used to validate the model. RESULTS The death group had 44 patients, while the survival group had 62 patients. The overall mortality was 41.5%. Binary logistic regression analysis showed that risk factors for mortality were age≥ 60 years(OR:4.419; 95%CI:1.093-17.862; P = 0.037), creatinine ≥ 132μmol/L(OR:11.166; 95%CI:2.234-55.816; P = 0.003), creatine kinase ≥ 1104 U/L(OR:4.019; 95%CI:1.134-14.250; P = 0.031), prothrombin time ≥ 24.4 s(OR:11.589; 95%CI:2.510-53.506; P = 0.002), and invasive mechanical ventilation (OR:17.404; 95%CI:4.586-66.052; P<0.000). The AUC of the model for predicting mortality was 0.940 (95% CI:0.894-0.986). When the cut-off value for the model was 4 points, the sensitivity was 95.5% and the specificity was 83.9%. CONCLUSION The death risk model in this study for NSTIs patients in the intensive care unit shows high sensitivity and specificity. Patients with a score of ≥ 4 points have a higher risk of mortality.
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Affiliation(s)
- Lu-Yao Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Wei-Jie Zheng
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Ke Li
- Lishui People's Hospital, Lishui 323000, China
| | - JianPing-Ye
- Lishui People's Hospital, Lishui 323000, China
| | - Zhi-Min Qiu
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Guang-Ju Zhao
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Pin-Pin Jin
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Long-Wang Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Ya-Hui Tang
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Guang-Liang Hong
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China
| | - Zhong-Qiu Lu
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China; Wenzhou Key Laboratory emergency and disaster medicine, Wenzhou 325000, China.
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Ueda H, Tomioka A, Higashiyama M, Kimoto Y, Oguro T, Okazaki S, Ayaki K, Yoshidome Y, Tahara H, Nishimura H, Ito S, Tanemoto R, Takajo T, Narimatsu K, Komoto S, Tomita K, Matsukuma S, Hokari R. Fulminant necrotizing fasciitis by Edwardsiella tarda in a patient with alcoholic liver cirrhosis: A case report. J Infect Chemother 2024; 30:343-347. [PMID: 37866623 DOI: 10.1016/j.jiac.2023.10.014] [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: 07/02/2023] [Revised: 09/15/2023] [Accepted: 10/18/2023] [Indexed: 10/24/2023]
Abstract
We herein present a unique and extremely rare fulminant case of Edwardsiella tarda infection-related necrotizing fasciitis. The patient had alcoholic cirrhosis and preferred to consume raw fish. He experienced painful swelling of the right forearm one day after he got a minor injury when falling from the ladder, and visited our hospital. His accompanied symptoms were diarrhea and general fatigue. His consciousness got deteriorated after the admission. The lesion of the right forearm had spread and the color had deteriorated with epidermolysis in a few hours. Necrotizing soft-tissue infection was suspected, and emergency debridement of the swollen forearm was performed 4 hours after the admission. However, unfortunately, he died of sepsis approximately 5 hours later. Histological examination of the biopsy specimen revealed features consistent with those of necrotizing fasciitis. The bacterial cultures of blood and the wound identified E. tarda. Since this microorganism is usually isolated from aquatic environments and can cause intestinal infection, sometimes followed by bacteremia especially in immunocompromised hosts, two possible infection routes were suspected. One route was from the skin injury, leading to bacteremia. Another possible route was per oral: orally taken E. tarda invaded deeper tissues from the intestine and reach the bloodstream, leading to extraintestinal infections, although direct evidence remains elusive. Raw fish eaten 1 week prior is considered to be the most possible contaminated food. Overall mortality rate of E. tarda bacteremia is very high and the clinician should pay attention on characteristic clinical findings of E. tarda infection on cirrhotic patients.
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Affiliation(s)
- Hiroki Ueda
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Akira Tomioka
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Masaaki Higashiyama
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan.
| | - Yuya Kimoto
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Takuma Oguro
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Soya Okazaki
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Kana Ayaki
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Yuta Yoshidome
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Hiroyuki Tahara
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Hiroyuki Nishimura
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Suguru Ito
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Rina Tanemoto
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Takeshi Takajo
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Kazuyuki Narimatsu
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Shunsuke Komoto
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Kengo Tomita
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
| | - Susumu Matsukuma
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama, Japan
| | - Ryota Hokari
- Department of Internal Medicine, National Defense Medical College, Saitama, Japan
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Tarekegn NG, Moges TG, Guluju FA. Retroperitoneal necrotizing fasciitis mimicking perforated appendicitis: A case report. Int J Surg Case Rep 2024; 116:109412. [PMID: 38382145 PMCID: PMC10943963 DOI: 10.1016/j.ijscr.2024.109412] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 02/13/2024] [Accepted: 02/15/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a rare and rapidly progressing soft tissue infection. The commonly involved body parts are the extremities and trunk. Necrotizing fasciitis (NF) involving the retroperitoneum is very uncommon but associated with higher morbidity and mortality. There are only a few patients survived according to the report. PRESENTATION OF CASE This is a 19-year-old male patient presented with abdominal pain, high-grade fever, vomiting and abdominal distension for 3 days. On physical examination, he was hypotensive, tachycardic and febrile. He had a distended, tender abdomen, and hypoactive bowel sound. There were no significant pertinent findings on the other systems. Laboratory tests showed leukocytosis, thrombocytopenia, and elevated liver enzymes. After optimizing with resuscitation and initiating antibiotics, a laparotomy was performed. The finding was 300 ml of hemorrhagic fluid, ischemic cecum and ascending colon, and retroperitoneal necrosis. Subsequently, multiple debridement and right hemicolectomy with stoma was performed. Despite the close monitoring in the ICU, the patient died of uncontrolled sepsis. CLINICAL DISCUSSION Necrotizing fasciitis (NF) is a rapidly progressing infectious condition that requires urgent intervention. While it is rare for the retroperitoneum to be affected by NF, it is associated with a high mortality rate. The symptoms of retroperitoneal NF are not specific, making it difficult to diagnose. Here, we present a case of retroperitoneal NF with signs and symptoms of generalized peritonitis, resembling perforated appendicitis. CONCLUSION When patients are presented with a case of generalized peritonitis, it is important to include retroperitoneal NF as a potential differential diagnosis.
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Affiliation(s)
| | - Tadesse Girma Moges
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia
| | - Feyera Abetu Guluju
- Department of Surgery, Faculty of Medicine, Institute of Health, Jimma University, Ethiopia
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10
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Peetermans M, Matheeussen V, Moerman C, De Rydt F, Thieren S, Pollet E, Casaer M, De Backer B, De Paep R, Debaveye Y, Desmet L, Desmet S, Duval EIM, Fraipont V, Geysels D, Hermans G, Lahaye F, Mathy X, Meersseman P, Meex C, Van Herck J, van Kleef-van Koeveringe S, Layios N, Wauters J, Jorens PG. Clinical and molecular epidemiological features of critically ill patients with invasive group A Streptococcus infections: a Belgian multicenter case-series. Ann Intensive Care 2024; 14:19. [PMID: 38286885 PMCID: PMC10825083 DOI: 10.1186/s13613-024-01249-7] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/14/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Recent alerts have highlighted an increase in group A streptococcal (GAS) infections since 2022 in Europe and the United States. Streptococcus pyogenes can cause limited skin or mucosal disease, but can also present as severe invasive disease necessitating critical care. We performed a multicenter retrospective study of patients with GAS infections recently admitted to Belgian intensive care units (ICUs) since January 2022. We describe patient characteristics and investigate the molecular epidemiology of the S. pyogenes strains involved. RESULTS Between January 2022 and May 2023, a total of 86 cases (56 adults, 30 children) with GAS disease were admitted to critical care in the university hospitals of Leuven, Antwerp and Liège. We noted a strikingly high incidence of severe community-acquired pneumonia (sCAP) (45% of adults, 77% of children) complicated with empyema in 45% and 83% of adult and pediatric cases, respectively. Two-thirds of patients with S. pyogenes pneumonia had viral co-infection, with influenza (13 adults, 5 children) predominating. Other disease presentations included necrotizing fasciitis (23% of adults), other severe skin/soft tissue infections (16% of adults, 13% of children) and ear/nose/throat infections (13% of adults, 13% of children). Cardiogenic shock was frequent (36% of adults, 20% of children). Fifty-six patients (65%) had toxic shock syndrome. Organ support requirements were high and included invasive mechanical ventilation (77% of adults, 50% of children), renal replacement therapy (29% of adults, 3% of children) and extracorporeal membrane oxygenation (20% of adults, 7% of children). Mortality was 21% in adults and 3% in children. Genomic analysis of S. pyogenes strains from 55 out of 86 patients showed a predominance of emm1 strains (73%), with a replacement of the M1global lineage by the toxigenic M1UK lineage (83% of emm1 strains were M1UK). CONCLUSIONS The recent rise of severe GAS infections (2022-23) is associated with introduction of the M1UK lineage in Belgium, but other factors may be at play-including intense circulation of respiratory viruses and potentially an immune debt after the COVID pandemic. Importantly, critical care physicians should include S. pyogenes as causative pathogen in the differential diagnosis of sCAP.
