Necrotizing fasciitis and gangrene associated with topical herbs in an infant.
ABSTRACT A 4-mo-old Chinese infant developed necrotizing fasciitis and gangrene from a small skin infection on his buttock that was treated with topical herbs. Sequential cultures revealed a number of organisms: Enterococcus species, sensitive to ampicillin, were isolated throughout the course, and coagulasenegative staphylococci replaced gram-negative rods during the later phase of the illness. The infant required prolonged intravenous antibiotic treatment and underwent multiple surgical procedures for debridement and reconstruction. This report serves to alert the public of the importance of avoiding application of unknown topical herbs in children with skin disease. A seemingly small wound, if inappropriately treated, may result in extensive tissue destruction and require extensive surgery.
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ABSTRACT: Necrotising fasciitis is a disease associated with high morbidity and mortality, and multi-focal necrotising fasciitis is uncommon. We present 2 cases of concurrent necrotising fasciitis of contralateral upper and lower limbs. Both presented with pain, swelling, bruising or necrosis of the affected extremities. Traditional medical therapy was sought prior to their presentation. After initial debridement, one patient subsequently underwent amputation of the contralateral forearm and leg. The other underwent a forearm amputation, but refused a below-knee amputation. Outcome: The first patient survived, while the second died. Traditional medical therapy can cause bacterial inoculation, leading to necrotising fasciitis, and also leads to delay in appropriate treatment. Radical surgery is needed to optimise patient survival.Annals of the Academy of Medicine, Singapore 05/2006; 35(4):270-3. · 1.36 Impact Factor
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ABSTRACT: Necrotizing fasciitis has been associated with significant morbidity and mortality. Thirty-three patients were studied over a 3-year period. Predisposing factors included intravenous drug abuse (30%), diabetes (21%), and obesity (18%). Severe pain (94%) and abnormal temperature (88%) were present, whereas laboratory data and x-ray were nonspecific. Gram-positive organisms were most frequently recovered (B-hemolytic streptococcus 45%). Treatment consisted of antibiotics, surgical debridement, re-exploration 24 hours before surgery, nutritional support, and early soft tissue coverage as needed. Mean duration from admission to operation was 43 hours. The average number of operative debridements was three and the average length of hospitalization was 47 days. Patients operated on less than 12 hours from admission or greater than 48 hours had shorter hospital stays (36 and 38 days). The critical time period was 12-48 hours after admission; all deaths and amputations were in this group and the average hospital stay was 62 days (p less than 0.05). The number of operations did not correlate to hospital stay. Despite antibiotics and aggressive debridement, significant morbidity exists if operation is delayed more than 12 hours. Methods of early detection such as local bedside diagnostic incision and fascial inspection may be needed in high risk patients to further reduce the morbidity and mortality.Annals of Surgery 12/1987; 206(5):661-5. · 6.33 Impact Factor
- American journal of diseases of children (1960) 05/1973; 125(4):591-5.