A clinicopathological study of necrotizing fasciitis - An institutional experience

S.M. Peer, G. Rodrigues, S. Kumar, S.A. Khan

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: To describe the clinicopathological features in necrotizing fasciitis with evaluation of its clinical presentation, diagnostic criteria and mortality rate. Design: A case series, observational study. Place and Duration of Study: Kasturba Medical College Hospital, Manipal, India, from January 2003 to May 2005. Patients and Methods: All patients meeting clinical and/or histopathologic criteria for necrotizing fasciitis were included. Patients were studied with particular importance to the mode of presentation, associated co-morbid conditions, relevant investigations, histopathological report, modalities of treatment and final outcome. Results: A total of 38 patients were studied. The major cause of infection was idiopathic/primary. The average duration of symptoms at presentation was 10.07 days. The specific signs such as bullae and blistering were seen in 18 patients (47.3%). Of the infections, 19 (50%) were monomicrobial and 15 (39%) were polymicrobial. The most common complication seen was systemic sepsis with 9 patients (23.6%), of which 4 patients (10.5%) developed septicemic shock, 3 patients (7.8%) developed acute renal failure, 1 patient (2.6%) consolidation with pleural effusion and 2 patients (5.2%) had acute myocardial infarction. The mortality was 21%. Conclusion: The successful treatment of necrotizing fasciitis lies in early diagnosis and aggressive surgical debridement. Diabetes mellitus and other pre-morbid conditions increase the risk of mortality. The presence of bullae and blistering, foul smelling discharge and discolouration of skin raised the suspicion of necrotizing fasciitis. Findings at surgical exploration and skin biopsy are the only reliable means of diagnosis.
Original languageEnglish
Pages (from-to)257-260
Number of pages4
JournalJournal of the College of Physicians and Surgeons--Pakistan : JCPSP
Volume17
Issue number5
Publication statusPublished - 2007

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Necrotizing Fasciitis
Blister
Mortality
Skin
Debridement
Pleural Effusion
Infection
Acute Kidney Injury
Observational Studies
Early Diagnosis
India
Shock
Sepsis
Diabetes Mellitus
Myocardial Infarction
Biopsy

