Cases reported "Fasciitis, Necrotizing"

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1/66. Neonatal necrotizing fasciitis: a report of three cases and review of the literature.

    OBJECTIVE: Necrotizing fasciitis (NF) is a predominantly adult disorder, with bacterial infection of the soft tissue. In children, it is relatively rare and has a fulminant course with a high mortality rate. In the neonate, most cases of NF are attributable to secondary infection of omphalitis, balanitis, mammitis, postoperative complications, and fetal monitoring. The objective of this communication is to report 3 cases of neonatal NF and provide a literature review of this disorder. RESULTS: This review yielded 66 cases of neonatal NF. Only 3 cases were premature. There was no sex predilection and the condition rarely recurred. Several underlying conditions were identified that might have contributed to the development of neonatal NF. These included omphalitis in 47, mammitis in 5, balanitis in 4, fetal scalp monitoring in 2, necrotizing enterocolitis, immunodeficiency, bullous impetigo, and maternal mastitis in 1 patient each. The most common site of the initial involvement was the abdominal wall (n = 53), followed by the thorax (n = 7), back (n = 2), scalp (n = 2), and extremity (n = 2). The initial skin presentation ranged from minimal rash to erythema, edema, induration or cellulitis. The lesions subsequently spread rapidly. The overlying skin might later develop a violaceous discoloration, peau d'orange appearance, bullae, or necrosis. Crepitus was uncommon. Fever and tachycardia were frequent but not uniformly present. The leukocyte count of the peripheral blood was usually elevated with a shift to the left. thrombocytopenia was noted in half of the cases. hypocalcemia was rarely reported. Of the 53 wound cultures available for bacteriologic evaluation, 39 were polymicrobial, 13 were monomicrobial, and 1 was sterile. blood culture was positive in only 20 cases (50%). Treatment modalities included the use of antibiotics, supportive care, surgical debridement, and drainage of the affected fascial planes. Two of the 6 cases who received hyperbaric oxygen therapy died. The overall mortality rate was 59% (39/66). In 12 cases, skin grafting was required because of poor granulation formation or large postoperative skin defects among the survivors. CONCLUSION: Neonatal NF is an uncommon but often fatal bacterial infection of the skin, subcutaneous fat, superficial fascia, and deep fascia. It is characterized by marked tissue edema, rapid spread of inflammation, and signs of systemic toxicity. The wound cultures are predominantly polymicrobial and the location of initial involvement depends on the underlying etiologic factor. High index of suspicion, prompt aggressive surgery, appropriate antibiotics, and supportive care are the mainstays of management in the newborn infant with NF.
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2/66. Infectious disease emergencies in primary care.

    Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, rocky mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated.
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3/66. Necrotizing fasciitis: an uncommon consequence of pressure ulceration.

    pressure ulcers may occur in patients with chronic illnesses, especially in those who are bed-bound or chair-bound. Local measures usually suffice to allow primary ulcer healing and support skin grafting or tissue transfer reconstruction. On rare occasions, however, pressure ulcers may progress to invasive infection and necrosis of adjacent soft tissues, possibly leading to necrotizing fasciitis. Early recognition and aggressive medical and surgical therapy are required to halt disease progression and prevent patient mortality. Two cases are presented to describe the severity of this soft-tissue infection.
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4/66. Cervical necrotizing fasciitis: a case report.

    Necrotizing fasciitis is a severe soft tissue infection characterized by cutaneous necrosis, suppurative fasciitis, vascular thrombosis and extreme systemic toxicity. Involvement of head and neck structures is rare, but occur most frequently in patients with diabetes and chronic alcoholism. Once initiated, the disease progresses rapidly and diffusely, involving adjacent fascial spaces. Necrotizing fasciitis may also extend to the cervical viscera, mediastinum and anterior chest wall. A 65-year-old chronic alcoholic man, with long-standing diabetes and liver cirrhosis under irregular treatment is described. The patient developed a deep neck infection from a buccal abscess after a local incision. The infection then extended to an orocutaneous fistula and deep neck superficial and middle layer fascias, with necrotizing fasciitis. Management requires early recognition, high doses of appropriate antimicrobial therapy, early surgical drainage and radical debridement of necrotic tissue. The disease carries a high rate of morbidity and mortality, especially in the elderly.
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5/66. Necrotizing fasciitis in infancy: an uncommon setting and a prognostic disadvantage.

    Necrotizing fasciitis is a potentially fatal, progressive soft tissue infection that typically occurs in adults, and only rarely occurs in infants. Although adults in whom necrotizing fasciitis develops are commonly diabetic, malnourished, or otherwise immunocompromised, infants in whom the disease develops are typically healthy and without clear predisposing factors. Herein, however, the authors report the case of an infant with compromised immunity secondary to the manifestations and treatment of panhypopituitarism, in whom postoperative necrotizing fasciitis developed after bilateral inguinal herniorrhaphy. The diagnosis, pathological mechanism, and treatment of necrotizing fasciitis are reviewed and the distinguishing features in infants are highlighted. The combination of a low incidence and very high mortality rate associated with necrotizing fasciitis in this subgroup strengthens the need for hypercritical suspicion. early diagnosis and the prompt initiation of surgical treatment are the most essential means to improve on the prognosis for necrotizing fasciitis in infants.
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6/66. Fulminant necrotising fasciitis caused by vibrio parahaemolyticus.