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Affiliation(s)
- Marijke Peetermans
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Veerle Matheeussen
- Department of Microbiology and Belgian Reference Centre for Invasive β-Hemolytic Streptococci, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
- Laboratory of Medical Biochemistry and Laboratory of Medical Microbiology, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
| | - Cedric Moerman
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
- Department of Anesthesiology and Critical Care Medicine, GZA Hospital Group, Antwerp, Belgium
| | - Fréderic De Rydt
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
- Department of Anesthesiology, Chirec Hospitals, Brussels, Belgium
| | - Sabine Thieren
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Department of Anesthesiology, VITAZ Hospital, Sint-Niklaas, Belgium
| | - Emily Pollet
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Michael Casaer
- Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Benjamin De Backer
- Service de Microbiologie Clinique, CHR Citadelle, Bd du Douzième de Ligne 1, 4000, Liège, Belgium
| | - Rudi De Paep
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Yves Debaveye
- Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Lars Desmet
- Pediatric Intensive Care Unit, Department of Intensive Care Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Stefanie Desmet
- Laboratory for Clinical Microbiology, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Els I M Duval
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Vincent Fraipont
- Service des Soins Intensifs, CHR Citadelle, Bd du Douzième de Ligne 1, 4000, Liège, Belgium
| | - Dieter Geysels
- Department of Microbiology and Belgian Reference Centre for Invasive β-Hemolytic Streptococci, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Greet Hermans
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Frederik Lahaye
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Xavier Mathy
- Service des Soins Intensifs, CHR Citadelle, Bd du Douzième de Ligne 1, 4000, Liège, Belgium
| | - Philippe Meersseman
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Cécile Meex
- Service de Microbiologie Clinique, University Hospital Liège, Avenue de l'Hôpital, 4000, Liège, Belgium
| | - Jozef Van Herck
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Stefanie van Kleef-van Koeveringe
- Department of Microbiology and Belgian Reference Centre for Invasive β-Hemolytic Streptococci, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
| | - Nathalie Layios
- Department of Intensive Care, University Hospital Liège, Avenue de l'Hôpital, 4000, Liège, Belgium
- Département des Sciences Cliniques, University of Liège, 4000, Liège, Belgium
| | - Joost Wauters
- Medical Intensive Care Unit, Department of General Internal Medicine, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium
- Laboratory for Clinical Infectious and Inflammatory Disorders, Department of Microbiology, Immunology and Transplantation, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Philippe G Jorens
- Department of Adult and Pediatric Intensive Care Medicine, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Antwerp, Belgium
- Department of Medicine and Health Sciences, Laboratory of Experimental Medicine and Pediatrics (LEMP), University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Antwerp, Belgium
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11
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Brands SR, Nawijn F, Foppen W, Hietbrink F. No role for standard imaging workup of patients with clinically evident necrotizing soft tissue infections: a national retrospective multicenter cohort study. Eur J Trauma Emerg Surg 2024:10.1007/s00068-023-02414-6. [PMID: 38253724 DOI: 10.1007/s00068-023-02414-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 11/25/2023] [Indexed: 01/24/2024]
Abstract
PURPOSE To assess the diagnostic contribution of different imaging studies to diagnose necrotizing soft tissue infections (NSTIs) and the time to surgery in relation to imaging with the hypothesis that imaging studies may lead to significant delays without being able to sufficiently dismiss or confirm the diagnosis since a NSTI is a surgical diagnosis. METHODS A retrospective multicenter cohort study of all NSTI patients between 2010 and 2020 was conducted. The primary outcome was the number of cases in which imaging contributed to or led to change in treatment. The secondary outcomes were time to treatment determined by the time from presentation to surgery and patient outcomes (amputation, intensive care unit (ICU) admission, length of ICU stay, hospital stay, and mortality). RESULTS A total of 181 eligible NSTI patients were included. The overall mortality was 21% (n = 38). Ninety-eight patients (53%) received imaging in the diagnostic workup. In patients with a clinical suspicion of a NSTI, 81% (n = 85) went directly to the operating room and 19% (n = 20) underwent imaging before surgery; imaging was contributing in only 15% (n = 3) by ruling out or determining underlying causes. In patients without a clinical suspicion of a NSTI, the diagnosis of NSTI was considered in 35% and only after imaging was obtained. CONCLUSION In patients with clinically evident NSTIs, there is no role for standard imaging workup unless it is used to examine underlying diseases (e.g., diverticulitis, pancreatitis). In atypical presenting NSTIs, CT or MRI scans provided the most useful information. To prevent unnecessary imaging and radiation and not delay treatment, the decision to perform imaging studies in patients with a clinical suspicion of a NSTI must be made extremely careful.
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Affiliation(s)
- Sanne R Brands
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Femke Nawijn
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter Foppen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Falco Hietbrink
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Benlghazi A, Benali S, Belouad M, Fakri A, El Mangoub F, Kouach J. Uncommon presentation of necrotizing fasciitis affecting the breast in a young breastfeeding patient: Case report. Int J Surg Case Rep 2024; 114:109147. [PMID: 38134617 PMCID: PMC10800673 DOI: 10.1016/j.ijscr.2023.109147] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Necrotizing fasciitis is a highly dangerous infection that poses a life-threatening risk as it rapidly spreads and causes tissue necrosis in the subcutaneous tissues and fascia. Although rare, the breasts can be affected by this infection, which adds to the complexity of the condition. CASE PRESENTATION A 26-year-old woman who had been breastfeeding for two months presented with pain, swelling, and fever in her left breast. The left breast showed skin darkening and foul-smelling discharge. The diagnosis was septic shock due to necrotizing fasciitis. Prompt treatment included surgical debridement, broad-spectrum antibiotics, and supportive care. The patient's condition remained challenging, and the infection was caused by multi-resistant bacteria. CLINICAL DISCUSSION Necrotizing fasciitis is a highly severe and aggressive type of soft tissue infection. It can range from minor or mild infections of the soft tissues to severe cases involving septic shock. While it is uncommon, necrotizing fasciitis can also affect the breasts. The diagnosis of breast NF relies on a combination of clinical evaluation, culture results, laboratory findings, and imaging studies. Swift surgical interventions, along with appropriate antibiotic therapy and supportive management, are vital for the patient's survival and improved prognosis. CONCLUSIONS Breast necrotizing fasciitis is frequently misdiagnosed due to the presence of thick breast tissue, which creates challenges in identifying the infection between the skin and deep fascia. Swift and extensive surgical debridement, combined with the administration of broad-spectrum antibiotics, are crucial components for effectively managing and preventing the significant morbidity and mortality associated with this condition.
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Affiliation(s)
- Abdelhamid Benlghazi
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V Rabat, Morocco.
| | - Saad Benali
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V Rabat, Morocco
| | - Moad Belouad
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V Rabat, Morocco
| | - Ahmed Fakri
- Department of anesthesia and intensive care unit, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V Rabat, Morocco
| | - Fatima El Mangoub
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V Rabat, Morocco
| | - Jaouad Kouach
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Faculty of Medicine and Pharmacy of Rabat, University Mohammed V Rabat, Morocco
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13
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Kobayashi N, Toyama S, Yoshida H, Shiraso S, Kawaguchi S. Necrotizing fasciitis wound after debridement could be successfully treated with negative-pressure wound therapy with instillation and dwelling: A case report. Trauma Case Rep 2023; 48:100957. [PMID: 37920808 PMCID: PMC10618752 DOI: 10.1016/j.tcr.2023.100957] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
Background Necrotizing fasciitis (NF) is associated with a high mortality rate. Adequate incision and drainage and repeated debridement are necessary for NF management. After drainage, daily local irrigation should be performed. Case presentation A 72-year-old male patient complained of left lower quadrant pain. Computed tomography revealed a 7 cm mass in the descending colon, with retroperitoneal penetration. Hence, he underwent emergency surgery. The left abdomen was widely incised, and a transverse colostomy was performed for local wound control. Daily debridement of necrotic tissue and wound irrigation were continued. On postoperative day 48, the wound was extensive and complex and obtained a positive bacterial culture. Subsequently, we began a negative-pressure wound therapy with instillation and dwelling (NPWTi-d), which was very effective for extensive and complicated wounds with infection. Thereafter, a split-thickness skin was grafted, and the skin graft survived well. Ultimately, the wound successfully closed. Conclusions NPWT is contraindicated for infected wounds, and an infection control period is required. However, NPWTi-d enables early initiation of wound care despite the presence of infection. Therefore, NPWTi-d is effective for extensive and complicated wounds with infection after NF debridement.
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Affiliation(s)
- Naoya Kobayashi
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Shingo Toyama
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Hiroshi Yoshida
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Satoru Shiraso
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
| | - Shinya Kawaguchi
- Department of Surgery, Iwaki City Medical Center, 16 Kusehara, Uchigomimayamachi, Iwaki-shi, Fukushima 973-8555, Japan
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Adhil I, Dahal S, Gyawali S, Neupane P, Kharel A, Neupane P, Pachhai P, Khadka R, Khatiwada RD, Shrestha JM. Evaluation of laboratory risk indicator for necrotizing fasciitis score as an early diagnostic tool for necrotizing fasciitis: a prospective observational study. Ann Med Surg (Lond) 2023; 85:5874-5878. [PMID: 38098577 PMCID: PMC10718372 DOI: 10.1097/ms9.0000000000001447] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/18/2023] [Indexed: 12/17/2023] Open
Abstract
Introduction From its historical identification to modern times with advancements in management modalities globally, the mortality of necrotizing fasciitis (NF) is high ranging from 19 to 30% for all affected sites. Although many diagnostic adjuncts have been developed to assist with the prompt and accurate diagnosis of NF, the primary diagnosis is still based on high clinical suspicion. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score was developed as a tool for distinguishing NF from other soft tissue infections. The main objective of this study is to evaluate LRINEC as a tool for early diagnosis of NF and differentiating it from other soft tissue infections like cellulitis. Methods This is a single-centered, prospective observational study. Patients presenting with soft tissue infections of the limbs to the emergency department from November 2020 to October 2021 were included in this study. The clinical findings and blood parameters for the LRINEC score were collected and the score was calculated. Based on clinical suspicion of NF, patients underwent debridement and had a tissue biopsy to confirm the diagnosis. The data obtained was analyzed using SPSS version 24 and MS Excel. The AUC curve was used to calculate a cutoff, sensitivity, specificity, positive predictive value, and negative predictive values for the LRINEC score based on our study. Results Forty-five patients with 28 males and 17 females were included. The average age was 53.667 years within a range of 19-79 years. Among them 44.4% of the patients had NF and 66.6% had other minor forms of soft tissue infections. The ROC curve obtained a cutoff value of greater than or equal to 6, with an AUC of 0.751. At this cut of value study showed a sensitivity of 85% with a specificity of 52%. Similarly, positive predictive value was found to be 58.62%, negative predictive values of 81.25%, and overall accuracy of 66.67% in early diagnosis of NF. Conclusion In conclusion, our study showed that the LRINEC score can be a reliable tool for the early diagnosis of NF in an ED setting. This scoring system is best to be used to rule out NF.
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Affiliation(s)
| | | | | | | | - Ashok Kharel
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu
| | | | | | | | - Raj D. Khatiwada
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu
| | - Jayan M. Shrestha
- Department of Plastic Surgery and Burns, Tribhuvan University Teaching Hospital, Institute of Medicine
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Ganapathy A, Ballard DH, Chen DZ, Schneider M, Lanier MH, Mazaheri P, Ilahi O, Kirby JP, Raptis CA, Mellnick VM. Preoperative computed tomography in Fournier's gangrene does not delay time to surgery. Emerg Radiol 2023; 30:711-717. [PMID: 37857761 DOI: 10.1007/s10140-023-02177-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
PURPOSE Fournier's gangrene (FG), a rapidly progressive necrotizing soft tissue infection of the external genitalia and perineum, necessitates urgent surgical debridement. The time to surgery effect of preoperative computed tomography (CT) in managing this condition is yet to be fully explored. The purpose of this study was to assess whether obtaining a preoperative CT in patients with FG impacts the time to surgical intervention. METHODS This was a single-center retrospective study of patients who underwent CT prior to surgical debridement of FG during a 9-year period vs patients who did not undergo CT. In 76 patients (male = 39, mean age = 51.8), 38 patients with FG received a preoperative CT, and 38 patients with FG did not receive CT prior to surgical debridement. Time to operating room and outcome metrics were compared between CT and non-CT groups. RESULTS The time from hospital presentation to surgical intervention was not significantly different between patients who underwent CT and those who did not (6.65 ± 3.71 vs 5.73 ± 4.33 h, p = 0.37). There were also no significant differences in cost ($130,000 ± $102,000 vs $142,000 ± $152,000, p = 0.37), mortality (8 vs 7, p = 1), duration of hospital stay (15.5 ± 15 vs 15.7 ± 11.6 days, p = 0.95), average intensive care unit stay (5.82 ± 5.38 days vs 6.97 ± 8.58 days, p = 0.48), and APACHE score (12 ± 4.65 vs 13.9 ± 5.6, p =0.12). CONCLUSION Obtaining a preoperative CT did not delay surgical intervention in patients with FG.
