scholarly journals Validation of finger test for necrotising soft tissue infection

2020 ◽  
pp. 221049172096154
Author(s):  
Jimmy KY Lau ◽  
KB Kwok ◽  
YW Hung ◽  
CH Fan
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Predictive Value ◽  
Definitive Diagnosis ◽  
Tissue Infection ◽  
Clinical Judgement ◽  
Soft Tissue Infections ◽  
Pathological Findings ◽  
Surgical Exploration ◽  
Early Diagnostic

Background: Necrotising soft tissue infection (NSTI) is rare but fatal. Andreasen proposed finger test as an early diagnostic tool to differentiate NSTI from other soft tissue infections. We aim to evaluate the accuracy and reproducibility of the test for the diagnosis of NSTI. Methods: Patients who were admitted to our department from 2012 to 2016 with suspicion of NSTI and finger test done were retrospectively reviewed. Finger test was done and interpreted as described by Andreasen. Definitive diagnosis of NSTI was confirmed with surgical and pathological findings. Results: Among the 35 patients included in the study, NSTI was confirmed in 10 cases. Finger test had a sensitivity of 100%, a specificity of 80%, positive predictive value of 66.7%, negative predictive value of 100% and an overall accuracy of 85.7%. There was no difference in demographics or comorbidities between NSTI and non-NSTI groups. Surgeons involved had 76.7% agreement and moderate reproducibility (kappa = 0.48) on the diagnostic criteria of finger test. Conclusion: A negative finger test was reliable to exclude NSTI and a positive test suggested further surgical exploration. Yet, clinical judgement was still of paramount importance to treat NSTI promptly.

Soft Tissue Infection

2019 ◽  
Author(s):  
Mark A. Malangoni ◽  
Christopher R McHenry
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Toxic Shock Syndrome ◽  
Bacterial Infections ◽  
Subcutaneous Tissue ◽  
Tissue Infection ◽  
Soft Tissue Infections ◽  
Toxic Shock ◽  
Necrotizing Soft Tissue Infection ◽  
Human Bites

Soft tissue infections are a diverse group of diseases that involve the skin and underlying subcutaneous tissue, fascia, or muscle. The authors review the diagnosis and management of the main soft tissue infections seen by surgeons, including both superficial infections and necrotizing infections. When the characteristic clinical features of necrotizing soft tissue infection are absent, diagnosis may be difficult. In this setting, laboratory and imaging studies become important. Studies emphasizes that computed tomography should continue to be used judiciously as an adjunct to clinical judgment. The delay between hospital admission and initial débridement is the most critical factor influencing morbidity and mortality. Once the diagnosis of necrotizing soft tissue infection is established, patient survival and soft tissue preservation are best achieved by means of prompt operation. Bacterial infections of the dermis and epidermis are covered in depth, along with animal and human bites. Methicillin-resistant Staphylococcus aureus (MRSA) accounts for up to 70% of all S. aureus infections acquired in the community and is the most common organism identified in patients presenting to the emergency department with a skin or soft tissue infection. The more classic findings associated with deep necrotizing infections—skin discoloration, the formation of bullae, and intense erythema—occur much later in the process. It is important to understand this point so that an early diagnosis can be made and appropriate treatment promptly instituted. The review’s discussion covers in depth the etiology and classification of soft tissue infection, pathogenesis of soft tissue infections, toxic shock syndrome, and reports on mortality from necrotizing soft tissue infection. This review 8 figures, 22 tables, and 58 references. Keywords: Erysipelas, cellulitis, soft tissue infection, necrotizing fasciitis, myonecrosis, toxic shock syndrome

Antimicrobial therapy of skin and soft tissue infection in children

1993 ◽  
Vol 83 (7) ◽  
pp. 398-405 ◽  
Author(s):  
I Brook
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Antimicrobial Therapy ◽  
Anaerobic Bacteria ◽  
External Genitalia ◽  
Tissue Infection ◽  
Soft Tissue Infections ◽  
Prevotella Species ◽  
The Common ◽  
Group D

