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Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center

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ABSTRACT

Purpose: No reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF.

Methods: Eighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated.

Results: Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia.

Conclusions: Most patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.

No MeSH data available.


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Extrahepatic cutaneous dermatitis and vasculitis in patient number 13. a Dermatitis with hyperpigmentation-affected bilateral lower limbs; b non-blanching purpura were the main characteristics of vasculitis
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Fig1: Extrahepatic cutaneous dermatitis and vasculitis in patient number 13. a Dermatitis with hyperpigmentation-affected bilateral lower limbs; b non-blanching purpura were the main characteristics of vasculitis

Mentions: In the present study, non-survivors had a higher prevalence of involved bilateral lower limbs and thrombocytopenia than did survivors. There is a paucity of reports on the risk factors for SMNF mortality. However, the mortality rate in cases of monofocal NF with upper extremity involvement is not significantly different from that in cases with lower extremity involvement [16, 17]. El-Khani et al. [2] reported a significantly higher mortality rate in bilaterally affected lower limbs than in bilaterally affected upper limbs (60 vs. 0%), but the clinical mechanism of mortality related to lower extremity involvement is unclear. In the present study, chronic liver diseases were the most common comorbidities (61%) in SMNF, especially in non-survivors (75%). Some evidence [18–20] indicates that atherosclerosis and cutaneous vasculitis in the lower limbs were highly associated with chronic liver diseases (e.g., viral hepatitis and alcoholic hepatitis). Also, extrahepatic cutaneous vasculitis [21], primarily of the lower limbs, leads to cutaneous lesions and to an insufficient barrier against bacterial invasions (Fig. 1). Atherosclerosis, vasculitis, and devitalized soft tissue are the results of a poor blood supply, which causes the clinical deterioration of necrotizing deep soft tissue infection [22]. These comorbidities might result in a higher prevalence of involved bilateral lower limbs in patients who die from NF (Fig. 2).Fig. 1


Synchronous multifocal necrotizing fasciitis prognostic factors: a retrospective case series study in a single center
Extrahepatic cutaneous dermatitis and vasculitis in patient number 13. a Dermatitis with hyperpigmentation-affected bilateral lower limbs; b non-blanching purpura were the main characteristics of vasculitis
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5121196&req=5

Fig1: Extrahepatic cutaneous dermatitis and vasculitis in patient number 13. a Dermatitis with hyperpigmentation-affected bilateral lower limbs; b non-blanching purpura were the main characteristics of vasculitis
Mentions: In the present study, non-survivors had a higher prevalence of involved bilateral lower limbs and thrombocytopenia than did survivors. There is a paucity of reports on the risk factors for SMNF mortality. However, the mortality rate in cases of monofocal NF with upper extremity involvement is not significantly different from that in cases with lower extremity involvement [16, 17]. El-Khani et al. [2] reported a significantly higher mortality rate in bilaterally affected lower limbs than in bilaterally affected upper limbs (60 vs. 0%), but the clinical mechanism of mortality related to lower extremity involvement is unclear. In the present study, chronic liver diseases were the most common comorbidities (61%) in SMNF, especially in non-survivors (75%). Some evidence [18–20] indicates that atherosclerosis and cutaneous vasculitis in the lower limbs were highly associated with chronic liver diseases (e.g., viral hepatitis and alcoholic hepatitis). Also, extrahepatic cutaneous vasculitis [21], primarily of the lower limbs, leads to cutaneous lesions and to an insufficient barrier against bacterial invasions (Fig. 1). Atherosclerosis, vasculitis, and devitalized soft tissue are the results of a poor blood supply, which causes the clinical deterioration of necrotizing deep soft tissue infection [22]. These comorbidities might result in a higher prevalence of involved bilateral lower limbs in patients who die from NF (Fig. 2).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Purpose: No reports have been published on synchronous multifocal necrotizing fasciitis (SMNF), a multifocal presence of necrotizing fasciitis in different extremities. We evaluated the clinical characteristics and outcomes of SMNF.

Methods: Eighteen patients (14 men, 4 women; mean age: 59 years) diagnosed with SMNF of the extremities between January 2004 to December 2012 were enrolled and evaluated.

Results: Vibrio species were the most commonly (78%; n = 14) isolated; others were two cases (11%) of Aeromonas spp., one case (6%) of group A β-hemolytic streptococcus, and one case of coagulase-negative staphylococcus. SMNF was in the bilateral lower limbs (72%; n = 13), bilateral upper limbs (17%; n = 3), and one patient with one upper and one lower limb (11%). Non-surviving patients had more bilateral lower limb involvement and thrombocytopenia.

Conclusions: Most patients with SMNF were male and had bilateral lower limb and marine Gram-negative bacteria involvement. The mortality of SMNF remained extremely high in patients with involvement of bilateral lower limb and initial thrombocytopenia.

No MeSH data available.


Related in: MedlinePlus