1/7. Post-varicella epiglottitis and necrotizing fasciitis.Varicella is a nearly ubiquitous acquired childhood disease. Infectious complications of varicella can be life- or limb-threatening. These complications appear 3 to 4 days after the appearance of varicella exanthem and are heralded by fever, pain, and erythema of the overlying skin. Airway complications of varicella are rare, rapidly evolving, and, unfortunately, difficult to visualize. We report a child who presented with a unique combination of varicella-induced airway complications-acute epiglottitis and subsequent necrotizing fasciitis of the head and neck. varicella, epiglottitis, necrotizing fasciitis, group A beta-hemolytic streptococcus, nasopharyngoscopy.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
2/7. Familial high factor viii level in a child with necrotizing fasciitis complicating primary varicella infection.This article describes an unusual association of familial high plasma factor viii level and necrotizing fasciitis in a 4-year-old girl with primary varicella infection.- - - - - - - - - - ranking = 0.55555555555556keywords = varicella (Clic here for more details about this article) |
3/7. Sudden unexpected death in a child with varicella caused by necrotizing fasciitis and streptococcal toxic shock syndrome.A 4-year-old child with chickenpox infection for 5 days prior to death complained of swelling and pain in his right leg that required medical assistance in the emergency department. Radiologic study was normal, and analgesic and bandage of the leg were prescribed. Some hours later, he presented cyanosis, dizziness, and vomiting and collapsed. A complete forensic autopsy was performed 12 hours after death. External examination of the body showed numerous crusty varicella skin lesions, especially over the trunk, and swelling and reddening of his right leg. The brain was swollen, with cerebellar herniation, and both adrenal glands were hemorrhagic.Microscopically, neutrophilic infiltration and muscle fiber necrosis were observed in soft tissues of his right leg, and fibrin microthrombus were numerous in capillaries of the plexus choroideus, larynx, lungs, and adrenals. Bacterial emboli were present in most of the tissues. Microbiologic cultures of blood and cerebrospinal fluid showed group A beta-hemolytic streptococcus (streptococcus pyogenes). death was attributed to fulminant streptococcal toxic shock syndrome, with necrotizing fasciitis as a complication of varicella.- - - - - - - - - - ranking = 0.66666666666667keywords = varicella (Clic here for more details about this article) |
4/7. Group A streptococcal necrotizing fasciitis complicating primary varicella: a series of fourteen patients.We retrospectively reviewed the clinical course of group A Streptococcus necrotizing fasciitis complicating primary varicella in children admitted to Children's Hospital and Medical Center, Seattle, WA, during a 18-month period. The potential benefit of various therapeutic interventions was examined. Fourteen children ages 6 months to 10 years were treated for group A Streptococcus necrotizing fasciitis as a complication of primary varicella. Eight patients experienced a delay in initial diagnosis as a result of nonspecific, early clinical findings of necrotizing fasciitis. Each patient underwent surgical exploration with fasciotomies and debridement. Initial antibiotic therapy was broad spectrum and included clindamycin. Hyperbaric oxygen therapy for as many as 6 treatments was used as adjunctively therapy in 12 patients, with subjective benefit in 6 patients. All 14 patients were discharged home with good function and no long term sequelae. This potentially fatal bacterial infection of the deep fascial layers requires early recognition by primary care physicians and an intensive, multidisciplinary therapeutic approach, including thorough surgical debridement and appropriate antibiotic therapy.- - - - - - - - - - ranking = 0.66666666666667keywords = varicella (Clic here for more details about this article) |
5/7. Orthopaedic manifestations of invasive group A streptococcal infections complicating primary varicella.The incidence of invasive group A streptococcal (GAS) infections in primary varicella appears to be increasing. GAS infections complicating varicella range from cellulitis, abscess, and septic arthritis to life-threatening necrotizing fasciitis and pyomyositis in association with GAS toxic shock syndrome (TSS). Four patients admitted in 1 year to the Children's Hospital and Medical Center in Seattle, whose care included evaluation and treatment by the Orthopaedic service, are presented to illustrate this spectrum. Three had a delay in diagnosis, including discharge from previous emergency department visits. One patient with polyarticular septic arthritis was treated with diagnostic aspiration and intravenous antibiotics. The remainder required urgent surgical debridement for treatment of deep infection. patients with necrotizing fasciitis or pyomyositis had life-threatening complications of TSS, including hypotension, adult respiratory distress syndrome (ARDS), coagulopathy, and acute renal failure. These patients required aggressive fluid resuscitation and prolonged intensive care unit support. diagnostic imaging studies were obtained in one patient with necrotizing pyomyositis but may have served only to delay definitive treatment. Recognition of the potential for secondary GAS infections and a high index of suspicion for the presence of necrotizing soft-tissue infection are essential in the evaluation of any child with fever and localized extremity pain with varicella.- - - - - - - - - - ranking = 0.77777777777778keywords = varicella (Clic here for more details about this article) |
6/7. Necrotizing fasciitis complicating disseminated cutaneous herpes zoster.The association of necrotizing fasciitis, often due to group A streptococcus and primary varicella (chicken pox), is unusual but recognized in children. The association in adults is rare but one report in the literature describes a previously healthy man with the two disorders. We now describe a case of disseminated cutaneous herpes zoster complicated by subacute necrotizing fasciitis in an elderly woman taking low dose methotrexate and prednisone for rheumatoid arthritis. staphylococcus aureus was isolated. Localized debridement and split skin grafting were required.- - - - - - - - - - ranking = 0.11111111111111keywords = varicella (Clic here for more details about this article) |
7/7. Group A streptococcal necrotizing fasciitis after varicella: report of two cases.The most common complication in children with varicella is cutaneous superimposed infection with pyogenic bacteria. The association between varicella and group A beta-hemolytic streptococci (GABHS) necrotizing fasciitis has been recorded for over 50 years. Two cases with the specific problems are presented here together with a review of the literature. This infection is caused by GABHS superinfection of the skin lesions due to chickenpox. It can be unrecognized or late-diagnosed, with fatal consequences. Because of prompt recognition and aggressive surgical and medical treatment, the two patients survived without loss of the affected limb.- - - - - - - - - - ranking = 0.66666666666667keywords = varicella (Clic here for more details about this article) |