Document Detail

Fatal craniocervical necrotizing fasciitis in an immunocompetent patient: a case report and literature review.
MedLine Citation:
PMID:  7672978     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Craniocervical necrotizing fasciitis (CCNF) is a rapidly progressive, severe bacterial infection of the superficial fascial planes of the head and neck. Group A beta-hemolytic Streptococcus, staphylococcus aureus, and obligate anaerobic bacteria are common pathogens. The disease usually results from a dental source or facial trauma. Extensive fascial necrosis and severe systemic toxicity are common manifestations of CCNF. Recently the lay press has referred to necrotizing fasciitis in several articles about "flesh eating" bacteria, which have resulted in several deaths. METHODS: We report the first case of a fatality in an otherwise immunocompetent patient. The patient was a 66-year-old black man with no identifiable source of infection and no history or evidence of immunocompromising disorders. RESULTS: Despite aggressive surgical debridement and broad-spectrum antibiotic coverage, he died 30 hours after admission from multisystem organ failure secondary to overwhelming sepsis. CONCLUSION: Treatment consists of early recognition of CCNF combined with aggressive surgical debridement and drainage of the involved necrotic fascia and tissue along with broad-spectrum intravenous antibiotic coverage. Although 11 other fatal cases of CCNF have been previously reported, all had an underlying medical problem which created an immunocompromised state, usually diabetes mellitus or chronic alcoholism. We present a case report and literature review along with a discussion of the related anatomy.
D E Henrich; T L Smith; W W Shockley
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Publication Detail:
Type:  Case Reports; Journal Article; Review    
Journal Detail:
Title:  Head & neck     Volume:  17     ISSN:  1043-3074     ISO Abbreviation:  Head Neck     Publication Date:    1995 Jul-Aug
Date Detail:
Created Date:  1995-10-18     Completed Date:  1995-10-18     Revised Date:  2010-03-24    
Medline Journal Info:
Nlm Unique ID:  8902541     Medline TA:  Head Neck     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  351-7     Citation Subset:  IM    
Division of Otolaryngology/Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill 27599-7070, USA.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use
Combined Modality Therapy
Fasciitis* / diagnosis,  physiopathology,  therapy
Fatal Outcome
Necrosis / diagnosis,  physiopathology,  therapy
Sepsis / etiology
Streptococcal Infections* / diagnosis,  physiopathology,  therapy
Streptococcus pyogenes / isolation & purification*
Tomography, X-Ray Computed
Reg. No./Substance:
0/Anti-Bacterial Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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