Myonecrosis Research Articles

Clostridium perfringens α-toxin up-regulates plasma membrane CD11b expression on murine neutrophils by changing intracellular localization

Gas gangrene caused by Clostridium perfringens type A infection is a highly lethal infection of soft tissue characterized by rapid spread of tissue necrosis. This tissue destruction is related to profound attenuation of blood flow accompanied by formation of platelet-leukocyte aggregates in the blood vessels. Several studies have identified α-toxin, which has both sphingomyelinase and phospholipase C activities, as a major virulence factor in the aggregate formation via activation of the platelet gpIIbIIIa. Here, we show that α-toxin greatly and rapidly increases plasma membrane localization of CD11b, which binds to the platelet gpIIbIIIa via fibrinogen, in mouse neutrophils. Interestingly, short-term treatment of α-toxin has little effect on gene expression profiles in neutrophils, and the toxin does not change the total protein expression levels of CD11b in whole cell lysates. The following analysis demonstrated that CD11b localizes to intracellular vesicles in intact cells, but the localization changed to the cytoplasmic membrane in α-toxin-treated cells. These results suggest that CD11b is recruited to the cytoplasmic membrane by α-toxin. Previously, we reported that α-toxin promotes the formation of ceramide by its sphingomyelinase activity in mouse neutrophils. Interestingly, a synthetic cell-permeable ceramide analog, C2-ceramide, increases plasma membrane localization of CD11b, suggesting that ceramide production by α-toxin recruits CD11b to the cytoplasmic membrane to promote platelet-leukocyte aggregation. Together, our results illustrate that the increase of cell membrane CD11b expression by α-toxin might be crucial for the pathogenesis of C. perfringens to promote formation of platelet-leukocyte aggregates, leading to rapid tissue necrosis due to ischemia.

Profile of Pedis Gangrene Patients With Type Ii Diabetes Mellitus at Bhayangkara Hospital Kediri Period January 2021 - March 2022

Gas gangrene is a disease that is identical to the incidence of type 2 diabetes mellitus with the characteristics of muscle necrosis / myonecrosis and is a very deadly infection of the inner soft tissues, often caused by gram-positive bacteria such as Staphylococcus aureus, Clostridium perifingens. Diabetes mellitus is a collection of symptoms caused by disturbances in the balance between carbohydrates, fats and proteins caused by absolute or relative insulin deficiency, causing hyperglycemia and glucosuria. to describe the profile of patients with gas gangrene pedis caused by type II diabetes mellitus obtained from the results of secondary data research at Bhayangkara Hospital Kediri Period January 2021 - March 2022. This study is an observational study (Non Experimental Design) using a cohort retrospective design method. The sample in this study were patients with Gas Gangrene Pedis who were obtained from the patient's medical records in the period January 2021 - March 2022 at Bhayangkara Hospital Kediri with Type II Diabetes Mellitus. Results: Based on the results of the Association Test between Wagner Grade and Gas Therapy, gangrene pedis has a p value of 0.199. The Wagner Grade variable with gas gangrene pedis therapy had an insignificant relationship with debridement measures n = 8 and the most common bacterium was Pseudomonas aeruginosa with n = 4. Patients with gas gangrene pedis who had a history of not routinely controlling because of their DM treatment, there was a high probability of progressive progression. worsening of his condition due to

Profile of Pedis Gangrene Patients With Type Ii Diabetes Mellitus at Bhayangkara Hospital Kediri Period January 2021 - March 2022

