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Necrotizing soft tissue infection

K Zemplenyi, B Lopez, M Sardesai, J K Dillon
The progression of odontogenic infections to necrotizing soft tissue infections (NSTIs) is unknown. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score is used to predict risk of NSTI. This study aimed to (1) estimate the frequency at which odontogenic infections progress to NSTIs, (2) measure the value of LRINEC in predicting progression to NSTI, and (3) estimate the charges associated with managing NSTIs. This retrospective cohort study enrolled all subjects admitted for the management of odontogenic infections from 2001 to 2013...
October 15, 2016: International Journal of Oral and Maxillofacial Surgery
Christopher Thom, Mary Warlaumont
BACKGROUND: Point-of-care ultrasound has an increasing role in characterizing soft-tissue infections and has been described previously in the evaluation of necrotizing fasciitis (NF). The identification of air within the soft tissues can be very suggestive of NF in the correct clinical context. CASE REPORT: A 78-year-old male presented to the emergency department with extensive lower-extremity redness and edema. A point-of-care ultrasound revealed hyperechoic areas within the soft tissues consistent with air, and the patient was taken to surgery and found to have NF...
October 12, 2016: Journal of Emergency Medicine
Arzu Karlı, Nurşen Belet, Keramettin Yanık, Özlem Köken, Mesut Kılıç, Meltem Ceyhan Bilgici, Gülnar Şensoy
Staphylococcus aureus is a common cause of musculoskeletal infections. Panton-Valentine leukocidin (PVL) is an exotoxin produced by S. aureus and is an important virulence factor. PVL-positive S. aureus infections have been associated with soft tissue infections and necrotizing pneumonia. In this case report, the clinical course of a 13-year-old boy who was admitted with right hip pain and fever, diagnosed with a gluteal abscess and incidentally discovered multiple cavitary pulmonary lesions, and had a methicillin susceptible and PVL-producing S...
November 2015: Turkish Journal of Pediatrics
Mohammad Reza Hayeri, Pouya Ziai, Monda L Shehata, Oleg M Teytelboym, Brady K Huang
Infection of the musculoskeletal system can be associated with high mortality and morbidity if not promptly and accurately diagnosed. These infections are generally diagnosed and managed clinically; however, clinical and laboratory findings sometimes lack sensitivity and specificity, and a definite diagnosis may not be possible. In uncertain situations, imaging is frequently performed to confirm the diagnosis, evaluate the extent of the disease, and aid in treatment planning. In particular, cross-sectional imaging, including computed tomography and magnetic resonance imaging, provides detailed anatomic information in the evaluation of soft tissues due to their inherent high spatial and contrast resolution...
October 2016: Radiographics: a Review Publication of the Radiological Society of North America, Inc
Jagdish Chander, Nidhi Singla, Mandeep Kaur, Rajpal Singh Punia, Ashok Attri, Ana Alastruey-Izquierdo, José F Cano-Lira, Alberto Miguel Stchigel, Josep Guarro
BACKGROUND: Saksenaea erythrospora is an emerging and recently described pathogenic fungus mainly causing invasive cutaneous infections. Globally, very few human cases, caused by S. erythrospora, have been reported. In India, among the genus Saksenaea, S. vasiformis was the only reported pathogenic species, until recently when a case of fungal rhinosinusitis was reported to be caused by S. erythrospora. We observed five human cases of necrotizing skin and soft tissue infections caused by S...
October 4, 2016: Infectious Diseases
Jason P Burnham, John P Kirby, Marin H Kollef
PURPOSE: To review the salient features of the diagnosis and management of the most common skin and soft tissue infections (SSTI). This review focuses on severe SSTIs that require care in an intensive care unit (ICU), including toxic shock syndrome, myonecrosis/gas gangrene, and necrotizing fasciitis. METHODS: Guidelines, expert opinion, and local institutional policies were reviewed. RESULTS: Severe SSTIs are common and their management complex due to regional variation in predominant pathogens and antimicrobial resistance patterns, as well as variations in host immune responses...
October 3, 2016: Intensive Care Medicine
Nikolai Siemens, Bhavya Chakrakodi, Srikanth Mairpady Shambat, Marina Morgan, Helena Bergsten, Ole Hyldegaard, Steinar Skrede, Per Arnell, Martin B Madsen, Linda Johansson, Julius Juarez, Lidija Bosnjak, Matthias Mörgelin, Mattias Svensson, Anna Norrby-Teglund
Necrotizing fasciitis caused by group A streptococcus (GAS) is a life-threatening, rapidly progressing infection. At present, biofilm is not recognized as a potential problem in GAS necrotizing soft tissue infections (NSTI), as it is typically linked to chronic infections or associated with foreign devices. Here, we present a case of a previously healthy male presenting with NSTI caused by GAS. The infection persisted over 24 days, and the surgeon documented the presence of a "thick layer biofilm" in the fascia...