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@article{9c4ef3321e7643929f9db58c688d5de1,
title = "A clinicopathological study of necrotizing fasciitis - An institutional experience",
abstract = "Objective: To describe the clinicopathological features in necrotizing fasciitis with evaluation of its clinical presentation, diagnostic criteria and mortality rate. Design: A case series, observational study. Place and Duration of Study: Kasturba Medical College Hospital, Manipal, India, from January 2003 to May 2005. Patients and Methods: All patients meeting clinical and/or histopathologic criteria for necrotizing fasciitis were included. Patients were studied with particular importance to the mode of presentation, associated co-morbid conditions, relevant investigations, histopathological report, modalities of treatment and final outcome. Results: A total of 38 patients were studied. The major cause of infection was idiopathic/primary. The average duration of symptoms at presentation was 10.07 days. The specific signs such as bullae and blistering were seen in 18 patients (47.3{\%}). Of the infections, 19 (50{\%}) were monomicrobial and 15 (39{\%}) were polymicrobial. The most common complication seen was systemic sepsis with 9 patients (23.6{\%}), of which 4 patients (10.5{\%}) developed septicemic shock, 3 patients (7.8{\%}) developed acute renal failure, 1 patient (2.6{\%}) consolidation with pleural effusion and 2 patients (5.2{\%}) had acute myocardial infarction. The mortality was 21{\%}. Conclusion: The successful treatment of necrotizing fasciitis lies in early diagnosis and aggressive surgical debridement. Diabetes mellitus and other pre-morbid conditions increase the risk of mortality. The presence of bullae and blistering, foul smelling discharge and discolouration of skin raised the suspicion of necrotizing fasciitis. Findings at surgical exploration and skin biopsy are the only reliable means of diagnosis.",
author = "S.M. Peer and G. Rodrigues and S. Kumar and S.A. Khan",
note = "Cited By :5 Export Date: 10 November 2017 CODEN: JSPJE Correspondence Address: Rodrigues, G.; Department of Surgery, KMC Quarters, Manipal - 576 104 Karnataka, India; email: gabyrodricks@gmail.com Chemicals/CAS: metronidazole, 39322-38-8, 443-48-1; penicillin G, 1406-05-9, 61-33-6; tinidazole, 19387-91-8 References: Young, M.H., Aronoff, D.M., Engleberg, N.C., Necrotising fasciitis: Pathogenesis and treatment (2005) Expert Rev Anti Infect Tber, 3, pp. 279-294; Sehgal, V.N., Sehgal, N., Sehgal, R., Khandpur, S., Sharma, S., Necrotizing fasciitis (2006) J Dermatol Treat, 17, pp. 184-186; Wong, C.H., Chang, H.C., Pasupathy, S., Khin, L.W., Tan, J.L., Low, C.O., Necrotizing fasciitis: Clinical presentation, microbiology, and determinants of mortality (2003) J Bone Joint Surg Am, 8, pp. 1454-1460; Singh, G., Sinha, S.K., Adhikary, S., Babu, K.S., Ray, P., Khanna, S.K., Necrotizing infections of soft tissues: A clinical profile (2002) Eur J Surg, 168, pp. 366-371; Rangaswamy, M., Necrotizing fasciitis: A 10-year retrospective study of cases in a single university hospital in Oman (2001) Acta Trop, 80, pp. 169-175; Smeets, L., Bous, A., Lecog, J., Damas, P., Heymans, O., Necrotizing fasciitis: Diagnosis and treatments (2006) Rev Med Liege, 61, pp. 240-244; Elliott, D.C., Kufera, J.A., Myers, R.A., Necrotizing soft tissue infections: Risk factors for mortality and strategies for management (1996) Ann Surg, 224, pp. 672-683; Bosshardt, T.L., Henderson, V.J., Organ Jr., C.H., Necrotizing soft-tissue infections (1996) Arch Surg, 131, pp. 846-852; Hefny, A.F., Eid, H.O., Al-Hussona, M., ldris, K.M., Abu-Zidan, F.M., Necrotizing fasciitis: A challenging diagnosis (2007) Eur J Emerg Med, 14, pp. 50-52; Kihiczak, G.G., Schwartz, R.A., Kapila, R., Necrotizing fasciitis: A deadly infection (2006) J Eur Acad Dermatol Venereol, 20, pp. 365-369; McHenry, C.R., Piotrowski, J.J., Petrinic, D., Malangoni, M.A., Determinants of mortality for necrotizing soft-tissue infections (1995) Ann Surg, 221, pp. 558-565; Chelsom, J., Halstensen, A., Haga, T., Hoiby, E.A., Necrotizing fasciitis due to group - a Streptococci in western Norway: Incidence and clinical features (1994) Lancet, 344, pp. 1111-1115; Tsai, Y.H., Hsu, R.W., Huang, T.J., Hsu, W.H., Huang, K.C., Li, Y.Y., Necrotizing soft-tissue infections and sepsis caused by Vibrio vulnificus compared with those caused by Aeromonas species (2007) J Bone Joint Surg Am, 89, pp. 631-636; Wang, K.C., Shih, C.H., Necrotizing fasciitis of the extremities (1992) J Trauma, 32, pp. 179-182; Cheng, N.C., Chang, S.C., Kuo, Y.S., Wang, J.L., Tang, Y.B., Necrotizing fasciitis caused by methicillin-resistant Staphylococcus aureus resulting in death: A report of three cases (2006) J Bone Joint Surg Am, 88, pp. 1107-1110; Necrotizing fasciitis, dermal infections and NSAIDs: Caution (2007) Prescrire Int, 16, p. 17; Weinbren, M.J., Perinpanayagam, R.M., Streptococcal necrotizing fasciitis (1992) J Infect, 25, pp. 299-302; Donaldson, P.M.W., Naylor, B., Lowe, J.W., Gouldesbrough, D.R., Rapidly fatal necrotizing fasciitis caused by Streptococcal pyogenes (1993) J Clin Pathol, 46, pp. 617-620; McHenry, C.R., Protrowski, J.J., Petrinic, D., Determinants of mortality for necrotizing soft tissue infections (1995) Ann Surg, 221, pp. 558-565",
year = "2007",
language = "English",
volume = "17",
pages = "257--260",
journal = "Journal of the College of Physicians and Surgeons--Pakistan : JCPSP",
issn = "1022-386X",
publisher = "College of Physicians and Surgeons Pakistan",
number = "5",

}

A clinicopathological study of necrotizing fasciitis - An institutional experience. / Peer, S.M.; Rodrigues, G.; Kumar, S.; Khan, S.A.

