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Results for “Fasciitis, Necrotizing”

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PubMed1986

Necrotizing fasciitis precipitating diabetic ketoacidotic coma.

Necrotizing fasciitis is a rapidly spreading infection of the subcutaneous tissue and fascia; diabetes mellitus appears to be the most frequent underlying disease. Early diagnosis and immediate aggressive surgical therapy are paramount to curtail morbidity and mortality, but diagnosis is often difficult and unnecessarily delayed. We describe a case of necrotizing fasciitis precipitating diabetic ketoacidotic coma where correct diagnosis was not made until the 14th hospital day. We stress the fact that physicians caring for critically ill patients should be keenly aware of the possibility of necrotizing fasciitis when tending diabetic patients with unexplained fever; failure to recognize the disease can have devastating results. Finally, we believe this to be the first reported case of diabetic ketoacidotic coma precipitated by necrotizing fasciitis.

Adult↗

PubMed2004

Necrotizing fasciitis: a dramatic surgical emergency.

OBJECTIVES: Necrotizing fasciitis is a challenging and potentially lethal disease; early diagnosis is of paramount importance and aggressive multidisciplinary treatment is mandatory. Overall mortality rates of 33-73% have been reported. The aim of this study was to report the experience with necrotizing fasciitis of an emergency surgery department. METHODS: From October 1995 to December 2001 we observed 11 cases of necrotizing fasciitis. The patients were five men and six women, with ages ranging from 33 to 80 years. RESULTS: Triggering aetiological factors were found in eight cases. In all patients a multidisciplinary approach was utilized. Every patient had a daily surgical debridement of the necrotic areas in the operating room. Polyantibiotic therapy was performed, and was changed according to culture results. After surgery, nine patients were submitted to hyperbaric oxygen therapy. Seven deaths (63.6%) were observed: two cases of pulmonary embolism and five cases of septic shock. Four patients survived; three had a complete recovery with progressive healing of the wounds, whereas one patient had severe impairment of the motility of the affected hand. The mean interval between the onset of symptoms and hospital admission was 5.4 days; for patients who ultimately died it was 7.3 days, whereas for patients who ultimately survived it was 2 days (P<0.05); moreover these patients were significantly younger than those who died (P<0.05). CONCLUSION: The treatment for necrotizing fasciitis is a combination of surgical debridement, appropriate antibiotics and optimal oxygenation of the infected tissues. However, the mortality for this disease is quite high, and is related to late diagnosis and advanced age. Necrotizing fasciitis must be considered a true dramatic surgical emergency.

Adult↗

PubMed2001

Necrotizing fasciitis of the chest wall.

Necrotizing fasciitis is a highly morbid soft tissue infection that rarely involves the upper torso. An extremely unusual case of necrotizing fasciitis of the chest wall is reported, including the method by which an open thoracic cage was managed. This represents the second reported case of a patient surviving necrotizing fasciitis of the chest wall requiring rib resection and chest wall reconstruction.

Anti-Bacterial Agents↗

PubMed1998

Magnetic resonance imaging differentiates between necrotizing and non-necrotizing fasciitis of the lower extremity.

BACKGROUND: Distinction between uncomplicated infective fasciitis and early necrotizing fasciitis can be extremely difficult without operation, yet the management and prognosis of both conditions depend greatly on early recognition and assessment of the extent of involvement. STUDY DESIGN: This was a prospective review of the utility of magnetic resonance imaging (MRI) in nine patients with suspected infective or necrotizing fasciitis treated at an academic medical center or a Veterans Administration hospital. RESULTS: Magnetic resonance imaging documented fascial inflammation, characterized by low intensity on T1-weighted images and high intensity on T2-weighted images, in all nine patients. Absence of gadolinium contrast enhancement on T1-weighted images reliably detected fascial necrosis in all six patients who required operative debridement. Magnetic resonance imaging was extremely useful in defining the extent of fasciitis and was more accurate in predicting necrosis or pyomyositis than was myoglobinuria or elevation of serum creatine kinase or lactate dehydrogenase. Operation was avoided in two patients without evidence of necrosis on MRI. One patient without evidence of necrosis, explored because of contradictory clinical findings, was confirmed at operation to have cellulitis without necrosis. CONCLUSIONS: Magnetic resonance imaging with gadolinium contrast accurately determines the presence of necrosis and the need for operation in patients with fasciitis of the lower extremity. Preoperative determination of the extent of involvement facilitates operative planning.

