scholarly journals Concurrent Pseudomonas Periorbital Necrotizing Fasciitis and Endophthalmitis: A Case Report and Literature Review

Pathogens ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 854
Author(s):  
Yu-Kuei Lee ◽  
Chun-Chieh Lai
Keyword(s):  
Soft Tissue ◽  
Literature Review ◽  
Necrotizing Fasciitis ◽  
Subcutaneous Tissue ◽  
Superficial Fascia ◽  
Upper Eyelid ◽  
Case Presentation ◽  
Phthisis Bulbi ◽  
Eyelid Swelling ◽  
The Rich

(1) Background: Necrotizing fasciitis (NF) is an infection involving the superficial fascia and subcutaneous tissue. Endophthalmitis is an infection within the ocular ball. Herein we report a rare case of concurrent periorbital NF and endophthalmitis, caused by Pseudomonas aeruginosa (PA). We also conducted a literature review related to periorbital PA skin and soft-tissue infections. (2) Case presentation: A 62-year-old male had left upper eyelid swelling and redness; orbital cellulitis was diagnosed. During eyelid debridement, NF with the involvement of the upper Müller’s muscle and levator muscle was noted. The infection soon progressed to scleral ulcers and endophthalmitis. The eye developed phthisis bulbi, despite treatment with intravitreal antibiotics. (3) Conclusions: Immunocompromised individuals are more likely than immunocompetent hosts to be infected by PA. Although periorbital NF is uncommon due to the rich blood supply in the area, the possibility of PA infection should be considered in concurrent periorbital soft-tissue infection and endophthalmitis.

Noma and Necrotizing Fasciitis of the Face and Neck

2021 ◽  
Author(s):  
Lauren E. Miller ◽  
David A. Shaye
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Head And Neck ◽  
Subcutaneous Tissue ◽  
Neck Region ◽  
Superficial Fascia ◽  
Soft Tissue Infections ◽  
Head And Neck Region ◽  
Necrotizing Soft Tissue Infections ◽  
The Face

AbstractNecrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.

scholarly journals Necrotizing Fasciitis: A Review of Management Guidelines in a Large Obstetrics and Gynecology Teaching Hospital

1993 ◽  
Vol 1 (1) ◽  
pp. 16-22 ◽  
Author(s):  
C. D. Thompson ◽  
A. L. Brekken ◽  
W. H. Kutteh
Keyword(s):  
Risk Factors ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Operating Room ◽  
Teaching Hospital ◽  
Subcutaneous Tissue ◽  
Diabetic Woman ◽  
Wound Complications ◽  
Morbidly Obese ◽  
Superficial Fascia

Necrotizing fasciitis is a severe, life-threatening soft tissue infection that results in rapid and progressive destruction of the superficial fascia and subcutaneous tissue. Because of its varied clinical presentation and bacteriological make-up, it has been labelled with many other names such as acute streptococcal gangrene, gangrenous erysipelas, necrotizing erysipelas, hospital gangrene, and acute dermal gangrene. Although described by Hippocrates and Galen, it has received increasing attention in obstetrical and gynecological literature only within the last 20 years. This review includes two recent cases successfully managed at Parkland Memorial Hospital, Dallas, Texas. The first patient was a 50 year old, morbidly obese, diabetic woman who presented with a small, painful lesion on the vulva. After failing triple antibiotic therapy with ampicillin, clindamycin, and gentamicin, the diagnosis of necrotizing fasciitis of the vulva was made, and she was taken to the operating room for extensive excision. She was discharged home on hospital day 29. The second patient was a 65 year old, obese, diabetic woman with risk factors for atherosclerosis who had a wound separation after an abdominal hysterectomy. Two days later a loss of resistance to probing was noted in the subcutaneous tissue. Necrotizing fasciitis was suspected, and she was taken to the operating room for resection. The patient was discharged home on hospital day 27. The mortality rate after diagnosis of necrotizing fasciitis has been reported to be 30% to 60%. We review the literature and outline the guidelines used in a large Ob/Gyn teaching hospital to minimize the adverse outcome. Lectures on soft-tissue infections are included on a regular basis. The high-risk factors of age over 50, diabetes, and atherosclerosis are emphasized. The need for early diagnosis and surgical treatment within 48 hours is stressed, and any suspicious lesions or wound complications are reported to experienced senior house officers and staff. We use two recent cases to highlight the diagnostic clues and management strategies for this often fatal polymicrobial infection.