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Affiliation(s)
- Aravinda Ganapathy
- School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - David H Ballard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO, 63110, USA.
| | - David Z Chen
- School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - McGinness Schneider
- School of Medicine, Washington University in St. Louis, St. Louis, MO, 63110, USA
| | - M Hunter Lanier
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO, 63110, USA
| | - Parisa Mazaheri
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO, 63110, USA
| | - Obeid Ilahi
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - John P Kirby
- Department of Surgery, Washington University School of Medicine, St. Louis, MO, 63110, USA
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO, 63110, USA
| | - Vincent M Mellnick
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd; Campus Box 8131, St. Louis, MO, 63110, USA
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16
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Gilardi R, Parisi P, Galassi L, Firmani G, Bene MD. Candida albicans necrotizing fasciitis following cosmetic tourism: A case report. JPRAS Open 2023; 38:129-133. [PMID: 37869730 PMCID: PMC10587449 DOI: 10.1016/j.jpra.2023.10.004] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/01/2023] [Indexed: 10/24/2023] Open
Abstract
Background Necrotizing fasciitis is a rare and potentially life-threatening soft tissue infection, even more so when associated with fungal causative agents. Onset has been identified in nosocomial settings following elective surgery, but not in esthetic surgery. Case presentation We here present a case of necrotizing fasciitis related to Candida albicans infection which occurred in an immunocompetent patient who received a cosmetic breast augmentation mastopexy combined with a Brazilian Butt Lift using autologous fat grafting. The case was managed with aggressive wound exploration and debridement. Treatment was delayed by the diagnostic challenge and the difficulty in identifying the causative agent, but the patient fully healed and recovered once the C. albicans was isolated in culture tests and appropriate antimycotic treatment was implemented. Conclusion Considerations should be made regarding the possibility of implementing an antimycotic option for first-line empirical treatment despite the rarity of fungal etiology because of the threat of diagnostic delay and worse outcome.
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Affiliation(s)
- Roberta Gilardi
- Division of Plastic & Reconstructive Surgery, San Gerardo Hospital of Monza, Italy
| | - Paola Parisi
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS Rome, Italy
| | - Luca Galassi
- Division of Vascular Surgery, San Gerardo Hospital of Monza, Italy
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome – Department of Plastic Surgery Sant'Andrea Hospital, Rome, Italy
| | - Massimo Del Bene
- Division of Plastic & Reconstructive Surgery, San Gerardo Hospital of Monza, Italy
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17
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Tong M, Lai C, Su H. A case of perianal abscess-induced massive necrotizing fasciitis extending to perineum, scrotum, left groin, left waist and chest wall. Asian J Surg 2023; 46:5387-5388. [PMID: 37541879 DOI: 10.1016/j.asjsur.2023.07.107] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023] Open
Affiliation(s)
- Mingye Tong
- Department of Urology, Dehua Hospital Affiliated to Huaqiao University, Quanzhou, China
| | - Chuanjin Lai
- Department of Urology, Dehua Hospital Affiliated to Huaqiao University, Quanzhou, China
| | - Hongshu Su
- Department of Urology, Dehua Hospital Affiliated to Huaqiao University, Quanzhou, China.
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18
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Gilardi R, Galassi L, Del Bene M, Firmani G, Parisi P. Further insights on infective complications of cosmetic tourism. J Plast Reconstr Aesthet Surg 2023; 86:271-272. [PMID: 37797374 DOI: 10.1016/j.bjps.2023.09.023] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/08/2023] [Indexed: 10/07/2023]
Affiliation(s)
- Roberta Gilardi
- Division of Plastic & Reconstructive Surgery, San Gerardo Hospital of Monza, Italy
| | - Luca Galassi
- Division of Vascular Surgery, San Gerardo Hospital of Monza, Italy
| | - Massimo Del Bene
- Division of Plastic & Reconstructive Surgery, San Gerardo Hospital of Monza, Italy
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome - Department of Plastic Surgery Sant'Andrea Hospital, Rome, Italy.
| | - Paola Parisi
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS Rome, Italy
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19
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Delgado C, Erice A, García Navlet M. Necrotizing fasciitis following an arthroscopic shoulder surgery: a case report and literature review. JSES Rev Rep Tech 2023; 3:548-552. [PMID: 37928981 PMCID: PMC10624992 DOI: 10.1016/j.xrrt.2023.04.004] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Affiliation(s)
- Cristina Delgado
- Shoulder and Elbow Reconstructive Surgery Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Alejo Erice
- Internal Medicine Department, Hospital Asepeyo Coslada, Madrid, Spain
| | - Miguel García Navlet
- Shoulder and Elbow Reconstructive Surgery Unit, Hospital Asepeyo Coslada, Madrid, Spain
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Trabelsi MM, Nasseh S, Khalfallah M, Kammoun N, Chaouch MA, Bellil M, Oueslati A, Dougaz MW, Nouira R. Necrotizing fasciitis of the thigh: An unexpected route to discover an infected colonic cancer. IDCases 2023; 34:e01914. [PMID: 37886695 PMCID: PMC10597850 DOI: 10.1016/j.idcr.2023.e01914] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction Necrotizing fasciitis (NF) is a rare but potentially fatal soft tissue infection characterized by its aggressive nature. This case report highlights a unique and atypical presentation of NF associated with colorectal cancer. Case presentation A 76-year-old male with no significant medical history presented with left knee pain and rapidly progressing septic shock. Clinical examination revealed skin necrosis, inflammation, and swelling in the left thigh and inguinal region. Laboratory investigations showed leukocytosis and elevated C-reactive protein levels. Computed tomography angiography revealed fluid and gas tracking along fascial planes in the left thigh. Surgical intervention revealed NF in the thigh and abdominal wall, with the underlying cause being a perforated sigmoid colon cancer. Conclusion Recognizing the polymorphic clinical manifestations of NF and its potential association with underlying abdominal pathology can aid in early diagnosis and improve patient outcomes. This report serves as a reminder of the life-threatening nature of NF and the necessity for rapid and comprehensive management.
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Affiliation(s)
| | - Souhir Nasseh
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mehdi Khalfallah
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | - Neirouz Kammoun
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Ali Chaouch
- Department of Visceral and Digestive Surgery, Monastir University Hospital, Monastir, Tunisia
| | - Mehdi Bellil
- Department of Orthopedics and Traumatology, Charles Nicolle Hospital, Tunis, Tunisia
| | - Anouar Oueslati
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Ramzi Nouira
- Department B of Surgery, Charles Nicolle Hospital, Tunis, Tunisia
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Chen L, Zhu Y, Fan D. Necrotizing fasciitis due to mycobacterium tuberculosis: A case report. Heliyon 2023; 9:e20733. [PMID: 37842604 PMCID: PMC10568099 DOI: 10.1016/j.heliyon.2023.e20733] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 09/29/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023] Open
Abstract
We admitted a patient with extensive and rapidly progressing necrotizing fasciitis, pulmonary tuberculosis, cutaneous tuberculosis, and bacterial infections because of late diagnosis and treatment. Early diagnosis is necessary for both cutaneous tuberculosis and necrotizing fasciitis. However, these are rare clinical manifestations and are difficult to detect. Despite surgical and pharmacologic treatment, the patient had poor outcomes. We discussed the next-generation sequencing test for early tuberculosis diagnosis, especially for atypical ones. The modified and typical laboratory risk indicator for necrotizing fasciitis score was used for diagnosing and identifying patients at high risk for necrotizing fasciitis. Subcutaneous effusions and gas accumulations observed through imaging were useful in assessing necrotizing fasciitis progression. Debridement or tuberculosis treatment should be initiated as early as possible in managing patients with both necrotizing fasciitis and cutaneous tuberculosis. Clinicians should be alert in identifying the condition, whether Mycobacteria tuberculosis is the independent cause of necrotizing fasciitis, and treating the condition. The choice of rapid microbial diagnostic tools should be of concern. Debridement or tuberculosis treatment should be initiated as early as possible in managing patients with both necrotizing fasciitis and cutaneous tuberculosis. Multidisciplinary cooperation should be considered.
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Affiliation(s)
- Liying Chen
- Department of Respiratory Medicine, The Third Hospital of Changsha, Hunan, 410004, China
| | - Yinhui Zhu
- Department of Respiratory Medicine, The Third Hospital of Changsha, Hunan, 410004, China
| | - Du Fan
- Department of Respiratory Medicine, The Third Hospital of Changsha, Hunan, 410004, China
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22
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Paynter JA, Qin KR, Situ D, Lee CHA. Fournier gangrene with concurrent multifocal necrotizing fasciitis: a systematic review and case report. Ann Coloproctol 2023; 39:421-426. [PMID: 35615761 PMCID: PMC10626333 DOI: 10.3393/ac.2022.00192.0027] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/13/2022] [Accepted: 04/13/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE A patient presented to a regional surgical center with Fournier gangrene (FG) and concurrent multifocal necrotizing fasciitis (NF). Given the rarity, it was decided to undertake a systematic review to investigate the incidence and prevalence of FG with multifocal NF and consequently determine the treatment and approach to management of such presentation. METHODS Firstly, the report of the 56-year-old male patient is discussed regarding his surgical management. Secondly, a systematic review was undertaken according to PRISMA guidelines using MEDLINE, Scopus, and Embase databases. Searches used the following MeSH terms: ("fournier's gangrene") AND ((necrotising fasciitis) OR (necrotising soft tissue infection)). Once the search results were obtained, duplicate articles were removed. Titles, abstracts, and articles were reviewed by 2 authors. RESULTS The search strategy using the 3 databases revealed a total of 402 studies. Fifty-seven studies were removed due to duplication. A total of 345 records were screened via title and abstract, of which 115 were excluded. Two hundred and thirty studies were reviewed for eligibility. A total of all 230 studies were excluded; 169 were excluded as they included the incorrect patient population (patients suffered from FG or NF, but not both collectively), 60 studies were excluded due to incorrect study designs, and 1 report occurred in the wrong setting. CONCLUSION This highlights that while being a relatively known, uncommon infection both FG and NF are well documented separately within the literature. However, FG with concurrent multifocal NF has not been documented within the literature.
