Ponce CJG, Rodríguez HP, Torres AMA, Muñoz VME

Language: Spanish
References: 14
Page: 64-70
PDF size: 221.43 Kb.

ABSTRACT

Necrotizing fasciitis (NF) is a serious, potentially deadly, soft tissue infection characterized by the rapid spread of necrosis of fascia and subcutaneous tissue. Necrotising fasciitis of the genitalia is a rare urological urgency that is especially uncommon in children, but its incidence due to invasive Streptococcus has increased significantly in children, it causes hospitalization in a 0.03% equivalent to 0.8 To 1 per 100,000 patients. We present a case of Fournier gangrene of the penis, testicles and thighs, caused by chickenpox in a 9-year-old boy, who under his initial medical management, given the septic shock process that our patient presented was given on the basis of resuscitation hydrophilic, impregnation of antibiotics in the first hour and antivirals as well as debridement and surgical toilets, however, due to the slow recovery and the poor response of conventional and surgical treatment, it was decided to experimentally initiate the use of hemoglobin in aerosol, improving thus providing oxygen to the wounds, presenting a significant improvement both in the granulation and healing of the wounds, being in the case of pediatric patients an innovation in the management of these entities and establishing a background for future treatments of them. Thus, the initial management and added to the experimental management with the hemoglobin in spray, the results were encouraging for these entities without presenting adverse reactions. Conclusion: The initial management for any pediatric or adult of septic shock regardless of the trigger event is still the use of aggressive water reanimation; as well as the initial management of empirical antibiotic therapy, not forgetting the steps of adequate hemodynamic stabilization that may include: cardiac maneuvers, airway protection and aminergic support. Knowing that the triggering event is a fascitis, the post-stabilization treatment of the patient is the surgical debridation of the lesions as well as keeping them clean to avoid superinfections and have an adequate clinical improvement of the same. However the process and natural history of the disease is slow with a wide possibility of complications so today there are medicines that help the rapid granulation and healing of it, such as hemoglobin spray, used in this clinical case with favorable results marking its use in pediatric patients, decreasing the hospital stay and improvement in the short term, not forgetting the initial management in the patient with septic shock.

REFERENCES

1. Clark P, Davidson D, Letts M, Lawton L, Jawadi A. Necrotizing fasciitis secondary to chickenpox infection in children. Can J Surg. 2003; 46 (1): 9-14.

2. Fustes MA, Gutierrez CP, Duran MC, Orozco CL, Tamayo SL, Ruiz MR. Necrotizing fasciitis: report of 39 pediatric cases. Arch Dermatol. 2002; 138 (7): 893-899.

3. Aebi C, Ahmed A, Ramilo O. Bacterial complications of primary varicella in children. Clin Infect Dis. 1996; 23 (4): 698-705.

4. Eneli I, Davies HD. Epidemiology and outcome of necrotizing fasciitis in children: an active surveillance study of the Canadian Paediatric Surveillance Program. J Pediatr. 2007; 151 (1): 79-84, 84.e1.

5. Misago N, Narisawa Y, Ryu S, Gotoh Y, Tanaka T, Yokoyama M et al. Necrotizing fasciitis due to group A streptococci: a clinicopathological study of six patients. J Dermatol. 1996; 23 (12): 876-882.

6. Ziebold C, von Kries R, Lang R, Weigl J, Schmitt HJ. Severe complications of varicella in previously healthy children in Germany: a 1-year survey. Pediatrics. 2001; 108 (5): E79.

7. Maia C, Fonseca J, Carvalho I, Santos H, Moreira D. Estudo clínico-epidemiológico da infeção complicada por vírus varicela-zoster na idade pediátrica. Acta Med Port. 2015; 28 (6): 741-748.

8. Mifsud S, Schembri EL, Mallia Azzopardi C, Zammit MA. Multifocal necrotising fasciitis and septic shock complicating varicella infection in an adult. BMJ Case Rep. 2013; 2013. pii: bcr2013201984.

9. Arenberger P, Engels P, Arenbergerova M, Gkalpakiotis S, García Luna Martínez FJ, Villarreal-Anaya A et al. Clinical results of the application of a hemoglobin spray to promote healing of chronic wounds. GMS Krankenhhyg Interdiszip. 2011; 6 (1): Doc05.

10. Cenoz MG, Catalán JC, Zamarbide FI, Berastegui MA, Gurrea AB. Impact of universal vaccination against chicken pox in Navarre, 2006-2010. An Sist Sanit Navar. 2011; 34 (2): 193-202.

11. Shapiro ED, Vazquez M, Esposito D, Holabird N, Steinberg SP, Dziura J et al. Effectiveness of 2 doses of varicella vaccine in children. J Infect Dis. 2011; 203 (3): 312-315.

12. El-Khani U, Nehme J, Darwish A, Jamnadas-Khoda B, Scerri G, Heppell S et al. Multifocal necrotising fasciitis: an overlooked entity? J Plast Reconstr Aesthet Surg. 2012; 65 (4): 501-512.

13. Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004; 32 (7): 1535-1541.

14. Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, Sharma S et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med. 2006; 34 (6): 1589-1596.