scholarly journals Necrotizing Fasciitis: Diagnostic Challenges and Current Practices

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Abhishek Vijayakumar ◽  
Rajeev Pullagura ◽  
Durganna Thimmappa
Keyword(s):  
Soft Tissue ◽  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Subcutaneous Tissue ◽  
Scoring Systems ◽  
Risk Groups ◽  
Deep Fascia ◽  
Superficial Fascia ◽  
Diagnosis And Management ◽  
Necrotizing Soft Tissue Infections

Necrotizing fasciitis or necrotizing soft-tissue infections (NSTIs) are infrequent but highly lethal infections. They can be defined as infections of any of the layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle) that are associated with necrotizing changes. At onset, necrotizing fasciitis can be difficult to differentiate from cellulitis and other superficial infections of the skin. In fact, only 15% to 34% of patients with necrotizing fasciitis have an accurate admitting diagnosis. Early diagnosis and management with surgical debridement, antimicrobials, and supportive measures reduce mortality. Even with modern ICU care mortality ranges between 16 and 36%; this is related to delays in diagnosis and comorbidities. Various scoring systems have been developed which help in diagnosis and stratifying patients into risk groups. The present review deals with varied presentation, early diagnosis, and management of necrotizing fasciitis.

scholarly journals Klebsiella Pneumoniae Necrotizing Fascitis of The Lower Extremity in A 7-Month-Old Male: A Case Report and Literature Review

2021 ◽  
Vol 4 (2) ◽  
pp. 52
Author(s):  
Marelno Zakanito ◽  
Iswinarno Saputro
Keyword(s):  
Soft Tissue ◽  
Klebsiella Pneumoniae ◽  
Lower Extremity ◽  
Necrotizing Fasciitis ◽  
Subcutaneous Tissue ◽  
Initial Period ◽  
Academic Medical Center ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Laboratory Evaluation

Introduction: Klebsiella pneumoniae necrotizing fasciitis is an uncommon soft tissue infection characterized by rapidly progressing necrosis involving the skin, subcutaneous tissue, and fascia. This condition may result in gross morbidity and mortality if not treated in its early stages. In fact, the mortality rate of this condition is high, ranging from 25 to 35%. We present a case of 7-month-old male with K. pneumoniae necrotizing fasciitis of the lower extremity. Materials and Methods: A 7-month-old male presented with large areas over both left and right inferior side of the lower limbs to the emergency department of Dr. Soetomo Academic Medical Center Hospital, Surabaya, Indonesia. Physical examination revealed elevated heart rate of 136 times per minute and increased body temperature of 38oC. The large areas on both lower limbs were darkened, sloughed off, and very tender to palpation. A small area over the right hand was erythematous and sloughed off. Laboratory evaluation demonstrated decreased hemoglobin of 6.2 g/dL and elevated leukocyte of 28,850 g/dL. Blood cultures demonstrated that K. pneumoniae was present. Discussion: NF is usually hard to diagnose during the initial period. The findings of NF can overlap with other soft tissue infections including cellulitis, abscess or even compartment syndrome. However, pain out of proportion to the degree of skin involvement and signs of systemic shock should alert the clinical to the possibility of NF. The clinical manifestations of NF start around a week after the initiating event, with induration and edema, followed by 24 to 48 hours later by erythema or purple discoloration and increasing local fever In the next 48 to 72 hours, the skin turns smooth, bright, and serous, or hemorrhagic blisters develop. If unproperly treated, necrosis develops, and by the fifth or sixth day, the lesion turns black with a necrotic crust. Conclusions: K. pneumoniae necrotizing fasciitis is a rare but lifethreatening disease. A high index of suspicion is required for early diagnosis and treatment of this condition

scholarly journals Osteomyelitis Infection ofMycobacterium marinum: A Case Report and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Hao H. Nguyen ◽  
Nada Fadul ◽  
Muhammad S. Ashraf ◽  
Dawd S. Siraj
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Literature Review ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Immunocompromised Patient ◽  
Skin Lesions ◽  
Immunocompromised Patients ◽  
Deep Soft Tissue ◽  
Invasive Infections