July 7, 2016: JCI Insight
Daltry Dott, Christopher Canlas, Christopher Sobey, William Obremskey, Andrew Brian Thomson
OBJECTIVE: Necrotizing fasciitis is an infection of the soft tissue that is characterized by rapidly spreading inflammation and subsequent necrosis. It is a rare complication of peripheral nerve blocks. We report a rare case of necrotizing fasciitis after placement of a peripheral nerve catheter. CASE REPORT: A 58-year-old woman presented for an elective right second metatarsal resection and received a sciatic nerve catheter for postoperative pain control. On postoperative day 7, clinical examination and imaging supported the diagnosis of necrotizing fasciitis...
September 22, 2016: Regional Anesthesia and Pain Medicine
Federico Canavese, Marco Corradin, Ahmad Khan, Mounira Mansour, Marie Rousset, Antoine Samba
PURPOSE: Chronic osteomyelitis and infected nonunion are relatively rare conditions in pediatric patients and are more frequently seen in developing countries. Although relatively rare, they are medically and surgically challenging. Here we report a novel surgical technique used to manage five patients with chronic osteomyelitis of long bones. METHODS: Five skeletally immature patients with chronic osteomyelitis and infected nonunion of the long bones were treated surgically between 2010 and 2014 by a combination of resection of necrotic infected bone, debridement of surrounding soft tissue, and application of antibiotic-laden cement spacer inducing periosteal membrane before final bone reconstruction...
September 19, 2016: European Journal of Orthopaedic Surgery & Traumatology: Orthopédie Traumatologie
Dong Hwi Kim, Ji Sung Lee, Sung Woon Pyo, Jung Ho Lee
Facial necrotizing fasciitis (NF) is a rare fulminant infection of the soft and connective tissues that spreads along the fascial planes of the face. Its origins most commonly involve odontogenic infection and it is usually associated with a history of dentoalveolar surgery, such as tooth extraction or implant placement. We present a case of ascending facial NF with odontogenic origin in a patient taking a bisphosphonate.
August 24, 2016: Journal of Oral and Maxillofacial Surgery
Americo Testa, Rosangela Giannuzzi, Valeria De Biasio
BACKGROUND: Myonecrosis can rapidly develop in soft tissue necrotizing infections, often with initial sparing of the skin. Despite the improvements in management of necrotizing soft tissue infections, mortality remains high, according to the location, microbial agents and comorbidities, ranging between 17 and 46 %. A prompt diagnosis represents the greatest challenge for the emergency physician. CASE REPORT: We describe the case of a patient with a history of hypertension and arrhythmia who developed nonclostridial necrotizing fasciitis with extensive myonecrosis, after articular infiltration procedure...
September 2016: Journal of Ultrasound
Nicholas D Ward, Jennifer W Harris, David A Sloan
Necrotizing fasciitis is a rare, aggressive, soft-tissue infection that results in necrosis of skin, subcutaneous tissue, and fascia. It spreads rapidly and may progress to sepsis, multi-organ failure, and death. Predisposing conditions include diabetes, chronic alcoholism, advanced age, vascular disease, and immunosuppression and many cases are preceded by an injury or invasive procedure. Necrotizing soft-tissue infection of the breast is uncommon, with only a few reported cases in the literature. We present a 53-year-old diabetic woman who presented to the emergency room with several weeks of worsening breast and shoulder pain, swelling, and erythema...
September 16, 2016: Breast Journal
Bryan Stanistreet, Derek Bell
Mucormycosis is a rare, rapidly progressive and often fatal fungal infection. The rarity of the condition lends itself to unfamiliarity, delayed treatment, and poor outcomes. Diagnosis of fungal infections early enough to enable appropriate treatment occurs in less than half of affected patients. A 56-year-old male with a history of diabetes mellitus II, hepatitis C, and intravenous drug abuse was involved in a rollover motor vehicle accident. He sustained circumferential partial and full-thickness burns to his lower extremities with 20% BSA burns...
