Gangrene Due to the Hemolytic Streptococcus — A Rare but Treatable Disease

Collins, Rachel; Nadel, Molly

doi:10.1056/nejm196503182721109

Cited by 40 publications

(11 citation statements)

References 6 publications

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“…Although there are known risk factors (table 2), mainly related to mild (alcoholism,6 17 20 23 26 29 32 35 36 44 45 52 53 55 64 70 diabetes,6 10 11 15 22 50 51 58 68 rheumatological disease,18 45 48 chronic corticosteroid use and a combination of these conditions25 40 55) and severe (chemotherapy for malignancies and lymphoproliferative disorders)28 41 48 62 67 immune suppression, about one-half of the patients with reported NF were previously healthy 4 6–8 12 13 16 19 21 23 24 27 30–35 37–39 41–43 45–47 49 54–57 60 63 66 69 72–74. Haematological malignancy itself (our case) and neutropenia caused by chemotherapy may be an important predisposing factor for NF, because of the reduction in the number and activity of effector cells such as neutrophils and monocytes, and disruption of the barrier function of mucosal membranes.…”

Section: Resultsmentioning

confidence: 99%

“…Rare causative agents include S. aureus alone,12 59 66 68 72 Pseudomonas aeruginosa ,62 67 Moraxella catarrhalis 65 and Cryptococcus neoformans 4 mainly in the setting of immunosuppression. Groups of Gram-positive aerobes or mixed Gram-positive and Gram-negative aerobes were also cultured 6 7 13 23 29–31 34 42 43 55 58 60…”

Section: Resultsmentioning

confidence: 99%

“…While greater age (>50 years),89 96–100 immunosuppression98 100–103 and streptococcal toxic shock syndrome97 100 104 105 were identified as three significant, independent predictors of mortality from NF, affecting other body sites, in periorbital NF risk factors for mortality include mainly the causative organisms (and therefore streptococcal toxic shock syndrome) since all cases of death were caused by β-haemolytic Streptococcus7 48 (principally S. pyogenes )10 20 27 37 40 alone or associated with other bacteria cultures 6 13 17 30 34 42 48 50. There was no strong correlation with age >50 years and the presence of associated chronic illness.…”

Section: Discussionmentioning

confidence: 99%

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Periorbital necrotising fasciitis

Lazzeri

Figus

et al. 2009

British Journal of Ophthalmology

109

141

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Necrotising fasciitis involving the periorbita is a devastating infection. Potential outcomes range from severe disfigurement, loss of the eye and even to death. Early recognition is critical, although its initially non-distinctive appearance frequently delays diagnosis and treatment. Herein, the authors have performed a systematic review of previously published cases including clinical features, diagnoses and differential diagnoses, pathological characteristics and management. Periorbital necrotising fasciitis is seen mainly in adults with a female predominance (54%); about one-half (47%) of the patients were previously healthy. The infection can follow local blunt trauma (17%), penetrating injuries (22%) and face surgery (11%), but in about one-third of cases (28%) no cause was identified. Non-specific erythema and localised painful swelling of the eyelids characterise the earliest manifestation of the disease, followed by formation of blisters and necrosis of the periorbital skin and subcutaneous tissues. The causative organism in periorbital infection was mainly β-haemolytic Streptococcus alone (50%), occasionally in combination with Staphylococcus aureus (18%). The overall mortality rate was 14.42%. The main risk factor for mortality was the type of causative organism, since all reported cases of death were caused by β-haemolytic Streptococcus alone or associated with other organisms. Unlike necrotising fasciitis affecting other body sites, there was not a strong correlation with age >50 years or the presence of associated chronic illness. Management of periorbital necrotising fasciitis is then based on early distinction of symptoms and signs and aggressive multidisciplinary treatment. Thus, the delay between initial debridement and initiating parenteral broad-spectrum antibiotic therapy should be considered the most critical factor influencing morbidity and mortality.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Periorbital necrotising fasciitis

Lazzeri

Figus

et al. 2009

British Journal of Ophthalmology

109

141

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“…Early recognition of uncontrolled head and neck infection is critical. We report 3 recent cases of NF of the head and neck complicated by mediastinal and thoracic extension and review the diagnostic approaches and therapeutic options.…”

mentioning

confidence: 99%

Mediastinal and thoracic complications of necrotizing fasciitis of the head and neck

Lalwani

Kaplan

1991

Head & Neck

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Mediastinal and thoracic extension of head and neck infections are rare but occur even in the modern antibiotic era. Early intervention is paramount to successful clinical outcome. 111Indium-labeled white blood cell (WBC) scan, a new imaging modality, appears to play a role in complementing computed tomographic (CT) findings, demonstrating early extension of disease, and following therapeutic efficacy. Together, the CT scan and WBC scan aid in directing early intervention and extent of surgery in this disease of high-potential mortality. We report 3 cases of deep head and neck infection complicated by mediastinal extension, including mediastinitis, pericardial effusion, and tamponade, empyema, and respiratory failure. Early surgical intervention included neck drainage, tracheostomy, thoracotomy, and pericardiotomy. While usually associated with greater than 50% mortality, all of the patients in this series survived. Based on our experience, we recommend prompt aggressive surgical debridement in treating mediastinal complications resulting from head and neck infections.

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“…The treatment of this condition should be started immediately (6), as mortality is higher when treatment is delayed (6,11,13). Spontaneous arrests in this condition are rare (2,6).…”

Section: Discussionmentioning

confidence: 99%