Fascitis necrosante por Staphylococcus aureus resistente a la meticilina adquirido en la comunidad productor de leucocidina de Panton-Valentine

Community-Acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA) is a worldwide emerging pathogen that is able to produce serious skin and soft- tissue infections such as necrotizing fasciitis, as well as pneumonia and osteomyelitis. We present a 14 month child with necrotizing fasciitis, confirmed by magnetic resonance imaging, produced by CA-MRSA Panton-Valentine leukocidin producer. The clinical outcome was good after early surgical treatment and the administration of intravenous clindamycin for two weeks. We review microbiological aspects and treatment guidelines of these infections.     

Necrotizing fasciitis with chickenpox

Necrotizing fasciitis can be observed in a wide variety of clinical settings in the pediatric age group. But necrotizing fasciitis as a complication of chickenpox is rare. Five cases of necrotizing fasciitis following chickenpox were treated in the authors’ institutions. Clinical signs like fever, tachycardia, pallor, erythema, marked edema of the affected area and patchy areas of discoloration or gangrene of the skin were present and were the important clues to the seriousness of infection. Patients were treated with aggressive surgical debridement, frequent dressings, broad-spectrum antibiotics, nutritional support, and split skin grafting. Early diagnosis and aggressive surgical therapy are critical. Literature search showed necrotizing fasciitis following chickenpox has not been reported in India. We feel early suspicion and aggressive management can decrease the morbidity and mortality in this rare complication.     

Community-associated methicillin-resistant Staphylococcus aureus necrotizing fasciitis in a neonate

Neonatal necrotizing fasciitis is rare and is predominantly associated with methicillin-susceptible Staphylococcus aureus (MSSA). Necrotizing fasciitis associated with community-associated methicillin-resistant S aureus (CA-MRSA) has only recently been reported in the literature, primarily among adults. We present a case of a previously healthy neonate with necrotizing fasciitis of the back caused by CA-MRSA, pulsed-field type USA-300. We describe a 5-day-old infant with necrotizing fasciitis of the back caused by CA-MRSA. Treatment of necrotizing fasciitis requires prompt medical evaluation, prompt surgical debridement, and appropriate antibiotic selection. The potential involvement of CA-MRSA in necrotizing fasciitis in children needs to be considered before institution of antibiotics.     

Necrotizing fasciitis following liver and small intestine transplantation

Necrotizing fasciitis is a rare, subcutaneous infection. It can occur in patients after solid-organ transplantation. We herein report two patients who developed necrotizing fasciitis following combined liver and small intestine transplantation. The first patient experienced this infection 4 yr after transplantation and 1 yr after the closure of the ileostomy. The second patient suffered from necrotizing fasciitis 2 days after the transplant. Both cases were diagnosed on the physical findings, culture of subcutaneous lavage, and the computed tomography findings. The site of entrance of the organism was not clear in either case. Both patients had a fulminant course and died within 1 week from the onset, despite aggressive surgical intervention. Therefore, necrotizing fasciitis has to be recognized as a potential complication of intestinal transplantation.     

Infections cutanées sévères à Streptococcus pyogenes chez l’enfant : résultats d’une enquête multicentriqueSevere cutaneous infections due to streptococcus pyogenes in children.

To assess pediatric cases of severe cutaneous infections due to Streptococcus pyogenes. Since the beginning of 1980, the incidence of cellulitis and necrotizing fasciitis due to S. pyogenes has increased in adults. Serotyping of obtained isolates are in most cases M1, M3 or M5 protein.Patients and Method. – A retrospective (1990-2000) survey was carried out in pediatric hospital centers.Results. – Three cases of necrotizing fasciitis and 15 of cellulitis were observed. In 30 % of the cases, varicella lesions were associated ; in the other cases, minor wounds were the site of the infection. Bacteriologic diagnosis was made by local samples in 14 cases ; blood cultures were positive in four cases. In 11 cases, initial intravenous treatment consisted of third generation cephalosporin, in six cases of penicillin M or G and in one case of fusidic acid. In the second time, penicillin M was perfused in the majority of the cases. Mean duration of intravenous antibiotics perfusion was 15 days. There were no sequelae or death in this survey.Conclusions. – Despite this study had limited epidemiological characteristics, it confirms that these two infections are rare. The frequency is probably underestimated, due to the difficulty in performing a diagnosis. The major site of infection was the varicella lesion. These two infections are so similar that it is frequent to mistake one infection for the other. Nonsteroidal anti-inflammatory drugs and site of infections did not influence prognosis. The treatment of cellulitis is penicillinotherapy whereas in necrotizing fasciitis early major surgery is often correlated with the rate of survival.     

