Epidemiological study on Fournier syndrome in a tertiary hospital in Jundiaí-SP from October 2016 to October 2018†

Abstract

Introduction Fournier’s gangrene is a polymicrobial infection caused by aerobic and anaerobic microorganisms, which determine a fast and progressive necrotizing fasciitis, compromising mainly the perineal region and the genital region, being able to evolve to sepsis, multiple organ failure and death. Treatment consists of early surgical diagnosis and debridement, associated with broad-spectrum antibiotic therapy and hyperbaric oxygen therapy. Objective Compare the most prevalent epidemiological data of patients with Fournier's Syndrome with the data examined in the literature in order to evaluate the incidence in the analyzed service, treatment form and evolution of the patients with the disease. Materials and methods Observational transversal study from the medical records of patients diagnosed with the disease at the São Vicente de Paulo Charity Hospital in Jundiaí, SP, from October 2016 to October 2018. Results 23 patients with Fournier’s Syndrome, all included in the study, and were analyzed. The most prevalent epidemiological data on the disease, such as age, sex, association with other comorbidities, treatment performed, mortality and early surgical procedure, had obtained a similar data as compared as the medical literature that was in studied. Conclusion Despite the recognized severity of Fournier’s Syndrome, early diagnosis combined with extensive surgical debridement, broad-spectrum antibiotic therapy and measures and oxygen therapy when available are important measures to contain the rapid progression of the disease, thus decreasing its levels of mortality.

Hyperbaric oxygen therapy decreases mortality due to Fournier’s gangrene: a retrospective comparative study

“…40 One study concluded that early diagnosis combined with extensive surgical debridement, broad-spectrum antibiotic therapy and oxygen therapy, when available, are important measures to contain the rapid progression of the disease, thus decreasing the mortality rate. 33 …”

“…Some studies show that HBOT reduces mortality in patients with FG. 30 33 However, other data do not support the routine use of HBOT in the treatment of FG. 34 Thus, we conducted this study to compare the evolution of patients treated with all classical measures with or without adjuvant HBOT oxygen therapy.…”

Gangrena de Fournier: Novas abordagens terapêuticas com o uso de pressão negativa e oxigenoterapia hiperbárica

“…Tal afecção foi relatada pela primeira vez por Baurienne, no ano de 1764, porém, nos anos de 1863 e 1864, com a publicação de 2 trabalhos, o urologista francês Jean Alfred Fournier descreveu com detalhes a patologia, que acometera o escroto e pênis de 5 homens jovens (Singh, Ahmed, Aydin, Khan, & Dasgupta, 2016), que primeiro ele chamou de gangrena idiopática fulminante (Inácio et al, 2020) (Yanaral et al, 2017) (Lima, Almeida, Góes, & Izabel, 2019) e, posteriormente, herdou seu nome em sua homenagem (Azevedo et al, 2016) (Yanaral et al, 2017).…”

“…Com a ação sinérgica dos patógenos aeróbios e anaeróbios, que compõe a flora polimicrobiana responsável pela infecção, há uma produção variada de exotoxinas e enzimas, como colagenases, heparinases, hialuronidases e estreptocinases (Inácio et al, 2020). Além disso, as bactérias anaeróbias causam agregação plaquetária e induzem a fixação do complemento, o que contribui para a coagulação e formação de microtrombos (Inácio et al, 2020). A partir desse ponto, um quadro de endarteríte obliterante se instala, desencadeando trombose vascular cutânea e subcutânea e necrose de tecidos irrigados por essa vasculatura.…”

“…Além disso, outras doenças e comorbidades, como o HIV e a desnutrição estiveram relacionados com pior prognóstico, necessitando de mais pesquisas que abordem tal relação, bem como a hipertensão arterial, tabagismo, obesidade, linfomas, baixos níveis socioeconômicos e, potencialmente, uma higiene deficitária em região perineal, que aparecem como fatores de risco importantes (Singh et al, 2016) (Moreira et al, 2017). Além do citado, a realização de procedimentos cirúrgicos, o uso de cateter e a técnica de fístulas uretrais também podem ser predisponentes para a patologia (Inácio et al, 2020) (Lima et al, 2019).…”