Brazilian scientific evidence on Fournier’s gangrene

Abstract

The objective of this study was to describe the Brazilian scientific reports published over the past twenty years on Fournier's gangrene. It is an integrative review conducted through incursions in the LILACS, MEDLINE, BDENF and Coleciona SUS databases with the descriptor 'Fournier's Gangrene'. Texts published between January 1994 and July 2014, in Portuguese, and freely available online were selected. According to the 14 articles found, the main symptoms of Fournier's gangrene include discomfort with painful sensations, high fever, edema, malaise, and sweating. In most cases erythema and blistering are observed, evolving into a wound. The clinical profile assists in the selection of empirical antimicrobial therapy even before the culture results. It was concluded that early diagnosis and appropriate and aggressive treatment are crucial in patient prognosis. There is still a shortage of Brazilian scientific production with a high power of evidence on the subject. Descriptors: Fournier Gangrene; Wounds and Injuries; Therapeutics; Review. Objetivou-se descrever os registros científicos brasileiros publicados nos últimos vinte anos acerca da gangrena de Fournier. Trata-se de uma revisão integrativa realizada por intermédio de incursões nas bases LILACS, MEDLINE, BDENF e Coleciona SUS com o descritor "Gangrena de Fournier". Foram selecionados os textos publicados entre janeiro de 1994 e julho de 2014, em português e disponíveis gratuitamente online. De acordo com os 14 artigos encontrados, os principais sintomas da gangrena de Fournier incluem desconforto com sensações dolorosas, febre elevada, edema, mal estar e sudorese. Na maior parte dos casos são observados eritema e formação de bolhas, evoluindo para uma ferida. O quadro clínico auxilia na seleção da terapêutica antimicrobiana empírica antes mesmo do resultado da cultura. Conclui-se que o diagnóstico precoce e o tratamento adequado e agressivo são determinantes no prognóstico do paciente. Ainda há escassez de produções científicas brasileiras com alto poder de evidência sobre o tema. Descritores: Gangrena de Fournier; Ferimentos e Lesões; Terapêutica; Revisão. El objetivo fue describir producciones brasileñas publicadas en los últimos veinte años acerca de la gangrena de Fournier. Revisión integradora realizada en las bases de datos LILACS, MEDLINE, BDENF y Colecciona SUS, con el descriptor "Gangrena de Fournier". Se seleccionaron textos publicados entre enero de 1994 y julio de 2014, en portugués y disponibles gratuitamente en Internet. Según los 14 artículos encontrados, los principales síntomas de la gangrena de Fournier incluyen malestar, con sensaciones dolorosas, fiebre alta, edema, malestar general, sudoración. En la mayor parte de los casos, son observados eritema y formación de bollas, surgiéndose una herida. El cuadro clínico ayuda en la selección de la terapia antimicrobiana empírica antes del resultado de la cultura. En conclusión, el diagnóstico precoz y el tratamiento apropiado y agresivo son cruciales en el pronóstico del paciente. Aún, hay escas...

Profile of patients with Fournier’s gangrene and their clinical evolution

“…It can originate in the scrotum and penis in men, and in the vulva and in the groin in women 9,10 . It can also be associated with injuries, burns, abrasions, lacerations, bruises, animal bites, insect bites, subcutaneous and intravenous injections 2 . In our study, the FG etiology was predominantly associated with perianal abscess and with late or inadequate treatment.…”

“…F ournier's Gangrene (FG) is a severe infectious disease of soft tissues, of fast progression, that affects the genital region and adjacent areas, characterized by intense tissue destruction, involving the subcutaneous and the fascia. This is a necrotizing fasciitis of the perineal region, also known as scrotal gangrene, synergistic necrotizing cellulitis, synergic gangrene, idiopathic gangrene and fulminant gangrene 1,2 . If not treated early, it can progress to sepsis and multiple organ failure 3,4 .…”

Profile of Patients With Fournier's Syndrome Treated in a Public Hospital in The: Oeste Do Paraná

“…FS is a synergistic necrotizing fasciitis of the perineum and abdominal wall, which originates from the scrotum and penis in men, and from the vulva and groin in women [9][10]. Fournier's gangrene can also be associated with cuts, burns, abrasions, lacerations, bruises, animal bites, insect bites, subcutaneous and intravenous injections [2]. In our study, the etiology of FS was predominantly associated with perianal abscesses with delayed or incomplete approach.…”

“…As aerobic and anaerobic bacteria spread, the oxygen concentration in the tissues is reduced; With hypoxia and tissue ischemia, metabolism is impaired, causing greater dissemination of facultative microorganisms, which benefit from the energy sources of the cells, forming gases (hydrogen and nitrogen) responsible for the crackling, demonstrated in the first 48 to 72 hours of infection [13][14]. According to Santos [2] and Mehl [6] signs and symptoms can be found such as: discomfort with painful sensation, high fever, malaise, sweating, apparently uninjured edema, erythema and blistering, evolving into a wound, corroborating the findings. found in the present study.…”

“…It occurs predominantly in males, between the third and sixth decade of life, and the presence of associated comorbidities is common [5]. It is an infectious, aggressive disease that, despite all treatment, has high levels of mortality [6], ranging from 13 to 30.8% in Brazil [1][2][3][4][5][6][7]. It represents a public health problem, given its incidence, prevalence, mortality and the high costs in the treatment and rehabilitation process [8].…”