1/13. Neonatal necrotizing fasciitis: a report of three cases and review of the literature.OBJECTIVE: Necrotizing fasciitis (NF) is a predominantly adult disorder, with bacterial infection of the soft tissue. In children, it is relatively rare and has a fulminant course with a high mortality rate. In the neonate, most cases of NF are attributable to secondary infection of omphalitis, balanitis, mammitis, postoperative complications, and fetal monitoring. The objective of this communication is to report 3 cases of neonatal NF and provide a literature review of this disorder. RESULTS: This review yielded 66 cases of neonatal NF. Only 3 cases were premature. There was no sex predilection and the condition rarely recurred. Several underlying conditions were identified that might have contributed to the development of neonatal NF. These included omphalitis in 47, mammitis in 5, balanitis in 4, fetal scalp monitoring in 2, necrotizing enterocolitis, immunodeficiency, bullous impetigo, and maternal mastitis in 1 patient each. The most common site of the initial involvement was the abdominal wall (n = 53), followed by the thorax (n = 7), back (n = 2), scalp (n = 2), and extremity (n = 2). The initial skin presentation ranged from minimal rash to erythema, edema, induration or cellulitis. The lesions subsequently spread rapidly. The overlying skin might later develop a violaceous discoloration, peau d'orange appearance, bullae, or necrosis. Crepitus was uncommon. fever and tachycardia were frequent but not uniformly present. The leukocyte count of the peripheral blood was usually elevated with a shift to the left. thrombocytopenia was noted in half of the cases. hypocalcemia was rarely reported. Of the 53 wound cultures available for bacteriologic evaluation, 39 were polymicrobial, 13 were monomicrobial, and 1 was sterile. blood culture was positive in only 20 cases (50%). Treatment modalities included the use of antibiotics, supportive care, surgical debridement, and drainage of the affected fascial planes. Two of the 6 cases who received hyperbaric oxygen therapy died. The overall mortality rate was 59% (39/66). In 12 cases, skin grafting was required because of poor granulation formation or large postoperative skin defects among the survivors. CONCLUSION: Neonatal NF is an uncommon but often fatal bacterial infection of the skin, subcutaneous fat, superficial fascia, and deep fascia. It is characterized by marked tissue edema, rapid spread of inflammation, and signs of systemic toxicity. The wound cultures are predominantly polymicrobial and the location of initial involvement depends on the underlying etiologic factor. High index of suspicion, prompt aggressive surgery, appropriate antibiotics, and supportive care are the mainstays of management in the newborn infant with NF.- - - - - - - - - - ranking = 1keywords = bacterial infection (Clic here for more details about this article) |
2/13. Necrotizing fasciitis and malpractice claims.BACKGROUND: Necrotizing fasciitis (NF) is an aggressive bacterial infection of the superficial fascia and subcutaneous tissues that is increasing in incidence. The high toll exacted by this illness provides a setting for malpractice claims. METHOD: We reviewed 180 consecutive malpractice claims submitted by attorneys for medical expert review between 1987 and late 1997. Four cases involved NF. RESULTS: Alleged failure to obtain timely surgical consultation was the basis for three claims, and alleged failure to prevent NF by proper nursing care was the basis for the fourth. Three cases were closed and one was settled. CONCLUSIONS: The cornerstone of risk management for a clinical presentation compatible with NF is immediate surgical consultation, with other diagnostic steps a secondary consideration.- - - - - - - - - - ranking = 0.5keywords = bacterial infection (Clic here for more details about this article) |
3/13. Necrotizing fasciitis after peritonsillar abscess in an immunocompetent patient.Cervical necrotizing fasciitis (CNF) is a rapidly progressive, severe bacterial infection of the fascial planes of the head and neck. Group A beta haemolytic Streptococcus spp. (GABHS), staphylococcus spp., or obligatory anaerobic bacteria are the most common causative pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CNF. review of the literature reveals only seven such cases, with four successful outcomes. The authors present the case of a 50-year-old immunocompetent female with CNF arising from a peritonsillar abscess. Intravenous immunoglobulins in conjunction with surgery and antibiotics were used successfully. The authors also suggest the importance of the early diagnosis, aggressive surgical debridement, broad-spectrum antibiotics, and possible usefulness of the intravenous immunoglobulins in the treatment of CNF, especially when the disease is associated with toxic shock syndrome.- - - - - - - - - - ranking = 0.5keywords = bacterial infection (Clic here for more details about this article) |
4/13. Successfully managed genital necrotizing fasciitis with multiple debilitating diseases. A case report.Genital necrotizing fasciitis is a rapidly progressive bacterial infection of soft tissues with a reported average mortality of about 36%; associated debilitating diseases increase the mortality rate. The Authors report a case of successful management, due to an aggressive medical and surgical therapy, despite the presence of multiple debilitating diseases and an advanced necrosis.- - - - - - - - - - ranking = 0.5keywords = bacterial infection (Clic here for more details about this article) |
