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

Cervical necrotizing fasciitis (CNF) is an aggressive infection associated with high mortality. Various complications have been described in previous literature. However, internal jugular vein thrombosis is rare in such lesions. We presented a case of internal jugular vein thrombosis caused by CNF and analyzed related literature.
Fasciitis, Necrotizing ; complications ; Humans ; Jugular Veins ; Neck ; Venous Thrombosis ; etiology

Liposuction is one of the most frequently performed cosmetic surgeries worldwide for reshaping the body contour. Although liposuction is minimally invasive and relatively safe, it is a surgical procedure, and it carries the risk of major and minor complications. These complications vary from postoperative nausea to life-threatening events. Common complications include infection, abdominal wall injury, bowel herniation, bleeding, haematoma, seroma, and lymphoedema. Life-threatening complications such as necrotizing fasciitis, deep vein thrombosis, and pulmonary embolism have also been reported. In this paper, we provide a brief introduction to liposuction with the related anatomy and present computed tomography and ultrasonography findings of a wide spectrum of postoperative complications associated with liposuction.
Abdomen/ultrasonography ; Fasciitis, Necrotizing/etiology ; Hematoma/etiology ; Humans ; Lipectomy/*adverse effects ; Postoperative Complications/*etiology ; Pulmonary Embolism/etiology ; Tomography, X-Ray Computed ; Venous Thrombosis/etiology

INTRODUCTIONNecrotising fasciitis (NF) is often found in patients with diabetes mellitus, chronic renal failure, alcoholism, malignancy or liver cirrhosis. However, it remains unknown whether liver cirrhosis is an independent risk factor for the occurrence of NF. This study aimed to determine whether liver cirrhosis is an independent risk factor for the occurrence of NF, and to identify the relationship between severity of liver cirrhosis and occurrence of NF.

METHODSThe National Health Insurance Research Database, maintained by Taiwan's National Health Insurance programme, was retrospectively analysed, and the hospitalisation data of 40,802 cirrhotic patients and 40,865 randomly selected, age‑ and gender‑matched non‑cirrhotic control patients was collected. The medical records of all patients were individually followed for a three‑year period from the patients' first hospitalisation in 2004.

RESULTSDuring the three‑year follow‑up period, there were 299 (0.7%) cirrhotic patients with NF and 160 (0.4%) non‑cirrhotic patients with NF. Cox regression analysis showed that liver cirrhosis was a risk factor for the occurrence of NF during the study period (hazard ratio 1.982; p < 0.001). Among cirrhotic patients, those with complicated liver cirrhosis had a higher risk for the occurrence of NF than patients with non‑complicated liver cirrhosis (hazard ratio 1.320; p = 0.028).

CONCLUSIONCirrhotic patients had a higher risk for the occurrence of NF than non‑cirrhotic patients, and the risk for NF was especially high among patients with complicated liver cirrhosis.

Adult ; Age Factors ; Aged ; Alcoholism ; complications ; Comorbidity ; Fasciitis, Necrotizing ; complications ; physiopathology ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Incidence ; Liver Cirrhosis ; complications ; physiopathology ; Male ; Middle Aged ; Proportional Hazards Models ; Retrospective Studies ; Risk Factors ; Sex Factors ; Taiwan ; Treatment Outcome

Varicella is a self-limited disease, but sometimes it may be associated with some serious life-threatening complications.Necrotizing fasciitis is a rare complication of varicella. This is a case of a 7-year-old girl with septic shock caused by necrotizing fasciitis as a complication of varicella. Swelling and pain in the left inguinal region and left axillary region were found five days after varicella. Then a high fever occurred followed by hypotension. Fluid infusion, vasopressor and antibiotics were administered. Group A beta-hemolytic Streptococcus was isolated from exudates from the wounds. The clinical symptoms markedly improved after surgical drainage and removal of the necrotic tissue. Both wounds were covered with skin grafts after healthy granulation tissue formed. Although there have been few reports of life-threatening necrotizing fasciitis following varicella in western countries, it is rare in China. Usually patients with varicella were admitted to pediatric or infectious disease department but not surgical departments; so that the clinicians should be aware that varicella may be complicated by life-threatening surgical infections. Necrotizing fasciitis should be suspected in patients of varicella who showed an increasing pain and swelling in any body areas associated with increasing fever and local erythema. Early identification, surgical drainage and debridement are essential for successful treatment of necrotizing fasciitis.
Chickenpox ; complications ; Child ; Fasciitis, Necrotizing ; diagnosis ; drug therapy ; etiology ; Female ; Humans ; Shock, Septic ; diagnosis ; drug therapy ; etiology