In: Journal of the College of Physicians and Surgeons--Pakistan : JCPSP, Vol. 17, No. 5, 2007, p. 257-260.

Research output: Contribution to journalArticle

TY - JOUR

T1 - A clinicopathological study of necrotizing fasciitis - An institutional experience

AU - Peer, S.M.

AU - Rodrigues, G.

AU - Kumar, S.

AU - Khan, S.A.

N1 - Cited By :5 Export Date: 10 November 2017 CODEN: JSPJE Correspondence Address: Rodrigues, G.; Department of Surgery, KMC Quarters, Manipal - 576 104 Karnataka, India; email: gabyrodricks@gmail.com Chemicals/CAS: metronidazole, 39322-38-8, 443-48-1; penicillin G, 1406-05-9, 61-33-6; tinidazole, 19387-91-8 References: Young, M.H., Aronoff, D.M., Engleberg, N.C., Necrotising fasciitis: Pathogenesis and treatment (2005) Expert Rev Anti Infect Tber, 3, pp. 279-294; Sehgal, V.N., Sehgal, N., Sehgal, R., Khandpur, S., Sharma, S., Necrotizing fasciitis (2006) J Dermatol Treat, 17, pp. 184-186; Wong, C.H., Chang, H.C., Pasupathy, S., Khin, L.W., Tan, J.L., Low, C.O., Necrotizing fasciitis: Clinical presentation, microbiology, and determinants of mortality (2003) J Bone Joint Surg Am, 8, pp. 1454-1460; Singh, G., Sinha, S.K., Adhikary, S., Babu, K.S., Ray, P., Khanna, S.K., Necrotizing infections of soft tissues: A clinical profile (2002) Eur J Surg, 168, pp. 366-371; Rangaswamy, M., Necrotizing fasciitis: A 10-year retrospective study of cases in a single university hospital in Oman (2001) Acta Trop, 80, pp. 169-175; Smeets, L., Bous, A., Lecog, J., Damas, P., Heymans, O., Necrotizing fasciitis: Diagnosis and treatments (2006) Rev Med Liege, 61, pp. 240-244; Elliott, D.C., Kufera, J.A., Myers, R.A., Necrotizing soft tissue infections: Risk factors for mortality and strategies for management (1996) Ann Surg, 224, pp. 672-683; Bosshardt, T.L., Henderson, V.J., Organ Jr., C.H., Necrotizing soft-tissue infections (1996) Arch Surg, 131, pp. 846-852; Hefny, A.F., Eid, H.O., Al-Hussona, M., ldris, K.M., Abu-Zidan, F.M., Necrotizing fasciitis: A challenging diagnosis (2007) Eur J Emerg Med, 14, pp. 50-52; Kihiczak, G.G., Schwartz, R.A., Kapila, R., Necrotizing fasciitis: A deadly infection (2006) J Eur Acad Dermatol Venereol, 20, pp. 365-369; McHenry, C.R., Piotrowski, J.J., Petrinic, D., Malangoni, M.A., Determinants of mortality for necrotizing soft-tissue infections (1995) Ann Surg, 221, pp. 558-565; Chelsom, J., Halstensen, A., Haga, T., Hoiby, E.A., Necrotizing fasciitis due to group - a Streptococci in western Norway: Incidence and clinical features (1994) Lancet, 344, pp. 1111-1115; Tsai, Y.H., Hsu, R.W., Huang, T.J., Hsu, W.H., Huang, K.C., Li, Y.Y., Necrotizing soft-tissue infections and sepsis caused by Vibrio vulnificus compared with those caused by Aeromonas species (2007) J Bone Joint Surg Am, 89, pp. 631-636; Wang, K.C., Shih, C.H., Necrotizing fasciitis of the extremities (1992) J Trauma, 32, pp. 179-182; Cheng, N.C., Chang, S.C., Kuo, Y.S., Wang, J.L., Tang, Y.B., Necrotizing fasciitis caused by methicillin-resistant Staphylococcus aureus resulting in death: A report of three cases (2006) J Bone Joint Surg Am, 88, pp. 1107-1110; Necrotizing fasciitis, dermal infections and NSAIDs: Caution (2007) Prescrire Int, 16, p. 17; Weinbren, M.J., Perinpanayagam, R.M., Streptococcal necrotizing fasciitis (1992) J Infect, 25, pp. 299-302; Donaldson, P.M.W., Naylor, B., Lowe, J.W., Gouldesbrough, D.R., Rapidly fatal necrotizing fasciitis caused by Streptococcal pyogenes (1993) J Clin Pathol, 46, pp. 617-620; McHenry, C.R., Protrowski, J.J., Petrinic, D., Determinants of mortality for necrotizing soft tissue infections (1995) Ann Surg, 221, pp. 558-565

