Necrotising fasciitis as a complication of primary varicella infection in an immunocompetent child

Darmasseelane, Karthik; Banks, T; Rjabova, T.

doi:10.1136/bcr-2018-225018

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…24 By far, the most frequent manifestation of these superinfections is cellulitis, but cases have been reported of myositis, septic arthritis, craniofacial abscesses, and NF. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]25 NF as a sequela of chickenpox is well described in the medical literature. A systematic review of all reported NF cases in children identified 324 cases, with an association to VZV identified in 100 of them.…”

Section: Discussionmentioning

confidence: 99%

“…This is in keeping with the delay of 3 to 5 days most commonly reported in the literature. 10,12,[15][16][17][18][19][20] Parents noted that this was preceded by high fever, whereas the initial chickenpox symptoms presented with mild or absent fever. We suggest that parents should be informed that new high temperatures, particularly if an initial mild fever has already resolved, should warrant extra vigilance for signs of soft tissue infection and a lower threshold to seek medical attention.…”

Section: Discussionmentioning

confidence: 99%

“…2,9-20 Group A Streptococcus (GAS) is frequently implicated in NF and other SSTIs that complicate chickenpox. 9,10,13,14,16,17,20 NF is a severe necrotizing infection of the soft tissues that rapidly spreads along fascial planes and is fatal if left untreated. Urgent surgical debridement is mandatory and often results in significant soft tissue defects, warranting additional reconstructive procedures and causing long-term functional deficits.…”

Section: Introductionmentioning

confidence: 99%

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Life-Threatening Streptococcal Soft Tissue Infections in Children with Chickenpox: A Post-COVID-19 Case Series

McKechnie

Mishra

Torres-Grau

et al. 2023

J Pediatr Infect Dis

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Objective Children with chickenpox complicated by soft tissue infections can become critically unwell. We investigated cases that were referred to our center to examine the role of medical and surgical management in their care. Methods Children presenting with severe soft tissue infections (SSTIs) associated with varicella infections to a tertiary children's hospital in London serving the South East of England were identified. A retrospective review of the patients' records was performed. Results Ten patients presented having developed severe fever and localized cellulitis at around day 4 of their varicella infection. Group A Streptococcus (GAS) was identified as the causative organism in 90% of cases. Every patient required surgical intervention in addition to medical therapy to establish control of their soft tissue infection. We report 100% survival, and no patients required further reconstructive surgery. Conclusion SSTIs, often caused by invasive GAS, can severely complicate otherwise innocuous cases of chickenpox. Failure to respond to maximal medical therapy should prompt urgent referral to a specialist center, and early surgical intervention can prevent progression to more serious illness.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Life-Threatening Streptococcal Soft Tissue Infections in Children with Chickenpox: A Post-COVID-19 Case Series

McKechnie

Mishra

Torres-Grau

et al. 2023

J Pediatr Infect Dis

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A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018

Schröder¹,

Gerin

Firth

et al. 2019

BMC Infect Dis

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Background Necrotising fasciitis is a rapidly progressing soft-tissue infection with a low incidence that carries a relevant risk of morbidity and mortality. Although necrotising fasciitis is often fatal in adults, its case fatality rate seems to be lower in children. A highly variable clinical presentation makes the diagnosis challenging, which often results in misdiagnosis and time-delay to therapy. Methods We conducted a protocol-based systematic review to identify specific features of necrotising fasciitis in children aged one month to 17 years. We searched ’PubMed’, ’Web of Science’ and ’SCOPUS’ for relevant literature. Primary outcomes were incidence and case fatality rates in population-based studies, and skin symptoms on presentation. We also assessed signs of systemic illness, causative organisms, predisposing factors, and reconstructive procedures as secondary outcomes. Results We included five studies reporting incidence and case fatality rates, two case-control studies, and 298 cases from 195 reports. Incidence rates varied between 0.022 and 0.843 per 100,000 children per year with a case-fatality rate ranging from 0% to 14.3%. The most frequent skin symptoms were erythema (58.7%; 175/298) and swelling (48%; 143/298), whereas all other symptoms occurred in less than 50% of cases. The majority of cases had fever (76.7%; 188/245), but other signs of systemic illness were present in less than half of the cohort. Group-A streptococci accounted for 44.8% (132/298) followed by Gram-negative rods in 29.8% (88/295), while polymicrobial infections occurred in 17.3% (51/295). Extremities were affected in 45.6% (136/298), of which 73.5% (100/136) occurred in the lower extremities. Skin grafts were necessary in 51.6% (84/162) of the pooled cases, while flaps were seldom used (10.5%; 17/162). The vast majority of included reports originate from developed countries. Conclusions Clinical suspicion remains the key to diagnose necrotising fasciitis. A combination of swelling, pain, erythema, and a systemic inflammatory response syndrome might indicate necrotising fasciitis. Incidence and case-fatality rates in children are much smaller than in adults, although there seems to be a relevant risk of morbidity indicated by the high percentage of skin grafts. Systematic multi-institutional research efforts are necessary to improve early diagnosis on necrotising fasciits. Electronic supplementary material The online version of this article (10.1186/s12879-019-3941-3) contains supplementary material, which is available to authorized users.

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Necrotising fasciitis as a complication of primary varicella infection in an immunocompetent child

Cited by 3 publications

References 15 publications

Life-Threatening Streptococcal Soft Tissue Infections in Children with Chickenpox: A Post-COVID-19 Case Series

Life-Threatening Streptococcal Soft Tissue Infections in Children with Chickenpox: A Post-COVID-19 Case Series

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A systematic review of necrotising fasciitis in children from its first description in 1930 to 2018

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