Fascitis necrotizante asociada a esteatohepatitis en el curso del lupus eritematoso sistémico / Necrotizing Fasciitis Associated with Steatohepatitis in The Course of Systemic Lupus Erythematosus

Introducción: La fascitis necrotizante es un cuadro muy grave causado por una infección bacteriana de la piel y de tejidos blandos subcutáneos, cuya evolución es hacia la destrucción y necrosis de los tejidos en un corto espacio de tiempo; el lupus eritematoso sistémico es una enfermedad autoinmune de causa desconocida que quienes la padecen tienen una mayor probabilidad de contraer infecciones debido al mal funcionamiento del sistema inmunológico y/o los efectos secundarios causados por los medicamentos. Objetivo: Observar la importancia de un tratamiento rápido y eficaz de la fascitis necrotizante en un paciente con lupus eritematoso sistémico y esteatohepatitis no alcohólica. Presentación de caso: Se presentó el caso clínico de un paciente de 30 años con diagnóstico de lupus eritematoso sistémico que desarrolló de forma concomitante de fascitis necrotizante y esteatohepatitis no alcohólica. A pesar de un tratamiento adecuado, el paciente fue agresivo. Tuvo una estadía hospitalaria de 83 días, con una evolución desfavorable que conllevó a la muerte(AU)

Introduction: Necrotizing fasciitis is a very serious condition caused by a bacterial infection of the skin and subcutaneous soft tissues, whose evolution is towards the destruction and necrosis of the tissues in a short space of time; Systemic lupus erythematosus is an autoimmune disease of unknown cause that sufferers are more likely to contract infections due to poor immune system function and/or side effects caused by medications. Objective: To observe the importance of rapid and effective treatment of necrotizing fasciitis in a patient with systemic lupus erythematosus and non-alcoholic steatohepatitis. Case report: We report the clinical case of a 30-year-old patient diagnosed with systemic lupus erythematosus who concomitantly developed necrotizing fasciitis and nonalcoholic steatohepatitis. Despite adequate treatment, the patient was aggressive. The patient had a hospital stay of 83 days, with an unfavorable evolution that led to his death(AU)

Predictive factors of lethality and complications of deep fascial space infections of the neck / Fatores preditivos de letalidade e complicações das infecções dos espaços fasciais profundos do pescoço

ABSTRACT Objective: to identify predictive factors for lethality and complications of deep fascial space infections of the neck (DFSIN), establishing an early and aggressive treatment in the neck before the progression to descending mediastinitis. Methods: we retrospectively analyzed 133 cases of DFSIN treated at Discipline of Head and Neck Surgery of the Medicine School of Santa Casa de Misericórdia de São Paulo. We accessed demographic characteristics, associated diseases, clinical presentation, laboratorial tests, length of hospital stay, number of involved anatomic neck spaces, intra-operative and microbiology findings. We analyzed these data using logistic regression to predict DFSIN lethality and life threatening complications (mediastinitis, septic shock, pneumonia, pleural empyema, skin necrosis). Results: lethality and complication ratios were 9% and 50.3%, respectively. The logistic regression model showed that patients with septic shock were more likely to have progression to death (p < 0.001) and, the presence of more than two involved neck spaces (p < 0.001) and older individuals (p = 0.017) were more likely to have complicated deep neck infections. Descending necrotizing mediatinitis increased the lethality ratio by 50%, and was associated to necrotizing fasciitis (p=0.012) and pleural empyema (p<0.001). Conclusion: septic shock is a lethal predictive factor and age as well as more than two involved neck spaces are the predictive factors for complications. Necrotizing fasciitis is an important factor for complications and death. Therefore, its surgical treatment must be more aggressive. Descending mediastinitis has a high lethal rate and the successful treatment is based on early diagnosis and aggressive surgical approach.

