Pattern of presentation and outcome of patients treated for Fournier’s gangrene at Kilimanjaro Christian Medical Centre in Moshi, Tanzania

Abstract

Background: Fournier’s gangrene (FG) is a rapidly progressive and potentially fatal infective necrotizing fasciitis which affects the perineal and perianal regions as well as the external genitalia. This study aimed at evaluating the management of FG and its outcomes at Kilimanjaro Christian Medical Centre (KCMC) in Moshi, TanzaniaMethods: This was a retrospective hospital based study involving case notes of all patients who had Fournier’s gangrene at KCMC from January 2003 to December 2013. Patients managed for Fournier’s gangrene and the medical records of the patients eligible for the study retrieved manually.Results: A total of 25case notes of patients treated for Fournier’s gangrene during the study period were reviewed. All were males and majority of them (60%) were ≥50 years (mean=57.4 years). Hypertension was the commonest reported risk factor (41%). Diabetes mellitus was reported as a risk factor in 20% of all patients with FG. These risk factors were mentioned as comorbid conditions in traumatic urethral catheterization and suprapubic catheterization. All patients received a combination treatment of wound debridement, antibiotics, fluid replacement, analgesics and daily wound dressing. The average hospital stay for patients with FG was about 25 days.Conclusion: Fournier’s gangrene at KCMC is exclusively a male disease affecting those above 50 years. Hypertension and diabetes mellitus were the common comorbid condition in patients with Fournier’s gangrene.

Prevalence, Pattern and Early Treatment Outcomes Predictors of Patients with Fournier's Gangrene at University of Dodoma Affiliated Teaching Hospitals

“…This could be explained by the fact that as age increases the immunity system becomes weaker predisposing an individual to infections, also with increase in age the risk for diseases such as hypertension and diabetes mellitus. This is similar to other studies which reported FG being more common among individuals with advanced age years [7,8,12,20] and other studies from Nigeria Nepal and other countries where all patients reviewed were males with mean age of 57.4 years; majority were +50-years [10,[21][22][23].…”

“…Mortality rates reported in the literature range from 3% to as high as 45% [1], relating with the study population and severity of the disease. Mortality of 16.4% as obtained in this study was similar to the findings of Mabula, et al [7] where reported to be 16% however, higher mortality rates have been reported by Oymacı, et al (18.8%), Ersay, et al (22.8%), and Benjelloun, et al in Nigeria. The lower mortality rate in this study may be attributed to the population, which was more of younger age, and had no comorbidity explaining the survival of the initial septic state probable due to higher immunity in a population that have been exposed to chronic and recurrent microbial infection.…”

“…Majority of patients had no Comorbidities in other hand the common comorbidities were diabetes mellitus and HIV/AIDS. These findings with slight differences were found to be similar to the study done in northern Tanzania [7]. The difference from this study was that majority of the patients had nocomorbidity and HIV was the commonest followed by Diabetes mellitus.…”

“…This study found FG being almost exclusively a male disease (95.5%) similar to a retrospective study which conducted at KCMC kilimanjaro in which all patients recruited in the study were males [7]. The that the hypertonic saline through its high osmotic gradient controls exudation and inhibits bacterial proliferation, while the povidone-iodine is bactericidal with antimicrobial activity against gram-positive and gram-negative bacteria including fungi and protozoa [1,9,11,12,14,23].…”

“…It is reported to be associated with comorbidities as a predisposing factors and the most common mentioned includes Diabetic Mellitus (DM), Human Immunodeficiency virus ( HIV), Hypertension, Chronic alcoholism, Chronic renal failure and prolonged steroid use [7,8]. The most clinical symptoms includes external genitalia severe pain or discomfort, fever, generalized body malaise and systemic symptoms such as nausea, vomiting, or confusion in severe cases and signs includes scrotal swelling, hyperaemic scrotal skin and discoloration, blisters, ulcers, foul smelling discharges or pus [9].…”