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Affiliation(s)
| | - Kirby R. Qin
- Department of Surgery, Austin Health, Heidelberg, VIC, Australia
| | - Dongrong Situ
- Department of General Surgery, Bendigo Health, Bendigo, VIC, Australia
- Department of Surgery, Austin Health, Heidelberg, VIC, Australia
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Iwata E, Kusumoto J, Susukida Y, Matsui T, Takata N, Hasegawa T, Tachibana A, Akashi M. Is the LRINEC score useful for predicting necrotizing fasciitis as a complication of MRONJ? J Bone Miner Metab 2023; 41:642-651. [PMID: 37270712 DOI: 10.1007/s00774-023-01441-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/11/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Necrotizing fasciitis as a complication of medication-related osteonecrosis of the jaw (MRONJ), which we named "ONJ-NF", has been sometimes reported. This study aimed to investigate the usefulness of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score for predicting ONJ-NF. MATERIALS AND METHODS We included patients with acute MRONJ who required hospitalization at a single institution from April 2013 to June 2022. They were divided into two groups: patients with ONJ-NF and those with severe cellulitis as a complication of MRONJ, which we named "ONJ-SC." LRINEC scores were compared between the groups and the cut-off value of the score was set by creating a receiver operating characteristic curve. RESULTS Eight patients with ONJ-NF and 22 patients with ONJ-SC were included. The LRINEC score was significantly higher in patients with ONJ-NF (median: 8.0 points, range 6-10 points) than in those with ONJ-SC (median: 2.5 points, range 0-6 points). A LRINEC score of ≥ 6 points had a sensitivity of 100.0%, a specificity of 77.3%, and an area under the curve of 0.97. Among 6 parameters of LRINEC score, only C-reactive protein (CRP) and white blood cell count (WBC) had significant differences between two groups. Most of the patients with ONJ-NF were rescued by antibiotic therapy and surgical drainage including debridement of necrotic tissues, but unfortunately, one patient did not survive. CONCLUSION Our results suggested that the LRINEC score may be a useful diagnostic tool to predict ONJ-NF but valuating only CRP and WBC may be sufficient particularly in patients with osteoporosis.
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Affiliation(s)
- Eiji Iwata
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Hon-machi, Kakogawa-cho, Kakogawa, 675-8611, Japan.
| | - Junya Kusumoto
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuriko Susukida
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Hon-machi, Kakogawa-cho, Kakogawa, 675-8611, Japan
| | - Taiki Matsui
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Hon-machi, Kakogawa-cho, Kakogawa, 675-8611, Japan
| | - Naoki Takata
- Department of Oral and Maxillofacial Surgery, Hyogo Prefectural Awaji Medical Center, Awaji, Japan
| | - Takumi Hasegawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Akira Tachibana
- Department of Oral and Maxillofacial Surgery, Kakogawa Central City Hospital, 439 Hon-machi, Kakogawa-cho, Kakogawa, 675-8611, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Gilardi R, Galassi L, Del Bene M, Firmani G, Parisi P. Infective complications of cosmetic tourism: A systematic literature review. J Plast Reconstr Aesthet Surg 2023; 84:9-29. [PMID: 37320953 DOI: 10.1016/j.bjps.2023.05.021] [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: 10/30/2022] [Revised: 04/16/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cosmetic tourism has increased dramatically over the years. We performed a systematic review of the literature to find reports of infective complications following cosmetic surgery, focusing on epidemiology, clinical, and surgical management. In addition, we identified cosmetic tourism trends in terms of mobilization from the country of origin and travel destinations. METHODS A search on PubMed, Embase, and Web of Science was performed between March and August 2022. The search was not restricted based on study date. Only English manuscripts were assessed. Reviews, short communications, letters, and correspondences were excluded after reviewing their references for potentially relevant studies. Articles related to non-cosmetic surgeries were also excluded from the study. RESULTS We identified 152 articles, of which 31 were duplicates and 47 were excluded based on title/abstract assessment. Three non-English manuscripts, 13 reviews, 12 letters to the editor, and 10 articles that did not feature clinical cases were also rejected. Thirty-six articles were included for analysis. We found 370 patients with infective complications following cosmetic surgery. The severity of complications was stratified according to the Clavien-Dindo classification. Most reports were from the United States (56.5%), followed by Switzerland and the United Kingdom. Travel destinations included the Dominican Republic (34.3%), Turkey, and Colombia. CONCLUSION Infective complications commonly occurred after abdominoplasties in patients who underwent cosmetic surgeries in Latin America or Asia. Most infective complications required management with surgical procedures that involved the administration of local, regional, or general anesthesia. Gluteal augmentations were the fourth most common cosmetic procedures; however, they were associated with the highest number of severe cases, which required intensive care treatment.
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Affiliation(s)
- Roberta Gilardi
- Division of Plastic & Reconstructive Surgery, San Gerardo Hospital of Monza, Italy
| | - Luca Galassi
- Division of Vascular Surgery, San Gerardo Hospital of Monza, Italy
| | - Massimo Del Bene
- Division of Plastic & Reconstructive Surgery, San Gerardo Hospital of Monza, Italy
| | - Guido Firmani
- Faculty of Medicine and Psychology, Sapienza University of Rome - Department of Plastic Surgery Sant'Andrea Hospital, Rome, Italy
| | - Paola Parisi
- Department of Plastic and Regenerative Surgery, San Gallicano Dermatological Institute IRCCS Rome, Italy.
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Haykal S, Hadzimustafic N, Ghazarian D, Musgrave M. Three Ds for diagnosing necrotizing fasciitis by front-line clinicians. J Plast Reconstr Aesthet Surg 2023; 84:37-46. [PMID: 37320950 DOI: 10.1016/j.bjps.2023.05.020] [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: 08/23/2022] [Revised: 04/01/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a life-threatening infection and a surgical emergency. Not all clinicians have the experience or resources to detect NF in its early stages. OBJECTIVE To develop a diagnostic algorithm for primary care and emergency physicians to identify patients with possible NF, including an initial approach to triaging such individuals. METHODS Medline was searched to identify studies of validated algorithms for NF diagnosis and/or cohort or case series providing clinical and diagnostic features of NF. Candidate algorithms were validated via application to 3 published cases of initially misdiagnosed NF. We retrospectively reviewed NF cases between 2011 and 2022 at our center to validate our algorithm. RESULTS The search yielded 540 articles; 109 were included following a review of abstracts. No published validated diagnostic algorithm was identified. Using the reported clinical and diagnostic features of NF, we generated an algorithm of the "3Ds" of NF: Disproportionate pain, Dermatological findings, and Disorganized physiology. A larger number of Ds indicated a greater level of suspicion for NF and prioritization for urgent surgical consultation. In 3 published cases of missed NF, the 3Ds algorithm successfully identified all as having possible NF. On reviewing our cases, we identified 56 patients with NF during an 11 year period. 66% of whom had the 3Ds at their initial presentation. DISCUSSION The 3Ds algorithm, a simple and easy-to-remember tool can be easily applied in a primary or emergency care setting, and may improve the early diagnosis of NF. Retrospective analysis of NF cases allows for validation of this algorithm. However, this algorithm requires prospective validation.
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Affiliation(s)
- Siba Haykal
- Division of Plastic and Reconstructive Surgery, University Health Network, Toronto General Hospital, Department of Surgery, University of Toronto, Canada.
| | | | - Danny Ghazarian
- Department of Pathology, University Health Network, Toronto General Hospital, University of Toronto, Canada
| | - Melinda Musgrave
- Division of Plastic and Reconstructive Surgery, St. Michael's Hospital, Department of Surgery, University of Toronto, Canada
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26
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Lin PH, Lin YH, Chen CC, Lin HC. An uncommon case of necrotizing fasciitis caused by non-O1, non-O139 vibrio cholerae. Asian J Surg 2023; 46:3829-3830. [PMID: 37024373 DOI: 10.1016/j.asjsur.2023.03.126] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 04/07/2023] Open
Affiliation(s)
- Pei-Hsin Lin
- Division of Plastic Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
| | - Yu-Hsien Lin
- Division of Plastic Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
| | - Cha-Chun Chen
- Division of Plastic Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan
| | - Hwang-Chi Lin
- Division of Plastic Surgery, Department of Surgery, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan.
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Othman RE, Allaw F, Kharsa A, Hallit S. Salmonella typhimurium necrotizing fasciitis: a case report. J Med Case Rep 2023; 17:345. [PMID: 37573427 PMCID: PMC10423414 DOI: 10.1186/s13256-023-04090-x] [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: 11/29/2022] [Accepted: 07/20/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis is an aggressive disease that causes necrosis in the muscular fascia and subcutaneous tissues. The infection spreads rapidly along the fascia and perifascial planes, followed by extension of the infection to nearby soft tissues and muscles. Necrotizing fasciitis can be attributed to different pathogens, namely Staphylococcus aureus, group A streptococci, and Clostridium perfringes. Only a few cases of skin and soft tissue infections from Salmonella species have been reported to date. Herein we report a case of Salmonella non-typhi necrotizing fasciitis, an exceedingly rare entity. This case report may serve as a potential management plan in similar cases in light of the scarcity of evidence. CASE PRESENTATION A 20-year-old Caucasian male patient with congenital cardiac anomaly presented with diarrhea and unilateral lower extremity cellulitis causing septic shock. Cultures from blood and the bullae associated with the lower extremity cellulitis grew Salmonella typhimurium. Surgical debridement was performed. Intraoperative tissue cultures were positive for Salmonella typhimurium, and surgical pathology confirmed the diagnosis of necrotizing fasciitis. After a total of 6 weeks of appropriate antimicrobial therapy, another surgical debridement was executed for poor wound healing. New intraoperative cultures grew Fusarium species, and the patient received voriconazole with an adequate response. Immunologic studies showed humoral and cellular immunodeficiency. CONCLUSION It is important to maintain a high index of suspicion for rare entities that can cause skin and soft tissue infections, such as Salmonella non-typhi, in particular in immunosuppressed patients where a delay in diagnosis and management may have significant morbidity and mortality.
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Affiliation(s)
- Radwan El Othman
- Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Fatima Allaw
- Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
- Division of Infectious Diseases, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Antoine Kharsa
- Department of Internal Medicine, American University of Beirut Medical Center (AUBMC), Beirut, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, P.O. Box 446, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
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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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Yu L, Yuan K, Chen L, Lei Y. Management challenges of perianal necrotizing fasciitis complicated by haemophilia A: A clinical case report. Int J Surg Case Rep 2023; 109:108470. [PMID: 37441981 PMCID: PMC10362345 DOI: 10.1016/j.ijscr.2023.108470] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 06/28/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Haemophilia A (HA) is a hereditary X-linked recessive hemorrhagic disorder that results from a deficiency or dysfunction of coagulation factor VIII (FVIII) caused by gene mutations. CASE PRESENTATION This case report presents the challenging management of a 37-year-old man who developed perianal necrotizing fasciitis accompanied by severe infection, necrosis, and septic shock. The patient underwent emergency surgery. However, significant bleeding occurred during and after the surgery. CLINICAL DISCUSSION Despite initial treatment with fresh frozen blood plasma infusion satisfactory efficacy was not achieved. Investigation into the patient's family history revealed a haemophiliac niece, prompting further testing for haemophilia. Ultimately, the patient was diagnosed with haemophilia A. Hemorrhage controlled was obtained through coagulation factor VIII infusion. With subsequent treatment, the patient experienced significant recovery, and normal anal function was restored. CONCLUSION In summary, routine coagulation examination may not effectively evaluate coagulation dysfunction in patients with severe infectious diseases. Comprehensive preoperative evaluations are necessary for acute anorectal surgeries, with emphasis on screening for haemophilia.
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Affiliation(s)
- Lelai Yu
- Department of anorectal, Leshan People's Hospital, Leshan 614000, Sichuan Province, China
| | - Ke Yuan
- Department of anorectal, Leshan People's Hospital, Leshan 614000, Sichuan Province, China
| | - Lina Chen
- Department of anorectal, Leshan People's Hospital, Leshan 614000, Sichuan Province, China
| | - Yinfu Lei
- Department of anorectal, Leshan People's Hospital, Leshan 614000, Sichuan Province, China.
