Successful Treatment of Necrotizing Fasciitis in the Hind Limb of a Great Dane

A 5-month-old, intact female Great Dane was presented for an acute onset of rapidly progressive lameness, severe pain, and diffuse swelling of the right hind limb. Ultrasound evaluation revealed echogenic fluid pockets extending along fascial planes of the right hind limb, from the proximal femur to the hock. Necrotic soft tissues were debrided, and closed-suction drains were placed. No foreign material was identified at surgery. Fluid culture identified a beta-hemolytic Streptococcus sp., and affected fascial histopathology was consistent with necrotizing fasciitis. Postoperatively, the puppy was managed with intravenous broad-spectrum antibiotics, local infusions of amikacin, and daily physical rehabilitation. Oral pentoxifylline was administered to treat bronchopneumonia and streptococcal toxic shock syndrome that developed secondary to necrotizing fasciitis. To our knowledge, this is the first report of a successfully managed case of beta-hemolytic, streptococcal, necrotizing fasciitis successfully managed after a single surgical debridement in combination with systemic broad-spectrum antibiotics, local amikacin infusion, active closed-suction drainage, daily cytology, massage, and passive range-of-motion exercises to maintain limb function.

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Gangrena de Fournier. Reporte de caso

Studies in the Economic History of Southern Africa ◽

10.22201/fm.24484865e.2020.63.5.04 ◽

2020 ◽

Vol 63 (5) ◽

pp. 26-30

Author(s):

Paloma Pérez Ladrón de Guevara ◽

Georgina Cornelio Rodríguez ◽

Oscar Quiroz Castro

Keyword(s):

Mortality Rate ◽

Necrotizing Fasciitis ◽

Broad Spectrum ◽

Soft Tissues ◽

Fournier’S Gangrene ◽

Type Ii ◽

Necrotic Tissue ◽

Fournier's Gangrene ◽

Necrotizing Fascitis ◽

Key Words Fournier's Gangrene

Fournier’s Gangrene is a type II necrotizing fascitis that leads to thrombosis of small subcutaneous vessels and spreads through the perianal and genital regions and the skin of the perineal. Most cases have a perianal or colorectal focus and in a smaller proportion it originates from the urogenital tract. The mortality rate varies between 7.8 and 50%1-3, only timely diagnosis decreases the morbidity and mortality of this condition. Treatment includes surgical debridement of all necrotic tissue and the use of broad-spectrum antibiotics. Key words: Fournier’s gangrene; gangrene; necrotizing fasciitis; infectious necrotizing of soft tissues.

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A Very Rare Case of Necrotizing Fasciitis Caused by Metallosis

The International Journal of Lower Extremity Wounds ◽

10.1177/15347346211009401 ◽

2021 ◽

pp. 153473462110094

Author(s):

Dun-Wei Huang ◽

Nien-Tzu Liu ◽

Hung-Hui Liu ◽

Niann-Tzyy Dai ◽

Shyi-Gen Chen ◽

...

Keyword(s):

Necrotizing Fasciitis ◽

Rare Case ◽

Soft Tissues ◽

Group A Streptococcus ◽

Anaerobic Bacteria ◽

Metal Debris ◽

Joint Replacement Surgery ◽

Replacement Surgery ◽

Group A ◽

The Right

Necrotizing fasciitis is a surgically diagnosed infection of the deep soft tissues that results in high mortality. It is usually caused by aerobic and anaerobic bacteria and group A Streptococcus. Metallosis is characterized by the deposition of metal debris in the blood that causes metal poisoning and tissue damage. The abrasion of metal components that occurs after joint replacements causes metallosis, which may lead to severe complications. We report a rare case of metallosis-induced necrotizing fasciitis of the right thigh. Metallosis should be considered as a cause of necrotizing fasciitis if the patient has had a joint replacement surgery.

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Necrotizing Fasciitis of the Thigh as Unusual Colonoscopic Polypectomy Complication: Review of the Literature with Case Presentation

Medicina ◽

10.3390/medicina58010131 ◽

2022 ◽

Vol 58 (1) ◽

pp. 131

Author(s):

Sara Sablone ◽

Elpiniki Lagouvardou ◽

Gerardo Cazzato ◽

Francesco Carravetta ◽

Roberto Maselli ◽

...

Keyword(s):

Necrotizing Fasciitis ◽

Lower Limb ◽

Soft Tissues ◽

Systemic Infection ◽

Right Hemicolectomy ◽

Colon Perforation ◽

Colonoscopic Polypectomy ◽

Muscle Fascia ◽

The Right ◽

Surgery Department

Necrotizing fasciitis (NF) is an infection characterized by necrosis of the superficial muscle fascia and surrounding soft tissues. It usually occurs following skin breaches from penetrating traumas or high-degree burns. Less frequently, it could be related to major abdominal surgery. However, no cases of thigh NF after minor abdominal procedures have ever been reported. A previously healthy 59-year-old male patient underwent a colonoscopic polypectomy. After the procedure, the patient developed an increasing right groin pain. The CT scan showed a gas collection in the right retroperitoneum space and in the right thigh soft tissues. Thus, a right colon perforation was hypothesized, and the patient was moved to the nearest surgery department and underwent a right hemicolectomy procedure. During surgery, the right thigh was also incised and drained, with gas and pus leakage. Nevertheless, the right lower limb continued to swell, and signs of systemic infection appeared. Afterward, clinical conditions continued to worsen despite the drainage of the thigh and antibiotic therapy, and the patient died of septic shock after just two days. This case shows that, although rare, lower limb NF should be considered among the causes of early post-operative local painful symptoms.