    We report a patient with septicaemia and fulminant necrotising fasciitis caused by vibrio parahaemolyticus. This organism is strongly associated with seawater exposure and seafood ingestion. The patient recovered due to expedient management, prompt recognition of the organism, appropriate antimicrobial cover and surgical debridement. The lesson to be learned is that this organism should be clinically suspected and recognised from its typical history of injury and fulminant clinical progress as a delay in diagnosis and treatment may result in an increased risk of mortality.
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7/66. Successfully managed genital necrotizing fasciitis with multiple debilitating diseases. A case report.

    Genital necrotizing fasciitis is a rapidly progressive bacterial infection of soft tissues with a reported average mortality of about 36%; associated debilitating diseases increase the mortality rate. The Authors report a case of successful management, due to an aggressive medical and surgical therapy, despite the presence of multiple debilitating diseases and an advanced necrosis.
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8/66. Necrotizing fasciitis secondary to group A streptococcus. morbidity and mortality still high.

    OBJECTIVE: To update physicians on Group A streptococcal necrotizing fasciitis, including current methods of diagnosis and treatment. QUALITY OF EVIDENCE: Current literature (1990-1998) was searched via medline using the MeSH headings necrotizing fasciitis, toxic shock syndrome, and Streptococcus. Articles were selected based on clinical relevance and design. Most were case reports, case series, or population-based surveys. There were no randomized controlled trials. MAIN MESSAGE: The hallmark of clinical diagnosis of necrotizing fasciitis is pain out of proportion to physical findings. Suspicion of underlying soft tissue infection should prompt urgent surgical examination. Therapy consists of definitive excisional surgical debridement in conjunction with high-dose intravenous penicillin g and clindamicin. risk factors for mortality include advanced age, underlying illness, hypotension, and bacteremia. CONCLUSION: Necrotizing soft tissue infections due to Group A streptococcus might be increasing in frequency and aggression. overall mortality remains high (20% to 34% in larger series). Clinical diagnosis requires a high level of suspicion and should prompt urgent surgical referral.
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9/66. Rapidly fatal necrotizing fasciitis after aesthetic liposuction.

    Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection involving primarily the superficial fascia and subcutaneous tissue. The disease is caused by streptococcus pyogenes or synergistic infection of anaerobic and facultative anaerobic bacteria. Further characteristics are severe, intolerable pain and a mortality rate of 30 to 50%. The NF can be initiated after surgical procedures, minor trauma, trivial scratches, in the setting of a chronic wound, or even in apparently intact skin. The age of the patient is not relevant for the prognosis of NF. As it is shown in this reported case, a young and previously healthy patient died after aesthetic liposuction in the course of a NF. Necrotizing fasciitis is a rare disease, therefore, it is important to review its diagnostic and clinical features, because only early diagnosis and prompt, radical surgery improves the survival rate.
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10/66. Cervical necrotizing fasciitis of odontogenic origin: a report of 11 cases.

    PURPOSE: Although most cases of cervical necrotizing fasciitis (CNF) are odontogenic in origin, reports of this disease in the dental literature are sparse. The purpose of this study was to review the cases treated on our service, and to analyze the features of this disease and the responses to management, to supplement the understanding of this relatively rare and life-threatening disease. patients AND methods: All cases of infection admitted to the OMS service in a period of 10.5 years were studied retrospectively. The diagnosis of CNF was established by the findings on surgical exploration and histologic examination. The patients' age, sex, medical status, causes of the infection, bacteriology, computed tomography scan findings, surgical interventions, complications, survival, and other clinical parameters were reviewed. RESULTS: A total of 422 cases of infection were admitted, and 11 cases of cervical necrotizing fasciitis were found. The incidence of CNF was 2.6% among the infections hospitalized on the OMS service. There were 7 male and 4 female patients. Eight patients were older than 60 years of age. Seven patients had immunocompromising conditions, including diabetes mellitus in 4, concurrent administration of steroid in 2, uremia in 1, and a thymus carcinoma in 1. All patients showed parapharyngeal space involvement; four also showed retropharyngeal space involvement. Gas was found in the computed tomography scan in 6 patients, extending to cranial base in 3 of them. Anaerobes were isolated in 73% of the infections, whereas Streptococcus species were uniformly present. All patients received 1 or more debridements. Major complications occurred in 4 patients, including mediastinitis in 4, septic shock in 2, lung empyema in 1, pleural effusion in 2, and pericardial effusion in 1. All major complications developed in the immunocompromised patients, leading to 2 deaths. CONCLUSION: The mortality rate in this study was 18%. Early surgical debridement, intensive medical care, and a multidisciplinary approach are advocated in the management of CNF.
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