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30
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Li D, Wang Y, Song X. Pneumatosis in cervical fascial space and necrotizing fasciitis of neck. Acta Otolaryngol 2023:1-4. [PMID: 37394773 DOI: 10.1080/00016489.2023.2220369] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
BACKGROUD Pneumatosis in the cervical fascial space is a common imaging manifestation of cervical necrotizing fasciitis. At present, although there are some literature reports on pneumatosis in the cervical necrotizing fasciitis, there are few comparative reports. OBJECTIVE To compare the imaging findings of necrotizing fasciitis of the neck and other cervical space infections, and explore the relationship between pneumatosis in cervical fascial space and necrotizing fasciitis of the neck. METHODS A retrospective study was conducted on 56 cases of cervical fascia space infection in our department from May 2015 to March 2021, including 22 cases of necrotizing fasciitis and 34 cases of non-necrotizing fasciitis. 22 cases underwent incision, debridement and catheter drainage in the necrotizing fasciitis group. 26 cases underwent incision, debridement and catheter drainage, and 8 cases underwent ultrasound-guided puncture biopsy and catheter drainage in the non-necrotizing fasciitis group. All cases were confirmed by operation or pathological biopsy and took purulent secretions for bacterial culture and drug sensitivity test during or after operation. All cases were examined by neck CT or MRI before operation. The previous history of surgical incision or puncture and the rupture of cervical space infection were excluded. RESULTS In 22 cases of necrotizing fasciitis, there were 19 cases had air accumulation in the fascial space (86.4%); In 34 cases of non necrotizing fasciitis, 2 cases had air accumulation in the fascial space (5.9%).There was significant difference between the two groups (χ2 = 36.9141, p < .01). Bacterial culture results were positive in 18 (81.8%) patients in the necrotizing fasciitis group. In the non necrotizing fasciitis group, 12 (35.3%) patients had positive bacterial culture results. There was significant difference in the positive rate of bacterial culture between the two groups (χ2 = 11.6239, p < .01). Except one death in necrotizing fasciitis group, all other patients were cured. There was no recurrence after follow-up for 3-6 months. CONCLUSIONS AND SIGNIFICANCE The pneumatosis of necrotizing fasciitis in the neck is dramatically more than that of other infectious diseases.It is suggested that pneumatosis in cervical fascial space is of great significance in the diagnosis of cervical necrosis, the gas production of bacteria may be closely related to the pathogenesis and development of necrotizing fasciitis of the neck, and early measures to block the generation and dissemination of gas is of great significance for treatment.
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Affiliation(s)
- Dajian Li
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, China
| | - Yan Wang
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, China
| | - Xicheng Song
- Department of Otorhinolaryngology, Head and Neck Surgery, Yantai Yuhuangding Hospital, Qingdao University, Yantai, China
- Shandong Provincial Clinical Research Center for Otorhinolaryngologic Diseases, Yantai, China
- Yantai Key Laboratory of Otorhinolaryngologic Diseases, Yantai, China
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BISSA H, AMANA E, AMEGBLE KDJ, REOULEMBAYE DJIM H, FOMA W. [Necrotizing fasciitis of the posterior neck. A rare clinical form of head and neck cellulitis: a case report from Togo]. Med Trop Sante Int 2023; 3:mtsi.v3i2.2023.303. [PMID: 37525679 PMCID: PMC10387305 DOI: 10.48327/mtsi.v3i2.2023.303] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/08/2023] [Indexed: 08/02/2023]
Abstract
We report the case of a 75-year-old diabetic patient who presented with posterior cervical necrotizing fasciitis complicating cellulitis. Medical management in intensive care and surgical drainage were undertaken; sequential excision of the necrotic tissue left a large loss of substance of the nuchal region for which we opted for directed healing in the first instance. The definitive coverage of this loss of substance by locoregional rotation flap or by thin skin grafting was discussed. However, it was refused by the patient.
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Affiliation(s)
- Haréfétéguéna BISSA
- Service de chirurgie maxillo-faciale, Centre hospitalier universitaire d'Aneho, Togo
| | - Essobiziou AMANA
- Service d'oto-rhino-laryngologie et chirurgie maxillo-faciale, Centre hospitalier universitaire Sylvanus Olympio de Lomé, Togo
| | - Koffi Dzidzo Jude AMEGBLE
- Service des brûlés, des plaies et de la cicatrisation, Centre hospitalier universitaire Sylvanus Olympio de Lomé, Togo
| | - Hervey REOULEMBAYE DJIM
- Service d'oto-rhino-laryngologie et chirurgie maxillo-faciale, Centre hospitalier universitaire Sylvanus Olympio de Lomé, Togo
| | - Winga FOMA
- Service d'oto-rhino-laryngologie et chirurgie maxillo-faciale, Centre hospitalier universitaire Sylvanus Olympio de Lomé, Togo
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Miyazaki H, Takahashi Y, Kuruma T, Someda SK, Kakizaki H. Treatment strategies for orbital gas-producing necrotizing fasciitis secondary to odontogenic maxillary sinusitis: Technical notes. J Stomatol Oral Maxillofac Surg 2023:101544. [PMID: 37392845 DOI: 10.1016/j.jormas.2023.101544] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 06/15/2023] [Accepted: 06/27/2023] [Indexed: 07/03/2023]
Abstract
This paper presents treatment strategies for orbital necrotizing fasciitis (NF) in a case of a 33-year-old male diagnosed with orbital NF, which developed after dental root canal treatment. Although orbital NF is rare, it is rapidly progressive and can easily lead to the loss of tissue and visual function, sometimes to a life-threatening extent. Prompt and adequate treatment has been a challenge yet remains quite essential. In addition to the conventional approach to NF, such as immediate antibiotic administration and drainage, orbital NF patients like this case were often treated by incorporating additional steps, which include: 1) performing minimally invasive but adequate removal of necrotic tissue through intraoperative use of ultrasound equipment and postoperative use of proteolytic enzyme-containing ointment for chemical debridement; 2) managing intraorbital pressure by lateral cantholysis and orbital floor removal (decompression); and 3) maintaining the aerobic conditions of the wound after surgical drainage via orbital wall removal. Thus far, satisfactory results in patients with extensive NF of the orbit, including the presented case, were achieved with regards to preserving periorbital tissues, vision, and ocular motility through a multidisciplinary approach. These should be considered as optional means of preserving the orbital tissue and visual function.
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Affiliation(s)
- Hidetaka Miyazaki
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
| | - Yasuhiro Takahashi
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Tessei Kuruma
- Department of Otolaryngology and Head and Neck Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Steffani Krista Someda
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
| | - Hirohiko Kakizaki
- Department of Oculoplastic, Orbital and Lacrimal Surgery, Aichi Medical University Hospital, Nagakute, Aichi, Japan
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Okamoto M, Tsuruno Y, Fukuzawa H. Neonatal necrotizing fasciitis with gas gangrene due to peripherally inserted central catheter-related infection. Surg Case Rep 2023; 9:105. [PMID: 37314669 DOI: 10.1186/s40792-023-01690-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 06/07/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Necrotizing fasciitis in neonates is a rare and life-threatening infection involving necrosis of the skin, subcutaneous tissues, deep fascia, and sometimes underlying muscles, with a fulminant course and high mortality rate. Necrotizing fasciitis with gas gangrene related to infection of a peripherally inserted central catheter is very rare. CASE PRESENTATION The patient was a full-term female neonate born by vaginal delivery. Following diagnosis of patent ductus arteriosus, indomethacin was administered from a peripherally inserted central catheter for 3 days. Four days after the termination of medical treatment for the patent ductus arteriosus, the patient developed fever and a severely elevated inflammatory response was identified from blood testing. Around the right anterior chest wall, corresponding to the site of the catheter tip, redness was increased and gas crepitus was felt under the skin. Computed tomography revealed emphysema in the anterior chest, in subcutaneous areas and between muscles. Emergency surgical debridement was performed under a diagnosis of necrotizing fasciitis with gas gangrene. With antibiotic treatment, we started to fill the wound with a dialkyl carbamoyl chloride-coated dressing and povidone-iodine sugar ointment after washing with saline once a day. The patient survived and after 3 weeks of treatment with the dressing, the wound had successfully resolved without motor impairments. CONCLUSIONS In addition to medical treatment and prompt surgical debridement, we used dialkyl carbamoyl chloride-coated dressing and povidone-iodine sugar ointment for antiseptic dressings and successfully treated neonatal necrotizing fasciitis with gas gangrene caused by peripherally inserted central catheter infection with Citrobacter koseri.
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Affiliation(s)
- Mitsumasa Okamoto
- Department of Pediatric Surgery, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan.
| | - Yudai Tsuruno
- Department of Pediatric Surgery, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
| | - Hiroaki Fukuzawa
- Department of Pediatric Surgery, Himeji Red Cross Hospital, 1-12-1, Shimoteno, Himeji, Hyogo, 670-8540, Japan
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Tramallino J, Wojda A, Farhat H, Muhadri A. The Subacute Necrotizing Fasciitis: The Forgotten form of this Life-threatening Infection. A Case Report. J Orthop Case Rep 2023; 13:94-98. [PMID: 37398527 PMCID: PMC10308974 DOI: 10.13107/jocr.2023.v13.i06.3710] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/26/2023] [Indexed: 07/04/2023] Open
Abstract
Introduction Necrotizing fasciitis (NF) is a life-threatening soft-tissue infection. While the fulminate form is well documented, the subacute NF is rarely reported. Failure to consider NF as a diagnosis during this indolent presentation can be detrimental to patients because the surgical aggressive debridement remains the key of the treatment. Case Report We report a case of a 54-year-old man who developed a subacute NF. After an initial diagnosis of cellulitis, the patient failed to show improvement with antibiotic treatment; he was referred to our institution in view to benefit of a surgical management. The patient developed progressive systemic toxic symptoms and an emergency debridement was made 10 h after his admission. Our patient achieves to show improvement with antibiotic treatment, vacuum-assisted closure therapy, hyperbaric oxygen therapy, and reconstructive surgery. Complete recovery was observed after 2 months. Conclusion NF is a surgical emergency. Early diagnosis is essential, it is often ambiguous and commonly misdiagnosed including the subacute form. There needs to be a high suspicion for NF even in patients presenting with cellulitis without systemic symptoms.
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Affiliation(s)
- Jorge Tramallino
- Department of Orthopaedics and Traumatology, University Hospital of Charleroi, Charleroi, Belgium
| | - Adelaide Wojda
- Department of Orthopaedics and Traumatology, University Hospital of Charleroi, Charleroi, Belgium
| | - Houssein Farhat
- Department of Orthopaedics and Traumatology, University Hospital of Charleroi, Charleroi, Belgium
| | - Atdhe Muhadri
- Department of Orthopaedics and Traumatology, University Hospital of Charleroi, Charleroi, Belgium
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Fakhar M, Alian S, Zakariaei A, Nourzad F, Zakariaei Z. Massive dermal ulcerative lesions because of brown recluse spider bite: a rare case report and review of literature. J Surg Case Rep 2023; 2023:rjad357. [PMID: 37360745 PMCID: PMC10284676 DOI: 10.1093/jscr/rjad357] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
A brown recluse spider (BRS) bite is challenging to confirm, but can be clinically diagnosed by considering the location, the season of the year and the clinical manifestations. We described a 26-year-old male who presented after a BRS bite with a skin lesion, bruising, severe swelling and diffuse blisters on the right lower extremity after 3 days. This case should be considered in the differential diagnosis of necrotizing fasciitis. Although spider bite poisoning is rare, proper diagnosis and management are important because, in some cases, it can have devastating outcomes.