September 9, 2016: Journal of Burn Care & Research: Official Publication of the American Burn Association
Tae-Hee Kim, Bel Seap, Soo Ah Kim, Gyeong-Eun Heo
Infections of the vulva can present a complex differential to the gynecologist, ranging from superficial skin infections to lifethreatening necrotizing fasciitis. Recognition and timely treatment remain universal to skin and soft-tissue infections as the subcutaneous anatomy of the vulva can facilitate rapid spread to other tissues with significant morbidity and mortality. Employing a multidisciplinary team approach to care for vulvar cellulitis and abscess can guide treatment from antibiotic therapies to more aggressive surgical debridement...
August 2016: Journal of Menopausal Medicine
Stefan Walter Leichtle, Lily Tung, Moazzam Khan, Kenji Inaba, Demetrios Demetriades
BACKGROUND: The role of diagnostic imaging in suspected necrotizing soft tissue infections (NSTIs) is not clear owing to concerns about its value and possible delays in definitive surgical care. METHODS: Plain radiograph (XR) and computed tomography (CT) results of all patients who underwent operative debridement for a presumed NSTI from 2007 through 2014 at LAC + USC Medical Center were reviewed. Preoperative imaging was classified as being negative, suspicious (inflammatory changes), or diagnostic (soft tissue gas) for NSTI...
November 2016: Journal of Trauma and Acute Care Surgery
Riad Khatib, Mamta Sharma, Leonard B Johnson, Kathleen Riederer, Laurence Briski
Staphylococcus aureus bacteremia (SAB) is usually monomicrobial (M-SAB). We reviewed SAB in adults (≥18years old) over a 13year-period and compared polymicrobial (P-SAB) and M-SAB. We encountered 93 P-SAB among 1537 SAB cases (6.1%). The source distribution was comparable; however, source-specified differences were apparent. P-SAB was noted in 12/58 (20.7%) necrotizing soft tissue infections/sacral decubiti and foot gangrene vs. 1/122 (0.8%) cellulitis/abscesses (P<0.001), in 7/64 (10.9%) femoral intravascular catheters (IVC) vs...
November 2016: Diagnostic Microbiology and Infectious Disease
Magali S Rüfenacht, Ernesto Montaruli, Eléonore Chappuis, Klara M Posfay-Barbe, Giorgio C La Scala
BACKGROUND: Necrotizing fasciitis is a serious soft-tissue infection associated with sepsis and tissue destruction. Surgical management usually requires extensive débridement of necrotic fascia and overlying skin, with significant aesthetic and functional consequences. The authors review the outcome of all recent cases of necrotizing fasciitis treated with skin-sparing débridement at their institution. METHODS: The authors conducted a retrospective review of all of their cases of necrotizing fasciitis treated with skin-sparing débridement...
September 2016: Plastic and Reconstructive Surgery
Binh An Diep, Vien T M Le, Zehra C Visram, Harald Rouha, Lukas Stulik, Etyene Castro Dip, Gábor Nagy, Eszter Nagy
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA), especially the USA300 pulsotype, is a frequent cause of skin and soft tissue infections and severe pneumonia. Despite appropriate antibiotic treatment, complications are common and pneumonia is associated with high mortality. S. aureus strains express multiple cytotoxins, including alpha-hemolysin (Hla) and up to five bicomponent leukocidins that specifically target phagocytic cells for lysis. CA-MRSA USA300 strains carry the genes for all six cytotoxins...
October 2016: Antimicrobial Agents and Chemotherapy
Tomonori Takazawa, Jou Ohta, Tatsuo Horiuchi, Hiroshi Hinohara, Fumio Kunimoto, Shigeru Saito
BACKGROUND: Gas gangrene is a necrotic infection of soft tissue associated with high mortality rates. We report a case of postoperative gas gangrene with very acute onset and rapid progression of symptoms. To our knowledge, this case is the most acute onset of postoperative gas gangrene ever reported. CASE PRESENTATION: A 65-year-old Japanese female patient developed a shock state 16 h after radical cystectomy with ileal conduit reconstruction. Two days after the operation, she was transferred to the intensive care unit because of deterioration in her respiratory and circulatory condition...
2016: BMC Research Notes
Seung Hwan Bae, Ho-Seong Lee, Sang Gyo Seo, Sang Woo Kim, Heui-Chul Gwak, Su-Young Bae
BACKGROUND: An infected Achilles tendon after tendon repair is particularly difficult to treat because of the poor vascularity of the tendon as well as the thin surrounding soft tissue. For treatment of an infected Achilles tendon following tendon repair, we first focused on complete debridement and then promoted fibrous scar healing of the Achilles tendon using functional treatment. METHODS: We retrospectively reviewed all of the medical records of 15 tertiary referral patients with postoperative infection of the Achilles tendon occurring between 2007 and 2012...
July 20, 2016: Journal of Bone and Joint Surgery. American Volume
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