RESUMO Objetivo: identificar os fatores preditivos de letalidade e complicações associados às infecções dos espaços fasciais profundos do pescoço, com intuito de estabelecer tratamento mais precoce antes de evolução para a mediastinite. Métodos: estudo retrospectivo de 133 casos, tratados na Disciplina de Cirurgia de Cabeça e Pescoço da Faculdade de Ciências Médicas da Santa Casa de São Paulo. Por meio da análise de regressão logística, estes dados foram estudados para a predição de letalidade e complicações graves (mediastinite, choque séptico, empiema pleural, pneumonia e necrose de pele). Resultados: a taxa de letalidade identificada foi de 9% e, de complicações de 50,3%. Identificou-se como fator preditivo de letalidade, a presença de choque séptico (p<0,001) e, para o ocorrência de complicações, a idade (p=0,017) e o acometimento de mais de dois espaços anatômicos (p<0,001). A ocorrência de mediastinite descendente necrosante esteve associada à presença de fasciíte necrosante (p=0,012) e empiema pleural (p<0,001). Conclusão: o fator preditivo de letalidade foi a presença de choque séptico e, para ocorrência de complicações graves, a idade e/ou a presença de mais de dois espaços anatômicos acometidos pela infecção. A fasciíte necrosante é fator importante para ocorrência de complicações e morte. Nestes casos, a conduta cirúrgica deve ser mais agressiva. A mediastinite descendente apresenta taxa de letalidade alta e o sucesso no tratamento está no diagnóstico precoce e na intervenção cirúrgica agressiva.

Necrotizing fasciitis: eight-year experience and literature review

OBJECTIVES: To describe clinical, laboratory, microbiological features, and outcomes of necrotizing fasciitis. METHODS: From January 1, 2004 to December 31, 2011, 115 patients (79 males, 36 females) diagnosed with necrotizing fasciitis were admitted to Mackay Memorial Hospital in Taitung. Demographic data, clinical features, location of infection, type of comorbidities, microbiology and laboratory results, and outcomes of patients were retrospectively analyzed. RESULTS: Among 115 cases, 91 survived (79.1%) and 24 died (20.9%). There were 67 males (73.6%) and 24 females (26.4%) with a median age of 54 years (inter-quartile ranges, 44.0-68.0 years) in the survival group; and 12 males (50%) and 12 females (50%) with a median age of 61 years (inter-quartile ranges, 55.5-71.5 years) in the non-surviving group. The most common symptoms were local swelling/erythema, fever, pain/tenderness in 92 (80%), 87 (76%) and 84 (73%) patients, respectively. The most common comorbidies were liver cirrhosis in 54 patients (47%) and diabetes mellitus in 45 patients (39%). A single organism was identified in 70 patients (61%), multiple pathogens were isolated in 20 patients (17%), and no microorganism was identified in 30 patients (26%). The significant risk factors were gender, hospital length of stay, and albumin level. DISCUSSION: Necrotizing fasciitis, although not common, can cause notable rates of morbidity and mortality. It is important to have a high index of suspicion and increase awareness in view of the paucity of specific cutaneous findings early in the course of the disease. Prompt diagnosis and early operative debridement with adequate antibiotics are vital. .

Accurate diagnosis and treatment of Vibrio vulnificus infection: a retrospective study of 12 cases

BACKGROUND AND AIMS: Vibrio vulnificus causes an infectious disease that has extremely poor convalescence and leads to necrotic fasciitis. In this study, we sought to define the characteristic epidemiology of V. vulnificus infection and clarify its diagnosis at the global level. METHODS: Over a period of 10 years, we investigated the appearance of symptoms, underlying conditions, treatment, and mortality in 12 patients (eight men, four women; >50 years old; average age, 66 years,) infected with V. vulnificus. RESULTS: The development of symptoms occurred primarily between June and September, a period during which seawater temperature rises and the prevalence of V. vulnificus increases. All patients had underlying diseases, and seven patients reported a history of consuming fresh fish and uncooked shellfish. The patients developed sepsis and fever with sharp pain in the limbs. Limb abnormalities were observed on visual examination. All patients underwent debridement; however, in the survival group, the involved limb was amputated early in 80% patients. The mortality rate was 58.3%. CONCLUSION: Recognition of the characteristic epidemiology and clinical features of this disease is important, and positive debridement should be performed on suspicion. When the illness reaches an advanced stage, however, amputation should be the immediate treatment of choice.

Management dilemma of cervicofacial necrotizing fasciitis

Cervicofacial necrotizing fasciitis is a rare polymicroibial infection, which carries high morbidity as well as mortality rate. It is usually the result of rapid spread of infection along the fascial planes, causing necrosis of the fascia and overlying skin, which eventually involve the blood vessels and muscles. Early diagnosis is crucial in limiting the fatal consequences of the disease process and the establishment of the appropriate line of management. We discuss the management dilemma in selected cases treated at the Department of Oral and Maxillofacial Surgery, Salmaniya Medical Complex, Bahrain during the period 1 999-2006 and outline briefly the medical as well as the surgical management

