Case Cluster of Necrotizing Fasciitis and Cellulitis Associated with Vein Sclerotherapy

Chan, Hiu Tat; Low, Jillian; Wilson, Lorraine; Harris, Owen C.; Cheng, Allen; Athan, Eugene

doi:10.3201/eid1401.070250

Cited by 9 publications

(4 citation statements)

References 12 publications

(18 reference statements)

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“…Thus, the existence of small abrasions, lacerations, burns, dermatitis secondary to poor skin hygiene (inguinal, buttock), folliculitis may be sufficient to trigger the pathological process. Otherwise, the initial lesion can be more easily identified in cases of secondary infection of the visceral perforation, perirectal abscesses, infected invasive rectal tumors, cardiac catheterization, laparoscopy or venous sclerotherapy (6,7,8). Signs and symptoms that the patient presents at the time of examination vary with the onset of the disease.…”

Section: Discusionsmentioning

confidence: 99%

Soft Tissue Infections in Diabetic Patients

Mustăţea¹,

Bugă²,

Doran³

et al. 2018

chr

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Introducere: pacientul cu diabet zaharat prezintă o susceptibilitate crescută la infecţii, cu potenţial evolutiv negativ conducând la o morbiditate şi mortalitate crescute faţă de populaţia generală. Cauza este reprezentată de alterarea mecanismelor imune de apărare, mediul hiperglicemic conducând la alterarea funcţiei neutrofilelor, supresia sistemului antioxidant şi a activităţii umorale, micro şi macroangiopatia sistemică, neuropatia, deprimarea activităţii antibacteriene a tractului genitourinar şi digestiv. Infecţiile localizate la nivelul părţilor moi (tegument, fascii şi aponevroze, ţesut subcutanat, muşchi) la pacientul diabetic necesită o abordare medico-chirurgicală complexă în care tratamentul chirurgical agresiv trebuie să fie completat de echilibrare metabolică şi antibioterapie susţinută. Material şi Metodă: aceste particularităţi vor fi expuse şi analizate într-un studiu descriptiv retrospectiv realizat în Clinica de Chirurgie Generală "I. Juvara" a Spitalului Clinic Dr I. Cantacuzino în perioada 2013-2017, care a urmărit tipul leziunilor, localizarea acestora, germenii implicaţi, comorbidităţile, parametrii bioumorali, tratamentul antibiotic şi chirurgical precum şi evoluţia postoperatorie. Studiul nu include pacienţii cu infecţii localizate la nivelul piciorului diabetic. Rezultate: Au fost identificaţi 150 de pacienţi diabetici cu infecţii de părţi moi localizate la nivelul membrului superior, gambei, coapsei, perineului, peretelui abdominal şi toracic. Cea mai frecventă localizare s-a regăsit la nivelul membrului inferior (54%). Prezenţa acestor infecţii a fost mai mare la bărbaţi (55%), iar decada de

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Section: Discusionsmentioning

confidence: 99%

Soft Tissue Infections in Diabetic Patients

Mustăţea¹,

Bugă²,

Doran³

et al. 2018

chr

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“…The patient with necrotizing fasciitis was submitted to debridement. Streptococcus A was isolated from specimen cultures [34] .…”

Section: Serious Local Aementioning

confidence: 99%

Safety Concerns for Sclerotherapy of Telangiectases, Reticular and Varicose Veins

Yiannakopoulou¹

2016

Pharmacology

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Background: Sclerotherapy has been extensively used in the treatment of valvular insufficiency of superficial veins. Although sclerotherapy seems safe, reports of serious adverse events (AE) have been published. This paper aims to review AE of sclerosing agents. Methods: Electronical databases were searched for identifying articles on local, serious and long-term AE of sclerotherapy. Results: Hyperpigmentation and matting are the most often local AE of sclerotherapy. Other local AE include superficial thrombophlevitis, pyoderma gangrenosum, pain, ulcer formation, and hypertrichosis. Local AE can be serious, that is, it can include cutaneous necrosis, intra-arterial injection with subsequent acute ischemia that can lead to amputation, and necrotizing fasciitis. Most data on systemic AE of sclerotherapy are extracted from case series and case reports. Systemic AE include neurological complications, such as ischemic stroke, transient ischemic attack, visual disturbances and cardiac toxicity, that is, myocardial infarction, Takotsubo cardiomyopathy, chest tightness, pulmonary embolism, deep vein thrombosis, septicemia, anaphylaxis. It is difficult to estimate the frequency of serious systemic AE of sclerotherapy. Conclusion: Physicians practicing sclerotherapy should be aware of the possible local and systemic AE of sclerotherapy, inform patients accordingly and be prepared for the appropriate management of the rare but possibly lethal serious AE.

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“…An example of this includes injection sites, cesarean section, plastic surgery and even minor cosmetic procedures [37][38][39][40][41][42][43]. Where nosocomial GAS NF is suspected or if there is a cluster of cases, the source may prove to be a member of the hospital staff [44][45][46].…”

Section: Pathophysiologymentioning

confidence: 99%

Necrotizing fasciitis: The importance of early diagnosis, prompt surgical debridement and adjuvant therapy

Machado¹

2011

North Am J Med Sci

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Background: Necrotizing Fasciitis (NF) is a necrotizing soft tissue infection involving the fascia and subcutaneous tissue that can cause rapid local tissue necrosis and life-threatening severe sepsis. Aim: This article aims to review the aetiopathogenesis, investigations and management based on a literature review. Methods and Materials: The Medline literature search of relevant articles restricted to English language on necrotizing fasciitis was conducted and reviewed. Results: Necrotizing fasciitis is rare with an incidence ranging from 0.15 to 0.55 cases per 100,000 of the population. Accurate assessment and timely intervention are critical in the treatment of patients affected with NF. Understanding the history and unique characteristics of this disease is crucial to achieve early recognition, effective treatment and a favorable outcome. Classic symptoms include severe pain out of proportion to local findings, erythema, mottling, crepitus, skin anesthesia, warmth, tenderness, hemorrhagic bullous formation, edema in the affected area and fever. Predisposing conditions of NF are classified into 2 main categories (type I and II) based on causative microorganisms. Radical surgical debridement, broad spectrum antibiotics, negative pressure wound dressings, and hyperbaric oxygen therapy are considered to be the cornerstone of treatment. The mortality rate ranges widely from 10% to 75% and is related to delay in initial debridement, patient age of more than 60 years, associated hypotension, acidosis, bacteremia, renal failure, hyponatremia, peripheral vascular disease, myonecrosis and myositis. Conclusion: Necrotizing fasciitis is a devastating infection of the fascia and subcutaneous tissue. The presentation of the disease is nonspecific and variable. Delay in recognition and effective treatment increases the mortality. Prompt radical surgical debridement, appropriate antibiotics and adjuvant therapy contribute to an improved outcome.

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Case Cluster of Necrotizing Fasciitis and Cellulitis Associated with Vein Sclerotherapy

Cited by 9 publications

References 12 publications

Soft Tissue Infections in Diabetic Patients

Soft Tissue Infections in Diabetic Patients

Safety Concerns for Sclerotherapy of Telangiectases, Reticular and Varicose Veins

Necrotizing fasciitis: The importance of early diagnosis, prompt surgical debridement and adjuvant therapy

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