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Massive cutaneous complications due to snake bite: A rare case and literature review

10.22541/au.161181333.36256033/v1 ◽

2021 ◽

Author(s):

Mahdieh Sadeghi ◽

Maryam Barazandeh ◽

Zakaria zakariaei ◽

Lotfollah Davoodi ◽

Rabeeh Tabaripour ◽

...

Keyword(s):

Literature Review ◽

Necrotizing Fasciitis ◽

Compartment Syndrome ◽

Surgical Procedures ◽

Broad Spectrum ◽

Rare Case ◽

Snake Bite ◽

Broad Spectrum Antibiotics

Snake bite is a common and very important issue threatening health worldwide. Patients who develop hemorrhagic or non-hemorrhagic blisters following snakebite, in addition to anti-venom, need broad-spectrum antibiotics and sometimes emergency surgical procedures and hospitalization to prevent serious complications such as necrotizing fasciitis, compartment syndrome.

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Pencegahan Kejadian Ventilator-Associated Pneumonia (VAP) dengan Kepatuhan Pelaksanaan Bundle: Literature Review

HOLISTIK JURNAL KESEHATAN ◽

10.33024/hjk.v14i3.2661 ◽

2020 ◽

Vol 14 (3) ◽

pp. 354-368

Author(s):

Solikin Solikin ◽

Matius Sakundarno Adi ◽

Septo Pawelas Arso

Keyword(s):

Literature Review ◽

Antibiotic Therapy ◽

Broad Spectrum ◽

Early Treatment ◽

Review Literature ◽

Ventilator Associated Pneumonia ◽

Broad Spectrum Antibiotics ◽

Increased Risk ◽

Detection And Diagnosis ◽

The Right

Prevention of Ventilator-Associated Pneumonia (VAP) Events with Compliance with Bundle Implementation: Literature Review Background: Patients who experience critical illness and use a mechanical ventilator in the ICU have an increased risk of experiencing ventilator associated pneumonia (VAP) which is a major cause of morbidity and mortality in the ICU and causes lengthening the length of stay and an increase in hospital costs.Purpose: To conduct a recent literature review with regard to VAP primarily related to causes, risk factors, pathogenesis, prevention, early detection and diagnosis, and administration of antibiotics to patients with VAP. At the end of this article conclusions will be presented that can be used by practitioners as a clinical guide.Method: The design used was literature review, articles were collected using a search engine, including (Clinicalkey) 27 articles, (Cochrane) 25 articles, (Medline) 17 articles and (Pubmed) 19 articles. From the predetermined article inclusion criteria, we found 7 articles out of 88 that were suitable for different interventionsResults: Prevention of VAP incidents in hospitals using multimodal interventions, one of which is the application of a VAP prevention bundle, can effectively reduce the incidence of VAP in hospitals. Examination of the lower respiratory tract culture should be carried out for all patients before administering antibiotic therapy provided that it should not delay giving antibiotic therapy to critical patients. Early treatment of broad-spectrum antibiotics with the right dosage can maximize the efficacy of antibiotics and the outcome of VAP patients in the ICU. Antibiotic combinations must be used wisely to treat VAP because certain pathogens increase the life expectancy of patients with severe infections especially those with septic shock. Negative culture results can also be used to stop antibiotic therapy in patients undergoing culture without antibiotic changes within the last 72 hours. The health team must consider the need for antibiotic de-escalation based on the culture results and the clinical response of the patient.Conclusion: VAP prevention bundles that implement multimodal interventions effectively reduce the incidence of VAP in hospitals. An examination of airway culture must be carried out for all patients before administering antibiotic therapy. Early treatment of broad-spectrum antibiotics can maximize the efficacy of antibiotics and the outcome of VAP patients in the ICU.Keywords: VAP; ICU; Patients; Morbidity; Mortality; BundlePendahuluan: Pasien yang mengalami penyakit kritis dan menggunakan ventilator mekanik di ICU mempunyai peningkatan resiko untuk mengalami ventilator associated pneumonia (VAP) yang merupakan penyebab utama morbiditas dan mortalitas di ICU serta menyebabkan pemanjangan lenght of stay dan peningkatan biaya rumah sakit.Tujuan: Untuk melakukan review literature terkini sehubungan dengan VAP terutama terkait dengan penyebab, faktor resiko, pathogenesis, pencegahan, deteksi dini dan diagnosis, serta pemberian antibiotik pada pasien dengan VAP. Di ahir artikel ini akan disampaikan kesimpulan yang dapat digunakan praktisi sebagai panduan di klinis.Metode: Desain yang digunakan adalah literature review, artikel dikumpulkan menggunakan mesin pencarian antara lain (Clinicalkey) 27 artikel, (Cochrane) 25 artikel, (Medline) 17 artikel dan (Pubmed) 19 artikel. Dari kriteria inklusi artikel yang telah ditentukan, ditemukan 7 artikel dari 88 yang sesuai dengan intervensi yang berbeda.Hasil: Pencegahan kejadian VAP di rumah sakit menggunakan intervensi multimodal, yang mana salah satunya berupa penerapan bundle pencegahan VAP, dapat dengan efektif menurunkan kejadian VAP di rumah sakit. Pemeriksasan kultur saluran nafas bawah perlu dilakukan kepada semua pasien sebelum pemberian terapi antibiotik dengan catatan tidak boleh menunda pemberian terapi antibiotik pada pasien kritis. Terapi dini antibiotik spektum luas dengan dosis yang tepat dapat memaksimalkan kemanjuran antibiotik dan luaran pasien VAP di ICU. Kombinasi antibiotik harus digunakan dengan bijaksana untuk mengobati VAP karena pathogen tertentu untuk meningkatkan harapan hidup pasien dengan infeksi berat terutama yang mengalami shok sepsis. Hasil kultur yang negatif juga dapat digunakan untuk menghentikan terapi antibiotik pada pasien yang dilakukan kultur tanpa perubahan antibiotik dalam 72 jam terahir. Tim kesehatan harus mempertimbangkan perlunya deeskalasi antibiotik berdasarkan hasil kultur dan respon klinik pasien.Simpulan: Bundle pencegahan VAP yang menerapkan intervensi multimodal efektif menurunkan kejadian VAP di rumah sakit. Pemeriksasan kultur saluran nafas harus dilakukan kepada semua pasien sebelum pemberian terapi antibiotik. Terapi dini antibiotik spektum luas dapat memaksimalkan kemanjuran antibiotik dan luaran pasien VAP di ICU.