5/13. Descending necrotizing mediastinitis: report of a case following steroid neck injection.Cervical necrotizing fasciitis is a rare, rapidly progressive, severe bacterial infection of the soft tissues of the neck. Uncommonly, it may descend into the mediastinum. We describe a case of descending necrotizing mediastinitis in a young man, where there was diagnostic confusion and delay, with an eventual fatal outcome. A steroid injection for neck pain is thought to be the source of infection. In this case, the signs of mediastinitis were initially masked, and the diagnosis delayed until cardiopulmonary arrest occurred. Early recognition with a low threshold for computed tomography (CT) scanning is essential. Aggressive multidisciplinary therapy with mediastinal drainage is mandatory.- - - - - - - - - - ranking = 0.5keywords = bacterial infection (Clic here for more details about this article) |
6/13. Necrotising fasciitis and myositis that originated from gastrointestinal bacterial infection: two fatal cases.We present two cases of aggressive myofasciitis after gastrointestinal infections. The first patient developed necrosis of the legs over 5 days and he died on the 20th day. vibrio vulnificus was cultured. The second patient developed bullae on his thigh and he died the next day. streptococcus pyogenes was cultured.- - - - - - - - - - ranking = 2keywords = bacterial infection (Clic here for more details about this article) |
7/13. life-threatening necrotizing fasciitis of the neck: an unusual consequence of a sore throat.BACKGROUND: Necrotizing fasciitis is life-threatening bacterial infection which spreads with frightening speed along the fascial planes resulting in extensive tissue necrosis and often death. The infection is caused by either Group A streptococci or a combination of aerobic and anaerobic bacteria. Necrotizing fasciitis of the neck is rare and commonly has a dental origin. CASE REPORT: Here we present a unique case of the condition that was preceded by a sore throat in a young immunocompetent woman. We also describe, for the first time, a successful outcome involving primary skin closure and daily irrigation of the wound with hydrogen peroxide.- - - - - - - - - - ranking = 0.5keywords = bacterial infection (Clic here for more details about this article) |
8/13. Chron's disease, rare association with selective IgA immunodeficiency, and development of life-threatening bacterial infections.life-threatening necrotizing fasciitis and relapsing lemierre syndrome associated with fusobacterium necrophorum septicaemia occurred in young adults with a moderate Chron's disease and a missed profound iga deficiency. This unexpected association of a chronic bowel inflammatory syndrome with prominent IgA abnormalities and severe bacterial infection deserves careful attention by physicians faced with young patients with Chron's disease.- - - - - - - - - - ranking = 2.5keywords = bacterial infection (Clic here for more details about this article) |
9/13. Cranio-cervical necrotizing fascitiis: case report and review of the literature.Necrotising fascitiis is a rapidly progressive bacterial infection of the soft tissues and generally attacks the walls of the abdomen, the perineum, the limbs or, to a lesser degree, the cranio-cervical area. In the latter region, the infection involves the soft tissues of the neck, in a more or less extensive manner, and causes diffuse necrosis. Crepitation, areas with linear infiltration and others with fluctuation are detected on manual examination. Systemic symptoms such as fever, tachycardia, tachypnoea and signs of septic shock are always present, at least during the more advanced stages of the disease. Computed tomography may prove fundamental since it reveals an increase in the thickness and degree of impregnation of the cervical soft tissues, as well as the presence of liquid or gaseous infiltration in the thoracic areas, especially in cases of mediastinitis. Personal experience in a case is described which led to a review of the literature. The best approach in the management of this devastating condition is early diagnosis, adequate antibiotic treatment and radical surgical procedures, which may often need to be repeated several times.- - - - - - - - - - ranking = 0.5keywords = bacterial infection (Clic here for more details about this article) |
10/13. Necrotizing fasciitis in a child: a rare complication of idiopathic nephrotic syndrome.In nephrotic syndrome there is an increased tendency for bacterial infections due to immunological changes secondary to proteinuria, treatment (including steroids), and other as yet unknown causes. However, necrotizing fasciitis (NF) is an uncommon complication of the disease and has rarely been reported in nephrotic children. We report a 14-month-old boy with nephrotic syndrome who developed sepsis and NF as a complication. He was treated successfully with intensive medical and surgical treatment.- - - - - - - - - - ranking = 0.5keywords = bacterial infection (Clic here for more details about this article) |
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