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Affiliation(s)
- Mahdi Fakhar
- Iranian National Registry Center for Lophomoniasis and Toxoplasmosis, Mazandaran University of Medical Sciences, Sari, Iran
| | - Shahriar Alian
- Antimicrobial Resistance Research Center, Department of Infectious Diseases, Mazandaran University of Medical Sciences, Sari, Iran
| | - Ashkan Zakariaei
- Student Research Committee, Babol Branch, Islamic Azad University, Babol, Iran
| | - Fatemeh Nourzad
- Toxicology Ward, Qaemshahr Razi Hospital, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zakaria Zakariaei
- Correspondence address. Toxicology and Forensic Medicine Division, Mazandaran Registry Center for Opioids Poisoning, Antimicrobial Resistance Research Center, Imam Khomeini Hospital, Mazandaran University of Medical Sciences, PO Box 48166-33131, Sari, Iran. Tel/Fax: 981133357916; E-mail:
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Bayileyegn N, Mengiste DT. Necrotizing fasciitis of the chest wall caused by empyema necessitans following tuberculosis: Case report and literature review. Int J Surg Case Rep 2023; 106:108300. [PMID: 37150161 DOI: 10.1016/j.ijscr.2023.108300] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/26/2023] [Accepted: 04/28/2023] [Indexed: 05/09/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Empyema is a serious complication characterized by pus and bacteria in the pleural space which may progress to necrosis, cavitation, or fistulas in the thoracic cavity. Infection and trauma are the commonest causes in the developed countries while tuberculosis is the commonest cause of empyema in developing countries. Empyema necessitans is a rare complication of pleural space infections. CASE PRESENTATION A 50 years old male patient presented to our hospital with right side chest pain and shortness of breath of 3-week duration. He had completed treatment of pulmonary tuberculosis 6 months ago. The patient was apparently healthy for the last six months after the treatment. The patient was acutely sick looking and has tachycardia with pulse rate of 115, respiratory rate was 36 and arterial oxygen saturation of 80 % with atmospheric air but becomes 96 % with facemask humidified oxygen. Tube thoracostomy and chest wall debridement was done for empyema necessitans with chest wall necrotizing fasciitis. CLINICAL DISCUSSION Empyematous collection with time may lead to a more complicated scenario called empyema necessitans. Empyema necessitans is the dissection of puss thru the pleural space and collection in the torso/ free rupture with or without collection of air. The most common cause of empyema globally is untreated parapneumonic effusion. Tuberculosis constitutes for most of the cases of empyema necessitans in third world countries. Debridement and wound care are monumental for the management of necrotizing fasciitis in addition to broad spectrum antibiotics. CONCLUSION Timely treatment/drug adherence to pneumonia and tuberculosis decreases the rate of having empyema and subsequent complication. Chest wall necrotizing fasciitis is extremely rare and judicious management with debridement and wound care is appropriate whenever it happens. Broad spectrum antibiotics with drainage are the norm of management of empyema/empyema necessitans.
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Affiliation(s)
- Nebiyou Bayileyegn
- Department of Surgery, Jimma University Medical Center, Jimma, Ethiopia.
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Satheakeerthy S, Tang H, Arafat Y, Udayasiri D, Yeung JM. Perineal necrotizing soft tissue infection secondary to rectal perforation from a large fish bone -a painful lesion not to be missed. Radiol Case Rep 2023; 18:2011-2013. [PMID: 37006838 PMCID: PMC10060143 DOI: 10.1016/j.radcr.2023.03.011] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 04/04/2023] Open
Abstract
Necrotizing soft tissue infection caused by a large 70 mm fish bone that led to a single perforation of the rectum is an incredibly rare phenomenon. We report a case of an adult male in his 50s who presented with perianal pain. A prompt computed tomography (CT) scan revealed a foreign body had perforated through the rectum into the retrorectal space with associated gas locules, indicating a necrotizing infection. In addition, our case report explores the principles of wide exploration and debridement, the role of a defunctioning colostomy in perineal wound management, and principles of wound closure in the context of a foreign body causing significant perineal sepsis.
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Affiliation(s)
- Shriranshini Satheakeerthy
- Department of General Surgery, Western Health, Footscray Hospital, 160 Gordon St, Footscray, VIC 3011, Australia
| | - Howard Tang
- Department of General Surgery, Western Health, Footscray Hospital, 160 Gordon St, Footscray, VIC 3011, Australia
| | - Yasser Arafat
- Department of Colorectal Surgery, Western Health, Footscray Hospital, 160 Gordon St, Footscray, VIC 3011, Australia
- University of Melbourne, Victoria, Australia
| | - Dilshan Udayasiri
- Department of Colorectal Surgery, Western Health, Footscray Hospital, 160 Gordon St, Footscray, VIC 3011, Australia
- University of Melbourne, Victoria, Australia
| | - Justin Mc Yeung
- Department of Colorectal Surgery, Western Health, Footscray Hospital, 160 Gordon St, Footscray, VIC 3011, Australia
- Department of Surgery, Western Precinct, University of Melbourne, Victoria, Australia
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Takagi M, Kobayashi T, Fukushima A, Moody S, Yoshida A. A case of left leg necrotizing fasciitis caused by streptococcus pyogenes in a healthy Japanese man. IDCases 2023; 32:e01775. [PMID: 37324237 PMCID: PMC10267757 DOI: 10.1016/j.idcr.2023.e01775] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/25/2023] [Indexed: 06/17/2023] Open
Abstract
•We experienced a case of necrotizing fasciitis (NF) due to Group A streptococcus in a healthy Japanese man.•Cutaneous manifestations with NF can be initially minimal.•It is important to recognize that one of the characteristic symptoms of NF is severe pain out of proportion.•When NF is suspect, emergent surgical exploration and debridement are required.
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Affiliation(s)
- Miyu Takagi
- Department of General Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Takaaki Kobayashi
- Division of Infectious Diseases, University of Iowa, Iowa City, IA, USA
| | - Akina Fukushima
- Department of General Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
| | - Sandra Moody
- Department of Medicine, Divisions of Hospital Medicine & Geriatrics, University of California, San Francisco, USA
| | - Akihito Yoshida
- Department of General Internal Medicine, Kameda Medical Center, Kamogawa, Chiba, Japan
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Zhang CS, Chicoine N, Thede K, Frink I, Singh K, Bochan M. A case report of necrotizing fasciitis caused by Haemophilus influenzae co-infection in the setting of COVID-19 pneumonia. Int J Surg Case Rep 2023; 106:108264. [PMID: 37119748 PMCID: PMC10131800 DOI: 10.1016/j.ijscr.2023.108264] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/19/2023] [Accepted: 04/22/2023] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Necrotizing fasciitis is an aggressive skin and soft tissue infection that is a surgical emergency, and Haemophilus influenzae (H. flu) is a rare cause. We present a case of H. flu co-infection causing necrotizing fasciitis in the setting of COVID-19 pneumonia. CASE PRESENTATION A 56-year-old male presented with 2 weeks of upper respiratory symptoms. He was unvaccinated against COVID-19 and tested positive for COVID-19 five days prior. He developed respiratory failure requiring intubation, and was treated with dexamethasone, remdesivir, and tocilizumab for COVID-19 pneumonia. On hospital day 2, he was hypotensive with new rapidly evolving erythematous lesions with crepitus of his lower extremities suspicious for necrotizing fasciitis. He underwent wide excision and debridement with significant hemodynamic improvements. H. flu co-infection was identified from blood cultures. Aberrant cells with 94 % lymphocytes were noted and suggested chronic lymphocytic leukemia (CLL) that was not previously known. He developed progressive lesions globally, concerning for purpura fulminans with clinical disseminated intravascular coagulation and neurological decline ultimately leading to withdrawal of care. CLINICAL DISCUSSION COVID-19 infection is often associated with concomitant opportunistic infections. Our patient was also immunocompromised by CLL, diabetes, chronic steroids, and initial appropriate COVID-19 treatments. Despite appropriate treatments, he could not overcome his medical comorbidities and multiple infections. CONCLUSION Necrotizing fasciitis caused by H. flu is rare, and we present the first case as a co-infection in the setting of COVID-19 pneumonia. Due to the patient's immunocompromised state with underlying CLL, this proved to be fatal.
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Affiliation(s)
- Crystal Siyu Zhang
- Ascension St. Vincent Hospital, 2001 W. 86th St, Indianapolis, IN 46260, United States of America.
| | - Nicole Chicoine
- Ascension St. Vincent Hospital, 2001 W. 86th St, Indianapolis, IN 46260, United States of America.
| | - Katrina Thede
- Ascension St. Vincent Hospital, 2001 W. 86th St, Indianapolis, IN 46260, United States of America.
| | - Ian Frink
- Ascension St. Vincent Hospital, 2001 W. 86th St, Indianapolis, IN 46260, United States of America.
| | - Kirpal Singh
- Ascension St. Vincent Hospital, 2001 W. 86th St, Indianapolis, IN 46260, United States of America.
| | - Markian Bochan
- Ascension St. Vincent Hospital, 2001 W. 86th St, Indianapolis, IN 46260, United States of America.
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Cheng NC, Cheng Y, Tai HC, Chien KL, Wang SH, Chen YH, Fang CT, Hsueh PR. High Mortality Risk of Type III Monomicrobial Gram-Negative Necrotizing Fasciitis: the Role of Extraintestinal Pathogenic Escherichia coli (ExPEC) and Klebsiella pneumoniae. Int J Infect Dis 2023; 132:64-71. [PMID: 37059297 DOI: 10.1016/j.ijid.2023.04.390] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/02/2023] [Accepted: 04/08/2023] [Indexed: 04/16/2023] Open
Abstract
OBJECTIVES The aim of this study was to investigate the prognostic value of reclassified new type III monomicrobial gram-negative necrotizing fasciitis (NF) and the microbial factors associated with an increased risk of mortality. METHODS This study included 235 NF cases treated at National Taiwan University Hospital. We compared the mortality risk of NF caused by different causal microorganisms and examined the bacterial virulence genes profile and antimicrobial susceptibility pattern associated with an increase in mortality risk. RESULTS Type III NF (n=68) had a mortality risk 2-fold higher than type I (polymicrobial, n=64) or type II (monomicrobial gram-positive, n=79) NF (42.6% vs. 23.4% or 19.0%, P= 0.019 and 0.002, respectively). Mortality differed by causal microorganism (Escherichia coli [61.5%], Klebsiella pneumoniae [40.0%], Aeromonas hydrophila [37.5%], Vibrio vulnificus [25.0%], polymicrobial [23.4%], group A streptococci [16.7%], and Staphylococcus aureus [16.2%], in decreasing rank, P < 0.001). Type III NF caused by E. coli, identified as extra-intestinal pathogenic E. coli (ExPEC) via virulence gene analyses, was associated with a particularly high mortality risk (adjusted odds ratio: 6.51, P = 0.003) after adjusting for age and comorbidities. Some (38.5%/7.7%) of the E. coli strains were non-susceptible to third/fourth-generation cephalosporins but remained susceptible to carbapenems. CONCLUSION Type III NF, especially cases caused by E. coli or K. pneumoniae, are associated with a comparatively high mortality risk than type I or type II NF. Wound gram stain-based rapid diagnosis of type III NF may inform empirical antimicrobial therapy to include a carbapenem.