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Management of Necrotizing Fasciitis with Proximal Tibia Fracture

Journal of Orthopaedic Case Reports ◽

10.13107/jocr.2021.v11.i05.2216 ◽

2021 ◽

Vol 11 (5) ◽

Author(s):

Shubhankar Patil ◽

Dilip Kumar ◽

Karthik Rao ◽

Navratan Dipu

Keyword(s):

Necrotizing Fasciitis ◽

High Mortality ◽

Broad Spectrum ◽

Proximal Tibia ◽

Road Traffic ◽

Group A Streptococcus ◽

Tibia Fracture ◽

Surgical Debridement ◽

Proximal Tibia Fracture ◽

Broad Spectrum Antibiotics

Introduction: Necrotizing fasciitis is a rare disease of soft tissue infection with a high mortality. It is characterized by rapidly spreading inflammation and necrosis of fascial planes. It usually follows an injury, though the cause may be a small abrasion or an insect bite or surgical incisions. It is commonly caused by bacteria such as Group A streptococcus. It may be accompanied by septic shock. It causes rapid death unless it is diagnosed quickly and managed aggressively. Prompt surgical debridement must be done to reduce mortality. Rapid diagnosis, antibiotic therapy, fluid resuscitation, and surgical debridement of the infection are all needed in the management of this fatal disease. However, when necrotizing fasciitis is associated with an underlying fracture the treatment becomes even challenging and limb-threatening. Case Report: A 48-year-male patient of South Asian descent came to Emergency Room with history of road traffic accident and sustained injury to the right (RT) leg. He was admitted with pain, swelling and blisters of the RT leg and suspected to have necrotizing fasciitis with proximal tibia fracture of the RT leg. He was treated with thorough surgical debridement, broad-spectrum antibiotics, free flap, and Masquelet’s technique with limb reconstruction system (LRS). At 18 months of follow-up the fracture healed, LRS was removed, pin tracts healed and patient was able to walk without any support. Conclusion: Necrotizing fasciitis is rare, rapidly progressive disease with a high mortality rate which requires prompt diagnosis, early surgical debridement, broad-spectrum antibiotics, careful fluid, and electrolyte management. These patients require a combined multidisciplinary approach for their management. Keywords: Necrotizing fasciitis, proximal tibia fracture, surgical debridement.

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Fatal necrotizing fasciitis caused by Haemophilus influenzae serotype f

Journal of Medical Microbiology ◽

10.1099/jmm.0.47603-0 ◽

2008 ◽

Vol 57 (2) ◽

pp. 249-251 ◽

Cited By ~ 14

Author(s):

Elizabeth McLellan ◽

Kim Suvarna ◽

Rob Townsend

Keyword(s):

Haemophilus Influenzae ◽

Necrotizing Fasciitis ◽

Broad Spectrum ◽

Lower Limb ◽

Limb Amputation ◽

Causative Organism ◽

Broad Spectrum Antibiotics

We describe a case of fatal lower limb necrotizing fasciitis in a 65-year-old man who was treated with broad-spectrum antibiotics, limb amputation and tissue debridement. The causative organism was identified by PCR as Haemophilus influenzae serotype f, which is a highly unusual cause of necrotizing fasciitis.

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