1/16. Necrotizing fasciitis secondary to group A streptococcus. morbidity and mortality still high.OBJECTIVE: To update physicians on Group A streptococcal necrotizing fasciitis, including current methods of diagnosis and treatment. QUALITY OF EVIDENCE: Current literature (1990-1998) was searched via medline using the MeSH headings necrotizing fasciitis, toxic shock syndrome, and streptococcus. Articles were selected based on clinical relevance and design. Most were case reports, case series, or population-based surveys. There were no randomized controlled trials. MAIN MESSAGE: The hallmark of clinical diagnosis of necrotizing fasciitis is pain out of proportion to physical findings. Suspicion of underlying soft tissue infection should prompt urgent surgical examination. Therapy consists of definitive excisional surgical debridement in conjunction with high-dose intravenous penicillin g and clindamicin. risk factors for mortality include advanced age, underlying illness, hypotension, and bacteremia. CONCLUSION: Necrotizing soft tissue infections due to Group A streptococcus might be increasing in frequency and aggression. overall mortality remains high (20% to 34% in larger series). Clinical diagnosis requires a high level of suspicion and should prompt urgent surgical referral.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/16. Necrotizing fasciitis and toxic shock-like syndrome caused by group B streptococcus.A recent increase in reports of necrotizing fasciitis resulting from group B streptococcus has alerted physicians to a possible concomitant increase of toxic shock-like syndrome. We report the second case of group B streptococcus causing necrotizing fasciitis and toxic shock-like syndrome. A black woman, aged 52 years, with newly diagnosed diabetes mellitus had necrotizing fasciitis type II of the left groin. hypotension, elevated bilirubin and liver enzymes, and adult respiratory distress syndrome rapidly developed. Because group B streptococcus was isolated from a normally sterile site, the patient's condition met the criteria for toxic shock-like syndrome. Extensive surgical debridement, hyperbaric oxygen therapy, and intravenous antibiotic therapy (including clindamycin) were required for complete recovery. The antitoxin effects of hyperbaric oxygen therapy and clindamycin should be further investigated for the treatment of such patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/16. Necrotizing fasciitis: a plea for early diagnosis and treatment.INTRODUCTION: Necrotizing fasciitis is an uncommon infectious entity that poses difficult diagnostic and therapeutic management decisions. PURPOSE: This paper addresses the presentation, evaluation and management of the patient with a necrotizing soft tissue infection. CASE REPORT: A 54-year-old man presented to his physician with pain and swelling of the left anterior chest wall following a presumed insect bite several days prior. He was treated with oral antibiotics but returned to the office three days later with increased swelling, pain, and erythema in the axilla. Necrotizing fasciitis was diagnosed. He was hospitalized and taken to the operating room for debridement of the chest wall. Extensive necrosis of the skin, subcutaneous tissue and muscle was encountered. Muscle debridement extended from the pectoralis major and both obliques anteriorly to the latissimus dorsi and para-spinalis muscles posteriorly. Multiple operative debridements were performed over several days. The patient developed septic shock requiring blood pressure support, and multiple organ system failure requiring hemodialysis, prolonged ventilatory support and eventual tracheostomy. Split-thickness skin grafts were placed during the third operative debridement and concluded on the 15th day of hospitalization. The patient eventually recovered and on the 53rd hospital day was transferred to the rehabilitation service, where he spent the next four weeks recovering movement in the left arm. CONCLUSION: Necrotizing fasciitis is an infectious entity that requires rapid diagnosis, surgical debridement, and tissue coverage if the patient is to survive.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/16. Trocar-site hernia complicated by necrotizing fasciitis--case report and review of the literature.Only a few reports have been published describing necrotizing soft tissue infection (NSTI) following laparoscopic surgery; none identify trocar-site hernia as an etiologic factor. We present a case report and review of the literature. A 43-year-old previously healthy man underwent uneventful laparoscopic cholecystectomy. An unrecognized strangulated lateral trocar-site hernia resulted in fatal NSTI. A medline database search (1966-2002) identifies ten detailed reports of NSTIs following laparoscopic surgery. Multiple risk factors were identified in almost all patients. The mortality rate was 20%. Patient survival from NSTI requires early recognition, aggressive surgical intervention, and intensive medical care. NSTI can occur following minimally invasive surgery, and physicians should maintain a high index of suspicion when patients begin to develop postoperative symptoms. Trocar-site hernia arises as another etiologic factor for NSTI in the domain of minimally invasive surgery.