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Affiliation(s)
- Nai-Chen Cheng
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yin Cheng
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hao-Chih Tai
- Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kuo-Liong Chien
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Szu-Hui Wang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yi-Hsuan Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Centers for Disease Control, Taipei, Taiwan
| | - Chi-Tai Fang
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
| | - Po-Ren Hsueh
- Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan; Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
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Huang C, Zhong Y, Yue C, He B, Li Y, Li J. The effect of hyperbaric oxygen therapy on the clinical outcomes of necrotizing soft tissue infections: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:23. [PMID: 36966323 PMCID: PMC10040118 DOI: 10.1186/s13017-023-00490-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/15/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND To determine the efficacy of hyperbaric oxygen therapy (HBO) in the treatment of necrotizing soft tissue infections (NSTI), we conducted a meta-analysis of the available evidence. METHODS Data sources were PubMed, Embase, Web of Science, Cochrane Library, and reference lists. The study included observational trials that compared HBO with non-HBO, or standard care. The primary outcome was the mortality rate. Secondary outcomes were the number of debridement, amputation rate and complication rate. Relative risks or standardized mean differences with 95% confidence intervals were calculated for dichotomous and continuous outcomes, respectively. RESULTS A total of retrospective cohort and case-control studies were included, including 49,152 patients, 1448 who received HBO and 47,704 in control. The mortality rate in the HBO group was significantly lower than that in the non-HBO group [RR = 0.522, 95% CI (0.403, 0.677), p < 0.05]. However, the number of debridements performed in the HBO group was higher than in the non-HBO group [SMD = 0.611, 95% CI (0.012, 1.211), p < 0.05]. There was no significant difference in amputation rates between the two groups [RR = 0.836, 95% CI (0.619, 1.129), p > 0.05]. In terms of complications, the incidence of MODS was lower in the HBO group than in the non-HBO group [RR = 0.205, 95% CI (0.164, 0.256), p < 0.05]. There was no significant difference in the incidence of other complications, such as sepsis, shock, myocardial infarction, pulmonary embolism, and pneumonia, between the two groups (p > 0.05). CONCLUSION The current evidence suggests that the use of HBO in the treatment of NSTI can significantly reduce the mortality rates and the incidence rates of complications. However, due to the retrospective nature of the studies, the evidence is weak, and further research is needed to establish its efficacy. It is also important to note that HBO is not available in all hospitals, and its use should be carefully considered based on the patient's individual circumstances. Additionally, it is still worthwhile to stress the significance of promptly evaluating surgical risks to prevent missing the optimal treatment time.
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Affiliation(s)
- Chengzi Huang
- Department of Anorectum, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yilian Zhong
- Department of Anorectum, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Chaochi Yue
- Department of Anorectum, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Bin He
- Department of Anorectum, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yaling Li
- Department of Pharmacy, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
| | - Jun Li
- Department of Anorectum, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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42
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Espeillac C, Charles T, Donatini G, David R, Bertheuil N, Leclère FM. [Outcome, quality of life and functional assessment after perineal and external genitalia gangrene]. Prog Urol 2023:S1166-7087(23)00063-5. [PMID: 36935331 DOI: 10.1016/j.purol.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 12/22/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023]
Abstract
INTRODUCTION External genitalia gangrene is a well-known uncommon disease; however, mortality remains important. Recent literature focuses on early management. The object of this study was to assess quality of life and disease-specific function, in the medium- and long-term. METHOD We evaluated retrospectively adult inpatients with external genitalia gangrene who had a surgical debridement between 2010 and 2020 at CHU de Poitiers. Preoperatory FGSI Score was calculated for patients included. In a second phase, surviving patients at 2020 who had agreed to take part in the follow-up were assessed by clinical examination, and asked to complete Short-Form 36 test and two additional disease-specific questionnaire (USP, IIEF5). RESULTS The patients consisted of 33 men. Mean age was 61.18. Eleven patients (33%) died primarily from external genitalia gangrene. Median FGSI score was 6 (1-13). We were able to reach 11 patients (33%) for secondary clinical revaluation. Time before revaluation was 3months to 8years. All parts of SF-36 were significantly low. Mean USP score was 1.27±2.68/4.54±4.43/0.72±1.84. Nine patients (81%) suffered erectile dysfunction without any sexual intercourse possible. CONCLUSION Patients with external genitalia gangrene experience severe deterioration of their quality of life. Multidisciplinary healthcare process should systematically be carried out, as so as early screening of vulnerability risks factors, to improve functional outcomes and quality of life.
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Rath E, Palma Medina LM, Jahagirdar S, Mosevoll KA, Damås JK, Madsen MB, Svensson M, Hyldegaard O, Martins Dos Santos VAP, Saccenti E, Norrby-Teglund A, Skrede S, Bruun T. Systemic immune activation profiles in streptococcal necrotizing soft tissue infections: A prospective multicenter study. Clin Immunol 2023; 249:109276. [PMID: 36871764 DOI: 10.1016/j.clim.2023.109276] [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: 12/07/2022] [Revised: 02/05/2023] [Accepted: 02/28/2023] [Indexed: 03/07/2023]
Abstract
OBJECTIVE Early stages with streptococcal necrotizing soft tissue infections (NSTIs) are often difficult to discern from cellulitis. Increased insight into inflammatory responses in streptococcal disease may guide correct interventions and discovery of novel diagnostic targets. METHODS Plasma levels of 37 mediators, leucocytes and CRP from 102 patients with β-hemolytic streptococcal NSTI derived from a prospective Scandinavian multicentre study were compared to those of 23 cases of streptococcal cellulitis. Hierarchical cluster analyses were also performed. RESULTS Differences in mediator levels between NSTI and cellulitis cases were revealed, in particular for IL-1β, TNFα and CXCL8 (AUC >0.90). Across streptococcal NSTI etiologies, eight biomarkers separated cases with septic shock from those without, and four mediators predicted a severe outcome. CONCLUSION Several inflammatory mediators and wider profiles were identified as potential biomarkers of NSTI. Associations of biomarker levels to type of infection and outcomes may be utilized to improve patient care and outcomes.
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Affiliation(s)
- Eivind Rath
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.
| | - Laura M Palma Medina
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Huddinge, Sweden
| | - Sanjeevan Jahagirdar
- Laboratory of Systems and Synthetic Biology, Wageningen University & Research, Wageningen, the Netherlands
| | - Knut A Mosevoll
- Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Norway
| | - Jan K Damås
- Department of Infectious Diseases, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Centre of Molecular Inflammation Research, Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Martin B Madsen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Mattias Svensson
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Huddinge, Sweden
| | - Ole Hyldegaard
- Department of Anaesthesia- and Surgery, Head and Orthopaedic centre, Hyperbaric Unit, Copenhagen University Hospital, Rigshospitalet, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Vitor A P Martins Dos Santos
- Laboratory of Systems and Synthetic Biology, Wageningen University & Research, Wageningen, the Netherlands; LifeGlimmer GmbH, Berlin, Germany
| | - Edoardo Saccenti
- Laboratory of Systems and Synthetic Biology, Wageningen University & Research, Wageningen, the Netherlands
| | - Anna Norrby-Teglund
- Center for Infectious Medicine, Department of Medicine Huddinge, Karolinska Institutet, Huddinge, Sweden
| | - Steinar Skrede
- Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Norway
| | - Trond Bruun
- Department of Medicine, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Norway
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R K, Tandup C, Reddy D, Jayant D, Naik K, Sahu S, Thakur V, Khare S, Sakaray Y, Irrinki S, Kaman L. Prospective Validation and Comparison of Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) and Site Other Than Lower Limb, Immunosuppression, Age, Renal Impairment, and Inflammatory Markers (SIARI) Scoring Systems for Necrotizing Fasciitis. J Surg Res 2023; 283:719-725. [PMID: 36462382 DOI: 10.1016/j.jss.2022.11.001] [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: 04/23/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 12/03/2022]
Abstract
INTRODUCTION Necrotizing fasciitis (NF) is a rapidly progressing infection of the soft tissues associated with high morbidity and mortality and hence it is a surgical emergency. Early diagnosis and treatment are of paramount importance. LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) and SIARI (Site other than lower limb, Immunosuppression, Age, Renal impairment, and Inflammatory markers) scoring systems have been established for early and accurate diagnosis of necrotizing fasciitis. This study compared the two scoring systems for diagnosing NF, predicting management, and elucidating the prognostic performance for re-operation and mortality. METHODS This prospective study was conducted in PGIMER Chandigarh, India, between February 2020 and June 2021. The study was approved by the Institutional Review Board (No. INT/IEC/2020-90). The clinical presentation, laboratory parameters, and imaging were used to classify patients into NF or severe cellulitis groups. We also calculated the LRINEC and SIARI scores. Demographic variables and mortality were recorded. The area under the receiver operating characteristic was used to express the accuracy of both scores at a cut-off LRINEC and SIARI scores of ≥6 and ≥ 4, respectively. RESULTS The study comprised 41 patients with NF and 11 with severe cellulitis. Informed written consent was taken from all the participants. At LRINEC score ≥6, the C-statistic for NF diagnosis was 0.839 (95% confidence interval [CI] 0.682-0.995, P 0.001), which was better than SIARI score at ≥ 4, C-statistic of 0.608 (95% CI 0.43-0.787, P 0.297). Both scores accurately predicted 30-day mortality. The LRINEC score showed a C-statistic of 0.912 (95% CI 0.798-1, P 0.001). Simultaneously, the SIARI score showed 70% sensitivity and 77% specificity, with a C-statistic of 0.805 (0.62-0.99, P = 0.017). CONCLUSIONS LRINEC score is an effective diagnostic tool for distinguishing necrotizing fasciitis from severe cellulitis. Additional research is required to establish the SIARI score's external validity.