Anti-Infective Agents↗

PubMed2005

Cervical necrotizing fasciitis due to bacterial tonsillitis.

Necrotizing fasciitis is a severe and potentially fatal soft tissue infection, but involvement of the head and neck is rare. We report on 4 cases of cervical necrotizing fasciitis arising from tonsillitis. One patient was diabetic and one had received steroids before disease development. One patient developed acute respiratory failure and died of septic shock. Three patients recovered, helped by early recognition, aggressive surgical intervention, appropriate broad-spectrum antibiotics, and supportive therapy. The common bacteria found in all abscess samples were Streptococcus sp., but mixed flora with anaerobic organisms was seen in all but 1 case. Tonsillitis and peritonsillar abscess must be suspected as a cause of cervical necrotizing fasciitis and a successful result can be achieved with immediate aggressive treatment.

Adult↗

PubMed2006

[Necrotizing fasciitis due to Streptococcus pyogenes].

Necrotizing fasciitis is a severe infection, with systemic involvement and tissue necrosis. The clinical course is rapid and often fatal. Although this entity is uncommon, early recognition and treatment is essential to improve prognosis. Necrotizing fasciitis should be suspected when there are symptoms of toxicity and there is severe pain, frequently out of proportion to the clinical findings. In addition, in the last few years the incidence of invasive disease due to Streptococcus pyogenes in children has increased. Treatment is based on life support, aggressive debridement, and antimicrobial therapy. Intravenous immunoglobulin (IVIG) as adjunctive therapy seems useful and reduces mortality. The case of an infant with necrotizing fasciitis of four extremities is presented.

Fasciitis, Necrotizing↗

PubMed2002

V-Y fasciocutaneous pudendal thigh flap for repair of perineum and genital region after necrotizing fasciitis: modification and new indication.

Necrotizing fasciitis is an aggressive, deep-seated infection of the fascia and subcutaneous fat with necrosis of the overlying skin, and it is a toxin-mediated disease. The aim of this study was to review 13 cases of necrotizing fasciitis of the perineum and the external genitalia region with regard to the diagnosis, treatment, and methods of reconstruction of secondary defects. The study was performed from June 1997 to May 2001 and involved 11 men and 2 women who ranged in age from 35 to 67 years (mean age, 53 years). All patients presented to the plastic surgery unit with huge secondary defects of the urogenital region, upper thigh, and lower abdomen after being excised initially by general surgeons. Eight patients were treated with bilateral flaps, and the unilateral flap was used in 2 patients. The V-Y island fasciocutaneous flap, used to resurface the urogenital region after necrotizing fasciitis, is considered a new indication. The V-Y axial-pattern design of the flap is also considered a new modification, which enabled the flap to be advanced and tailored nicely in the midline. The idea of using the V-Y-plasty design is raised because the perineum has a pair of symmetrical anatomic structures. In addition, this procedure conserves tissue and the flap donor site is closed primarily without tension. Both aesthetic and functional results were satisfactory.

Adult↗

PubMed1998

Streptococcal necrotizing fasciitis complicating a conjunctival dacryocystorhinostomy.

Necrotizing fasciitis is a rare infection of the deep and subcutaneous tissue layers most commonly caused by group A beta-hemolytic Streptococcus. The disease begins as a typical cellulitis. Necrosis of the deeper tissues progresses rapidly, accompanied by a dusky, gray-blue skin discoloration with erythematous margins. Even with appropriate treatment, mortality rates remain as high as 36%. Most cases of necrotizing fasciitis have been reported in the general surgical literature, associated with trauma or as a postoperative wound infection after abdominal and gynecologic procedures. Of the 50 cases involving the eyelids reported in the literature, only three were reported to have occurred as a "postoperative" complication. This report is of the first known case of streptococcal necrotizing fasciitis complicating a conjunctival dacryocystorhinostomy.

Aged↗

PubMed2005

[Face necrotizing fasciitis following spinocellular epithelioma excision].

