Fournier’s gangrene in the HIV era

Ngugi, P M; Magoha, G. A. O.; Nyaga, Paul

doi:10.4314/ahs.v14i4.38

Cited by 19 publications

(20 citation statements)

References 16 publications

(14 reference statements)

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“…This rate of HIV infection is higher than seen in other large studies. Ngugi et al [13] reviewed 146 patients presenting with FG in Kenya and found an HIV rate of 16.4%. Chalya et al [14] reviewed 84 patients with FG in Tanzania and found an HIV rate of 11.3%.…”

Section: Discussionmentioning

confidence: 99%

The presentation, management and outcomes of Fournier’s gangrene at a tertiary urology referral centre in South Africa

Elsaket

Maharajh²,

Urry

2018

S Afr Med J

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In a resource-constrained environment such as SA, outcome prediction is necessary to enable resource allocation. Patients with an FGSI >9 have a high risk of mortality and will benefit from ICU care. The combination of FGSI >9, requirement for organ support and extension beyond the perineum is associated with a very high risk of mortality and may be useful as an exclusion criterion when allocating scarce resources.

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Section: Discussionmentioning

confidence: 99%

The presentation, management and outcomes of Fournier’s gangrene at a tertiary urology referral centre in South Africa

Elsaket

Maharajh²,

Urry

2018

S Afr Med J

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“…It showed HIV may be emerging as an important predisposing factor for Fournier's Gangrene. 9 Fournier's gangrene mainly involves perineal region most commonly scrotum. Scrotal involvement along with medial thigh, anterior abdominal wall suggest severe disease.…”

Section: Discussionmentioning

confidence: 99%

A clinical study of Fournier’s gangrene and use of honey dressing in treatment

2018

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Genitals and perineal regions are more prone for infection as their tendency to responds to inflammation by causing ABSTRACT Background: Fournier's gangrene is necrotizing fasciitis involving genitals and perineal regions. Fournier's gangrene is a surgical emergency. If not treated immediately it spreads rapidly causing septicemia leading to death. Mainstay of treatment is surgical and regular dressing. Various dressing materials are available like eusol, in our study we use Honey as dressing material. This is a small work to attempt to study incidence, etiology and pathogenesis and use of dressing for the treatment of Fournier's Gangrene. Methods: in our study we study 40 male patients of Fournier's gangrene. We studied clinico-pathology of disease and use of honey dressing for the management of Fournier's gangrene. Out of 40 patients 18 were treated with honey as dressing material and remaining 22 with eusol. Results: 40 patients were admitted, and majority of patients were in age group > 60 years mean age was 54.08_15.47 years. Majority of patients belonged to lower socioeconomic class 82.5%. Most of patients presented in hospital within 7 days of initial symptoms. In this study etiological causes found in 85% of patients and among which most common were urogenital causes 32.5%. Majority of patients had chronic alcoholism and bad hygiene as predisposing factors. 25% were associated with diabetes mellitus. In this study 12% of patients were HIV positive. Most common organism found in pus culture was E. coli (42.5%) followed by Coagulase Negative Staphylococci in 32.5%, Klebsiella in 12.5%, Pseudomonas in 7.5% and no organism were isolated in 5%. Mean days required for healthy granulation by honey dressing was 9.62+-4.5 days and for eusol was 10.5 +-3.79 days. In our study mortality was 22.5%. Conclusions: Diabetes and alcoholism are predisposing factors associated with this disease. HIV is emerging predisposing factor for Fournier's gangrene. Honey is very useful for treatment of Fournier's gangrene it reduces days for clearance of slough and hospital stay.

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“…[6] The mortality from studies done in other African countries range from 3.6% to 24%. [7,8,9] A recent 3 year review study on 20 patients from Saudi Arabia recorded zero mortality. [10] They attributed the good prognosis to the moderate severity of their cases and aggressive radical surgical debridement.…”

Section: Discussionmentioning

confidence: 99%

“…In similar study to ours HIV infection has overtaken diabetes mellitus (16% vs 11%) as the commonest underlying risk factor. [9] The HIV epidemic potentially opens a huge population at risk of developing Fournier's gangrene in sub Saharan Africa. The presence of HIV infection is not a significant factor associated with non-survival similar to findings by Elem and colleagues.…”

Section: Discussionmentioning

confidence: 99%

Fournier's gangrene: outcome analysis and prognostic factors

Meki¹,

Mangwiro²,

Lazarus³

2018

S. Afr. j. surg.

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Background: Fournier's gangrene is an infective necrotising fasciitis of the external genitalia and perineum associated with significant morbidity and mortality. The factors associated with non survival have been described but are not universally accepted. The identification of prognostic factors remains critical to improve outcomes. Objectives: To determine the hospital based mortality and factors associated with non-survival among subjects with a clinical diagnosis of Fournier's gangrene. Methods: A prospective hospital based observational study on 51patients with a clinical diagnosis of Fournier's gangrene over a 2-year period. A comparison was made between survivors and non-survivors to establish prognostic factors associated with non survival. Results: The disease related hospital mortality was 27% (14/51). The mean age of the 51, all male patients was 47 years. An older age was significantly associated with non-survival (p=0.02). The presence of renal dysfunction (p=0.001), severe sepsis (p=0.000), delay in surgical debridment (p=0.04), urogenital source of infection (p=0.01), a body surface area involvement of greater than 5% (p=0.006), abdominal wall involvement (p=0.02) on admission were significant factors associated with mortality. The presence of either HIV infection or diabetes mellitus was not a prognostic indicator of mortality. The clinical and biochemical parameters on admission associated with non survival were a high respiratory rate (p=0.03), a low hemoglobin(p=0.0001), an elevated blood urea nitrogen (p=0.005) and creatinine (p=0.01). Multivariate logistic regression analysis did not show any independent factors associated with non survival. Conclusion: Fournier's gangrene remains a fatal condition with a hospital mortality of 27%. Prognostic factors for non survival include an advanced age, a urogenital source of infection, abdominal involvement, severe sepsis and renal dysfunction.S Afr J Surg 2018;56 (3) http://dx.

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Fournier’s gangrene in the HIV era

Cited by 19 publications

References 16 publications

The presentation, management and outcomes of Fournier’s gangrene at a tertiary urology referral centre in South Africa

The presentation, management and outcomes of Fournier’s gangrene at a tertiary urology referral centre in South Africa

A clinical study of Fournier’s gangrene and use of honey dressing in treatment

Fournier's gangrene: outcome analysis and prognostic factors

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