PY - 2007

Y1 - 2007

N2 - Objective: To describe the clinicopathological features in necrotizing fasciitis with evaluation of its clinical presentation, diagnostic criteria and mortality rate. Design: A case series, observational study. Place and Duration of Study: Kasturba Medical College Hospital, Manipal, India, from January 2003 to May 2005. Patients and Methods: All patients meeting clinical and/or histopathologic criteria for necrotizing fasciitis were included. Patients were studied with particular importance to the mode of presentation, associated co-morbid conditions, relevant investigations, histopathological report, modalities of treatment and final outcome. Results: A total of 38 patients were studied. The major cause of infection was idiopathic/primary. The average duration of symptoms at presentation was 10.07 days. The specific signs such as bullae and blistering were seen in 18 patients (47.3%). Of the infections, 19 (50%) were monomicrobial and 15 (39%) were polymicrobial. The most common complication seen was systemic sepsis with 9 patients (23.6%), of which 4 patients (10.5%) developed septicemic shock, 3 patients (7.8%) developed acute renal failure, 1 patient (2.6%) consolidation with pleural effusion and 2 patients (5.2%) had acute myocardial infarction. The mortality was 21%. Conclusion: The successful treatment of necrotizing fasciitis lies in early diagnosis and aggressive surgical debridement. Diabetes mellitus and other pre-morbid conditions increase the risk of mortality. The presence of bullae and blistering, foul smelling discharge and discolouration of skin raised the suspicion of necrotizing fasciitis. Findings at surgical exploration and skin biopsy are the only reliable means of diagnosis.

AB - Objective: To describe the clinicopathological features in necrotizing fasciitis with evaluation of its clinical presentation, diagnostic criteria and mortality rate. Design: A case series, observational study. Place and Duration of Study: Kasturba Medical College Hospital, Manipal, India, from January 2003 to May 2005. Patients and Methods: All patients meeting clinical and/or histopathologic criteria for necrotizing fasciitis were included. Patients were studied with particular importance to the mode of presentation, associated co-morbid conditions, relevant investigations, histopathological report, modalities of treatment and final outcome. Results: A total of 38 patients were studied. The major cause of infection was idiopathic/primary. The average duration of symptoms at presentation was 10.07 days. The specific signs such as bullae and blistering were seen in 18 patients (47.3%). Of the infections, 19 (50%) were monomicrobial and 15 (39%) were polymicrobial. The most common complication seen was systemic sepsis with 9 patients (23.6%), of which 4 patients (10.5%) developed septicemic shock, 3 patients (7.8%) developed acute renal failure, 1 patient (2.6%) consolidation with pleural effusion and 2 patients (5.2%) had acute myocardial infarction. The mortality was 21%. Conclusion: The successful treatment of necrotizing fasciitis lies in early diagnosis and aggressive surgical debridement. Diabetes mellitus and other pre-morbid conditions increase the risk of mortality. The presence of bullae and blistering, foul smelling discharge and discolouration of skin raised the suspicion of necrotizing fasciitis. Findings at surgical exploration and skin biopsy are the only reliable means of diagnosis.

M3 - Article

VL - 17

SP - 257

EP - 260

JO - Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

JF - Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

SN - 1022-386X

IS - 5

ER -