FOURNIER GANGRENE

Fournier gangrene is a type of necrotizing fasciitis or gangrene affecting the external genitalia or perineum. It commonly occurs in older men, but it can also occur in women and children. It is more likely to occur in diabetics, alcoholics, or those who are immunocompromised.

Fournier gangreneSpecialty: Infectious disease
Frequency: 1 per 62,500 males a year[1]
Signs and symptoms: Initial symptoms of Fournier gangrene include swelling or sudden pain in the scrotum, fever, pallor, and generalized weakness. It is characterized by pain that extends beyond the border of the demarcated erythema.[2] Most cases present mildly, but can progress in hours. Subcutaneous air is often one of the specific clinical signs, but is not seen in >50% of presenting clinical cases. More marked cases are characterized by a foul odor and necrotic infected tissue. Crepitus has been reported.[2] It begins as a subcutaneous infection. However, necrotic patches soon appear in the overlying skin, which later develop into necrosis.[2]

Cause: Most cases of Fournier gangrene are infected with both aerobic and anaerobic bacteria such as Clostridium perfringens. It can also result from infections caused by group A streptococcus (GAS), as well as other pathogens such as Staphylococcus aureus and Vibrio vulnificus.[3] Lack of access to sanitation, medical care, and psychosocial resources has been linked to increased mortality.[4]

A 2006 Turkish study reported that blood sugar levels were elevated in 46 percent of patients diagnosed with Fourniers.[5] Another study reported that about one third of patients were alcoholic, diabetic, and malnourished, while another ten percent had been immunosuppressed through chemotherapy, steroids, or malignancy

Treatment: Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of dead tissue.[2] In addition to surgery and antibiotics, hyperbaric oxygen therapy may be useful and acts to inhibit the growth of and kill the anaerobic bacteria
Diagnosis: Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of dead tissue.[2] In addition to surgery and antibiotics, hyperbaric oxygen therapy may be useful and acts to inhibit the growth of and kill the anaerobic bacteria.[9]