Skin and soft tissue infection and cutaneous abscesses are common in children. They may be polymicrobial in nature, especially when located proximal to mucous membranes. A general knowledge of the common causative bacterial organisms in these infections enables the physician to empirically institute antimicrobial therapy before culture results are available. This review assesses the number and types of aerobic and anaerobic bacteria that occur in skin and soft tissue infections in children. Staphylococcus aureus and Streptococcus pyogenes were recovered from infections occurring at all body sites, but predominated in infections of the leg, neck, and hand. Group D streptococci, Enterobacteriaceae, Neisseria gonorrhoeae, Bacteroides fragilis, and Prevotella species were isolated mostly from infections of the external genitalia and perirectal areas; pigmented Prevotella and Porphyromonas and Haemophilus influenzae can be isolated from infections of the head and neck. Management of skin and soft tissue infections in children should include surgical and medical therapy.

scholarly journals Necrotizing Soft Tissue Infection Occurring after Exposure toMycobacterium marinum

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Shivani S. Patel ◽  
M. Lance Tavana ◽  
M. Sean Boger ◽  
Soe Soe Win ◽  
Bassam H. Rimawi
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Skin Barrier ◽  
Tissue Infection ◽  
Soft Tissue Infections ◽  
Upper Limbs ◽  
Necrotizing Soft Tissue Infection ◽  
Cutaneous Infections ◽  
Fish Exposure ◽  
Necrotizing Soft Tissue Infections

Cutaneous infections caused byMycobacterium marinumhave been attributed to aquarium or fish exposure after a break in the skin barrier. In most instances, the upper limbs and fingers account for a majority of the infection sites. While previous cases of necrotizing soft tissue infections related toM. marinumhave been documented, the importance of our presenting case is to illustrate the aggressive nature ofM. marinumresulting in a persistent necrotizing soft tissue infection of a finger that required multiple aggressive wound debridements, followed by an amputation of the affected extremity, in order to hasten recovery.

Complicated Bone and Soft-Tissue Infections

1996 ◽  
Vol 37 (3P2) ◽  
pp. 870-876
Author(s):  
I. Hovi
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
False Positive ◽  
False Negative ◽  
Tissue Infection ◽  
Positive Finding ◽  
Soft Tissue Infections ◽  
True Negative ◽  
False Positive Finding ◽  
Labeled Leukocytes

Purpose: To assess the value of imaging by 0.1 T MR and by 99mTc-HMPAO-labeled leukocytes in confirming skeletal infection in patients with soft-tissue infections and/or bone pathology. Methods: Thirty-nine anatomical sites (35 patients) with suspected bone infection were prospectively imaged with 0.1 T MR and 99mTc-HMPAO-labeled leukocytes. Thirty-two infected areas were confirmed: 12 osteomyelitis (out of which 3 were spondylitis) and 27 soft-tissue infections (both bone and soft-tissue infection in 7 areas). Results: MR imaging showed 31 true-positive, 3 true-negative, 4 false-positive and one false-negative diagnosis of infection and scintigraphy 27, 7, 0 and 5 respectively. The sensitivity of MR for osteomyelitis was 100% (12/12) and of scintigraphy 42% (5/12), p<0.01. The specificity of MR and of scintigraphy for osteomyelitis were 81% (22/27) and 93% (25/27) respectively. The sensitivity of MR for soft-tissue infection was 96% (26/27) and specificity 75% (9/12). The correspoding figures for scintigraphy were 85% (23/27) and 100% (12/12). MR and scintigraphy were concordant with respect to the final diagnosis in 28/39 (72%) sites and discordant in 10 (26%). In one patient with Charcot osteoarthropathy a false-positive finding was found by both methods. MR detected all 3 cases of spondylitis, scintigraphy none. Nonpyogenic inflammations and neuroarthropathic joints were indistinguishable from infection by MR. Conclusion: Combined imaging with MR and 99mTc-labeled leukocytes is recommended in diagnostically complicated bone infections except for spondylitis where MR is the method of choice. Congruent positive findings are highly suggestive of infection, the extent of which can be determined. Congruent negative results exclude infection.

