Cervical necrotizing fasciitis: an overlooked diagnosis of a fatal disease

Al-Ali, Mohamed A.; Hefny, Ashraf F.; Idris, Kamal; Abu‐Zidan, Fikri M.

doi:10.1080/00016489.2017.1393841

Cited by 16 publications

(14 citation statements)

References 18 publications

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“…For the period 1987–2018 105 total papers were identified. After excluding duplicate studies, nonodontogenic cases, review articles, and studies without analyzable individual patient data, a total of 58 studies reporting 164 total patients were identified [ 1 , 7 – 63 ]. Case reports, case series, and cohort studies containing individual analyzable patient data on patients of any age with a pathologic diagnosis of odontogenic necrotizing fasciitis were included in the systematic review.…”

Section: Methodsmentioning

confidence: 99%

Odontogenic necrotizing fasciitis: a systematic review of the literature

Gore

2018

BMC Ear Nose Throat Disord

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BackgroundWhile odontogenic soft tissue infections of the head and neck are common, progression to necrotizing fasciitis is relatively rare. Necrotizing fasciitis is a potentially life-threatening and rapidly progressive soft tissue infection that can lead to significant skin and soft tissue loss, mediastinitis, vascular thrombosis or rupture, limb loss, organ failure, and death.MethodsA PubMed literature search was conducted for case reports and case series on odontogenic necrotizing fasciitis. Individual patient data was analyzed and compiled and demographic, treatment, microbiology, and mortality data were extracted. Fisher’s exact test was used to examine the relationship between death from odontogenic necrotizing fasciitis and diabetes mellitus (DM) and human immunodeficiency virus (HIV) positivity.ResultsA total of 58 studies totaling 164 patients were identified. Thirty-three patients had DM and 3 were HIV +. All patients underwent aggressive surgical debridement and treatment with IV antibiotics. Twenty patients were also treated with hyperbaric oxygen. There were 16 deaths reported, for a mortality rate of 9.8%. The mortality rate among patients with DM was 30.3 and 0% among HIV positive patients. There was a statistically significant increase in the mortality rate in DM patients with odontogenic necrotizing fasciitis (p = 0.0001, odds ratio for death 9.1).ConclusionsNecrotizing fasciitis arising from odontogenic infection is a rapidly progressive and life-threatening illness. Prompt recognition of the infection, aggressive and often serial surgical debridement, and aggressive broad-spectrum antibiotics are necessary to prevent serious morbidity and mortality. Patients with diabetes mellitus are at a significantly increased risk of death from odontogenic necrotizing fasciitis.

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Section: Methodsmentioning

confidence: 99%

Odontogenic necrotizing fasciitis: a systematic review of the literature

Gore

2018

BMC Ear Nose Throat Disord

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“…Cervical fasciitis (CF) is a group of bacterial infections, usually of odontogenic or amygdala origin, characterized by necrosis of the fascia and subcutaneous cellular tissue of the neck [1, 2]. It is a rare disease with high morbimortality rates.…”

Section: Introductionmentioning

confidence: 99%

Subphrenic abscess secondary to cervical abscess and fasciitis from dental focus: case report

et al. 2019

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Background Cervical fasciitis is a group of severe infections with high morbimortality. Reports in the literature of patients with cases evolving with mediastinal dissemination of deep cervical abscess are common. However, cases of abdominal dissemination by contiguity are much rarer. Case presentation A 34-year-old Caucasian man presented to the emergency department with a 15-day history of left neck edema, local pain, and fever. Seventeen days prior to presentation, he had undergone odontogenic surgical treatment in a dental clinic. Laboratory examinations did not show meaningful changes. He underwent computed tomography of the neck, thorax, and abdomen, which showed evidence of left collection affecting the retromandibular, submandibular, parapharyngeal, vascular, and mediastinal spaces, bilateral pleural effusion, right subphrenic collection and a small amount of liquids between intestinal loops. A cervical, thoracic, and abdominal surgical approach at the same surgery was indicated for odontogenic cervical abscess, descending necrotizing mediastinitis, and subphrenic abscess. The patient remained in the intensive care unit for three days, and he was discharged on the 22nd day after surgery with no drains and no tracheostomy. His outpatient discharge occurred after 6 months with no sequelae. Conclusions Aggressive surgical treatment associated with antibiotic therapy has been shown to be effective for improving the clinical course of cervical fasciitis. Despite the extension of the infection in our patient, a surgical approach of all infectious focus associated with a broad-spectrum antibiotic therapy led to a good clinical evolution and has significant implications for aggressive treatment.