Is it acute omphalitis or necrotizing fasciitis? Report of three fatal cases

We describe 3 Costa Rican newborns that developed acute omphalitis, complicated with fulminant abdominal wall and genital necrotizing fasciitis. The emergency practitioner should be capable of distinguishing promptly between acute omphalitis and early necrotizing fasciitis. Prompt medical treatment and surgical debridement should be encouraged to decrease the high associated morbidity and mortality rates.     

Varicella complicated with necrotizing fasciitis caused by group A hemolytic Streptococcus]

Chickenpox has a high risk of invasive group A streptococcal disease and necroziting fasciitis. CASE REPORT: A five-year-old girl, during chickenpox treated with ibuprofen, developed sepsis and edematous and necrotic lesions of the pelvis and the abdominal wall. The child improved with surgical treatment and adjunction of clindamycin to the antibiotic therapy. CONCLUSION: We review the optimal medical and surgical treatment of necrotizing fasciitis and discuss the role of chickenpox and non steroidal antiinflammatory agents in this disease.     

Periumbilical necrotizing fasciitis in the newborn.

Periumbilical necrotizing fasciitis (PNF) in the newborn is an invasive bacterial infection of the abdominal wall with a fulminant course and a high mortality rate. Little is known about the etiology, risk factors and microbiology of the disease. 18 patients with periumbilical necrotizing fasciitis were included in this retrospective study and were compared with 50 patients with omphalitis over a 6-year period, between 1992 and 1998. This represents the largest reported study. The children with periumbilical necrotizing fasciitis presented at a younger age compared to the omphalitis group (8.4 days vs. 9.1 days) and had a shorter clinical history (1.9 days vs. 2.8 days), suggesting that PNF is not a mere sequela of omphalitis but has distinctive underlying causes. None of our patients in the omphalitis group had a progression of the disease towards necrotizing fasciitis. The microbial spectrum of cultures obtained in patients with PNF consisted of mixed anaerobes and aerobes in 55%, and mixed aerobes in 36% of cases. Early aggressive therapy, including elective endotracheal intubation, immediate surgical debridement of the abdominal wall, antibiotics and supportive measurements resulted in a survival rate of 56%. Far from being satisfactory, this is nevertheless higher than the 12.5% to 45% survival rate quoted in previous publications.     

Necrotizing fasciitis of the perineum

Background

Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries a high mortality rate and requires prompt diagnosis and urgent treatment with radical debridement and antibiotics; but early diagnosis, which is essential to successful treatment, remains a challenge.

Methods

Physical examination findings, preoperative and operative findings, histopathological results of the structure, and follow-up results of the patient are discussed with related reports.

Results

A 15-month old girl had a history of trivial perineal dermatitis after treatment of anemia and pneumonia. Perineal dermatitis progressed fastly as necrotizing fasciitis which was successfully managed with intensive medical treatment, surgical debridement and reconstructive surgery.

Conclusions

Lack of cutaneous findings early in the disease makes the diagnosis challenging, so a high suspicion is essential. Recovery of the patient from this life-threatening condition needs a multi-disciplinary approach involving pediatrics, pediatric surgery, and plastic and reconstructive surgery.     

