ABSTRACT
A healthy 40-year-old woman was diagnosed with necrotizing fasciitis 2 days after her husband's death from the same infectious process. Prompt identification and immediate surgical intervention prevented a similar result in this patient. Additional investigation into both patients' medical records found the inciting organism to be group A streptococcus. Although the exact mechanism of inoculation is unknown, the spread of this infection within a household prompts the question of whether antibiotic prophylaxis should be given among close contacts in future cases of necrotizing fasciitis.
Subject(s)
Fasciitis, Necrotizing , Streptococcal Infections , Adult , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Female , Humans , Streptococcal Infections/drug therapy , Streptococcal Infections/surgery , Streptococcus pyogenesABSTRACT
Introducción: La fascitis necrotizante es una infección progresiva poco común, con alta letalidad que puede afectar a cualquier parte del cuerpo, pero es más frecuente en las extremidades, en especial en las piernas, causada en su mayoría por una infección polimicrobiana y se caracteriza por afectar la fascia superficial, tejido subcutáneo, grasa subcutánea con nervios, arterias, venas y fascia profunda. Objetivo: Reportar el caso de una puérpera diagnosticada de fascitis necrotizante. Presentación de caso: Puérpera de 28 años de edad con antecedentes de obesidad e infección por VIH, ingresada en el Servicio de Obstetricia en un hospital de la República Sudafricana, por presentar fiebre, escalofríos y dolor en el abdomen. Se utilizó tratamiento endovenoso con antibióticos y tratamiento quirúrgico. Resultados: Evolución satisfactoria de la paciente sin secuelas. Conclusiones: El diagnóstico oportuno de esta patología permite un accionar temprano, con la consecuente sobrevida de los pacientes(AU)
Introduction: Necrotizing fasciitis is a very lethal uncommon progressive infection that can affect any part of the body, however it is more frequent in the limbs, especially the legs, caused mostly by a polymicrobial infection. It affects the superficial fascia, subcutaneous tissue, subcutaneous fat with nerves, arteries, veins and deep fascia. Objective: To report the case of a puerpera diagnosed with necrotizing fasciitis. Case presentation: A 28-year-old woman with a history of obesity and HIV infection, was admitted to the Obstetrics Service at a hospital in the Republic of South Africa. She had fever, chills and pain in the abdomen. Intravenous treatment with antibiotics and surgical treatment was used. Results: Satisfactory evolution of the patient with no sequelae. Conclusions: The opportune diagnosis of this pathology allows acting early, with the consequent survival of the patients(AU)
Subject(s)
Humans , Female , Adult , Puerperal Infection/prevention & control , HIV Infections/etiology , Fasciitis, Necrotizing/complications , Fasciitis, Necrotizing/drug therapy , Debridement/methodsSubject(s)
Humans , Female , Infant , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/etiology , Clostridium septicum/isolation & purification , Immunologic Deficiency Syndromes/diagnosis , Intestinal Perforation/diagnosis , Mucormycosis/diagnosis , Pneumoperitoneum/diagnosis , Fasciitis, Necrotizing/drug therapy , Diagnosis, Differential , Mucormycosis/surgerySubject(s)
Anti-Infective Agents/therapeutic use , Cat Diseases/drug therapy , Cat Diseases/microbiology , Fasciitis, Necrotizing/veterinary , Streptococcal Infections/veterinary , Animals , Arthritis , Cats , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/microbiology , Shock, Septic/drug therapy , Shock, Septic/microbiology , Shock, Septic/veterinary , Streptococcal Infections/drug therapy , Streptococcal Infections/microbiology , StreptococcusABSTRACT
La Fascitis necrotizante (FN) es una infección aguda del tejido subcutáneo que puede comprometer la fascia y producir compromiso sistémico y sepsis. Es una complicación extremadamente rara posterior a una apendicitis aguda. Objetivo: Demostrar la importancia de realizar el diagnóstico a tiempo y la intervención de forma precoz. Caso clínico: Presentamos el caso de un paciente que evoluciona con una Fascitis necrotizante posterior a una apendicectomía. Se realiza una intervención quirúrgica y terapia antimicrobiana precoz, con una favorable evolución. Conclusiones: La FN es una patología con escasa sintomatología y signología clínica, por lo que se debe tener un alto grado de sospecha. Un diagnóstico e intervención a tiempo logra mejorar la sobrevida de los pacientes.
