Humans ; Fasciitis, Necrotizing/diagnosis* ; Prospective Studies ; Organ Dysfunction Scores ; Prognosis

This article analyzed the medical records of two patients with Vibrio vulnificus primary sepsis who were admitted to the First Affiliated Hospital of Naval Medical University and reviewed the latest literature. On November 6, 2019, a 54-year-old male patient was admitted to the hospital. The patient's lower limbs were red, swollen, and painful with ecchymosis and hemorrhagic bullae after he ate freshwater products. The emergency fasciotomy was performed 3 h after admission, and the multiple organ failure occurred after operation. The patient was given up treatment 24 h after admission. On August 12, 2020, a 73-year-old male patient was admitted to the hospital. He was in shock state on admission and had hemorrhagic bullae on his right lower limb after he ate seafood. At 3 h post admission, he underwent emergency surgical exploration and amputation of right thigh. Six days later, he received negative pressure wound treatment on the stump. On the 13^th day post admission, his families forgo the active treatment and he died 15 d after admission. The two cases were both failed to be diagnosed at the first time, and the disease progressed rapidly. Necrotizing fasciitis and multiple organ failure occurred. After the diagnosis was confirmed, timely fasciotomy and high amputation were performed respectively. The microbiological examinations both reported Vibrio vulnificus. Although the 2 cases were not cured successfully, the course of disease and some indexes of patient with early amputation were better than those of patients with fasciotomy. Vibrio vulnificus is widely distributed and frequently detected in fresh water products. The pathogenic pathway is fuzzy and complex, and it is easy to be misdiagnosed. It is necessary to establish the treatment process of Vibrio vulnificus sepsis. Early and aggressive surgical intervention should be carried out as soon as possible, fasciotomy and debridement should be thorough, and the patients with hemorrhagic bullae should be amputated early. Postoperative comprehensive measures are also important for improving the survival rate of patients.
Aged ; Fasciitis, Necrotizing/surgery* ; Humans ; Male ; Middle Aged ; Multiple Organ Failure ; Sepsis/diagnosis* ; Vibrio Infections/pathology* ; Vibrio vulnificus

We present five patients with vibrio necrotising fasciitis, a lethal and disabling disease. Two of these patients had a history of exposure to either warm seawater or raw/live seafood, three had underlying chronic liver disease, and four presented with hypotension and fever. There were three deaths and four patients required intensive care unit stays. Among the two survivors, one had high morbidity. Only one patient met the criteria of Laboratory Risk Indicator for Necrotising Fasciitis score > 6. A clinician should suspect possible vibrio necrotising fasciitis if the following are present: contact with fresh seafood/warm seawater, a known history of chronic liver disease and pain that is out of proportion to cutaneous signs. All patients must be managed via intensive care in high dependency units. We recommend a two-step surgical protocol for patient management involving an initial local debridement, followed by a second-stage radical debridement and skin grafting.
Aged ; Aged, 80 and over ; Debridement ; End Stage Liver Disease ; complications ; Fasciitis, Necrotizing ; diagnosis ; microbiology ; surgery ; Female ; Fever ; complications ; Hepatitis B ; complications ; Humans ; Hypotension ; complications ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; Seafood ; Seawater ; Severity of Illness Index ; Singapore ; Skin Transplantation ; Vibrio ; Vibrio Infections ; diagnosis ; surgery

Acute appendicitis is one of the most common surgical diseases. However, diagnosis is often delayed due to atypical manifestations of appendicitis. Delayed diagnosis causes complications such as perforation, wound infection, abscess, and peritonitis. Necrotizing fasciitis (NF) complicated by perforated appendicitis is extremely rare and can be fatal. Herein, we report the case of an elderly woman presenting with NF of the right leg due to hidden perforated appendicitis. She had multiple medical diseases and initially complained of right leg pain for 3 days without any abdominal symptoms or signs. Her vital signs became unstable on the second day after admission. Computed tomography showed deep NF of the right leg extending from the perforated appendicitis. Emergency surgery was performed after appropriate resuscitation, but she failed to recover from sepsis and died 42 days after surgery.
Abscess ; Aged ; Appendicitis* ; Delayed Diagnosis ; Diagnosis ; Emergencies ; Fasciitis, Necrotizing* ; Female ; Humans ; Leg ; Peritonitis ; Resuscitation ; Sepsis ; Thigh* ; Vital Signs ; Wound Infection

Necrotizing fasciitis is a significant factor of morbidity and mortality due to its sudden onset and rapid spread. It is accompanied by systemic toxicity and often fatal unless promptly recognized and aggressively treated. We reported a patient who presented symptoms confused with disc herniation and delayed initial diagnosis. The patient was treated for chronic low back pain. The origin of the pain was a foreign body-induced intra-abdominal infection that invaded the back muscles and eventually progressed to necrotizing fasciitis.
Back Muscles ; Diagnosis ; Fasciitis, Necrotizing* ; Humans ; Intervertebral Disc Displacement ; Intraabdominal Infections ; Low Back Pain* ; Mortality

Necrotizing fasciitis (NF) is an aggressive soft-tissue infection involving the deep fascia and is characterized by extensive deterioration of the surrounding tissue. Immediate diagnosis and intensive treatment, including debridement and systemic antibiotics, represent the most important factors influencing the survival of NF patients. In this report, we present a case of NF in the abdomen due to an infection caused by a perforated small bowel after abdominal liposuction. It was successfully treated using negative-pressure wound therapy, in which a silicone sheet functioned as a barrier between the sponge and internal organs to protect the small bowel.
Abdomen ; Abdominal Wall* ; Anti-Bacterial Agents ; Debridement ; Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Humans ; Lipectomy ; Negative-Pressure Wound Therapy* ; Peritoneum ; Porifera ; Silicon* ; Silicones*