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“…1,2 Syok sepsis dapat diidentifikasi dengan adanya klinis sepsis dengan hipotensi menetap yang membutuhkan vasopressor untuk mempertahankan Mean Atrerial Pressure <65 mmHg dan kadar laktat serum >2 mmol/L (18 mg/dL). 2,4 Kriteria klinis pasien sepsis dapat diketahui dengan menggunakan skor Sequential Organ Failure Assessment (SOFA score). Diagnosis sepsis dapat ditegakkan apabila skor SOFA>2.…”

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“…Penyakit ini termasuk infeksi kulit dan jaringan lunak (skin and soft tissue infection -SSTI). 3,4 Kasus ini jarang ditemukan, hanya sekitar 500-1500 kasus FN yang dilaporkan di Amerika Serikat. 1 Data terkait kasus FN di Indonesia belum tersedia.…”

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“…Kejadian ini diduga berkaitan dengan beberapa faktor risiko, yaitu usia, kondisi immunocompromised termasuk diabetes, Acquired Immunodeficiency Syndromes (AIDS), penyakit jantung kronis, penyakit pembuluh darah perifer, trauma, serta riwayat kecanduan alkohol dan penggunaan obat terlarang. 3,4,5 Fasiitis nekrotikans jarang terjadi namun bersifat progresif cepat dan berpotensi fatal. Percepatan tatalaksana dan perawatan dengan teknologi medis yang canggih sudah dilakukan terbukti tingkat kematian yang ditimbulkan masih tinggi, yaitu 24-34%, sehingga diagnosis dan manajemen penyakit ini masih menjadi tantangan.…”

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Syok Sepsis Pada Fasitis Nekrotikans Regio Colli Pasca Servikotomi Debridemen Disertai Gangren Radik Multipel Pasca Ekstraksi Gigi Multipel: Laporan Kasus

Widuri

2022

MACC

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Fasiitis nekrotikans, sering disebut bakteri pemakan daging, adalah nekrosis progresif pada lemak subkutan dan fasia. Fasiitis nekrotikans tipe II yang disebabkan oleh Acinetobacter baumannii jarang ditemukan tetapi menimbulkan infeksi yang serius. Infeksi ini terjadi melalui luka yang menyebar sangat cepat, serta melepaskan zat berbahaya yang menghancurkan jaringan di sekitarnya dan masuk ke aliran darah sehingga menimbulkan syok sepsis. Faktor risiko pada penyakit dapat terjadi pada golongan lanjut usia atau geriatri, kondisi immunocompromised, sakit kronis, trauma, dan alkoholisme. Laki-laki, 61 tahun, dengan fasiitis nekrotikans yang menjalani tindakan servikotomi, debridemen, pemberian antibiotik, serta perawatan luka dengan Negative Pressure Wound Therapy (NPWT).

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Cervical necrotizing fasciitis: an overlooked diagnosis of a fatal disease

Abstract: Maintaining a high index of suspicion is crucially important for diagnosing CNF. Early diagnosis, timely resuscitation, and aggressive surgical debridement are the key to a successful clinical outcome.

Cited by 16 publications

References 18 publications

Odontogenic necrotizing fasciitis: a systematic review of the literature

Odontogenic necrotizing fasciitis: a systematic review of the literature

Subphrenic abscess secondary to cervical abscess and fasciitis from dental focus: case report

Syok Sepsis Pada Fasitis Nekrotikans Regio Colli Pasca Servikotomi Debridemen Disertai Gangren Radik Multipel Pasca Ekstraksi Gigi Multipel: Laporan Kasus

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