Deep soft tissue infections in the neutropenic pediatric oncology patient

PURPOSE: Necrotizing fasciitis and myonecrosis can be rapidly fatal without prompt and aggressive medical and surgical therapy. We reviewed our experience with necrotizing fasciitis and myonecrosis in neutropenic pediatric oncology patients to describe associated clinical characteristics and outline therapeutic interventions. PATIENTS AND METHODS: A retrospective chart review was performed for all cases of deep soft tissue infection found in neutropenic pediatric oncology patients during an 11-year period. RESULTS: Seven cases of necrotizing fasciitis and/or myonecrosis associated with chemotherapy-induced neutropenia were diagnosed during the study period. Deep soft tissue infection was diagnosed a median of 14 days after the initiation of chemotherapy. All of the patients presented with fever and pain, generally out of proportion to associated physical findings. Most patients (86%) also had tachycardia and subtle induration at the site of soft tissue infection. The pathogenic organism in four of seven patients originated in the gastrointestinal tract. Patients were treated with antibiotics, surgical debridements, granulocyte colony-stimulating factor, and hyperbaric oxygen. Granulocyte transfusions were administered if there were no signs of neutrophil recovery. Five patients survived their deep soft tissue infection. CONCLUSIONS: The diagnosis of necrotizing fasciitis and/or myonecrosis should be considered in any neutropenic patient with fever, tachycardia, and localized pain out of proportion to the physical findings. Appropriate therapy includes broad-spectrum intravenous antibiotics and urgent surgical intervention. Granulocyte colony-stimulating factor should be administered to all patients to enhance neutrophil recovery. Granulocyte transfusions should be considered if a prolonged period of neutropenia is anticipated.     

Necrotizing fasciitis as a complication of chickenpox

Necrotizing fasciitis is a rapid, potentially fatal soft tissue infection. Chickenpox is a common childhood illness not usually associated with severe complications. We present the case of an 8-year-old girl with necrotizing fasciitis of the upper back arising from superinfection of varicella skin lesions. Necrotizing fasciitis may have devastating sequelae, including septic shock, which mandate vigorous fluid resuscitation, appropriate antimicrobial therapy, and early aggressive surgical debridement.     

婴儿肛周坏死性筋膜炎1例

对广州市第一人民医院儿科收治的1例肛周坏死性筋膜炎患儿的临床资料进行回顾性分析。患儿,女,5个月余,以发热、腹泻起病,仅发病10 d患儿肛周皮肤由红肿进展为肛周皮肤及软组织溃烂,脂肪液化,可见直肠暴露,予手术切开、彻底清创引流并选用敏感抗生素等治疗后患儿痊愈出院。肛周坏死性筋膜炎是一种极为罕见的、由多种细菌感染引起的坏死性软组织感染。因为其早期表现难以鉴别、症状严重、病死率高,所以应在临床工作中予以重视。     

Necrotizing fasciitis caused by Aeromonas hydrophilia in an immunocompetent child

Necrotizing fasciitis is a rapidly progressive and potentially fatal infection. It is characterized by extensive subcutaneous and muscle necrosis. Aeromonus hydrophilia is a gram-negative faculatively anaerobic bacillus that is part of the normal flora of nonfecal sewage and is found in most water systems, soil, and fresh brackish water. Necrotizing fasciitis caused by A. hydrophilia have occurred in children who had underlying systemic diseases or immune dysfunction. We report a 14-year-old boy without underlying systemic diseases or immunodeficiency who developed necrotizing fasciitis secondary to A. hydrophilia and he was successfully treated with extensive surgical debridement and systemic antibiotics.     

Cecal perforation presenting as abdominal-wall necrotizing fasciitis

 The preoperative diagnosis of a cecal perforation associated with Salmonella infection as a cause of abdominal-wall necrotizing fasciitis (AWNF) is clinically difficult. Computed tomography of the abdomen is helpful, and can detect the combined presence of a pneumoscrotum and pneumoperitoneum. Its presence indicates a patent processus vaginalis, which acts as the primary route for the spread of the intra-abdominal infectious process into the abdominal wall. An exploratory laparotomy should be done to confirm the presence of intra-abdominal pathology in order to avoid delayed treatment. Accepted: 21 October 1999     

Necrotizing fasciitis following BCG vaccination

We report a newborn with methicillin-resistant Staphylococcus aureus mediated necrotizing fasciitis after Bacilli-Calmette-Guerin vaccination. Radical debridement of the affected area coupled with twice daily surgical honey dressing and intravenous vancomycin and clindamycin resulted in satisfactory healing.     

