Necrotising fasciitis as a complication of varicella in children
Autor: Dr. Santino Figueroa Ángel | Publicado:  25/09/2012 | | |
Necrotising fasciitis as a complication of varicella in children .2

Figure 4: Patient of clinical case number 3, showing her right upper trunk lesion at the third week of admission, ready to be grafted.

fascitis_necrotizante_varicela/fascitis_necrosante_pectoral

Figure 5: Patient of clinical case number 4, at the third week of admission, now that the infection has faded. Note the multiple scars as sequels.

fascitis_necrotizante_varicela/cicatrices_secuelas_necrosis

The final surgical interventions were a full thickness graft in one patient, a meshed split-thickness skin graft in one patient, a split-thickness skin graft in one patient, and advancement of superior and inferior flaps in one patient. Only the patient of the clinical case number 1 required two surgical interventions; the second intervention needed to remodel a superior eyelid retraction.

TABLE 1: CLINICAL FEATURES OF THE 4 PATIENTS

Features PATIENT 1:

Age (years): 12
Sex: Female
Comorbidities or Immuno-compromise: No
NSAID history: Paracetamol
Presentation: 5 days after the onset of varicella, the girl presented right hemifacial oedema plus right sided periorbital pain and erythema , which progressed to a periorbital ulceration in 48 hours.
At admission: Cellulites, partial skin and soft tissue necrosis, crepitus, and foul purulent discharge.
Affected area: Right periorbital and temporal region.
Symptoms and systemic signs at admission: Fever, malaise, hypotension, tachycardia, tachypnea.
First debridement after admission: < 8 hours
Antibiotics used: Vancomycin, Meropenem, Metronidazole, Fluconazole**
Bacteria isolated from culture: None
Reconstruction surgery: Full thickness skin graft. (Two interventions)
Complications of the infection: Hemocultives positive with candida parapsilosis & Scars.
Hospital: Hospital Regional Licenciado Adolfo López Mateos

Features PATIENT 2:

Age (years): 7
Sex: Female
Comorbidities or Immuno-compromise: No
NSAID history: Paracetamol, Ibuprofen
Presentation: At the 4th day of the diagnosis of varicella, small ulcerations and a zone of erythema, rapidly progressed to become a large necrotic area within days.
At admission: Necrosis of skin, soft tissue and aponeurosis, plus crepitus and foul purulent, gray discharge.
Affected area: Low abdominal Wall and left inguinal region.
Symptoms and systemic signs at admission: Fever, irritability, malaise, hypotension, tachycardia, tachypnea.
First debridement after admission: < 12 hours
Antibiotics used: Penicillin, Gentamicin, Clindamycin
Bacteria isolated from culture: Streptococcus pyogenes and E. colli
Reconstruction surgery: Mesh, split-thickness skin graft
Complications of the infection: Hypertrophic Scars.
Hospital: Hospital Infantil de México Federico Gómez.

Features PATIENT 3:

Age (years): 8
Sex: Female
Comorbidities or Immuno-compromise: No
NSAID history: Methamizol
Presentation: 7 days after the appearance of vesicles, rapid confluent ulcers and skin discolorations appeared in the trunk, progressing to a cruent area.
At admission: Necrosis of skin, soft tissue and mayor pectoral aponeurosis, without discharge.
Affected area: Right pectoral area.
Symptoms and systemic signs at admission: Malaise, anorexia and Pain.
First debridement after admission: < 16 hours
Antibiotics used: Penicillin, Clindamycin
Bacteria isolated from culture: Streptococcus pyogenes
Reconstruction surgery: Split-thickness skin graft.
Complications of the infection: Minimal scars.
Hospital: Hospital Infantil de México Federico Gómez.

Features PATIENT 4:

Age (years): 2
Sex: Male
Comorbidities or Immuno-compromise: No
NSAID history: Methamizol
Presentation: At the 4th day after the onset of varicella, the boy presented fever, malaise, erythema, oedema of lower back, plus bullaes formation transforming into hemorrhagic.
At admission: Haemorrhagic Bullaes, skin discoloration and soft tissue necrosis, plus serohematic discharge.
Affected area: Lower back.
Symptoms and systemic signs at admission: Fever, malaise, irritability.
First debridement after admission: < 12 hours
Antibiotics used: Penicillin, Clindamycin
Bacteria isolated from culture: Staphylococcus aureus
Reconstruction surgery: Advancement flaps.
Complications of the infection: Minimal scars.
Hospital: Hospital Infantil de México Federico Gómez.



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