Necrotizing fasciitis is characterized by a necrotic infection that rapidly spreads along the fascia and progresses to systemic sepsis. A fatal complication of acute appendicitis is extremely rare. Objective: Ilustrates the importance of early diagnosis and prompt surgical intervention. Case Report: We present a case of necrotizing fasciitis after an appendicectomy. An early intervention and antibiotic therapy allowed a favorable evolution. Conclusions: The necrotizing fasciitis has a nonspecific symptomatology and signology, so we must suspect the patology. An early diagnosis and aggressive surgical intervention can be life- saving.
Subject(s)
Humans , Male , Child , Appendicitis/complications , Fasciitis, Necrotizing/surgery , Appendectomy , Appendicitis/surgery , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/drug therapy , Anti-Bacterial Agents/therapeutic useABSTRACT
Necrotizing fasciitis is a rapidly progressive destructive soft tissue infection with high mortality. Streptococcus pneumoniae as etiologic agent of necrotizing fasciitis is extremely unusual. The increased susceptibility to Streptococcus pneumoniae infection in patients with systemic lupus erythematosus is probably a multifactorial phenomenon. We report a case of a patient, a 36-year-old Caucasian female with 8-year history of systemic lupus erythematosus who presented a fatal Streptococcus pneumoniae necrotizing fasciitis. The role of computed tomography and the high performance of blood cultures for isolation of the causative microorganism are emphasized. Once diagnosis is suspected, empiric antibiotic treatment must be prescribed and prompt surgical exploration is mandatory.
Subject(s)
Fasciitis, Necrotizing/microbiology , Lupus Erythematosus, Systemic/complications , Opportunistic Infections/microbiology , Pneumococcal Infections/microbiology , Streptococcus pneumoniae/isolation & purification , Adult , Anti-Bacterial Agents/therapeutic use , Bacteriological Techniques , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/drug therapy , Fatal Outcome , Female , Humans , Immunocompromised Host , Immunosuppressive Agents/adverse effects , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/drug therapy , Lupus Erythematosus, Systemic/immunology , Opportunistic Infections/diagnosis , Opportunistic Infections/drug therapy , Opportunistic Infections/immunology , Pneumococcal Infections/diagnosis , Pneumococcal Infections/drug therapy , Pneumococcal Infections/immunology , Predictive Value of Tests , Streptococcus pneumoniae/drug effects , Streptococcus pneumoniae/immunology , Tomography, X-Ray ComputedABSTRACT
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.
Subject(s)
Humans , Male , Middle Aged , Staphylococcus epidermidis , Aeromonas hydrophila , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/drug therapy , Staphylococcal Skin Infections , Acquired Immunodeficiency Syndrome , Gram-Negative Bacterial Infections , Hepatitis C , Fasciitis, Necrotizing/rehabilitation , Diabetes MellitusABSTRACT
BACKGROUND: Mucormycosis are opportunistic infections with high morbidity and mortality caused by fungi of the class Zygomycetes, they mainly affect diabetic and immunocompromised patients. In up to 20% of all cases the main infection is localized in the skin, with a great number of them presenting in healthy patients that have suffered from severe trauma or burns. Zygomycetes tend to invade arteries, which leads to thrombosis and generates wide necrotic areas; this favors the progress of the infection and invasion of deep tissues. Up to 24% of primary cutaneous mucormycosis can be complicated with necrotizing fasciitis. CLINICAL CASE: We present the case of a 52 year-old male that received the clinical diagnosis of necrotizing fasciitis. The patient received wide spectrum antibiotics and was submitted to extensive debridement of the wound bed; transoperative biopsy revealed the presence of zygomycetes in the tissues and the diagnosis of primary cutaneous zygomycosis was made. Antifungal treatment with amphotericin B was initiated and two weeks later autologous skin grafts were applied over the wounds. CONCLUSION: A high index of suspicion is needed to diagnose cutaneous zygomycosis, therefore it should always be considered amongst the differentials of necrotic wounds that do not respond to standard treatment. The rapid evolution of the disease remarks the importance of biopsying the wound bed early and treating aggressively.