Gas gangrene is a disease that is identical to the incidence of type 2 diabetes mellitus with the characteristics of muscle necrosis / myonecrosis and is a very deadly infection of the inner soft tissues, often caused by gram-positive bacteria such as Staphylococcus aureus, Clostridium perifingens. Diabetes mellitus is a collection of symptoms caused by disturbances in the balance between carbohydrates, fats and proteins caused by absolute or relative insulin deficiency, causing hyperglycemia and glucosuria. to describe the profile of patients with gas gangrene pedis caused by type II diabetes mellitus obtained from the results of secondary data research at Bhayangkara Hospital Kediri Period January 2021 - March 2022. This study is an observational study (Non Experimental Design) using a cohort retrospective design method. The sample in this study were patients with Gas Gangrene Pedis who were obtained from the patient's medical records in the period January 2021 - March 2022 at Bhayangkara Hospital Kediri with Type II Diabetes Mellitus. Results: Based on the results of the Association Test between Wagner Grade and Gas Therapy, gangrene pedis has a p value of 0.199. The Wagner Grade variable with gas gangrene pedis therapy had an insignificant relationship with debridement measures n = 8 and the most common bacterium was Pseudomonas aeruginosa with n = 4. Patients with gas gangrene pedis who had a history of not routinely controlling because of their DM treatment, there was a high probability of progressive progression. worsening of his condition due to

Mixed lineage kinase-like protein protects against Clostridium perfringens infection by enhancing NLRP3 inflammasome-extracellular traps axis

SummaryDespite intense research in understanding Clostridium perfringens (C. perfringens) pathogenesis, the mechanisms by which it is cleared from the host are largely unclarified. In C. perfringens gas gangrene and enterocolitis model, Mlkl−/− mice, lacking mixed lineage kinase-like protein (MLKL), are more susceptible to C. perfringens infection. Mlkl deficiency results in a defect in inflammasome activation, and IL-18 and IL-1β releases. Exogenous administration of recombinant IL-18 is able to rescue the susceptibility of Mlkl−/− mice. Notably, K+ efflux-dependent NLRP3 inflammasome signaling downstream of active MLKL promotes bacterial killing and clearance. Interestingly, the defect of bactericidal activity is also mediated by decreased classical extracellular trap formation in the absence of Mlkl. Our results demonstrate that MLKL mediates extracellular trap formation in a NLRP3 inflammasome-dependent manner. These findings highlight the requirement of MLKL for host defense against C. perfringens infection through enhancing NLRP3 inflammasome-extracellular traps axis.

Phase-change composite filled natural nanotubes in hydrogel promote wound healing under photothermally triggered drug release.

It is of great importance to treat a bacterial-infected wound by a smart dressing capable of delivering antibiotics in a smart manner without causing drug resistance. The construction of smart release nanocontainers responsive to near-infrared (NIR) laser irradiation in an on-demand and stepwise way is a promising strategy for avoiding the emergence of multidrug-resistant bacteria. Here, we develop a hydrogel composite made of alginate and nanotubes with an efficient NIR-triggered release of rifampicin and outstanding antibacterial ability. This composite hydrogel is prepared through co-encapsulating antibacterial drug (rifampicin), NIR-absorbing dye (indocyanine green), and phase-change materials (a eutectic mixture of fatty acids) into halloysite nanotubes, followed by incorporation into alginate hydrogels, allowing the in-situ gelation at room temperature and maintaining the integrity of drug-loaded nanotubes. Among them, the eutectic mixture with a melting point of 39 °C serves as the biocompatible phase-change material to facilitate the NIR-triggered drug release. The resultant phase-change material gated-nanotubes exhibit a prominent photothermal efficiency with multistep drug release under laser irradiation. In an in vitro assay, composite hydrogel provides good antibacterial potency against Staphylococcus aureus, one of the most prevalent microorganisms of dangerous gas gangrene. A bacterial-infected rat full-thickness wound model demonstrates that the NIR-responsive composite hydrogel inhibits the bacteria colonization and suppresses the inflammatory response caused by bacteria, promoting angiogenesis and collagen deposition to accelerate wound regeneration. The NIR-responsive composite hydrogel has a great potential as an antibacterial wound dressing functionalized with controlled multistep treatment of the infected sites.