Necrotizing fasciitis is a bacterial dermo-hypodermitis with superficial aponevrosis necrosis due to Streptococcus pyogenes. Head and neck region are some rare localization of this infection especially after surgery. We report herein a case of a face necrotizing fasciitis following minor face surgery. A 86 year-old Caucasian male without any antecedents, nor treatment, has been operated for a fronthead spinocellular epithelioma under local anesthesia. Twelve hours later, a severe pain localized to the face occurred, with sleeplessness, followed up with a face orbitary oedema and fever. Twenty-four hours later, an intravenous antibiotherapy was therefore started and surgical treatment was performed as soon as the diagnosis of necrotizing fasciitis was considered. An important inflammatory oedema was noticed, associated to a large necrotic softening of the face, the eyelid and the neck sub-cutaneous tissues. Then, the patient has been transferred in intensive care unit because multi-organ failure clinical and biological signs occurred. Pre-operatory bacteriological samples culture identified Streptococcus pyogenes. Repeated surgical explorations and debridement (excision, cleaning, draining and bandages recovery) were performed daily as needed until all the necrotic tissue was all eradicated. The antibiotherapy was prescribed to totalised 15 days. Our report underlines the importance of an early recognition of the diagnosis of soft tissue infection, because early surgical treatment has a better prognosis and antibiotic treatment alone is inefficient for the recovery. Alert is delivered by the local signs quickly followed up by skin changes. Anti-inflammatory therapy must be avoid in case of any soft tissue infection sign: they may increase the lesions, hide alarm signs and delay surgical treatment.

Aged↗

PubMed1996

Monomicrobial necrotizing fasciitis complicating pregnancy and puerperium.

BACKGROUND: Necrotizing fasciitis is an uncommon, rapidly progressive, life-threatening infection involving the subcutaneous tissue and fascia. Usually, it is a synergistic polymicrobic infection that occurs in patients with coexisting factors predisposing them to bacterial inoculation and the spread of infection. CASES: We report a monomicrobial variant of necrotizing fasciitis affecting three otherwise healthy pregnant or postpartum women. The necrotizing fasciitis involved either the lower extremity or the abdominal wall. The causative bacteria were Streptococcus pyogenes (two cases) and Staphylococcus aureus (one). All patients presented with an acute fulminant infection, including one woman who died from overwhelming sepsis. CONCLUSION: These cases raise a question about the possible role of increased bacterial virulence and the immunologic changes of pregnancy as potential predisposing factors in the development of necrotizing fasciitis.

Adult↗

PubMed1998

Risk factors in necrotizing fasciitis: a case involving Cryptococcus neoformans.

Necrotizing fasciitis is a destructive soft tissue infection that is most typically caused by group A streptococci or a combination of facultative and anaerobic bacteria. Patients at risk for the development of necrotizing fasciitis often have compromised immune function or poor tissue perfusion. This report describes a case of necrotizing fasciitis caused by Cryptococcus neoformans, a pathogen not previously associated with this primary destructive soft tissue infection. The process occurred in a patient at risk for the development of opportunistic infection. We briefly review the risk factors for the development of necrotizing fasciitis and the typical bacteriologic findings. Cryptococcal infections and their treatment are described. Despite the uncommon pathogen, the treatment of this patient followed established principles-prompt surgical intervention and systemic antimicrobial therapy tailored to the offending organisms.

Adult↗

PubMed2005

What is subacute necrotizing fasciitis? A proposed clinical diagnostic criteria.

OBJECTIVE: Subacute necrotizing fasciitis is a poorly defined clinical entity. Its very existence has been the subject of much controversy. While rarely reported, subacute forms of necrotizing fasciitis have been documented in the literature by many authors. This paper highlights some recently reported cases in the literature that clearly shows that subacute forms of necrotizing fasciitis indeed exist and may in fact be under-reported because of the lack of awareness and a consistent diagnostic criteria. METHODS: A Medline search was performed with the following keyword; necrotizing fasciitis, subacute, variant and indolent. RESULTS: Majority of reported cases did not give sufficient information to satisfy the reviewer that these cases were indeed subacute forms of necrotizing fasciitis. We identified three cases of subacute necrotizing fasciitis that clearly are subacute cases and analysed their clinical presentation. A diagnostic criterion for defining subacute necrotizing fasciitis was proposed based on these cases and the authors' clinical experiences. CONCLUSION: This proposed diagnostic criterion serves to facilitate future reporting and documentation of this condition. The clinical significance and implication of this are discussed.