Mycobacterium marinum(M. marinum) is a ubiquitous waterborne organism that grows optimally at temperatures around 30°C. It is a nontuberculousMycobacteriumfound in nonchlorinated water with worldwide prevalence. It is the most common atypicalMycobacteriumthat causes opportunistic infection in humans.M. marinumcan cause superficial infections and localized invasive infections in humans, with the hands being the sites most frequently affected. It can cause skin lesions, which are either single, papulonodular lesions, confined to an extremity, or may resemble cutaneous sporotrichosis. This infection can also cause deeper infections including tenosynovitis, bursitis, arthritis, and osteomyelitis. Disseminated infections and visceral involvements have been reported in immunocompromised patients. We here report a case of severe deep soft tissue infection with necrotizing fasciitis and osteomyelitis of the left upper extremity (LUE) caused byM. marinumin an immunocompromised patient.

scholarly journals Necrotizing Fasciitis by Two Anaerobic Bacteria in an Immunocompetent Patient after Minor Trauma: A Case Report

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Marco Sciarra ◽  
Andrea Schimmenti ◽  
Tommaso Manciulli ◽  
Cristina Sarda ◽  
Marco Mussa ◽  
...  
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Rare Case ◽  
Subcutaneous Tissue ◽  
Anaerobic Bacteria ◽  
Immunocompetent Patient ◽  
Minor Trauma ◽  
Group A Streptococci ◽  
Group A

Necrotizing fasciitis (NF) is a soft tissue infection affecting subcutaneous tissue and the muscular fascia without involvement of the muscle and can be either monomicrobial or polymicrobial. Monomicrobial infections are usually caused by group A streptococci, while infections caused by anaerobic germs usually affect immunodepressed patients. We report a rare case of NF caused by two anaerobic bacteria in an immunocompetent patient.

Limb Salvage in a Diabetic with Necrotizing Fasciitis: Case Report and Literature Review

Foot & Ankle ◽  
1986 ◽  
Vol 6 (4) ◽  
pp. 199-207
Author(s):  
Steven B. Carlow ◽  
Richard L. Jacobs ◽  
Danica K. Vedder
Keyword(s):  
Case Report ◽  
Soft Tissue ◽  
Early Diagnosis ◽  
Literature Review ◽  
Necrotizing Fasciitis ◽  
Limb Salvage ◽  
Clinical Signs ◽  
Tissue Biopsy ◽  
Functional Limb

Necrotizing fasciitis must be considered in a diabetic with cutaneous ulceration. A case report of limb salvage in a 48-year-old diabetic female with progressive necrotizing fasciitis is presented. Methods of early diagnosis including clinical signs, radiographs, and soft tissue biopsy of the involved extremity are reviewed. The microbiology of the disease is also discussed. A modification of the Orr technique using infrequent dressing changes in the management of necrotizing fasciitis is presented. In our case this resulted in preservation of life and a functional limb.

scholarly journals A 5-year retrospective analysis of Necrotizing fasciitis: A single center experiences

2015 ◽  
Vol 72 (3) ◽  
pp. 258-264 ◽  
Author(s):  
Aleksandar Kiralj ◽  
Zlata Janjic ◽  
Jelena Nikolic ◽  
Borislav Markov ◽  
Marija Marinkovic
Keyword(s):  
Surgical Treatment ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
The Body ◽  
Etiological Factor ◽  
Rapid Progression ◽  
Type I ◽  
Superficial Fascia ◽  
Clinical Center ◽  
Novi Sad