BACKGROUND: Necrotizing fasciitis is a life-threatening soft tissue infection involving the fascia and subcutaneous tissues. Diagnosis of necrotizing fasciitis is often delayed because of an underestimation or an overlap between it and cellulitis. OBJECTIVE: We aimed to evaluate and compare the clinical, laboratory, and microbiological characteristics of cellulitis and necrotizing fasciitis. METHODS: We retrospectively reviewed medical records of patients diagnosed as having cellulitis or necrotizing fasciitis and hospitalized at our hospital between January 2011 and December 2016. RESULTS: The study included data from 185 patients having cellulitis and 33 patients having necrotizing fasciitis. There were significant differences between cellulitis and necrotizing fasciitis regarding clinical and laboratory factors. Necrotizing fasciitis was primarily associated with the following features at the time of admission: A thigh/buttock location [odds ratio (OR) 9.04, 95% confidence interval (CI) 1.72∼47.64, p=0.009], pain not controlled with use of non-opioid analgesics (OR 6.26, 95% CI 2.21∼17.71, p<0.001), serum sodium level <135 mEq/L (OR 17.44, 95% CI 7.27∼41.84, p<0.001), and a serum procalcitonin level >0.32 ng/mL (OR 9.41, 95% CI 4.18∼21.93, p <0.001). Additionally, polymicrobial infections and Gram-negative organisms were more commonly associated with necrotizing fasciitis compared to cellulitis. CONCLUSION: We found several differences between cellulitis and necrotizing fasciitis in terms of clinical, laboratory, and microbiological characteristics. When patients showing symptoms of cellulitis present with lesions on the thigh or buttock, pain not controlled with use of non-opioid analgesics, a serum sodium level <135 mEq/L, or a procalcitonin level >0.32 ng/mL, it would be appropriate to evaluate for the possibility of necrotizing fasciitis and use broad-spectrum antibiotics to cover for Gram-negative organisms.
Analgesics ; Anti-Bacterial Agents ; Buttocks ; Cellulitis* ; Coinfection ; Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Humans ; Medical Records ; Retrospective Studies ; Sodium ; Soft Tissue Infections ; Subcutaneous Tissue ; Thigh

Skin and soft tissue infection (SSTI) is common and important infectious disease. This work represents an update to 2012 Korean guideline for SSTI. The present guideline was developed by the adaptation method. This clinical guideline provides recommendations for the diagnosis and management of SSTI, including impetigo/ecthyma, purulent skin and soft tissue infection, erysipelas and cellulitis, necrotizing fasciitis, pyomyositis, clostridial myonecrosis, and human/animal bite. This guideline targets community-acquired skin and soft tissue infection occurring among adult patients aged 16 years and older. Diabetic foot infection, surgery-related infection, and infections in immunocompromised patients were not included in this guideline.
Adult ; Cellulitis ; Communicable Diseases ; Diabetic Foot ; Diagnosis ; Erysipelas ; Fasciitis ; Fasciitis, Necrotizing ; Humans ; Immunocompromised Host ; Impetigo ; Methods ; Pyomyositis ; Skin* ; Soft Tissue Infections*

Acute rhinosinusitis can usually be managed by appropriate medical therapy, but it may also extend to the periorbital area in some complicated cases. Periorbital necrotizing fasciitis is uncommon among orbital complications, but can be fatal if it leads to soft tissue infection characterized by extensive necrosis and gas formation in the fascia and subcutaneous tissue. Immunocompromised states such as old ages, diabetes mellitus, alcoholics, and chronic renal failure have been reported to be predisposing factors, but the disease has also been detected in healthy patients. If proper treatment is not performed at the right time, necrotizing fasciitis can lead to systemic toxicity, multisystem organ failure, and eventual death. Therefore, early diagnosis and treatment are important. We report a case of periorbital necrotizing fasciitis that occurred in a healthy 30-year-old male patient with acute rhinosinusitis, which was treated with a combination of intravenous antibiotics and debridement of necrotic tissue and local wound management.
Adult ; Alcoholics ; Anti-Bacterial Agents ; Causality ; Debridement ; Diabetes Mellitus ; Early Diagnosis ; Fascia ; Fasciitis, Necrotizing* ; Humans ; Kidney Failure, Chronic ; Male ; Necrosis ; Orbit ; Sinusitis ; Soft Tissue Infections ; Subcutaneous Tissue ; Wounds and Injuries

Necrotizing fasciitis (NF) is an infection that spreads along the fascial planes, causing subcutaneous tissue death characterized by rapid progression, systemic toxicity, and even death. NF often appears as a red, hot, painful, and swollen wound with an ill-defined border. As the infective process continues, local pain is replaced by numbness or analgesia. As the disease process continues, the skin initially becomes pale, then mottled and purple, and finally, gangrenous. The ability of NF to move rapidly along fascial planes and cause tissue necrosis is secondary to its polymicrobial composition and the synergistic effect of the enzymes produced by the bacteria. Treatment involves securing the airway, broad-spectrum antimicrobial therapy, intensive care support, and prompt surgical debridement, repeated as needed. Reducing mortality rests on early diagnosis and prompt aggressive treatment.
Analgesia ; Bacteria ; Debridement ; Early Diagnosis ; Fasciitis, Necrotizing* ; Head* ; Hypesthesia ; Critical Care ; Mortality ; Neck* ; Necrosis ; Skin ; Subcutaneous Tissue ; Wounds and Injuries