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/16. Subacute necrotizing fasciitis caused by gas-producing Staphylococcus aureus.Presented here is a case of necrotizing fasciitis that developed bilaterally on the thighs of a 54-year-old diabetic woman following subcutaneous insulin injection. Severe localized pain was the presenting symptom; later, soft-tissue gas appeared. Incisional biopsy, performed on day 10 following admission, confirmed the diagnosis. Staphylococcus aureus was the only pathogen isolated. The disease had a slowly progressive course despite appropriate medical treatment, and recovery of the patient was achieved only after fasciotomy, drainage, and debridement of necrotic tissue was undertaken 4 weeks following admission. Staphylococcus aureus may cause subacute necrotizing fasciitis, and infection with this organism should be considered in cases of soft-tissue infection with gas formation in diabetics. The development of soft-tissue infection at the site of insulin injection should alert physicians to the possibility of infection with Staphylococcus aureus.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/16. Cryptococcal necrotizing fasciitis with multiple sites of involvement in the lower extremities.BACKGROUND: Cryptococcal necrotizing fasciitis that is localized to the lower extremities is very rare. OBJECTIVE: We describe a case of a renal transplant recipient who presented with necrotizing fasciitis of the legs caused by cryptococcus neoformans, a fungus that is rarely associated with this disease. methods: This is a case report with literature review. RESULTS: The patient was hospitalized, and the site of infection was debrided to the level of the periosteum. Cultures and histopathologic examination of biopsy material revealed an invasive deep-seated infection with a fungal organism that was consistent with C. neoformans. After 21 days on parenteral amphotericin b (Ambisome; Er-Kim Pharmaceuticals) treatment, the patient was switched to oral itraconazole (Itraspor; Janssen-Cilag Pharmaceuticals) 200 mg/day. He was discharged after 30 days of hospitalization with his wounds completely healed. He continued on oral fluconazole for a total course of 6 weeks. CONCLUSION: Systemic fungal infections continue to be an important cause of morbidity and mortality in transplant recipients. The insidious nature and atypical manifestations of these infections often delay diagnosis and therapy. In immunosuppressed patients, persistent fever that does not respond to antibacterial therapy should alert the physician to the possibility of fungal infection.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/16. 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 = 1keywords = physician (Clic here for more details about this article) |
8/16. A rare complication of endoscopic sinus surgery: necrotizing fasciitis of the eyelid.Necrotizing fasciitis is a soft tissue infection characterized by necrosis of fascia and subcutaneous tissue. It frequently involves the groin, abdomen and lower extremities, but rarely involves the head and neck region. An unusual occurrence of periorbital necrotizing fasciitis after a routine endoscopic sinus surgery in a 57-year-old woman with a history of type II diabetes mellitus is presented. Although the disease is very rare, all the physicians should be aware of the manifestations of this disorder and its treatment. Early recognition and prompt intervention plays an important role in minimizing the morbidity and mortality rates.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/16. Necrotizing fasciitis during de novo minimal change nephrotic syndrome in a kidney transplant recipient.skin infections and particularly necrotizing fasciitis (NF) represent a rare but serious complication after transplantation. Optimal management depends on prompt diagnosis with identification of the causative organisms to allow appropriate antibiotic therapy in association with surgical debridement. We report a case of a methicillin-resistant staphylococcus aureus (MRSA) NF as the single pathogen in a renal transplant recipient, during the course of a de novo minimal-change nephrotic syndrome, treated with high-dose steroids. Antibiotic therapy together with surgical debridement and discontinuation of immunosuppressive treatment led to a complete recovery, despite persistence of the nephrotic syndrome. The development of de novo minimal-change nephrotic syndrome after renal allograft transplantation should alert physicians to the possibility of MRSA NF during an increase in the immunosuppressive regimen.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/16. Group A streptococcal necrotizing fasciitis complicating primary varicella: a series of fourteen patients.We retrospectively reviewed the clinical course of group A streptococcus necrotizing fasciitis complicating primary varicella in children admitted to Children's Hospital and Medical Center, Seattle, WA, during a 18-month period. The potential benefit of various therapeutic interventions was examined. Fourteen children ages 6 months to 10 years were treated for group A streptococcus necrotizing fasciitis as a complication of primary varicella. Eight patients experienced a delay in initial diagnosis as a result of nonspecific, early clinical findings of necrotizing fasciitis. Each patient underwent surgical exploration with fasciotomies and debridement. Initial antibiotic therapy was broad spectrum and included clindamycin. Hyperbaric oxygen therapy for as many as 6 treatments was used as adjunctively therapy in 12 patients, with subjective benefit in 6 patients. All 14 patients were discharged home with good function and no long term sequelae. This potentially fatal bacterial infection of the deep fascial layers requires early recognition by primary care physicians and an intensive, multidisciplinary therapeutic approach, including thorough surgical debridement and appropriate antibiotic therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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