667 Necrotizing Soft Tissue Infection Within 48 Hours Post-Scald Burn: A Rare Presentation

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S190-S190
Author(s):  
Luis E Meza ◽  
Sarah Rehou ◽  
Courtney H Grotski ◽  
Shahriar Shahrohki
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Burn Injury ◽  
Clinical Signs ◽  
Tissue Infection ◽  
Burn Patients ◽  
Soft Tissue Infections ◽  
Rare Presentation ◽  
Comfort Care ◽  
Necrotizing Soft Tissue Infection

Abstract Introduction We report a case of a patient with a burn injury who developed a devastating necrotizing soft tissue infection (NSTI) early in the post-burn period. Methods An elderly male was admitted to an ABA verified burn centre after sustaining a 20% scald burn to his back and right upper extremity. He was found in the bathtub; a fall was suspected based on his history of Parkinson’s disease and a finding of bruising to his bilateral knees. Initially, his hospital course was uneventful apart from an elevated creatine kinase, which decreased with adequate resuscitation without signs or symptoms of compartment syndrome. Thirty-six hours following his admission, he developed rapid onset of progressively worsening renal function, respiratory requiring intubation, mechanical ventilation, and circulatory failure requiring vasopressor support. After ruling out other causes of shock and upon re-examination of his burns there were clinical signs of a rapidly advancing necrotizing soft tissue infection. He was taken urgently to the operating room for aggressive debridement of nonviable tissue. He underwent a right shoulder disarticulation and extensive debridement of the right chest, abdomen, and back. Intra-operative tissue samples and preoperative blood cultures were positive for Group A Streptococcus. The patient was predicted to require multiple operations and a prolonged hospital stay. Despite these interventions, his prognosis was poor. The family and the treatment team, in the context of the patient’s previous independent functioning, revised his goals of care on his first post-operative day. Life-sustaining treatment was withdrawn, and comfort care measures were implemented. The patient passed away two days later. Results We report a case of a patient with a burn injury who developed a devastating NSTI early in the post-burn period within 36–48 hours of presentation to a burn center. Soft-tissue infections in the immediate post-burn period are rare unless there is subsequent contamination. Burned tissue contains a large amount of necrotic tissue and protein-rich wound exudate, which provides a rich growth medium for bacteria. This, in addition to the immunosuppression secondary to the burn insult, favors the development of infection. NSTI in the context of thermal injury is a rare phenomenon and in the few reported cases in burn patients, necrotizing infections occurred closer to two weeks following the initial injury. Conclusions Necrotizing soft tissue infections are entities with a rapid and devastating course. The diagnosis is challenging, and occlusive dressings may contribute to a delay in diagnosis in burns. Acute hemodynamic compromise without any obvious cause should raise the suspicion for a necrotizing soft tissue infection and lead to early exposure of wounds in burn patients.

scholarly journals Staphylococcus aureus soft tissue infection may increase the risk of subsequent staphylococcal soft tissue infections

2017 ◽  
Vol 60 ◽  
pp. 44-48 ◽  
Author(s):  
Cindy Bouvet ◽  
Shpresa Gjoni ◽  
Besa Zenelaj ◽  
Benjamin A. Lipsky ◽  
Elif Hakko ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Tissue Infection ◽  
Soft Tissue Infections

scholarly journals Study of the effectiveness of laboratory risk indicator for necrotizing fasciitis scoring system in the diagnosis of necrotizing fasciitis among patients presenting with soft tissue infections

2021 ◽  
Vol 8 (7) ◽  
pp. 2041
Author(s):  
Shreeniketan Nayak ◽  
Prakash S. Kattimani
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Scoring System ◽  
Tissue Infection ◽  
Risk Indicator ◽  
Soft Tissue Infections ◽  
Predictive Values ◽  
Necrotizing Soft Tissue Infection ◽  
Lrinec Score

Background: Necrotizing soft tissue infection (NSTI) is an uncommon but life threatening disease with a high mortality rate. Delay in diagnoses and in surgery for debridement is associated with increased mortality rates. Hence here we would like to use this scoring system - laboratory risk indicator for necrotizing fasciitis (LRINEC) in patients presenting to our hospital with necrotizing soft tissue infection and if found to have good predictive values, it would be a boon to developing countries like India where the mortality of the disease is high (7% to 76%).Methods: Patients presenting with symptoms suggestive of soft tissue infection underwent clinical examination and basic laboratory investigations. Following which, information collected using semi structured proforma cum observational checklist. LRINEC scoring system applied to each of the study subjects at admission. The confirmatory diagnosis of necrotizing fasciitis done on patients who undergo surgery vide histopathology, irrespective of the result of the LRINEC scoring system. Tissue cultures and sensitivity patterns analyzed.Results: A total of 100 patients were enrolled. LRINEC score has an ability to diagnose necrotizing fasciitis from other soft tissue infections. High LRINEC score had more incidences of features of sepsis. Presence of the co morbidities tended to increase the LRINEC score. And defines patients with a high LRINEC score of >8 had higher mortality rate.Conclusions: LRINEC score is a simple clinical tool for the diagnosis of necrotizing fasciitis from other soft tissue infections. LRINEC scoring system and clinical assessment should be used concurrently for diagnosing necrotizing fasciitis from other soft tissue infections.

