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

Skin and Soft Tissue Infections

2012 ◽  
pp. 341-350
Author(s):  
Imad M Tleyjeh ◽  
Larry M Baddour
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Skin Infection ◽  
Subcutaneous Tissue ◽  
Clinical Manifestations ◽  
Hair Follicles ◽  
Soft Tissue Infections ◽  
Exposed Skin ◽  
Common Skin ◽  
The Face

Common skin and soft tissue infections covered in this chapter include impetigo, folliculitis, furuncles, carbuncles, cellulitis, and necrotizing fasciitis. Impetigo is a superficial pustular skin infection. Multiple lesions occur on exposed skin of the face and extremities. Staphylococcus aureus causes most cases. Folliculitis is a superficial skin infection of hair follicles. A furuncle is a purulent, painful nodular skin infection involving the hair follicle that is usually a complication of folliculitis. A carbuncle is a cluster of abscesses in subcutaneous tissue that drain through hair follicles. The prevailing pathogen for both furuncles and carbuncles is S aureus. Skin abscesses involve the dermis and deeper skin tissues. Often a pustule is present on the skin. For most cases the pathogen is S aureus. Cellulitis involves skin and subcutaneous tissues. Clinical manifestations of cellulitis include swelling, erythema, tenderness, and warmth. Necrotizing forms of cellulitis are necrotizing fasciitis types I and II. Clinical features include fulminant destruction of tissue and systemic toxicity.

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 Cervical Necrotizing Fasciitis Caused by Dental Extraction

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
José Alcides Arruda ◽  
Eugênia Figueiredo ◽  
Pâmella Álvares ◽  
Luciano Silva ◽  
Leorik Silva ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Chronic Renal Disease ◽  
Subcutaneous Tissue ◽  
Clinical Manifestations ◽  
Acute Onset ◽  
Dental Extraction ◽  
Upper Airways ◽  
Irreversible Damage ◽  
Cervical Area ◽  
Ischemic Ulcers

Cervical necrotizing fasciitis is an unusual infection characterized by necrosis of the subcutaneous tissue and fascial layers. Risk factors for the development of necrotizing fasciitis include diabetes mellitus, chronic renal disease, peripheral vascular disease, malnutrition, advanced age, obesity, alcohol abuse, intravenous drug use, surgery, and ischemic ulcers. This report presents a case of necrotizing fasciitis in the cervical area caused by dental extraction in a 73-year-old woman. Cervical necrotizing fasciitis in geriatric patient is rare, and even when establishing the diagnosis and having it timely treated, the patient can suffer irreversible damage or even death. Clinical manifestations in the head and neck usually have an acute onset characterized by severe pain, swelling, redness, erythema, presence of necrotic tissue, and in severe cases obstruction of the upper airways. Therefore, the presentation of this clinical case can serve as guidance to dentists as a precaution to maintain an aseptic chain and be aware of the clinical condition of older patients and the systemic conditions that may increase the risk of infections.

Surgical Strategies: Necrotizing Fasciitis of the Foot and Ankle Treated With Dermal Regeneration Matrix for Limb Salvage

2020 ◽  
pp. 107110072095208
Author(s):  
Arvind S. Narayanan ◽  
Kempland C. Walley ◽  
Todd Borenstein ◽  
G. Aman Luther ◽  
J. Benjamin Jackson ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Necrotizing Fasciitis ◽  
Limb Salvage ◽  
Free Flap ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Flap Coverage ◽  
Split Thickness Skin Grafting ◽  
Dermal Regeneration

Although necrotizing fasciitis is a life-threatening entity that needs expeditious treatment, cases involving the lower extremity are less commonly encountered than in the upper extremity. Surgical intervention is often required and likely lead to amputation (below-knee or above-knee) vs debridement in the lower extremity. Coverage options in the foot and ankle after serial debridements can present many challenges for limb salvage. Patients are often left with large soft tissue defects requiring coverage with a subsequent increase in relative morbidity. Treatment options for coverage in these cases include negative-pressure wound therapy, split-thickness skin grafting, free flap coverage, or higher-level amputation. In the diabetic population, who present with a lower extremity necrotizing infection, limb salvage is often a challenge given the multiple comorbidities associated with these patients including peripheral vascular disease, immunocompromised state, and neuropathy. Optimal treatment strategies for these necrotizing infections in the foot and ankle remain uncertain. We offer a technique tip for utilization of a dermal regeneration matrix to allow coverage of large soft tissue defect with exposed tendon and/or bone without the need for free flap coverage or higher-level amputation, thus allowing for an additional limb salvage option. Level of Evidence: Level V, expert opinion.

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.

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 of The Abdominal Wall Following Colonoscopy with Fatal Outcome - A Case Report

2019 ◽  
pp. 1-3
Author(s):  
Daniel Matz ◽  
Oleg Heizmann
Keyword(s):  
Soft Tissue ◽  
Necrotizing Fasciitis ◽  
Soft Tissue Infection ◽  
Group A Streptococcus ◽  
Subcutaneous Tissue ◽  
Fatal Outcome ◽  
Anaerobic Bacteria ◽  
Tissue Infection ◽  
Life Threatening ◽  
Staphylococcus Spp

Necrotizing fasciitis (NF) is a serious and potentially life threatening soft tissue infection, usually caused by different types of bacteria such as group A streptococcus, staphylococcus spp. (type 1 infection) or mixed infection by aerobic and anaerobic bacteria (type 2 infection). Usually, the infection arises from skin injury, in injections or surgical procedures and effects the fascia as well as the subcutaneous tissue. Overwhelming progression and difficulties in diagnosing are very common. Mortality rate is up to 100% depending on the type of soft tissue infection and did not markedly decrease in the past decades [1]. Here we present a case of NF with fatal outcome following colonoscopy, which was primarily suspected to be a post polypectomy syndrome.

Necrotizing Fasciitis: Myalgia Is Diagnostic? A Case Series and Literature Review

2020 ◽  
pp. 153473462095860
Author(s):  
Sachin Teelucksingh ◽  
Vijai Deonarine ◽  
Shariful Islam ◽  
Shamir O’Cawich ◽  
Dave Harnanan ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Early Diagnosis ◽  
Necrotizing Fasciitis ◽  
Subcutaneous Tissue ◽  
Case Series ◽  
Muscular Activity ◽  
Clinical Suspicion ◽  
Prompt Treatment ◽  
Diagnostic Difficulties ◽  
Radiologic Features

Necrotizing fasciitis, commonly known as “flesh-eating disease,” is an aggressive soft tissue infection that destroys the fascia, subcutaneous tissue, and skin. Specific clinical features (crepitus or radiologic features of gas in tissues) either appear late or are of poor sensitivity. Thus, a high index of clinical suspicion is required for early diagnosis and prompt treatment, which are the best methods of minimizing its high associated morbidity and mortality. We present 3 cases to demonstrate diagnostic difficulties and challenges in management and highlight the feature of pain on muscular activity.

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