Bromine, bear-claw scratch fasciotomies, and the Eagle effect: management of group A streptococcal necrotising fasciitis and its association with trauma

Lamb, Lucy; Sriskandan, Shiranee; Tan, Lionel

doi:10.1016/s1473-3099(14)70922-3

Cited by 18 publications

(14 citation statements)

References 145 publications

(123 reference statements)

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“…GAS migration to the local draining lymph node was increased when a mild contusion force was applied at the same time as bacterial inoculation. The findings may be of relevance not only to contusion injury and compartment syndromes, which are recognized to be associated with serious iGAS infections [1,33], but also to the application of compression bandaging in lymphoedema. While this is recognized to enhance lymphatic drainage and overall tissue viability in the lower limb, caution may be required in the context of a more virulent bacterial infection such as GAS until it is known whether such bacterial transit promotes or prevents systemic dissemination.…”

Section: Discussionmentioning

confidence: 99%

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Impact of contusion injury on intramuscular emm1 group a streptococcus infection and lymphatic spread

Siggins

Scudamore

et al. 2018

Virulence

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Invasive group A Streptococcus (iGAS) is frequently associated with emm1 isolates, with an attendant mortality of around 20%. Cases occasionally arise in previously healthy individuals with a history of upper respiratory tract infection, soft tissue contusion, and no obvious portal of entry. Using a new murine model of contusion, we determined the impact of contusion on iGAS bacterial burden and phenotype.Calibrated mild blunt contusion did not provide a focus for initiation or seeding of GAS that was detectable following systemic GAS bacteremia, but instead enhanced GAS migration to the local draining lymph node following GAS inoculation at the same time and site of contusion. Increased migration to lymph node was associated with emergence of mucoid bacteria, although was not specific to mucoid bacteria. In one study, mucoid colonies demonstrated a significant increase in capsular hyaluronan that was not linked to a covRS or rocA mutation, but to a deletion in the promoter of the capsule synthesis locus, hasABC, resulting in a strain with increased fitness for lymph node migration.In summary, in the mild contusion model used, we could not detect seeding of muscle by GAS. Contusion promoted bacterial transit to the local lymph node. The consequences of contusion-associated bacterial lymphatic migration may vary depending on the pathogen and virulence traits selected.

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Section: Discussionmentioning

confidence: 99%

“…Invasive group A Streptococcus (iGAS) infections, such as necrotizing myositis and fasciitis have been historically associated with penetrating trauma [1]. Since the 1990s, invasive emm 1 ( emm /M1) infections have been reported in healthy individuals who have a history of blunt, rather than penetrating, trauma [2–4].…”

Section: Introductionmentioning

confidence: 99%

Impact of contusion injury on intramuscular emm1 group a streptococcus infection and lymphatic spread

Siggins

Scudamore

et al. 2018

Virulence

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“…Locations which are often affected are the trunk, extremities and the maxillofacial region. Frequently encountered specific locations include Fournier (perineum), Ludwig’s angina (submandibular) and Meleney’s synergistic gangrene (abdominal wall and/or post-operative) [ 24 , 25 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Triple diagnostics for early detection of ambivalent necrotizing fasciitis

et al. 2016

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BackgroundNecrotizing fasciitis is an uncommon, rapidly progressive and potential lethal condition. Over the last decade time to surgery decreased and outcome improved, most likely due to increased awareness and more timely referral. Early recognition is key to improve mortality and morbidity. However, early referral frequently makes it a challenge to recognize this heterogeneous disease in its initial stages. Signs and symptoms might be misleading or absent, while the most prominent skin marks might be in discrepancy with the position of the fascial necrosis. Gram staining and especially fresh frozen section histology might be a useful adjunct.MethodsRetrospective analysis of 3 year period. Non-transferred patients who presented with suspected necrotizing fasciitis are included. ASA classification was determined. Mortality was documented.ResultsIn total, 21 patients are included. Most patients suffered from severe comorbidities. In 11 patients, diagnoses was confirmed based on intra-operative macroscopic findings. Histology and/or microbiotic findings resulted in 6/10 remaining patients in a change in treatment strategy. In total, 17 patients proved to suffer necrotizing fasciitis. In the cohort series 2 patients died due to necrotizing fasciitisConclusionIn the early phases of necrotizing fasciitis, clinical presentation can be ambivalent. In the present cohort, triple diagnostics consisting of an incisional biopsy with macroscopic, histologic and microbiotic findings was helpful in timely identification of necrotizing fasciitis.

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“…This has made the condition synonymous with war field injuries. 1 Its incidence is low in children and diagnosis remains a challenge. 2 Despite maximum care, the mortality of necrotising fasciitis is as high as 40%, attributed to the failure to recognise the disease early.…”

Section: Introductionmentioning

confidence: 99%

“…2 Despite maximum care, the mortality of necrotising fasciitis is as high as 40%, attributed to the failure to recognise the disease early. 1 Previous non-orthopaedic surgery and minor trauma has been described as the initiating event for necrotising fasciitis in children. 3,4 A recent study reported four cases of necrotising fasciitis following external fixation device implantation for deformity correction or limb lengthening.…”

Section: Introductionmentioning

confidence: 99%

Necrotising fasciitis following a supracondylar fracture and an open radius fracture in a child

et al. 2018

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Background: Necrotising fasciitis is a rare, rapidly progressing soft-tissue infection with a high mortality rate. Historically, necrotising fasciitis has been associated with penetrating injuries, and more recently with immunocompromise and severe comorbidities. This case report highlights the association of necrotising fasciitis in a child with an open distal radius fracture and a supracondylar fracture. Method and results (case report): A 10-year-old boy was admitted 24 hours after falling from a tree with a Gustilo and Anderson grade II distal radius fracture and a Gartland grade III supracondylar humerus fracture. The wound was debrided and the fractures reduced and stabilised with Kirschner wires. Within 48 hours of admission he developed a necrotising fasciitis that extended onto the chest and eventually resulted in a shoulder disarticulation. The tissue defects were covered with flaps and skin grafts and the patient was discharged home. Conclusions: This case highlights the importance of having an early and high index of suspicion for necrotising fasciitis in a child with an open contaminated fracture and delay to both antibacterial chemotherapy and surgical debridement. Tissue trauma due to open fractures may obscure the early skin signs of necrotising fasciitis as well as laboratory risk factors. In the South African context, urgent administration of cephazolin and surgical exploration must be done to prevent the devastating complication of necrotising fasciitis.

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Bromine, bear-claw scratch fasciotomies, and the Eagle effect: management of group A streptococcal necrotising fasciitis and its association with trauma

Cited by 18 publications

References 145 publications

Impact of contusion injury on intramuscular emm1 group a streptococcus infection and lymphatic spread

Impact of contusion injury on intramuscular emm1 group a streptococcus infection and lymphatic spread

Triple diagnostics for early detection of ambivalent necrotizing fasciitis

Necrotising fasciitis following a supracondylar fracture and an open radius fracture in a child

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