Cervical necrotizing fasciitis caused by Serratia marcescens in a 2 year old

We report an unusual, life-threatening complication of producing fulminant cervical necrotizing fasciitis in a previously healthy 2-year-old girl. We reviewed the literature for necrotizing fasciitis in children and its morbidity, mortality, and treatment. This case illustrates the necessity of prompt recognition and aggressive management in patients presenting with cervical necrotizing fasciitis.     

Postoperative necrotizing fasciitis in children

Necrotizing fasciitis is a rapidly progressive soft tissue infection, involving the skin, subcutaneous tissue, and superficial fascia. It is a rare but life-threatening complication in the postoperative patient. In the last 7 years, we have treated four children in whom necrotizing fasciitis developed after appendectomy for ruptured appendix, bilateral inguinal herniorrhaphy, or gastrostomy closure. These four patients and seven well-described children from the literature with necrotizing fasciitis following surgery form the basis of this review. The ages ranged from six days to 15 years (mean 4.5 years). There were eight boys and three girls. There were five clean, five clean-contaminated, and one contaminated surgical procedures. No patient had evidence of malignancy or diabetes. Two of our four patients had evidence of failure to thrive. Only one patient had an intraabdominal abscess. In ten, the infection started in the abdominal wall; in one, the infection started in the chest wall. In our four patients, three had neutropenia and fever, four had tachycardia, and two had wound crepitation and radiographic evidence of subcutaneous gas. Cultures of all ten wounds were positive for bacteria; six were positive for more than one organism. Blood culture results were positive in five of five patients who died and in only two of five patients who survived. All survivors had wide surgical debridement and were treated with broad-spectrum antibiotics. The mortality rate was 45% in the whole series.(ABSTRACT TRUNCATED AT 250 WORDS)     

Multifocal necrotizing fasciitis in varicella

We describe a two-year-old patient who developed severe necrotizing fasciitis in three nonadjacent sites of his extremities during varicella. The recovery of purulent material by aspiration of deep soft tissues after seven days of fever, leukocytosis, and no response to antimicrobial therapy raised the suspicion of this diagnosis. The patient recovered following surgical drainage, debridement, and subsequent skin grafts. It is emphasized that early diagnosis of this severe complication is important since early surgical intervention decreases morbidity and facilitates recovery.     

Necrotizing fasciitis caused by Serratia marcescens after venous access port implantation in a child with acute lymphoblastic leukemia

Necrotizing fasciitis is a potentially life-threatening infection of deep skin layers and subcutaneous tissues that can easily spread across the fascia plate and is usually the result of a combined infection with anaerobic and aerobic microorganisms. The patient typically complains of excruciating pain, which is not necessarily in accordance with clinical signs. Early recognition of the condition is very important, and aggressive treatment with a combination of antibiotics and surgical procedure is crucial. We present a case of a 15-year-old girl with acute lymphoblastic leukemia who developed necrotizing fasciitis after venous access port implantation during induction chemotherapy.     

Infections superficielles de la peau et dermo-hypodermites bactériennes

Staphylococcus aureus and Streptococcus pyogenes are the two main bacteria involved in skin infections in children. Mild infections like limited impetigo and furonculosis should preferentially be treated by topical antibiotics (mupirocine or fucidic acid). Empiric antimicrobial therapy of dermohypodermitis consists in amoxicillin-clavulanate through oral route (80 mg/kg/d) or parenteral route (150 mg/kg amoxicillin per d. in 3–4 doses) for complicated features: risk factors of extension of the infection, sepsis or fast evolution. Clindamycin (40 mg/kg/d per d. in 3 doses) should be added to the beta-lactam treatment in case of toxinic shock, surgical necrotizing soft tissues or fasciitis infections.