Necrotizing fasciitis in children: diagnostic and therapeutic aspects

Bingöl-Koloğlu, Meltem; Yildiz, Rahşan Vargün; Alper, Bilal; Yağmurlu, Aydın; Çıftçı, Ergın; Gökçora, I. Haluk; İnce, Erdal; Emiroğlu, Murat; Dindar, Hüseyin

doi:10.1016/j.jpedsurg.2007.07.018

Cited by 100 publications

(83 citation statements)

References 17 publications

(76 reference statements)

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“…NF is a severe, life-threatening, rapidly progressive soft tissue infection, primarily involving the subcutaneous tissues and underlying fascia [11]. It is associated with systemic toxicity and high mortality [12].…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous Emphysema and Pneumomediastinum Following Oro-Facial First Degree Burns

Jaafar

Al-Hashemi

2015

Int J Clin Pediatr

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First degree oro-facial burns, particularly by hot liquids, are common in children, and usually heal without complications. Rarely, potentially serious complications that can lead to cardiorespiratory compromise and even death can occur. We present a 15-month-old girl who developed spontaneous subcutaneous emphysema and pneumomediastinum 3 days after sustaining a first degree oro-facial burn by a hot liquid, with a possible thermal inhalational injury. Two important diagnoses that needed to be ruled out are the injury of an air-containing structure, like the pharynx, larynx, trachea, esophagus and bronchial tree as well as necrotizing fasciitis. Literature review revealed a lack of medical research that focuses on the association between such complications and first degree oro-facial burns, particularly in toddlers. The study reveals that spontaneous subcutaneous emphysema and pneumomediastinum can complicate first degree oro-facial burns in toddlers. Our aims are to draw the attention to the possible association between superficial oro-facial burns and the development of spontaneous subcutaneous emphysema and pneumomediastinum, and to encourage further studies to investigate into this association.

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Section: Discussionmentioning

confidence: 99%

Subcutaneous Emphysema and Pneumomediastinum Following Oro-Facial First Degree Burns

Jaafar

Al-Hashemi

2015

Int J Clin Pediatr

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“…Retrospective studies indicate that up to 85% of cases are diagnosed late and are confused with cellulitis 9 . Because the infection starts in the deep fascia, specific symptoms such as blisters and crackles are uncommon (< 40% of cases) 8 .…”

Section: Discussionmentioning

confidence: 99%

“…For patients in early stages of fasciitis, debridement should be considered as soon as the margins of the necrotic lesion are clearly defined; in later stages, debridement should be performed after the patient is clinically stable 4 . This practice reduces the need for blood trans fusions, because of thrombosis of perforating vessels, and reduces surgical trauma in patients who are already metabolically compromised 4,9 . The lesion must be covered with skin (mostly partial skin grafts) as soon as the recipient bed is in an appropriate condition.…”

Section: Discussionmentioning

confidence: 99%

Fasceíte necrotizante após aplicação de injeção intramuscular

Alvarez¹,

Siqueira²,

Oliveira³

et al. 2012

Rev. Bras. Cir. Plást.

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We report the case of a 1-year-old boy who developed necrotizing fasciitis of the groin and thighs after intramuscular injection of metoclopramide. We discuss and highlight the key aspects of diagnosis and treatment of this disease, with an emphasis on the importance of early identification of factors that can contribute significantly to improved survival.Keywords: Fasciitis. Debridement. Metoclopramide. RESUMOÉ relatado o caso de um paciente do sexo masculino, de 1 ano e 2 meses, apresentando quadro de fasceíte necrotizante comprometendo região inguinal e coxas após injeção intramuscular de metoclopramida. Neste artigo, são discutidos e apontados os aspectos fundamentais do diagnóstico e tratamento da doença, ressaltando a importância da identificação precoce dos fatores que possam contribuir significativamente para melhora da sobrevida.Descritores: Fasciite. Desbridamento. Metoclopramida.

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“…Superinfection of skin, pyogenic arteritis, osteomyelitis, and necrotizing fasciitis (NF) are considered as the infectious complications (3). NF, as a complication of VZV infection, requires close attention especially in children (4). This disease should be managed by appropriate and timely antibiotic administration as well as early possible surgical debridement and close clinical care.…”

Section: Introductionmentioning

confidence: 99%

Skin and Soft Tissue Infection as a Complication of Varicella Infection Ended up in Using Intravenous Immunoglobulin Instead of Surgical Debridement: A Case Report and Short Review of Literature

Emami

Mirmohamadi

Esfehani

2017

Arch Clin Infect Dis

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Introduction: Varicella infection is a vaccine-preventable infection, which can result in different complications. Necrotizing fasciitis (NF) as a skin and soft tissue infection is a rare complication of varicella infection in childhood. Early diagnosis and treatment of necrotizing fasciitis can save life. Surgical debridement along with appropriate antimicrobial treatment is very common. However, some patients cannot undergo surgeries and physicians should try other options. Case Presentation: A 6-year-old male with a history of chicken pox infection was admitted due to abdominal pain and fever. On physical examination, abdominal tenderness and diffused erythema on the entire abdomen as well as crepitation was prominent. As acute abdomen was ruled out by abdominal sonography, the patient received antimicrobial treatment, which was ineffective. Meanwhile, his hemodynamic condition worsened and sign of scaly skin presented, antimicrobial regimen was changed and surgical consultation was ordered. Unfortunately, surgical debridement was impossible due to extensive tissue involvement. Intravenous immunoglobulin (IVIG) was initiated and patient was transferred to the intensive care unit (ICU). Within 72 hours of administering IVIG, skin erythema and abdominal pain decreased and on the 10th day of admission, the patient became afebrile and healthy. Antibiotics were discontinued on the 12th day and the patient was discharged in good conditions. Conclusions: Although tissue debridement is the cornerstone to treat necrotizing tissue infection, in some cases patients might benefit from adjuvant treatments such as IVIG. Although this treatment cannot be generalized to every patient, it may be concluded that physicians can save surgical options and try IVIG under close clinical observation to avoid possible multiple surgical debridement.

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Necrotizing fasciitis in children: diagnostic and therapeutic aspects

Cited by 100 publications

References 17 publications

Subcutaneous Emphysema and Pneumomediastinum Following Oro-Facial First Degree Burns

Subcutaneous Emphysema and Pneumomediastinum Following Oro-Facial First Degree Burns

Fasceíte necrotizante após aplicação de injeção intramuscular

Skin and Soft Tissue Infection as a Complication of Varicella Infection Ended up in Using Intravenous Immunoglobulin Instead of Surgical Debridement: A Case Report and Short Review of Literature

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