Fascitis necrosante en un niño. Evolución y tratamiento / Necrotizing fasciitis in a child. Evolution and treatment

La fascitis necrosante es una grave infección de progresión rápida y fulminante. Debe ser sospechada ante la progresión de lesiones dérmicas con necrosis de tejidos y afectación del estado general. En los niños no requiere una situación de inmunodepresión ni enfermedad de base. El tratamiento de elección es el abordaje quirúrgico precoz con desbridamiento amplio de la zona afectada. La situación funcional tras el tratamiento puede verse mermada. Presentamos un caso de fascitis necrosante en un niño, su evolución, el tratamiento y el abordaje rehabilitador tras la cirugía (AU)

Necrotizing fasciitis is a serious bacterial infection with rapid progression and fulminant course. It should be suspected in patients with rapidly progressing skin lesions with soft tissue necrosis and deterioration of general health status. This infection can occur in children without immunodepression or underlying diseases. The treatment of choice is wide surgical debridement of dead tissue. Functional recovery after treatment may be limited. We report a case of necrotizing fasciitis in a boy and his outcome, as well as the treatment of this infection and the approach to rehabilitation after surgery (AU)

Fasciite necrosante por Aeromonas hydrophila e Staphylococcus epidermidis ­ relato de caso / Necrotizing fasciitis caused by Aeromonas hydrophil a and Staphylococcus epidermidis ­ case report

Introdução: Fasciite necrosante (FN) é uma infecção rara dos tecidos subcutâneos e fáscia superficial, geralmente confundida com infecção benigna. Entretanto, apresenta enorme potencial para o desenvolvimento de complicações graves que contribuem para os elevados índices de mortalidade. Objetivos: Descrever um caso de FN polimicrobiana ocasionada por Aeromonas hydrophila e Staphylococcus epidermidis em paciente portador de síndrome da imunodeficiência adquirida, hepatite C e diabetes mellitus. Métodos: Analisaram-se dados de prontuário e resultados de exames laboratoriais de paciente internado no Hospital Universitário de Santa Maria, Santa Maria, Rio Grande do Sul. Resultados: Paciente do sexo masculino, 47 anos, com relato de fratura exposta em membro inferior esquerdo, desenvolvendo infecção no ferimento. Após desbridamento de tecido desvitalizado, identificaram-se A. hydrophila e S. epidermidis. Paciente continua em tratamento e aguarda cirurgia para enxerto. Conclusões: A FN é uma enfermidade rara que merece toda a atenção médica, pois a identificação e tratamento precoces são fundamentais para a recuperação física do paciente.

Introduction: Necrotizing fasciitis (NF) is a rare infection of the subcutaneous tissue and superficial fascia, usually confused with benign infection. However, it has tremendous potential for the development of serious complications which contribute to the high mortality rates. Objectives: To describe a case of FN caused by Aeromonas hydrophila polymicrobial and Staphylococcus epidermidis in patient immunodeficiency syndrome carrier acquired hepatitis C and diabetes mellitus. Methods: We analyzed data from medical records and laboratory test results of inpatient at the University Hospital of Santa Maria, Santa Maria, Rio Grande do Sul. Results: Male patient, 47 years of age, with compound fracture reporting in the left lower limb, developing infection in the wound. After debridement of devitalized tissue, A. hydrophila and S. epidermidis were identified. Patient continues processing and waits for grafting surgery. Conclusions: The FN is a rare disease that deserves medical attention, for the early identification and treatment are essential for the physical recovery of the patient.

The value of early intervention and a multidisciplinary approach in the management of necrotizing fasciitis of the neck and anterior mediastinum of odontogenic origin.

Necrotizing fasciitis (NF) is a serious clinical condition, which, if diagnosed late, invariably leads to a fatal outcome. A high index of suspicion of the presenting clinical signs and symptoms, supported by knowledge of the clinicopathologic processes that underlie its aggressive nature, should prompt early surgical intervention. Ultimately, the success of treatment requires a robust clinical pathway in which all members of the health care team are aligned by their skill sets and competencies to manage NF. This report describes the management of a case of a young man with aggressive NF of odontogenic origin affecting the neck and anterior mediastinum. A multidisciplinary approach brought about early recognition of the disease and surgical intervention, the use of frozen section biopsies to determine the extent of fascial spread, and aggressive debridement of the affected tissue. Teamwork, critical thinking, and situational awareness ensured that the patient received optimum care in a timely manner. The psychological, clinical, radiologic, pathologic, and microbiological aspects of the patient's care are presented with a literature review.

