Necrotizing fasciitis in children: diagnostic and therapeutic aspects.
BACKGROUND
Necrotizing fasciitis (NF) is a severe life-threatening soft tissue infection characterized by rapidly spreading necrosis of the fascia and the subcutaneous tissue. Its incidence owing to invasive Streptococcus pyogenes has significantly increased in children recently. Our experience with NF in children to describe diagnostic and therapeutic aspects is hence presented herein.


METHODS
Records of children who were treated for NF in our unit from 1999 to 2006, inclusive, were reviewed retrospectively. Information recorded for each patient included medical history, clinical characteristics, diagnostic procedures, treatment methods, and the outcome.


RESULTS
Thirteen patients with a mean age of 35 months were treated for NF during the study period. All of the 13 children had no previous immunosuppression. The predisposing factors were composed of varicella lesions, intramuscular injections, application of a cream containing menthol to the cervical region, penetrant gluteal trauma, omphalitis, dental abscess, and streptococcal toxic shock syndrome. The most common site of the initial involvement was the abdominal wall, followed by the gluteal region and thigh, head and neck, and upper and lower extremities. The initial skin presentations were induration or cellulitis and erythema and edema with progression to skin discoloration and bullae formation. Fever and tachycardia were the most common clinical features. S. pyogenes was the most common causative microorganism, followed by Staphylococcus epidermidis and Pseudomonas aeruginosa. All patients underwent extensive surgical debridement and received appropriate antibiotics and supportive therapy. Twelve patients survived, and 1 patient with delayed diagnosis of NF died of septic shock.


CONCLUSIONS
Although these infections are rare in children, their lethal potential and early diagnostic signs must be recognized. All children with NF should undergo early surgical debridement to prevent delay in treatment. The mortality and morbidity associated with NF in children can be decreased with clinical awareness, early diagnosis, and adequate and urgent surgical debridement followed by intensive supportive care and early wound resurfacing.
Bingöl-Koloğlu
Meltem
M
Department of Pediatric Surgery, Ankara University School of Medicine, Ankara 06100, Turkey. kologlu@medicine.ankara.edu.tr
Yildiz
Rahşan Vargün
RV
Alper
Bilal
B
Yağmurlu
Aydin
A
Ciftçi
Ergin
E
Gökçora
Ismail Haluk
IH
Ince
Erdal
E
Emiroğlu
Murat
M
Dindar
Hüseyin
H
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016038:Skin Transplantation / Q000379:methods; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D013297:Streptococcus pyogenes / Q000302:isolation & purification*; D015996:Survival Rate; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents