Abstract
Study objectiveNecrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. Bullae are special skin manifestations of NF. This study was conducted to analyze the differences between different types of bullae of limbs with NF for providing the information to emergency treatment.MethodsFrom April 2015 to August 2018, patients were initially enrolled based on surgical confirmation of limbs with NF. According to the presence of different bullae types, patients were divided into no bullae group (Group N), serous-filled bullae group (Group S), and hemorrhagic bullae group (Group H). Data such as demographics, clinical outcomes, microbiological results, presenting symptoms/signs, and laboratory findings were compared among these groups.ResultsIn total, 187 patients were collected, with 111 (59.4%) patients in Group N, 35 (18.7%) in Group S, and 41 (21.9%) in Group H. Group H had the highest incidence of amputation, required intensive care unit care, and most patients infected with Vibrio species. In Group N, more patients were infected with Staphylococcus spp. than Group H. In Group S, more patients were infected with β-hemolytic Streptococcus than Group H. Patients with bacteremia, shock, skin necrosis, anemia, and longer prothrombin time constituted higher proportions in Group H and S than in Group N.ConclusionsIn southern Taiwan, patients with NF accompanied by hemorrhagic bullae appear to have more bacteremia, Vibrio infection, septic shock, and risk for amputation. If the physicians at the emergency department can detect for the early signs of NF as soon as possible, and more patient’s life and limbs may be saved.
Highlights
BackgroundNecrotizing fasciitis (NF) is an extremely rare and fulminant necrotizing skin and soft tissue infection (NSSTI) characterized by rapidly progressive necrosis in the subcutaneous tissues, especially the superficial and deep fascia [1,2,3,4,5]
Data were presented as mean; Data were compared with ANOVA, †p < 0.05 vs. no bullae in the Tukey post hoc test; §p < 0.05 vs. serious bullae in the Tukey post hoc test a painful lesion (98.2% vs. 94.3% vs. 85.4%) than those in Groups S and H
With the evolution of the infective condition of NF, ischemic necrosis of the skin ensues accompanied by gangrene of the subcutaneous fat, dermis, and epidermis, manifesting progressively as bullae formation, ulceration, and skin necrosis [6]
Summary
BackgroundNecrotizing fasciitis (NF) is an extremely rare and fulminant necrotizing skin and soft tissue infection (NSSTI) characterized by rapidly progressive necrosis in the subcutaneous tissues, especially the superficial and deep fascia [1,2,3,4,5]. The clinical features of this infection include hemorrhagic bullae, subcutaneous bleeding, purpura, frank skin necrosis, and gangrene [6,7,8,9]. Hemorrhagic bullae are extremely rare and considered as an important skin manifestation of Vibrio infection [10,11,12,13,14,15,16,17]. For further exploration the Aeromonas and Vibrio infections and investigation the best therapeutic methods, our team, the “Vibrio NSSTIs Treatment and Research (VTR) Group,” were established at CGMH-Chiayi since 2004, is a professional medical group and specialized in treating and investigating Vibrio infectious disease [24, 25]. Our previous studies had reported numerous results, including Vibrio NF [11,12,13,14,15, 26,27,28], Vibrio cerebritis [29], Vibrio keratitis [30], and Aeromonas NF [25] to afford important information for these of infective diseases
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