LDLR, LRP1, and Megalin redundantly participate in the uptake of Clostridium novyi alpha-toxin

Clostridium novyi alpha-toxin (Tcnα) is a potent exotoxin that induces severe symptoms including gas gangrene, myositis, necrotic hepatitis, and sepsis. Tcnα binds to sulfated glycosaminoglycans (sGAG) for cell-surface attachment and utilizes low-density lipoprotein receptor (LDLR) for rapid entry. However, it was also shown that Tcnα may use alternative entry receptors other than LDLR. Here, we define that LRP1 and Megalin can also facilitate the cellular entry of Tcnα by employing reconstitutive LDLR family proteins. LDLR, LRP1, and Megalin recognize Tcnα via their ligand-binding domains (also known as LDL receptor type A repeats). Notably, LDLR and LRP1 have contrasting expression levels in many different cells, thus the dominant entry receptor for Tcnα could be cell-type dependent. These findings together increase our knowledge of the Tcnα actions and further help to understand the pathogenesis of C. novyi infection-associated diseases.

Major pathogenic Clostridia in human and progress toward the clostridial vaccines.

The Clostridium genus is composed of a large spectrum of heterogeneous bacteria. They are Gram-positive, mostly mesophilic, and anaerobic spore-forming strains. Clostridia are widely distributed in oxygen-free habitats. They are found principally in the soil and intestines of ruminants as normal flora, but also are the cause of several infections in humans. The infections produced by important species in humans include botulism, tetanus, pseudomembranous colitis, antibiotics-associated diarrhea, and gas gangrene. Immunization with toxoid or bacterin-toxoid or genetically modified or other vaccines is a protective way against clostridial infection. Several experimental or commercial vaccines have been developed worldwide. Although conventional vaccines including toxoid vaccines are very important, the new generation of vaccines is an effective alternative to conventional vaccines. Recent advances have made it possible for new vaccines to increase immunogenicity. This review discusses briefly the important species of clostridia in humans, their toxins structure, and vaccine development and usage throughout the world.

The application of negative pressure wound therapy in orthopedics: current concepts

We conducted a literature review to better understand the correct application and indications of negative pressure wound therapy (NPWT) in orthopedics and traumatology. A literature search was conducted on PubMed and all articles in English, Spanish, and Italian were included. Relevant articles, references, data, and relevant findings were identified, reviewed, extracted, and accepted by consensus of at least 66% of the researchers. Relevant articles were discussed by the research group. NPWT has several beneficial effects on the wound that contribute to the maintenance of a favorable biochemical and cellular environment, to the formation of granulation tissue and to faster healing. NWPT can be useful in the treatment of septic wounds after initial debridement surgery and removal of the septic foci, and in necrotizing fasciitis in the presence of gas gangrene, venous or pressure ulcers. NPWT can also be used “for prophylactic purposes” (incisional NPWT) in patients with risk factors for skin dehiscence and with a high risk of wound drainage in the post-operative period and after prosthetic surgery or internal fixation to protect the surgical scar. However, the available evidence is mostly unclear. The appropriate use of NPWT seems to reduce the number of dressing changes in complex wounds, reduce hospitalization times, and offer greater comfort to the patient; when applied on surgical incisions, it may reduce the risk of delayed healing and the risk of infections.

What are the Alternatives to the LRINEC Score in Identifying Necrotizing Soft Tissue Infections in the Emergency Department?

Background: The emergency department (ED) is an dynamically high-risk setting. Our aim is to determine the blood parameters associated with necrotizing soft tissue infections (NSTI) to strengthen the LRINEC score. 
 Materials and methods: We analyzed 109 patients who were diagnosed with necrotizing soft tissue infection in the Urology, Dermatology, Plastic surgery and General Surgery clinics of Atatürk University between 2013 and 2016. In the same period, we matched 624 patients diagnosed with cellulitis as a control group. 
 Results: Of four defined clinic's records to Atatürk University Hospital in 2013 to 2016, 109 matched and 624 matched control records were abstracted. Diagnoses associated with the NSTIs were: gangrene (n=47), gas gangrene (n=7), Fournier's gangrene (n=44) and necrotizing fasciitis (n=11). In patients with Necrotizing Soft Tissue Infection, BUN (p=0,00), K (0,011), Neutrofil (p=0,013), Lenfosit (p=0,003), Htc (p=0,00), RDW (p=0,002), Plt (p=0,042), AST (p=0,00), ALT (p=0,00) and INR (p=0,003) values were found to be statistically significant in making the diagnosis. 
 Conclusion: BUN, K, Neutrofil, Lenfosit, Htc, RDW, Plt, AST, ALT and INR values measured from blood tests of patients diagnosed with NSTI can be used in distinctive diagnosis of Soft Tissue Infection (STI). Increased awareness of these values may improve Emergency Department (ED) decision making and prevent miss diagnose.

Immunoinformatic analysis of the whole proteome for vaccine design: An application to Clostridium perfringens.

Clostridium perfringens is a dangerous bacterium and known biological warfare weapon associated with several diseases, whose lethal toxins can produce necrosis in humans. However, there is no safe and fully effective vaccine against C. perfringens for humans yet. To address this problem, we computationally screened its whole proteome, identifying highly immunogenic proteins, domains, and epitopes. First, we identified that the proteins with the highest epitope density are Collagenase A, Exo-alpha-sialidase, alpha n-acetylglucosaminidase and hyaluronoglucosaminidase, representing potential recombinant vaccine candidates. Second, we further explored the toxins, finding that the non-toxic domain of Perfringolysin O is enriched in CTL and HTL epitopes. This domain could be used as a potential sub-unit vaccine to combat gas gangrene. And third, we designed a multi-epitope protein containing 24 HTL-epitopes and 34 CTL-epitopes from extracellular regions of transmembrane proteins. Also, we analyzed the structural properties of this novel protein using molecular dynamics. Altogether, we are presenting a thorough immunoinformatic exploration of the whole proteome of C. perfringens, as well as promising whole-protein, domain-based and multi-epitope vaccine candidates. These can be evaluated in preclinical trials to assess their immunogenicity and protection against C. perfringens infection.

Piceatannol Alleviates Clostridium perfringens Virulence by Inhibiting Perfringolysin O.

Clostridium perfringens (C. perfringens) is an important foodborne pathogen that can cause diseases such as gas gangrene and necrotizing enteritis in a variety of economic animals, seriously affecting public health and the economic benefits and healthy development of the livestock and poultry breeding industry. Perfringolysin O (PFO) is an important virulence factor of C. perfringens and plays critical roles in necrotic enteritis and gas gangrene, rendering it an ideal target for developing new drugs against infections caused by this pathogen. In this study, based on biological activity inhibition assays, oligomerization tests and computational biology assays, we found that the foodborne natural component piceatannol reduced pore-forming activity with an inhibitory ratio of 83.84% in the concentration of 16 µg/mL (IC50 = 7.83 µg/mL) by binding with PFO directly and changing some of its secondary structures, including 3-Helix, A-helix, bend, and in turn, ultimately affecting oligomer formation. Furthermore, we confirmed that piceatannol protected human intestinal epithelial cells from the damage induced by PFO with LDH release reduced by 38.44% at 16 µg/mL, based on a cytotoxicity test. By performing an animal experiment, we found the C. perfringens clones showed an approximate 10-fold reduction in infected mice. These results suggest that piceatannol may be a candidate for anti-C. perfringens drug development.

Infectious shock after liposuction

BackgroundLiposuction has become one of the most popular cosmetic surgeries in China. However, few studies have discussed infectious shock caused by C. perfringens as one of the causes of death after liposuction.Case presentationA 24-year-old woman was brought to the emergency department (ED) of Guangzhou Chinese Overseas Hospital for treatment. The patient had undergone liposuction in her bilateral lower limbs two days prior. At the ED, the patient was unconscious, and had bilateral equal-sized (diameter, 6 mm) round pupils, no light reflex, a blood pressure (BP) of 71/33 mmHg, a heart rate of 133 bpm, and an SpO2 of 70%. She had bilateral limb swelling, extensive ecchymoses in her lower abdomen and bilateral thighs, local crepitus, blisters, weak pulses on her femoral artery and dorsalis pedis, high skin tension, and hemoglobin of 32 g/L. The patient was diagnosed with Clostridium perfringens infection, and she underwent debridement surgery and supportive treatment. But the patient’s BP could not improve. At 8:28 pm on the day of admission, the patient was declared clinically dead after the electrocardiograph showed a horizontal line and spontaneous respiration ceased.ConclusionsFailure to meet surgical disinfection and environmental standards may be the cause of infection of C. perfringens through wounds. Therefore, it is necessary to strengthen the environmental disinfection of the operating room, and standardize the sterile conditions of the operation staff and patients before and during operation. Liposuction surgery necrotizing fasciitis is a rare but fatal complications, especially if diagnosis delay, therefore it is critical for early diagnosis and treatment of gas gangrene.

Dr Agnes Savill: Pioneer, polymath and dermatology's renaissance woman.

Dr Agnes Savill was the UK's first female consultant dermatologist with a career journey which was, by any standards, extraordinary. She was awarded her MA in 1893 making her the first female graduate from St Andrews University. She then trained as a doctor in Glasgow in the earliest cohort of women granted the opportunity to study medicine. Following qualification, and during her early professional years, she maintained an involvement in the women's suffrage movement by publicly indicting the government for its brutal treatment of women suffrage prisoners in the 'Votes for Women' campaign. During World War 1 Dr Agnes Savill was one of a handful of women doctors who served at the Scottish Women's Hospital, a combat hospital in France. Dr Savill worked as the radiologist for the unit and developed expertise in the radiographic appearances of gas gangrene. After the war she returned to her dermatology practice, becoming the UK's leading expert in disorders of the hair and scalp and publishing widely on the subject. However, Agnes Savill had interests which extended into the humanities, particularly music. She was advocate for the use of music as treatment for psychological and physical disorders and wrote a book on this subject which helped promote music therapy as a para-clinical discipline. In her latter years she became fascinated by the history of classical antiquity and, at the age of 79, published a biography of Alexander the Great, an account praised for being both lucid and authoritative. Agnes Savill was a remarkable pioneering doctor: she was a ground-breaking dermatologist, she fought for women's rights and served in France as a combat doctor. Her work in music therapy and her writings on ancient history brought acclaim beyond the realm of medicine. Dr Agnes Savill is Dermatology's Renaissance Woman.

Inhumane medicine: imperial japan’s development and the use of biological weapons during World War II

There is currently an acute lack of information on the activities of Japanese doctors during World War II. Being a country with limited natural, financial, and human resources, Imperial Japan considered biological and chemical weapons one of the most promising and effective means of warfare in its quest to dominate Southeast Asia. In the mid 1920s, the Japanese leadership approved biological and chemical warfare research. The implementation of the biological weapons project, including human testing, was entrusted to Shiro Ishii and a group of Japanese scientists under his leadership, as well as to military and civilian experts. These studies examined the effectiveness of plague, gas gangrene, cholera, anthrax, and other pathogens. Experiments, including detailed descriptions of the subjects suffering and the results of autopsies/vivisections, were carefully documented. Field tests involved the distribution of contaminated food and crops to the Chinese population, as well as the contamination of water supplies. Similarly, in keeping with military interests, the effectiveness of munitions and the effects of decompression, hypothermia, and electric current were investigated on prisoners. After the end of World War II and the surrender of Imperial Japan, large-scale buried victims of experiments were found on the territory of the Peoples Republic of China, including the borders of the USSR. The paper focuses on the ethical component of the studies conducted, based on the dominant view in the Japanese society that all actions for the glory of the country and the emperor are justified and the absence of any ethical considerations due to the prejudice of the Japanese against foreigners in general and the Chinese in particular.

Hyperbaric oxygen therapy in low extremity trauma: A case series

IntroductionTrauma to the extremities is a common major health problem that requires special attention because it can have a dangerous impact on both the viability of the limb and the patient's life. Hyperbaric oxygen therapy is an alternative therapy hypothesized to improve the prognosis in lower extremity trauma. Case presentationWe present a series of 7 cases of lower extremity trauma treated with hyperbaric oxygen therapy: soft tissue loss, neglected chronic burn injury, high-voltage electrical burn, gas gangrene, crush injury, chemical burn, and excoriation with skin loss. DiscussionHyperbaric oxygen therapy involves giving 100% oxygen in a chamber at pressures above atmospheric pressure (2–3 atm absolute [ATA]). It can increase oxygen delivery to peripheral tissues with vascular compromise, cytogenic and vasogenic edema, and cellular hypoxia caused by limb trauma. ConclusionHyperbaric oxygen therapy has many benefits in lower extremity trauma for wound recovery, preventing complications, and helping patients return to daily activities.

Conservation and Evolution of the Sporulation Gene Set in Diverse Members of the Firmicutes.

The current classification of the phylum Firmicutes (new name, Bacillota) features eight distinct classes, six of which include known spore-forming bacteria. In Bacillus subtilis, sporulation involves up to 500 genes, many of which do not have orthologs in other bacilli and/or clostridia. Previous studies identified about 60 sporulation genes of B. subtilis that were shared by all spore-forming members of the Firmicutes. These genes are referred to as the sporulation core or signature, although many of these are also found in genomes of nonsporeformers. Using an expanded set of 180 firmicute genomes from 160 genera, including 76 spore-forming species, we investigated the conservation of the sporulation genes, in particular seeking to identify lineages that lack some of the genes from the conserved sporulation core. The results of this analysis confirmed that many small acid-soluble spore proteins (SASPs), spore coat proteins, and germination proteins, which were previously characterized in bacilli, are missing in spore-forming members of Clostridia and other classes of Firmicutes. A particularly dramatic loss of sporulation genes was observed in the spore-forming members of the families Planococcaceae and Erysipelotrichaceae. Fifteen species from diverse lineages were found to carry skin (sigK-interrupting) elements of different sizes that all encoded SpoIVCA-like recombinases but did not share any other genes. Phylogenetic trees built from concatenated alignments of sporulation proteins and ribosomal proteins showed similar topology, indicating an early origin and subsequent vertical inheritance of the sporulation genes. IMPORTANCE Many members of the phylum Firmicutes (Bacillota) are capable of producing endospores, which enhance the survival of important Gram-positive pathogens that cause such diseases as anthrax, botulism, colitis, gas gangrene, and tetanus. We show that the core set of sporulation genes, defined previously through genome comparisons of several bacilli and clostridia, is conserved in a wide variety of sporeformers from several distinct lineages of Firmicutes. We also detected widespread loss of sporulation genes in many organisms, particularly within the families Planococcaceae and Erysipelotrichaceae. Members of these families, such as Lysinibacillus sphaericus and Clostridium innocuum, could be excellent model organisms for studying sporulation mechanisms, such as engulfment, formation of the spore coat, and spore germination.

Clostridium septicum α-toxin activates the NLRP3 inflammasome by engaging GPI-anchored proteins.

Clostridium species are a group of Gram-positive bacteria that cause diseases in humans, such as food poisoning, botulism, and tetanus. Here, we analyzed 10 different Clostridium species and identified that Clostridium septicum, a pathogen that causes sepsis and gas gangrene, activates the mammalian cytosolic inflammasome complex in mice and humans. Mechanistically, we demonstrate that α-toxin secreted by C. septicum binds to glycosylphosphatidylinositol (GPI)-anchored proteins on the host plasma membrane, oligomerizing and forming a membrane pore that is permissive to efflux of magnesium and potassium ions. Efflux of these cytosolic ions triggers the activation of the innate immune sensor NLRP3, inducing activation of caspase-1 and gasdermin D, secretion of the proinflammatory cytokines interleukin-1β and interleukin-18, pyroptosis, and plasma membrane rupture via ninjurin-1. Furthermore, α-toxin of C. septicum induces rapid inflammasome-mediated lethality in mice and pharmacological inhibition of the NLRP3 inflammasome using MCC950 prevents C. septicum-induced lethality. Overall, our results reveal that cytosolic innate sensing of α-toxin is central to the recognition of C. septicum infection and that therapeutic blockade of the inflammasome pathway may prevent sepsis and death caused by toxin-producing pathogens.

