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Necrotizing soft tissue infections

Giorgio Persano, Enrico Pinzauti, Simone Pancani, Filippo Incerti
Ecthyma Gangrenosum is a manifestation of Pseudomonas Aeruginosa infection, usually occurring in immunocompromised patients, which can be associated with Pseudomonas Aeruginosa bacteremia with potentially lethal outcome. The clinical appearance is of an inflammatory cutaneous lesion with a central necrotic spot; the lesion then rapidly progresses to a gangrenous ulcer with a gray-black eschar extending in the deep soft tissues. Treatment of Ecthyma Gangrenosum includes both aggressive systemic antibiotic therapy and surgical procedures...
October 2018: Plastic and Reconstructive Surgery. Global Open
Anna K Steve, Valerie A Hurdle, Jevon Y Brown
Mucormycosis is a rare fungal infection caused by ubiquitous fungi in the order Mucorales. It is the most rapidly progressing fulminant fungal infection that mimics necrotizing soft-tissue infections. Overwhelming fungal sepsis develops quickly and mortality rates approach 70%. Culture negative necrotizing infections and cutaneous necrosis following a vascular pattern should raise suspicion for this rare entity. We describe avoiding mortality in a case of orbitomaxillofacial mucormycosis multifactorially treated with: radical serial debridement, topical amphotericin B irrigation and dressings, parenteral amphotericin B, and hyperbaric oxygen therapy...
October 2018: Plastic and Reconstructive Surgery. Global Open
Karen M Van de Velde-Kossmann
Renal failure patients have an increased risk of infection, including skin and soft tissue infections. This increased susceptibility is multifactorial, due to the conditions causing the renal failure as well as complications of treatment and renal failure's innate effects on patient health. These infections have a significant impact on patient morbidity, increased hospital and procedural demands, and the cost of health care. Many renal failure patients are seen regularly by their nephrology clinic caregivers due to the need for frequent dialysis and transplant monitoring...
December 5, 2018: Blood Purification
Shuichi Sato, Masahiro Ito, Tsuyoshi Sakai, Anri Kaneta, Fumie Sato
Streptococcal toxic shock syndrome (STSS) is a life-threatening disease caused by infection of beta-hemolytic streptococci . Here, we report an uncommon case of STSS with both diffuse peritonitis and necrotizing fasciitis and summarize previous cases. The patient was diagnosed with STSS due to an infection of the soft tissue of the lower extremity after surgery for diffuse peritonitis. The general condition had rapidly deteriorated with multiple organ dysfunction. Immediate intensive care, including mechanical ventilation, hemodiafiltration, and repeated debridement, is indispensable for a favorable outcome...
2018: Case Reports in Surgery
Annie Laurie Benzie, Jason Clark, Jason Farrah, Alejandro Garcia, Joshua Hagan, Winston Richards, Darwin Ang
No abstract text is available yet for this article.
September 1, 2018: American Surgeon
Manjari G Joshi, Paul R Cardinal, Sharon M Henry
This case report describes an immunocompromised patient with a skin boil that progressed to necrotizing fasciitis. The aim of this brief report is to raise awareness regarding necrotizing soft tissue infections caused by an unusual organism, Kocuria rosea , a typically non-pathogenic organism, and outline the course of treatment currently considered to be the standard of care.
November 2018: Journal of Surgical Case Reports
Adam Lee, Addison May, William T Obremskey
Necrotizing soft-tissue infections are caused by a variety of bacterial pathogens that may affect patients at any age or health status. This orthopaedic emergency initially presents with nonspecific signs such as erythema and edema. As the disease progresses, classic signs such as bullae, cutaneous anesthesia, ecchymosis, tense edema, and gas can be seen. A high level of suspicion is needed to properly identify and treat in a timely manner. Pain out of proportion to presentation and rapid progression even with appropriate antibiotic treatment should heighten suspicion of a necrotizing soft-tissue infection...