Background/Aim. Necrotizing fasciitis (NF) is usually an acute infection of superficial fascia with rapid progression in around soft tissue. If not promptly recognized and aggressively treated NF usualy leads to sepsis and multiorgan failure with fatal outcome, thus early diagnosis and prompt surgical treatment are crucial for healing of these patients. The aim of this article was to evaluate the clinical presentation of all patients with acute NF diagnosed and treated in surgical clinics of Clinical Center of Vojvodina, Novi Sad, Serbia. Methods. The medical records of patients treated for acute NF localized on a different parts of the body in Clinical Center of Vojvodina, Novi Sad, Serbia, during a 5- year period (from January 2008 to December 2012) were retrospectively evaluated. This study enrolled patients admitted via Emergency Center of Vojvodina with the diagnosis of acute NF either as the primary diagnosis or with the diagnosis at discharge after surgical treatment. Results. During a 5-year period there were 216 patients with final diagnosis of acute NF. Most of our patients (140 - 64.81%) were admitted with the initial diagnosis of cellulitis, abscesses, phlegmons or sepsis. Unfortunately, the clinical symptoms of acute NF were atypical at time of initial examination. Pain and swelling of the affected localization were the most presented bias of symptoms (183 - 84.72%). The majority of our patients were male (164 - 75.92%). Among the 216 patients, the most common pre-existing single factor was drug abuse (39 - 18.05%), followed by obesity (38 - 17.59%) and diabetes mellitus (31 - 14.35%). Trauma was most common etiological factor (22 - 10.8%) in infected wounds, followed by abdominal (15 - 6.94%) and orthopedic (11 - 5.09%) surgical intervention. In the present study idiopathic acute NF was diagnosed in 22 (10.18%) patients and more than one etiological factor were diagnosed in 20 (9.25%) patients. The majority of our patients had type I acute NF (172 - 79.62%) with Streptococcal species as the most common microorganism (125 - 71.02%). The most common localization was an extremity (151 - 69.90%). The minority of our patients had head and neck localization of infection (7 - 3.24%). Surgical treatment was performed in all the patients and most of them (183 - 84.72%) received the first surgery within 24 h. Other patients (23 - 10.64%) received operation after stabilization of general status or after getting the diagnosis of acute NF (unclear diagnosis on admission). During hospitalization, the most common complication among our patients was sepsis (156 - 72.22%). The mortality rate was 14.35%. Conclusion. Acute NF is a rare but very difficult and sometimes life-threatening disease of superficial fascia and around soft tissue. If acute NF is suspected, early radical excision of all the affected tissue with exploration and excision of superficial fascia with pathological and microbiological assessment are most significant for treatment. Appropriate antibiotics and intensive care setting to manage other organ failure of NF are recommended at the same time with surgery.

scholarly journals Anaesthetic Management of a Patient with Necrotizing Fasciitis: A Case Report

2021 ◽  
Vol 6 (3) ◽  
pp. 31-34
Author(s):  
Shallu Chaudhary ◽  
Major Amit Atwal
Keyword(s):  
Mechanical Ventilation ◽  
Severe Sepsis ◽  
Case Report ◽  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Tissue Injury ◽  
Subcutaneous Tissue ◽  
Soft Tissue Injury ◽  
Anaesthetic Management ◽  
Left Shoulder

Necrotizing fasciitis is a highly lethal bacterial infection of subcutaneous tissue and fascia. 77 year old male patient, smoker with necrotizing fasciitis underwent surgery:- left shoulder disarticulation in emergency OT under general anesthesia. Intraoperatively, the patient went into severe sepsis and developed arrythmias and hypotension which was managed with anti-arrythmic drugs and infusion norepinephrine. The patient responded to the treatment and the surgery was completed. Postoperatively mechanical ventilation was continued and subsequently the patient improved and was extubated 3 days later. Keywords: Necrotizing fasciitis, necrotizing acute soft tissue injury, NASTI.

scholarly journals Necrotizing Fasciitis in Neonate and Use of Allograft

2019 ◽  
Vol 8 (1) ◽  
pp. 8
Author(s):  
Nitinkumar Borkar ◽  
Phalguni Padhi ◽  
Jiten Kumar Mishra ◽  
Shamendra Anand Sahu ◽  
Debajyoti Mohanty ◽  
...  
Keyword(s):  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Skin Graft ◽  
Subcutaneous Tissue ◽  
Donor Site ◽  
Subcutaneous Fat ◽  
Surgical Debridement ◽  
Split Thickness Skin Graft ◽  
Superficial Fascia ◽  
Thickness Skin

Necrotising fasciitis is a fulminant and rapidly progressive infection of the superficial fascia and subcutaneous tissue. It is rare in newborn. Trunk is the commonest site of involvement in newborns. Early diagnosis and prompt surgical debridement is the preferred treatment. Debridement in NF leads to a large raw area which may not heal by primary intention and may a split thickness skin graft for healing. Presence of minimum subcutaneous fat, loose skin and large raw area at donor site like back in some neonate poses difficulty for harvesting of skin graft. In such neonates allograft make a valuable option temporarily. Herein we report a case of a neonate with NF in whom post debridement raw area was covered with allograft from mother.

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