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Necrotizing fasciitis secondary to chickenpox infection in children
Peter Clark1, Darin Davidson, Mervyn Letts
1Division of Orthopaedics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa Ont.
Insights
Necrotizing fasciitis, a severe complication of chickenpox in children, requires prompt surgical debridement and antibiotics. Early diagnosis and intervention are crucial for limb salvage and full recovery, preventing muscle necrosis and death.
Area of Science:
- Pediatric Infectious Diseases
- Pediatric Orthopedics
- Surgical Infections
Background:
- Necrotizing fasciitis is a rare but severe complication following chickenpox infection in children.
- Musculoskeletal tissue involvement is common, necessitating early orthopedic consultation.
- Understanding diagnostic features and treatment is vital for managing this condition.
Purpose of the Study:
- To review diagnostic indicators of necrotizing fasciitis in children post-chickenpox.
- To analyze treatment strategies for musculoskeletal necrotizing fasciitis.
- To evaluate outcomes of pediatric necrotizing fasciitis cases.
Main Methods:
- A review of cases at a Canadian pediatric trauma center.
- Inclusion of five children with necrotizing fasciitis secondary to chickenpox.
- Treatment involved surgical debridement and intravenous antibiotics (clindamycin and penicillin).
Main Results:
- The average age of affected children was 3.8 years.
- Lower extremities were most commonly involved; group A beta-hemolytic Streptococcus was identified in 4 cases.
- All children survived, limbs were salvaged, and full muscle function was recovered after 1 year.
Conclusions:
- Necrotizing fasciitis should be suspected in children with varicella infection presenting with pain, swelling, fever, and lethargy.
- Emergent surgical debridement and intensive antibiotic therapy are critical.
- Prompt treatment prevents muscle necrosis, limb dysfunction, and mortality.
Background:
Necrotizing fasciitis is an uncommon but serious complication of chickenpox infection in young children. Because many of these infections affect the musculoskeletal tissues, orthopedic surgeons are often the first caregivers to be involved in diagnosis and treatment. Our objective was to review the diagnostic features of necrotizing fasciitis and analyze treatment methods to control and eradicate the musculoskeletal infection.
Design:
A review.
Setting:
The Children's Hospital of Eastern Ontario, Ottawa, a major Canadian pediatric trauma and referral centre.
Patients:
Five children who presented with necrotizing fasciitis secondary to chickenpox infection.
Intervention:
Surgical debridement of the involved area of necrotizing fasciitis and intravenous antibiotic treatment with clindamycin and penicillin.
Main Outcome Measures:
Complications outcome.
Results:
The average age of the 5 children at presentation was 3.8 years (range from 2.9-5.8 yr). The necrotizing fasciitis involved the lower extremity in 5 children, the upper extremity in 3, and the abdomen, chest, neck and back in 1 child each. One child presented with involvement of all 4 extremities. In 4 children, culture specimens grew group A beta-hemolytic Streptococcus. They all survived and all limbs were salvaged, although secondary closure and skin grafting were required. At an average follow-up of 1 year, each child had fully recovered with no loss of muscle function.
Conclusions:
Necrotizing fasciitis should be suspected in any child with a history of varicella infection and an increasing complaint of pain and swelling in an extremity or other body area associated with increasing fever, erythema, lethargy and irritability. Emergent surgical debridement and intensive antibiotic therapy are essential to prevent muscle necrosis, major limb dysfunction and death.