Aged ; Fasciitis, Necrotizing ; complications ; Female ; Humans ; Mediastinitis ; complications ; Neck ; pathology

Necrotizing fasciitis is known to be a highly lethal infection of deep-seated subcutaneous tissue and superficial fascia. Reports of necrotizing fasciitis due to Streptococcus pneumoniae are exceedingly rare. We report a case of necrotizing fasciitis in a 62-yr-old man with liver cirrhosis and diabetes mellitus. He presented with painful swelling of left leg and right hand. On the day of admission, compartment syndrome was aggravated and the patient underwent surgical exploration. Intra-operative findings revealed necrotizing fasciitis and cultures of two blood samples and wound aspirates showed S. pneumoniae. The patient died despite debridement and proper antimicrobial treatment. To the best of our knowledge, this is the first case of fatal necrotizing fasciitis with meningitis reported in Korea. We also review and discuss the literature on pneumococcal necrotizing fasciitis.
Anti-Bacterial Agents/therapeutic use ; Diabetes Mellitus, Type 2/complications/diagnosis ; Fasciitis, Necrotizing/*diagnosis/drug therapy/microbiology/surgery ; Fatal Outcome ; Humans ; Leg/surgery ; Liver Cirrhosis/complications/diagnosis ; Male ; Middle Aged ; Streptococcal Infections/*diagnosis/drug therapy ; Streptococcus pneumoniae/isolation & purification

Bullae and sweat gland necrosis remain rare cutaneous manifestation, and these conditions can be misdiagnosed as Vibrio vulnificus infections or other soft tissue infections because of their low index of suspicion. A 46-yr-old man with a history of continued alcohol consumption presented with erythematous and hemorrhagic bullous lesions on his left arm. The patient reported that after the ingestion of clams, he slept for 12 hr in a heavily intoxicated state. Then the skin lesions started as a reddish patch that subsequently became hemorrhagic bullae. V. vulnificus infection, cellulitis, and necrotizing fasciitis were considered in initial differential diagnosis. However, on the basis of sweat gland necrosis on histopathologic examinations and negative results on bacterial cultures, we made the diagnosis of bullae and sweat gland necrosis. Therefore, bullae and sweat gland necrosis should also be considered in chronic alcoholic patients who present with bullae and a previous history of unconsciousness.
*Alcoholic Intoxication/etiology ; Alcoholism/diagnosis ; Blister/complications/*diagnosis ; Cellulitis/diagnosis ; Diagnosis, Differential ; Fasciitis, Necrotizing/diagnosis ; Humans ; Male ; Middle Aged ; Necrosis/complications/diagnosis ; Sweat Gland Diseases/complications/*diagnosis ; Vibrio Infections/diagnosis

Necrotizing fasciitis (NF) is a deep infection of the subcutaneous tissue that progressively destroys fascia and fat; it is associated with systemic toxicity, a fulminant course, and high mortality. NF most frequently develops from trauma that compromises skin integrity, and is more common in patients with predisposing medical conditions such as diabetes mellitus, atherosclerosis, alcoholism, renal disease, liver disease, immunosuppression, malignancy, or corticosteroid use. Most often, NF is caused by polymicrobial pathogens including aerobic and anaerobic bacteria. NF caused by Staphylococcus aureus as a single pathogen, however, is rare. Here we report a case of NF that developed in a healthy woman after an isolated shoulder sprain that occurred without breaking a skin barrier, and was caused by Staphylococcus aureus as a single pathogen.
*Arm ; Coagulase/metabolism ; Fasciitis, Necrotizing/*etiology/microbiology/pathology/surgery ; Female ; Humans ; Middle Aged ; Shoulder Joint/*injuries ; Sprains and Strains/*complications ; Staphylococcal Infections/*etiology/microbiology ; Staphylococcus aureus/enzymology/isolation & purification

Carotid Artery Diseases ; complications ; Fasciitis, Necrotizing ; complications ; Female ; Humans ; Middle Aged