Subject(s)
Fasciitis, Necrotizing/etiology , Mucormycosis/complications , Accidents, Traffic , Amphotericin B/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Biopsy , Combined Modality Therapy , Debridement , Diabetes Mellitus, Type 2/complications , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Humans , Hypertension/complications , Leg Injuries/complications , Leg Ulcer/etiology , Leg Ulcer/microbiology , Male , Middle Aged , Mucormycosis/microbiology , Risk Factors , Skin Transplantation , Smoking , Wound Infection/etiology , Wound Infection/microbiologySubject(s)
Community-Acquired Infections/microbiology , Fasciitis, Necrotizing/microbiology , Methicillin Resistance , Staphylococcal Infections/microbiology , Staphylococcus aureus/growth & development , Adult , Anti-Bacterial Agents/therapeutic use , Colombia , Community-Acquired Infections/drug therapy , Community-Acquired Infections/surgery , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Humans , Male , Middle Aged , Staphylococcal Infections/drug therapy , Staphylococcal Infections/surgery , Staphylococcus aureus/geneticsABSTRACT
La fasceitis necrotizante es la infección y posterior destrucción del tejido adiposo subcutáneo y de la fascia subyacente. Es una enfermedad infrecuente, pero con gran mortalidad asociada. Es de etiología bacteriana, mayormente polimicrobiana. Existen múltiples factores de riesgo asociados al desarrollo de una presentación invasiva de esta enfermedad. Las manifestaciones clínicas en la etapa inicial no son categóricas de esta patología, por lo cual se tiende a confundir con la celulitis y erisipela. De esta manera, la sospecha clínica inicial es fundamental para iniciar el manejo oportuno de los pacientes. Los pilares del tratamiento son la cirugía y el tratamiento antibiótico, que deben ser iniciados precozmente para lograr un pronóstico favorable. Existen otros tratamientos, como el uso de oxígeno hiperbárico y la administración endovenosa de inmunoglobulina, pero la evidencia no es suficiente para apoyar su uso de rutina. Se presenta un caso clínico de esta patología.
Subject(s)
Female , Aged , Humans , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/drug therapy , Acinetobacter Infections/complications , Acinetobacter baumannii/isolation & purification , Anti-Bacterial Agents/therapeutic use , Fatal OutcomeABSTRACT
A fasceite necrotizante cervical é uma infecção grave de partes moles do pescoço. Trata-se de entidade rara, porém quando presente tem como principal origem um foco infeccioso odontogênico. São descritos 4 casos de fasceite necrotizante cervical a partir de tonsilites e abscesso peritonsilar, os quais, foram admitidos e tratados na unidade de terapia intensiva. Um dos pacientes era portador de Diabetes Melittus não insulino- dependente e outro paciente havia recebido corticoterapia antes do desenvolvimento da infecção. Em um dos casos ocorreu mediastinite, insuficiência respiratória e o paciente evolui para o óbito em decorrência de choque séptico. Durante o tratamento, 3 pacientes evoluíram satisfatoriamente devido ao diagnostico precoce, tratamento cirúrgico agressivo e utilização de antibiótico terapia de largo espectro. A bactéria mais comumente encontrada foi o Streptococcus sp, mas flora mista com germes anaeróbios foi encontrada em 3 dos casos descritos. CONCLUSÕES: Deve-se suspeitar de tonsilite e abscesso peritonsilar como causa de fasceite necrotizante cervical para que tratamento agressivo e precoce seja realizado.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Fasciitis, Necrotizing/microbiology , Tonsillitis/complications , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Neck , Tonsillitis/microbiologyABSTRACT
Se presenta dos casos de fascitis necrotizante de cuello. Ambos pacientes corresponden a jóvenes sanos, sin factores de inmunosupresión ni trauma reciente, que desarrollan el cuadro clínico a partir de un foco amigdalino. El primer caso evoluciona con una mediastinitis necrotizante descendente y falla orgánica múltiple secundaria a sepsis, lo que le ocasiona la muerte. El segundo caso presenta una evolución satisfactoria, siendo dado de alta en buenas condiciones generales y sin secuelas funcionales. Al analizar los casos y la literatura se observa que uno de los factores más importantes en el pronóstico del cuadro, es la sospecha clínica y la derivación oportuna. Esto permite una rápida confirmación diagnóstica con la tomografía computarizada (TC) de cuello y el inicio precoz del tratamiento. Se concluye que, debido a la escasez de signos clínicos iniciales de la fascitis necrotizante, ésta debe ser siempre sospechada ante cualquier infección cervical, especialmente cuando el compromiso sistemático es desproporcionado a las manifestaciones locales. Además, es imprescindible la TC de cuello y tórax para el adecuado diagnóstico y determinar las posibles complicaciones. El tratamiento incluye cirugía agresiva, antibioticoterapia y el apoyo sistémico en Unidad de Cuidados Intensivos.
Subject(s)
Humans , Male , Adult , Female , Anti-Bacterial Agents/therapeutic use , Clindamycin/therapeutic use , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/therapy , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/drug therapy , Fatal OutcomeABSTRACT
A case study is presented of a 7-year-old boy, seriously injured in a car accident, who developed a fatal infection due to Aphophysomyces elegans--a mold of the Mucoracea family. Fungal invasion was initially manifested by a spotted wound in the left lumbar region which developed into a necrotizing fasciitis. Later this progressed to the right lumbar area, including the gluteus and the corresponding flank. Antimycotic treatment proved ineffective, and the child died 8 weeks after the accident. Other cases due to this fungus are reviewed.