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PubMed2002

Exploring the pathogenesis of necrotizing fasciitis due to Streptococcus pneumoniae.

Monobacterial necrotizing fasciitis is a rare form of soft tissue infection usually caused by the group A beta-hemolytic Streptococcus. Soft tissue infection is an uncommon clinical manifestation of invasive disease due to Streptococcus pneumoniae. We describe 3 cases of pneumococcal necrotizing fasciitis and explore potential pathogen-specific mechanisms of pathogenesis. The clinical characteristics of necrotizing fasciitis due to S. pneumoniae and group A beta-hemolytic Streptococcus appear to overlap. The similarities include predominant occurrence in elderly adults with underlying chronic illness, predilection for lower extremity infection, progression to toxic shock-like syndrome and a high case fatality rate. No DNA fragments corresponding to speA, speB or speC were amplified by PCR from the 3 pneumococcal isolates. Western immunoblot revealed no evidence of SpeA, SpeB or SpeC protein expression. Evaluation for protease production and cytotoxicity was unrevealing. The similar clinical presentation of pneumococcal necrotizing fasciitis to the disease caused by the group A beta-hemolytic Streptococcus has important therapeutic implications. The molecular mechanisms underlying the pathogenesis are unclear. Prospective population-based studies are required to define the epidemiology of this infection.

Aged↗

PubMed1998

[Necrotizing fasciitis after laparoscopic cholecystectomy].

Necrotizing fasciitis is a rare and potentially fatal infection of the fascia and subcutaneous tissue. We found only few reports about this disease following laparoscopic surgery. A contamination of the abdominal wall at the trocar position with pathogenic aerobic and anaerobic microorganisms in an "aerosol" is discussed. An increased incidence is associated with risk factors which lead to compromised tissue perfusion and immunosuppression. Early recognition and aggressive surgical management combined with intravenous antibiotics are crucial to a successful outcome. Various aspects of the pathophysiology, diagnosis and therapy of this severe complication following laparoscopic cholecystectomy are discusses.

Adult↗

PubMed1997

Necrotizing fasciitis. The changing spectrum.

Necrotizing fasciitis, by nature of its high inoculum of aggressive bacteria and the depth of the fascial involvement, is one of the most serious infections known to humans. Rapid tissue destruction of skin and fascia, along with bacteremia, is common. The mortality for this disease is much higher than that for cellulitis. Unfortunately, delay in diagnosis occurs commonly. The emergence of toxic shock strains of Streptococcus leading to fasciitis with organ dysfunction makes it necessary to make a rapid diagnosis and institute early antibiotic and surgical interventions.

Adult↗

PubMed1996

Necrotizing fasciitis: a nursing perspective.

Necrotizing fasciitis (NF) has been around for many years but recent media attention has brought attention to this potentially fatal disease. This paper examines the most recent descriptions of NF, and describes initial as well as advanced stages of the infection. Treatment of NF is widely agreed upon by physicians in that broad spectrum antibiotics and immediate debridement are crucial to patient outcome. Recent thoughts as to immune system response are briefly explored. The client presented is an extremely unusual case where spontaneous remission occurred after 4 days, and so gives rise to the potential immune system theory.

Anti-Bacterial Agents↗

PubMed2006

Necrotizing fasciitis: a deadly infection.

Necrotizing fasciitis (NF) is a life-threatening condition, consisting of a soft-tissue infection with rapidly progressive, widespread fascial necrosis. NF may be caused by a wide variety of microbes. Indeed, NF may be an infection of one species of bacteria or may be polymicrobial. Prompt diagnosis and treatment are essential. Surgical debridement and antibiotic therapy are the primary treatment options.

Anti-Bacterial Agents↗

PubMed1999

Systemic lupus erythematosus complicated by necrotizing fasciitis.

A case of necrotizing fasciitis (NF) is described in a 46-year-old woman with recent onset systemic lupus erythematosus (SLE). Deep-tissue infections are more common in SLE patients on high-dose corticosteroids, but, to our knowledge, this is the second case described in association with SLE. Although NF may initially be difficult to diagnose, the presence of marked systemic symptoms out of proportion to the local findings should suggest the correct diagnosis. NF diagnostic criteria, treatment and prognosis are discussed.

Fasciitis, Necrotizing↗