Fournier’s Gangrene – Current Concepts

Abstract

Fournier's gangrene (FG) is a rapidly progressive form of infective necrotising fasciitis of the perineal, genital, or perianal regions, leading to thrombosis of the small subcutaneous vessels and necrosis of the overlying skin. It is believed that the occurrence of the disease in women is underreported and may be unrecognised by some clinicians. Fournier's gangrene is a life-threatening condition, constituting an urological emergency. Many patients with Fournier's gangrene have medical or surgical conditions, which are predisposing factors to this disease or its more severe or fatal course. These comprise diabetes mellitus, hypertension, alcoholism and advanced age. Recent reports in the literature point to changes in the epidemiology of FG, comprising an increasing age of patients. Several authors reported that the mean age of FG patients is at present 53-55 years. Prognosis in FG patients is based on FGSI (Fournier's gangrene severity index) score. Despite the progress in medical care for FG patients, the mortality rate reported in the literature remains high--most often 20-40%, but ranges from 4% to 80%. The most common isolates cultured from FG lesions are both Gram-positive and Gram-negative, as well as strictly anaerobic bacteria. Recently community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an etiological agent of FG with severe clinical course and even fulminant sepsis. Rarely FG may have a fungal etiology, being caused by yeast-like fungi Candida spp. or by moulds. Antibiotics should be administered parenterally and in doses high enough to reach an effective concentration in the infected tissues.

Fournier Gangrene in A 65 Years Old Obese Female with Uncontrolled Type II Diabetes Mellitus - A Case Report

“…Another predisposing factor for Fournier gangrene are poor general health, including malnutrition or obesity, chronic renal failure, chronic liver disease, malignancies and other conditions causing immunosuppression. 2 Our patient was obese with body mass index (BMI) of 34.1 kg/m2, which is considered a contributing factor to the development of Fournier gangrene.…”

“…These risk factors consist of hypertension, diabetes mellitus, advanced age, alcoholism, and poor general health, including chronic renal failure, chronic liver disease, malnutrition or obesity, malignancies and other immunodeficiency conditions. 2 In this occasion, we hereby present a Fournier gangrene in a female patient, 65-year-old with diabetic and obese body mass index.…”

“…1 Fournier gangrene was first discovered and described by Baurienne in 1764, but it was named after Jean-Alfred Fourniera French venerology's, who reported it in 1883 as a rapidly progressive or fulminant genital gangrene in otherwise healthy young men, with a sudden onset and no apparent cause or specific etiology. 2 This condition is relatively rare, with an estimated overall incidence of 1.6 / 100,000 males. The disease typically affects and predominates in males, but rarely Fournier Gangrene is also diagnosed in woman.…”

Four Determinative Factors in Fournier’s Gangrene Mortality

“…The most common bacterial species encountered in our study was E. coli (Table 1). 7,15 However, positive cultures and the bacterial species isolated were not associated with mortality.…”

Evidence for Infections by the Same Strain of Beta 2-toxigenic Clostridium perfringens Type A Acquired in One Hospital Ward

“…C. perfringens is listed as one of the numerous bacteria identified in the course of this infection. Although in recent years, its share in the infection seems to be getting smaller (Kuzaka et al 2018), the literature still describes cases of Fournier gangrene in which C. perfringens was cultured among the other infectious agents (Wróblewska et al 2014;Stevens et al 2017). Type 2 of NSTI is usually associated with infection with a single bacterial species (e.g.…”