title: Group A streptococcal necrotizing fasciitis complicating primary varicella: a series of fourteen patients.
abstract: We retrospectively reviewed the clinical course of group A Streptococcus necrotizing fasciitis complicating primary varicella in children admitted to Children's Hospital and Medical Center, Seattle, WA, during a 18-month period. The potential benefit of various therapeutic interventions was examined. Fourteen children ages 6 months to 10 years were treated for group A Streptococcus necrotizing fasciitis as a complication of primary varicella. Eight patients experienced a delay in initial diagnosis as a result of nonspecific, early clinical findings of necrotizing fasciitis. Each patient underwent surgical exploration with fasciotomies and debridement. Initial antibiotic therapy was broad spectrum and included clindamycin. Hyperbaric oxygen therapy for as many as 6 treatments was used as adjunctively therapy in 12 patients, with subjective benefit in 6 patients. All 14 patients were discharged home with good function and no long term sequelae. This potentially fatal bacterial infection of the deep fascial layers requires early recognition by primary care physicians and an intensive, multidisciplinary therapeutic approach, including thorough surgical debridement and appropriate antibiotic therapy.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Children's Hospital and Medical Center, University of Washington, School of Medicine, Seattle 98105, USA.
authors.forename: T V
authors.initials: TV
authors.lastname: Brogan
authors.forename: V
authors.initials: V
authors.lastname: Nizet
authors.forename: J H
authors.initials: JH
authors.lastname: Waldhausen
authors.forename: C E
authors.initials: CE
authors.lastname: Rubens
authors.forename: W R
authors.initials: WR
authors.lastname: Clarke
mesh_terms: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D002644:Chickenpox / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003646:Debridement; D004359:Drug Therapy, Combination / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal