Cervicofacial Necrotizing Fasciitis and Its Relationship with Aeromona Hydrophila

Abstract

Introduction: Necrotizing fasciitis is a severe polymicrobial infection with rapid progression and significant tissue destruction, which requires immediate antimicrobial and surgical management; the frequent location is in the extremities (pelvic and thoracic), genitals and thorax, its appearance being rare in the cervicofacial region, it is very rarely associated with causal agents such as Aeromonahydrophila, however, the presence of said bacillus in contaminated water can manifest as Fasciitis Cervicofacial necrotizing agent (CNF). Material and Method: A retrospective, descriptive, cross-sectional, observational study was carried out in Maxillofacial Surgery at the “La Raza” Medical Center, for one year. All patients with a diagnosis of Necrotizing Cervicofacial Fasciitis (CNF). For one year who had cultures and blood cultures, with Aeromonahydrophila, who had been cared for in the Maxillofacial Surgery service from October 1, 2013, to October 1, 2014, were included. Discussion: Giant oral floor cysts located under the mylohyoid muscle are usually removed extra orally. We report the case of a large dermoid cyst of the floor of the mouth, with extension at the base of the tongue, removed intraorally. Results: A sample of 7 patients with a diagnosis of Necrotizing Cervicofacial Fasciitis was obtained; dental origin, of which 3 were women and 4 men; the mean age was 66.7 years; A correlation was made with respect to comorbidities, the management was given by the Maxillofacial Surgery service of the “La Raza” Medical Center was surgical and clinical, with support from the central laboratory of the “Dr. Antonio Fraga Mouret ”and the central epidemiology laboratory of the same hospital, blood cultures and bacterial tissue culture (biopsy) were performed, respectively. The taking of cultures was proportional to the number of surgical events, only 3 patients of which their blood cultures reported the development, two of them presented Gram (+) and Gram (-) and the third Gram (+) and Facultative aerobes. From the tissue cultures, the biota reported was: Candida Albicans; Candida Krusei, Morganella morganii, Coryneform bacilli, Enterobacter aerogenes, Trichosporonasahii, Pseudomona aeruginosa and only one developed AeromonaHydrophila. Antibiotic was administered based on the antibiogram obtained individually with specificity for each case as reported in the cultures. Discussion and Conclusion: CNF is an entity rarely associated with Aeromonahydrophila, it is common to find another type of microbiota in this entity, however, it should be known that this A.hydrophila bacillus is frequently isolated in contaminated water and the patient can acquire it by performing any daily activity, more if you have any injury or previous immunocompromise. The importance of medical-surgical management will determine the prognosis of the patient, the correct extension of debridement and resection will allow delimiting the CNF and the multidisciplinary management together will reduce complications (septic shock, multiple organ failure, death) if it is carried out in a timely manner.