Desarticulación coxofemoral por fascitis necrotizante y síndrome del shock tóxico estreptocócico / Coxofemoral disarticulation by necrotizing fasciitis and streptococcal toxic shock syndrome

La fascitis necrotizante es una infección rápidamente progresiva de la piel y los tejidos blandos, asociada a una rápida destrucción y necrosis de la fascia y de la grasa, que se acompaña de importante toxicidad sistémica y alta mortalidad. Supone la forma más grave de infección de partes blandas, y en un tercio de los pacientes da lugar a la aparición de shock y fracaso multiorgánico. Existen 2 tipos: tipo I, polimicrobiana, en la que existen factores predisponentes para su aparición, y la tipo II o estreptocócica en jóvenes sin comorbilidad asociada. El diagnóstico es clínico y no debe retrasarse la exploración quirúrgica, ya que su pronóstico depende en gran medida de un diagnóstico precoz y de un tratamiento agresivo inmediato. Presentamos un caso de fascitis necrotizante tipo II de miembro inferior derecho complicada con un síndrome del shock tóxico estreptocócico y que fue necesario realizar una desarticulación de cadera (AU)

Necrotizing fasciitis is a rapidly progressive infection of the skin and soft tissue characterized by widespread necrosis of the subcutaneous tissue and the fascia, which usually involves severe systemic toxicity and high index of mortality. This disease is the most serious form of skin and soft tissue infection. About one third of the patients develops shock and multiorgan failure. There are two types: type I, polymicrobial, for which there are predisposing risk factors and type II, or streptococcal in young patients without associated comorbidity. The diagnosis is based on the clinical manifestations and surgical intervention should not be delayed as its prognosis largely depends on an early diagnosis and immediate aggressive treatment. We report the case of a patient with necrotizing fasciitis type II of the lower right limb, who suffered streptococcal toxic shock syndrome and in whom hip disarticulation was required (AU)

Cultivo de piel, queratinocitos: resultado estético comprado con piel expandida en un caso de fasceitis necrotizante / Necrotizing fascitis: A case report

Se presenta la experiencia de colocación de cultivo de queratinocitos en un caso de fasceitis necrotizante

Burn center management of necrotizing soft-tissue surgical infections in unburned patients.

BACKGROUND: Patients with necrotizing soft-tissue infections present great challenges in management from initial presentation through definitive care. Because burn centers concentrate expertise in critical care, wound management, and rehabilitation, we examined the effectiveness of burn center care for patients with necrotizing infections. METHODS: We reviewed our burn center's experience with all patients admitted from 1990 through 1999 with a primary diagnosis of necrotizing fasciitis (NF) or Fournier's gangrene (FG). RESULTS: Fifty-seven patients were identified, 18 with FG and 39 with NF. Patients had a high incidence of preexisting medical problems, including diabetes (37%), obesity defined as greater than 20% above ideal body weight (33%), and hypertension (33%). Seven of 57 (12%) patients died. Patients required a mean of 4.1 operative procedures (range 1 to 15) for definitive wound closure. The mean length of stay (survivors only) was 28.5 days, (range 3 to 70). Although costs increased throughout this period, a formal program of cost-containment resulted in no increase in actual charges per day, from a mean of $4,735 in 1991 to $5,202 in 1999. CONCLUSIONS: Burn centers can provide successful and cost-effective acute care, definitive wound closure, and rehabilitation for patients with NF and FG.

The use of contingency management in the treatment of a geriatric nursing home patient with psychogenic vomiting.

A substantial percentage of nursing home residents evidence psychosocial and behavioral problems. However, surprisingly little is known about how effectively to treat geriatric patients with behavioral problems. The present study reports the behavioral treatment of a patient with psychogenic vomiting. The patient was successfully treated by changing the contingencies of her illness behavior and of behavior associated with rehabilitation goals. This indicates the importance of nursing home staff attending to the operants of illness behavior. Specifically, independent behavior should be rewarded by praise and attention and illness behavior should be ignored in terms of attention.