scholarly journals Distinguishing bone and soft tissue infections mimicking sarcomas requires multimodal multidisciplinary team assessment

2019 ◽  
Vol 101 (6) ◽  
pp. 405-410
Author(s):  
JR Lex ◽  
J Gregory ◽  
C Allen ◽  
JP Reid ◽  
JD Stevenson
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Multidisciplinary Team ◽  
Percutaneous Biopsy ◽  
Radiological Feature ◽  
Tissue Infection ◽  
Soft Tissue Infections ◽  
Infection Group ◽  
Team Assessment ◽  
Low Threshold

Introduction The aims of this study were to report the presenting characteristics and identify how best to distinguish bone and soft-tissue infections that mimic sarcomas. Materials and methods A total of 238 (211 osteomyelitis and 27 soft-tissue infections) patients referred to a tertiary sarcoma multidisciplinary team with suspected sarcoma who were ultimately diagnosed with a bone or soft tissue infection were included. Data from a prospectively collated database was analysed retrospectively. Results Of all possible bone and soft-tissue sarcoma referrals, a diagnosis of infection was made in 2.1% and 0.7%, respectively. Median age was 18 years in the osteomyelitis group and 46 years in the soft-tissue infection group. In the osteomyelitis group, the most common presenting features were pain (85.8%) and swelling (32.7%). In the soft-tissue infection group, the most common clinical features were swelling (96.3%) and pain (70.4%). Those in the soft-tissue group were more likely to have raised inflammatory markers. Radiological investigations were unable to discern between tumour or infection in 59.7% of osteomyelitis and 81.5% of soft-tissue infection cases. No organism was identified in 64.9% of those who had a percutaneous biopsy culture. Conclusions This study has highlighted that infection is frequently clinically indistinguishable from sarcoma and remains a principle non-neoplastic differential diagnosis. When patients are investigated for suspected sarcoma, infections can be missed due to falsely negative radiological investigations and percutaneous biopsy. As no single clinical, biochemical or radiological feature or investigation can be relied upon for diagnosis, clinicians should have a low threshold for tissue biopsy and discussion in a sarcoma multidisciplinary team meeting.

scholarly journals The burden of bone, native joint and soft tissue infections on orthopaedic emergency referrals in a city hospital

2016 ◽  
Vol 98 (1) ◽  
pp. 34-39 ◽  
Author(s):  
A Howell ◽  
S Parker ◽  
K Tsitskaris ◽  
MJ Oddy
Keyword(s):  
Soft Tissue ◽  
Length Of Stay ◽  
Soft Tissue Infection ◽  
Tissue Infection ◽  
City Hospital ◽  
Soft Tissue Infections ◽  
Suspected Infection ◽  
Number Of Patients ◽  
Common Diagnosis ◽  
Prosthetic Joint Infections

Introduction Bone, native joint and soft tissue infections are frequently referred to orthopaedic units although their volume as a proportion of the total emergency workload has not been reported previously. Geographic and socioeconomic variation may influence their presentation. The aim of this study was to quantify the burden of such infections on the orthopaedic department in an inner city hospital, determine patient demographics and associated risk factors, and review our current utilisation of specialist services. Methods All cases involving bone, native joint and soft tissue infections admitted under or referred to the orthopaedic team throughout 2012 were reviewed retrospectively. Prosthetic joint infections were excluded. Results Almost 15% of emergency admissions and referrals were associated with bone, native joint or soft tissue infection or suspected infection. The cohort consisted of 169 patients with a mean age of 43 years (range: 1–91 years). The most common diagnosis was cellulitis/other soft tissue infection and the mean length of stay was 13 days. Two-thirds of patients (n=112, 66%) underwent an operation. Fifteen per cent of patients were carrying at least one blood borne virus, eleven per cent were alcohol dependent, fifteen per cent were using or had been using intravenous drugs and nine per cent were homeless or vulnerably housed. Conclusions This study has shown that a significant number of patients are admitted for orthopaedic care as a result of infection. These patients are relatively young, with multiple complex medical and social co-morbidities, and a long length of stay.

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