Subject(s)
Fasciitis, Necrotizing/microbiology , Mucormycosis/microbiology , Phycomyces/isolation & purification , Accidents, Traffic , Antifungal Agents/therapeutic use , Child , Debridement/methods , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/surgery , Fatal Outcome , Humans , Immunocompetence , Male , Mucormycosis/drug therapy , Mucormycosis/surgerySubject(s)
Dermatomycoses/diagnosis , Fasciitis, Necrotizing/microbiology , Mucor/isolation & purification , Mucormycosis/diagnosis , Aged , Aged, 80 and over , Antifungal Agents/administration & dosage , Dermatomycoses/drug therapy , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/drug therapy , Female , Follow-Up Studies , Humans , Knee Joint , Mucor/classification , Mucormycosis/drug therapy , Treatment Outcome , VenezuelaABSTRACT
La gangrena de Fournier es una infección poco frecuente de las regiones genitales, perineal y perianal. Presentamos cinco casos de gangrena de Fournier, estudiados en siete años, cuatro hombres y una mujer con un promedio de edad de 60 años (52-68). Los cinco casos presentaron diabetes mellitus, 2 eran alcohólicos crónicos, todos los casos se manejaron con resucitación con líquidos parenterales, desbridación quirúrgica amplia con limpieza exhaustiva y triple esquema de antibioticoterapia. En 3 casos se realizó colostomía por tener un origen anorrectal, en un caso se realizó cistoscopía por presentar estrechez uretral, en un caso se realizó orquidectomía bilateral. Nuestra mortalidad fue del 60 por ciento (3 pacientes). La muerte fue por sepsis no controlada y acidosis metabólica severa, con un rango de hospitalización de 16 días.
Subject(s)
Humans , Male , Female , Middle Aged , Fasciitis, Necrotizing/surgery , Fasciitis, Necrotizing/drug therapy , Diabetes Mellitus/complications , Alcoholism/complications , Penis/pathology , Perineum/pathology , Scrotum/pathologyABSTRACT
La fascitis necrotizante es una infección de las partes blandas caracterizada por su rápida progresión y alta morbimortalidad. La ubicación en cabeza y cuello es poco frecuente, tiende a presentarse secundariamente a focos infecciosos dentarios en pacientes jóvenes. El tratamiento quirúrgico oportuno, el uso de antibióticos y medidas generales, son fundamentales en evitar el alto riesgo de muerte en estos pacientes. Se presentan dos casos de evolución fatal en dos pacientes de edad avanzada y patología concomitante (diabetes mellitus, coronariopatía). En ambos el diagnóstico no fue oportuno, resultando en tratamiento tardío. Se concluye la necesidad de la sospecha clínica de esta patología y del tratamiento oportuno y agresivo. La presunción clínica es fundamental y el diagnóstico precoz debe ser planteado y evaluado con tomografía axial computarizada en todo paciente con infección facial
Subject(s)
Humans , Female , Aged , Fasciitis, Necrotizing/diagnosis , Neck , Cefotaxime/therapeutic use , Fasciitis, Necrotizing/complications , Fasciitis, Necrotizing/drug therapy , Tomography, Emission-Computed , TracheostomyABSTRACT
Necrotizing fasciits (NF) is a rapidly progressive disease characterized by extensive necrosis of the fascia, skin, and subcutaneous tissue, with characteristical sparing of the underlying muscle. It is considered to be a rare entity and is associated with a high mortality rate since early recognition and treatment are not provided. Extensive surgical debridement of all necrotic tissues and appropriate antimicrobial treatment are the cornerstones for a successful treatment. We present a case of NF in a 36-year-old man and discuss it's pathophysiology, clinical manifestations and the best therapeutic choice for this potential life threatening disease.
Subject(s)
Fasciitis, Necrotizing , Adult , Debridement , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/drug therapy , Fasciitis, Necrotizing/physiopathology , Humans , MaleABSTRACT
É apresentando um caso de fasceíte necrotizante, na mama, em uma paciente de 68 anos que foi submetida à excisão de um volumoso lipoma mamário e evoluiu com infecção local agressiva, apresentando necrose extensa do parênquima da mama e de suas fáscias, além da pele, quadro este que caracteriza as fasceítes. O trabalho chama a atenção para a gravidade da entidade e a dificuldade diagnóstica, em razão do comprometimento cutâneo mais tardio e menos extenso; enfatiza-se a necessidade de afastar tal diagnóstico na vigência de infecções mamárias, assim como ter uma abordagem precoce e agressiva na presença de um quadro de fasceíte necrotizante mamária.