Fournier Gangrene in the Emergency Department: Diagnostic Dilemmas, Treatments and Current Perspectives.
Jonathan AuerbachKasha BornsteinMark RamzyJorge CabreraTim MontriefBrit LongPublished in: Open access emergency medicine : OAEM (2020)
Fournier gangrene (FG) is a rare and life-threatening urosurgical emergency characterized most often by a polymicrobial infection of the perineal, genital, or perianal region. FG has an increased incidence in male patients, patients with alcoholism, and patients with immunocompromise including human immunodeficiency virus (HIV) and uncontrolled diabetes. FG often begins as a simple abscess or cellulitis with progression to necrotizing soft tissue infection (NSTI). Delays in diagnosis and treatment confer high mortality. Early recognition and high clinical suspicion are important in making a timely diagnosis, as early manifestations are often subtle. The most significant modifiable risk factor associated with NSTI mortality is delay to surgical intervention. Coordination of both inpatient medical and surgical teams to implement appropriate therapy is vital to successful outcomes. The emergency medicine clinician must be vigilant for this condition and be aware of risk factors, prognostic indicators, and proper treatment protocols to recognize FG early and initiate appropriate management. The objective of this review is to provide updated and relevant information regarding recognition, diagnosis, and management of FG for the emergency medicine provider.
Keyphrases
- risk factors
- human immunodeficiency virus
- emergency medicine
- emergency department
- antiretroviral therapy
- hepatitis c virus
- hiv infected
- end stage renal disease
- randomized controlled trial
- hiv positive
- healthcare
- cardiovascular disease
- type diabetes
- hiv aids
- newly diagnosed
- chronic kidney disease
- cardiovascular events
- primary care
- public health
- palliative care
- peritoneal dialysis
- adipose tissue
- glycemic control
- stem cells
- hiv testing
- smoking cessation
- replacement therapy
- insulin resistance
- skeletal muscle
- south africa