November 13, 2018: Journal of the American Academy of Orthopaedic Surgeons
Basem ALShareef, Nourah ALSaleh
Necrotizing fasciitis is a life-threatening aggressive soft tissue infection which usually affects the extremities, abdominal wall, or perineum. Breasts are rarely affected, with most cases presenting after trauma or surgical intervention. It may be misdiagnosed as abscess or cellulitis, leading to treatment delays. Here, we report a case of necrotizing fasciitis affecting both breasts in a 60-year-old female. Treatment included core biopsy managed with intravenous antibiotic and surgical debridement followed by a simple mastectomy...
2018: Case Reports in Surgery
Mohammad Yousef Memar, Mina Yekani, Naser Alizadeh, Hossein Bannazadeh Baghi
Hyperbaric oxygen therapy (HBOT) is a treatment procedure that involves breathing 100% O2 for a certain time and under a certain pressure. HBOT is commonly administrated as a primary or alternative therapy for different diseases such as infections. In this paper, we reviewed the general aspect of HBOT procedures, the mechanisms of antimicrobial effects and the application in the treatment of infections. Parts of the antimicrobial effects of HBOT are believed to result of reactive from the formation of reactive oxygen species (ROS)...
November 3, 2018: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
Alejandra Ugarte-Torres, Sarah Perry, Angela Franko, Deirdre L Church
BACKGROUND: Aeromonas hydrophila is a water-dwelling, gram-negative rod-shaped bacterium, associated with diarrheal illness and, less commonly, necrotizing skin and soft tissue infections, especially among immunocompromised patients. Necrotizing fasciitis is associated with a high mortality rate, especially when caused by Aeromonas spp. Our patient was infected with an extremely aggressive form of multidrug-resistant Aeromonas spp. that produced both an extended-spectrum β-lactamase and an AmpC enzyme...
November 1, 2018: Journal of Medical Case Reports
Raquel M Fresnedo-Pérez, Ana Cabrera-Pereira, Rubén Rodríguez-García, Desirée Díaz-González, Javier Albaladejo-Magdalena
El éxito en el tratamiento de las infecciones necrotizantes de los tejidos blandos (INTB) depende de la precocidad diagnóstica y de la agresividad terapéutica, basada en el desbridamiento quirúrgico, la antibioticoterapia de amplio espectro y el soporte intensivo. Se presenta un caso de INTB secundaria a diverticulitis aguda perforada (Hinchey 4) con el fin de ilustrar las consideraciones particulares en el manejo de la INTB de localización en la pared abdominal, apoyadas en la evidencia disponible en la literatura científica...
2018: Cirugia y Cirujanos
Carter K Haag, Fnu Nutan, John W Cyrus, Jibanananda Satpathy, Kanade Shinkai, Alex G Ortega Loayza
Pyoderma Gangrenosum (PG) is a rare, ulcerative cutaneous disorder typically affecting the lower extremities. The clinical appearance of PG can mimic various cutaneous infections and neoplasms, leading to misdiagnosis and mistreatment including unnecessary surgical interventions such as debridements and even amputations. Diagnostic criteria exist, including characteristic clinical appearance and the exclusion of other diagnoses, however no definitive test exists to confirm the diagnosis of PG. We have sought to differentiate between the clinical characteristics of patients with PG and diseases that mimic PG resulting in amputation or were considered for amputation...
October 23, 2018: Journal of Trauma and Acute Care Surgery
Olayemi O Ayepola, Nurudeen A Olasupo, Louis O Egwari, Frieder Schaumburg
Background: Staphylococcus aureus  is a significant pathogen implicated in numerous nosocomial and community-acquired infections. The Panton-Valentine leukocidin (PVL) can be associated with severe necrotizing diseases such as pneumonia, skin and soft tissue infection (SSTI).  Methods : In total, 96 S. aureus isolates were obtained from patients presenting with wounds (n=48) and soft tissue infections (SSTIs, n=48). These were characterized based on their antimicrobial susceptibility profile, the possession of virulence genes (e...