Necrotizing fasciitis: study of 20 cases in Shifa hospital

Necrotizing Fasciitis [NF], although uncommon soft tissue infection but it is a diagnostic and therapeutic challenge to the surgeons due to their higher associated morbidity and mortality. This aggressive infection caused by aerobic and anaerobic infections mainly affects the subcutaneous fat and fascia, and later on the overlying skin, while the underlying muscles are almost always spared. Our objective is to put a plan for optimal care of such patients. The current study reviews our experience with 20 patients of NF admitted and treated at Surgery Department in Shifa Hospital in Gaza during the period from February 1995 to February 2003. They were 12 males and 8 females with a mean of age 53.5 years. After establishment of the diagnosis of NF by clinical examination and intra-operative findings, all the necrotic tissues were debrided under general anesthesia followed by minor debridement as frequent as needed under analgesia, while reconstructive procedures e.g. skin grafting and secondary suturing performed according to the condition. The mean time between the beginning of the disease and the operation was 4.4 days.Among the 20 patients with NF, 13 patients [65%] had diabetes mellitus [D.M.]; the mortality rate between the diabetics was 61.5%. The perineum was the most frequent site for primary infection, eight cases [40%] followed by the valvar region, four cases [20%]. Seven patients died out of the twenty giving a mortality rate of 35% in this study. In Recognition of the need for early diagnosis and surgical treatment of this rapidly progressive surgical infection [NF] is necessary for successful management, especially for patients with perianal or valvar infections

Assessing predictors of outcome in necrotizing fasciitis at Jordan University Hospital

Necrotizing fasciitis is a life threatening infection characterized by rapidly developing necrosis of the subcutaneous tissue and fascia with subsequent gangrene of the overlying skin. Necrotizing fasciitis [NF] is increasingly being diagnosed at Jordan University Hospital [JUH] with an apparent difference in the bacteriology of this disease. The aim of this study was to examine the presentation, etiology, course of the disease, treatment, and to identify the variables that are associated with high mortality. Information on the presentation, etiology, treatment, pathology and complications in all cases diagnosed with necrotizing fasciitis from January 1987 to January 1998 A total of 23 patients underwent surgical exploration for necrotizing fasciitis during the study period. Six variables identified that significantly increased the risk of death from necrotizing fasciitis: Age above 60 years, female sex, perineal location, delayed operative management, white blood cell count more than 30,000 cell per mm[3] and infection mainly with Gram negative [G-ve] bacteria species. This study suggests that necrotizing% fasciitis is a serious and potentially fatal infection particularly in old, female patients presenting with perineal infection, high WBC count, and Gram negative [G-ve] bacterial isolates. Early diagnosis, aggressive initial debridement and redebridement in addition to adequate nutritional support and antibiotics are the mainstay of treatment

Fascitis necrotizante / Necrotizing fascitis

La fascitis necrotizante es una infección que progresa rápidamente necrosando los tejidos, afectando al celular subcutáneo y fascia subyacente, acompañada de toxicidad sistémica. El reconocimiento tardío de esta infección provoca una alta mortalidad. Se presenta la experiencia de nuestro hospital en el tratamiento de 27 pacientes ingresados entre enero 1994 a junio 1996. La localización más frecuente fue perineal en 17 pacientes, seguida por extremidades inferiores en 8. La mitad de los pacientes tenían patología médica asociada, siendo un tercio del total portadores de diabetes mellitus. Todos ellos fueron sometidos a cirugías resectivas. Veinticinco de ellos requirieron 26 más cirugías llegando hasta 5 intervenciones en dos pacientes. La etiología bacteriana en la mitad de los casos fue polimicrobiana. En 5 pacientes se cultivo estreptococo beta hemolítico grupo A, aislado o asociado a otros gérmenes. La letalidad en esta serie corresponde al 29,6 por ciento, y todos fallecieron debido a falla multiorgánica

Infecciones necrosantes de tejidos blandos

Las infecciones necrosantes de tejidos blandos conocidas tambièn como fascitis necrosantes o mal llamadas gangrena gaseosa, son actualmente un reto para el personal mèdico ya sea porque no existe una terminologìa estandarizada, lo que dificulta el diagnòstico y en sì el tratamiento, como tambièn por el alto ìndice de mortalidad que presenta, asì del 38 por ciento puede ascender a un 71 por ciento inclusive al 100 por ciento si no se realiza una buena intervenciòn en el primero y en el segundo acto operatorio. El cuadro clìnico, diagnòstico y la mortalidad en sì depende de la capacidad del huèsped para defenderse ante una infecciòn, la localizaciòn de la misma, grado de afectaciòn tisular, trastornos predisponentes y de la virulencia como de la cantidad de microorganismos presentes...