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Affiliation(s)
- Karthikk R
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Cherring Tandup
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Dilip Reddy
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Divij Jayant
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Krishna Naik
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Swapnesh Sahu
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vipul Thakur
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Siddhant Khare
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Yashwant Sakaray
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Santosh Irrinki
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Lileswar Kaman
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Zhang S, Xie Y, Wang Y, Jin G, Cui R, Zou Y. Fournier's Gangrene with Growth of Actinomyces europaeus: A Case Report. Infect Dis Ther 2023; 12:1007-1011. [PMID: 36821033 PMCID: PMC10017900 DOI: 10.1007/s40121-023-00781-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Fournier's gangrene (FG) is a rare infectious disease with rapid disease progression and a high mortality rate. We report a case of a 61-year-old female with type 2 diabetes who developed FG caused by Actinomyces europaeus. A. europaeus is associated with abscesses, decubitus ulcers, and purulent urethritis. Although A. europaeus rarely causes FG as the main causative pathogen, we should still be alert to this pathogenic microorganism. To our knowledge, this is the first case report of FG caused by A. europaeus mono-infection, and it adds to the evidence that A. europaeus has the potential to cause necrotizing fasciitis.
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Affiliation(s)
- Shurong Zhang
- Department of Gynecological Oncology, Shandong Provincial Hospital, Shandong University, Jinan, 250000, China
| | - Yunkai Xie
- Department of Gynecological Oncology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yanqiu Wang
- Department of Operating Room, Shandong Provincial Hospital, Jinan, China
| | - Guoyu Jin
- Department of Gynecological Oncology, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Rongtao Cui
- Department of Burns and Plastic Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Yonghui Zou
- Department of Gynecological Oncology, Shandong Provincial Hospital, Shandong University, Jinan, 250000, China.
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Tsai YH, Chen HY, Huang TY, Chen JL, Hsiao CT, Huang KC. Bullous skin signs and laboratory surgical indicators can quickly and effectively differentiate necrotizing fasciitis from cellulitis. Int J Infect Dis 2023; 128:41-50. [PMID: 36521588 DOI: 10.1016/j.ijid.2022.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 12/07/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The purpose of this prospective study was to investigate the different microorganisms associated with mortality, to evaluate the bullous skin sign, and to identify the positive predictive factors for differentiating necrotizing fasciitis (NF) from cellulitis on initial onset at the emergency department. METHODS This prospective study was conducted in 145 consecutive patients with NF and 159 patients with cellulitis. Age, sex, comorbidities, infection site, microbiological results, condition of skin lesions, laboratory findings, vital signs, and clinical outcomes were compared between the two groups at the time of admission to the emergency room. RESULTS A total of 15 patients in the NF group and two patients in the cellulitis group died, resulting in a mortality rate of 10.3% and 1.3%, respectively. The NF group had a significantly higher incidence of white blood cell counts, band form neutrophil, and C-reactive protein than the patients in the cellulitis group. Hemorrhagic bullae presentation appeared to have significantly associated with NF and death. CONCLUSION The following diagnostic indicators can be effectively used to differentiate NF from cellulitis at the initial onset: presence of hemorrhagic bullae, white blood cell counts >11,000 cells/mm3, band forms >0%, C-reactive protein >100 mg/l, and systolic blood pressure ≤90 mm Hg at the time of consultation.
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Marks A, Patel D, Sundaram T, Johnson J, Gottlieb M. Ultrasound for the diagnosis of necrotizing fasciitis: A systematic review of the literature. Am J Emerg Med 2023; 65:31-35. [PMID: 36580698 DOI: 10.1016/j.ajem.2022.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Necrotizing fasciitis (NF) is a deadly disorder that can be challenging to diagnose on history and examination alone. Point-of-care ultrasound (POCUS) is widely available and has been increasingly used for diagnosing skin and soft tissue infections. We performed a systematic review to determine the accuracy of POCUS for diagnosing NF with subgroup analyses of the accuracy of specific POCUS examination components. METHODS PubMed, Scopus, CINAHL, LILACS, the Cochrane databases, Google Scholar, and bibliographies of selected articles were assessed for all retrospective, prospective, and randomized control trials evaluating the accuracy of POCUS for diagnosing NF. Data were dual extracted into a predefined worksheet and quality analysis was performed with the QUADAS-2 tool. Data were summarized and an overall summary was completed. RESULTS We identified three papers (n = 221 patients; 33% NF) that met our inclusion criteria. The overall sensitivity ranged from 85.4%-100% while the specificity ranged from 44.7% to 98.2%. Fluid accumulation along the fascial plane was the most sensitive (85.4%; 95% CI 72.2% - 93.9%), while subcutaneous emphysema was the most specific (100%; 95% CI 92.5% - 100%). CONCLUSIONS POCUS has good sensitivity and specificity for the diagnosis of NF. POCUS should be considered as an adjunct to the initial clinical decision making for the diagnosis of NF.
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Affiliation(s)
- Amy Marks
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.
| | - Daven Patel
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Tina Sundaram
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Jordan Johnson
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
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Suijker J, Stoop M, Meij-de Vries A, Pijpe A, Boekelaar A, Egberts M, Van Loey N. The impact of necrotizing soft tissue infections on the lives of survivors: a qualitative study. Qual Life Res 2023. [PMID: 36840905 DOI: 10.1007/s11136-023-03371-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/26/2023]
Abstract
PURPOSE Necrotizing soft tissue infections (NSTI) are potentially lethal infections marked by local tissue destruction and systemic sepsis, which require aggressive treatment. Survivors often face a long recovery trajectory. This study was initiated to increase understanding of the long-term impact of NSTI on health related quality of life (HRQoL), and how care may be improved. METHODS Thematic analysis was applied to qualitative data from 25 NSTI-survivors obtained through two focus groups (n = 14) and semi-structured interviews (n = 11). RESULTS The median age of the participants was 49 years, 14 were female. The median time since diagnosis was 5 years. Initial misdiagnosis was common, causing delay to treatment. Survivors experienced long-term physical consequences (scarring, cognitive impairment, fatigue, sleeping problems, recurrent infections), psychological consequences (traumatic stress symptoms, fear of relapse, adjusting to an altered appearance, sexual issues) and social and relational consequences (changes in social contacts, a lack of understanding). The disease also had a major psychological impact on family members, as well as major financial impact in some. There was a strong desire to reflect on 'mistakes' in case of initial misdiagnosis. To improve care, patient and family centered care, smooth transitions after discharge, and the availability of understandable information were deemed important. CONCLUSION This study reveals that NSTI have a large impact on physical and psychosocial wellbeing of survivors and their relatives. Except for a few differences (misdiagnosis, fear for re-infection and actual re-infection), the patient experience of patients with NSTI is largely similar to those of burn survivors. Thus, questionnaires to assess HRQoL in burn survivors may be used in future NSTI studies.
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Nyirjesy SC, Judd RT, Alfayez Y, Lancione P, Swendseid B, von Windheim N, Nogan S, Seim NB, VanKoevering KK. Use of 3-dimensional printing at the point-of-care to manage a complex wound in hemifacial necrotizing fasciitis: a case report. 3D Print Med 2023; 9:4. [PMID: 36813875 PMCID: PMC9948423 DOI: 10.1186/s41205-022-00166-4] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/31/2022] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Complex facial wounds can be difficult to stabilize due to proximity of vital structures. We present a case in which a patient-specific wound splint was manufactured using computer assisted design and three-dimensional printing at the point-of-care to allow for wound stabilization in the setting of hemifacial necrotizing fasciitis. We also describe the process and implementation of the United States Food and Drug Administration Expanded Access for Medical Devices Emergency Use mechanism. CASE PRESENTATION A 58-year-old female presented with necrotizing fasciitis of the neck and hemiface. After multiple debridements, she remained critically ill with poor vascularity of tissue in the wound bed and no evidence of healthy granulation tissue and concern for additional breakdown towards the right orbit, mediastinum, and pretracheal soft tissues, precluding tracheostomy placement despite prolonged intubation. A negative pressure wound vacuum was considered for improved healing, but proximity to the eye raised concern for vision loss due to traction injury. As a solution, under the Food and Drug Administration's Expanded Access for Medical Devices Emergency Use mechanism, we designed a three-dimensional printed, patient-specific silicone wound splint from a CT scan, allowing the wound vacuum to be secured to the splint rather than the eyelid. After 5 days of splint-assisted vacuum therapy, the wound bed stabilized with no residual purulence and developed healthy granulation tissue, without injury to the eye or lower lid. With continued vacuum therapy, the wound contracted to allow for safe tracheostomy placement, ventilator liberation, oral intake, and hemifacial reconstruction with a myofascial pectoralis muscle flap and a paramedian forehead flap 1 month later. She was eventually decannulated and at six-month follow-up has excellent wound healing and periorbital function. CONCLUSIONS Patient-specific, three-dimensional printing is an innovative solution that can facilitate safe placement of negative pressure wound therapy adjacent to delicate structures. This report also demonstrates feasibility of point-of-care manufacturing of customized devices for optimizing complex wound management in the head and neck, and describes successful use of the United States Food and Drug Administration's Expanded Access for Medical Devices Emergency Use mechanism.
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Affiliation(s)
- Sarah C. Nyirjesy
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Ryan T. Judd
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Yazen Alfayez
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Peter Lancione
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Brian Swendseid
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Natalia von Windheim
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Stephen Nogan
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Nolan B. Seim
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
| | - Kyle K. VanKoevering
- grid.412332.50000 0001 1545 0811Department of Otolaryngology- Head and Neck Surgery, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center, 915 Olentangy River Road, Columbus, OH 43210 USA
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Anthony N, Douthit NT, Foster A. Actinomyces europaeus as an emerging cause of necrotizing fasciitis. IDCases 2023; 31:e01712. [PMID: 36845908 PMCID: PMC9945764 DOI: 10.1016/j.idcr.2023.e01712] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/06/2023] [Accepted: 02/11/2023] [Indexed: 02/17/2023] Open
Abstract
Necrotizing fasciitis is a type of necrotizing soft tissue infection (NSTI) that can be polymicrobial or monomicrobial in origin. Polymicrobial infections typically involve anaerobes of the Clostridium or Bacteroides family. This case report highlights necrotizing fasciitis caused by an unusual culprit, Actinomyces europaeus, which is a gram-positive anaerobic filamentous bacillus that has only been documented in one prior report to cause NSTI. Currently, about half of the hospitals in the United States are equipped to perform antibiotic susceptibility testing for anaerobes, but less than one-quarter of hospitals actually utilize these tests routinely. Thus, it is common for polymicrobial actinomycoses to be blindly treated with antibiotics that are beta-lactamase resistant and active against anaerobes, such as with piperacillin-tazobactam. Here we examine the potential impact of this lack of testing, as well as the evolution of A. europaeus to cause necrotizing fasciitis.
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Affiliation(s)
- Nathan Anthony
- Edward Via College of Osteopathic Medicine-Auburn Campus in Auburn, AL, 910 S Donahue Dr, Auburn, AL 36832, United States of America,Correspondence to: Edward Via College of Osteopathic Medicine-Auburn Campus, 910 S. Donahue Dr., Auburn, AL 36832, United States of America.
| | - Nathan T. Douthit
- Edward Via College of Osteopathic Medicine-Auburn Campus in Auburn, AL, 910 S Donahue Dr, Auburn, AL 36832, United States of America,East Alabama Medical Center Internal Medicine Residency Core Faculty, 2000 Pepperell Pkwy, Opelika, AL 36801, United States of America
| | - Allen Foster
- East Alabama Medical Center Surgery Department, 2000 Pepperell Pkwy, Opelika, AL 36801, United States of America
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