2018: F1000Research
Esther Fernández Tormos, Fernando Corella Montoya, María Ángeles Martínez Izquierdo, Beatriz Sánchez-Artola, Borja Limousin Aranzabal, Ricardo Larraínzar-Garijo
Cutaneous mucormycosis due to Saksenaea vasiformis species is exceptional. There have been about 40 reported cases worldwide, with most being fatal. We report an exceptional nonlethal case of mucormycosis due to S. vasiformis following a spider bite. The patient was in an immunosuppressed state owing to previous chemotherapy and diabetes mellitus. The origin of the inoculation was the bite of a Loxosceles laeta spider, which caused loxoscelism. The initial skin injury was quickly progressive, requiring amputation of the right upper limb...
October 18, 2018: Journal of Hand Surgery
Alisson R Teles, Spencer Montgomery, Kenneth C Thomas
BACKGROUND: Necrotizing fasciitis (NF) is a surgical diagnosis characterized by a rapidly progressive soft tissue infection, widespread tissue necrosis, and associated systemic illness. Friability of the superficial fascia, dishwater-gray exudate, and absence of pus are surgical characteristics of this diagnosis. Due to the rapid progression of the infection, early recognition and aggressive surgical debridement are crucial to reduce mortality. Despite being commonly seen by general, plastic, and orthopedic surgeons, NF is an extremely rare spine surgery emergency...
October 12, 2018: World Neurosurgery
Travis L Perry, Lindsay M Kranker, Erin E Mobley, Eileen E Curry, R Michael Johnson
INTRODUCTION: Fournier's gangrene (FG) remains a forbidding necrotizing soft tissue infection (NSTI) that necessitates early recognition, prompt surgical excision, and goal-directed antibiotic therapy. Traditionally, surgical management has included wide radical excision for sepsis control, but this management often leaves large, morbid wounds that require complex wound coverage, prolonged hospitalizations, and/or delayed healing. OBJECTIVE: The purpose of this case series is to report the outcomes of FG using a surrogate approach of concurrent debridement of spared skin and soft tissue, negative pressure wound therapy (NPWT), and serial delayed primary closure (DPC)...
October 2018: Wounds: a Compendium of Clinical Research and Practice
Amelia Breyre, Bradley W Frazee
This article covers the diagnosis and treatment of skin and soft tissue infections commonly encountered in the emergency department: impetigo, cutaneous abscesses, purulent cellulitis, nonpurulent cellulitis, and necrotizing skin and soft tissue infections. Most purulent infections in the United States are caused by methicillin-resistant Staphylococcus aureus. For abscesses, we emphasize the importance of incision and drainage. Nonpurulent infections are usually caused by streptococcal species and initial empiric antibiotics need not cover methicillin-resistant Staphylococcus aureus...
November 2018: Emergency Medicine Clinics of North America
Seung-Han Shin, Il-Kyu Park, Jin-Woo Kang, Yong-Suk Lee, Yang-Guk Chung
BACKGROUND: Purulent musculoskeletal infections often require surgical debridement and drainage. However, when the infection is extensive or involving multiple layers of tissues, maintaining drainage of the involved spaces can be difficult, even with the application of vacuum-assisted closure (VAC) therapy. Wide exposure and aggressive debridement is often required for such cases, which in turn may complicate wound coverage. METHODS: A retrospective review was performed for 16 patients with musculoskeletal infections treated surgically...
September 2018: Journal of Hand Surgery Asian-Pacific Volume
Matthias Zirk, Charlotte Wenzel, Johannes Buller, Joachim E Zöller, Max Zinser, Franziska Peters
OBJECTIVES: A central role of infections in the treatment of MRONJ patients is widely accepted. An investigation of the MRONJ lesions' biofilms as potential pathogens seems logical. MATERIALS AND METHODS: We investigated the clinical data of our MRONJ patients who received surgery in advanced stage of the disease. Special attention was granted to the local colonizers harvested from osseous MRONJ specimens and submucosal putrid infections. RESULTS: Eleven out of 71 patients presented a spontaneous onset of the disease and for 60 out of 71 patients a trigger was detected...
October 1, 2018: Clinical Oral Investigations
Marco Sciarra, Andrea Schimmenti, Tommaso Manciulli, Cristina Sarda, Marco Mussa, Laura Sacco, Bianca Mariani, Angela Maria Di Matteo, Paolo Orsolini
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.
2018: Case Reports in Infectious Diseases
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