Sistem Pakar Diagnosa Penyakit Udang Vannamei Menggunakan Metode Forward Chaining Berbasis Web (Studi Kasus : Petambak Udang Dirawajitu)

One of the causes of failure in pond shrimp farming is disease. The most dangerous disease attacks and causing losses to farmers are due to viral attacks of Myo/Infectious Myo Necrosis Virus (IMNV) of Shrimp, White Spot Syndrome (WSS) of Shrimp, Early Mortality Syndrome (EMS), and Yellow Head Disease. / Yellow Head Disease. The purpose of the research is to build an expert system application that can diagnose pond shrimp disease using the backward chaining method so as to help the community in Rawajitu sub-district in aquaculture shrimp., the system design method used is Unified Modeling Language (UML), the system development method used is Waterfall, and system built using Adobe Dreamweaver 8 tools and MySQL database. The results of this study are the application of an expert system that can diagnose pond shrimp disease using the backward chaining method. The system created later is expected to provide services to shrimp farmers in obtaining information on shrimp disease and accurate disease management solutions.

Sino-orbital gas gangrene – A guest unknown

Orbital cellulitis is a dreaded entity that can lead to an array of complications from visual loss to cavernous sinus involvement. Paranasal sinus (PNS) infection and trauma are the most common etiology. We report a case series of three patients who were victims of landslide and developed orbital cellulitis. Facial edema, proptosis, central retinal artery occlusion and hyperdense foci in the orbit, and PNS with proven growth of Clostridium perfringes were the common features in all these patients. Natural calamity leading to this fulminant infection led to mortality of all three patients. This is the first case series of sino-orbital gas gangrene in victims of heavy rainfall causing landslide.

Outcomes of Patients with Necrotizing Soft Tissue Infections: A Propensity-Matched Analysis Using the National Inpatient Sample.

Background: Necrotizing soft tissue infections (NSTIs) are severe, rapidly spreading infections with high morbidity and mortality. Attempts to identify risk factors for mortality and morbidity have produced variable results. We hope to determine which factors across the NSTI population impact mortality, morbidities, and discharge disposition. Patients and Methods: Retrospective data from the National Inpatient Sample from 2012-2018 of patients with primary diagnosis of NSTI (gas gangrene, necrotizing faciitis, cutaneous gangrene, or Fournier gangrene) were identified for analysis. A 1:4 greedy match was performed and risk factors for in-hospital mortality and discharge disposition were examined. Continuous variables were assessed using t-tests and Wilcoxon rank sum tests. Categorical variables were assessed using χ2 and Fisher exact tests. Statistical significance was defined as p < 0.05. Results: A total of 6,608 patients were identified. Weighted, this represents 33,040 patients; 32,390 are in the no-mortality cohort and 650 in the mortality cohort. Advanced age group was a risk factor for both in-hospital mortality and morbidity, but not for discharge to a skilled nursing or rehabilitation facility. Having two or more comorbidities was a risk factor for mortality, morbidity, and discharge to skilled nursing or rehabilitation facility. Cancer, liver disease, and kidney disease were predictors of in-hospital mortality. Diabetes mellitus and kidney disease were predictors of experiencing an in-hospital complication. Diabetes mellitus, heart disease, and kidney disease were predictors for discharge to skilled nursing or rehabilitation facility. Conclusions: Necrotizing soft tissue infections are associated with substantial morbidity and mortality. Identifying patients at higher risk for mortality, morbidity, and higher level of care at discharge can help providers properly allocate resources to improve patient outcomes and reduce the financial burden on patients and healthcare facilities. Special attention should be paid to those with existing or acute kidney dysfunction because this was the only comorbidity associated with increased risk mortality, morbidity, and discharge to higher level of care.