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World Journal of Surgery

, Volume 15, Issue 2, pp 240–247 | Cite as

Necrotizing soft tissue lesions after a volcanic cataclysm

  • José F. Patiño
  • Daniel Castro
  • Alvaro Valencia
  • Pedro Morales
Progress Symposium—Surgery of Endemic Disease

Abstract

A volcanic cataclysm of major proportions, the fourth largest in terms of total casualties in the history of mankind, wiped out the town of Armero, Colombia, in 1985 resulting in over 23,000 deaths and 4,500 wounded. Among the hundreds of survivors who were transferred to hospitals in the capital city of Bogotá, there was as overwhelming number who developed necrotizing fasciitis. These patients constitute, perhaps, the single largest group of this type of lesions in the recorded literature. Thirty-eight patients with well established necrotizing fasciitis were identified at 4 selected hospitals in Bogotá; 8 of them presented with zygomycetic infection (mucormycosis), a highly lethal entity. Many additional cases were treated at other hospitals in Bogotá and several cities in Colombia. The main clinical features of these 38 patients affected by necrotizing fasciitis are reviewed, with special emphasis on the patients with mucormycosis. Patients with necrotizing fasciitis had an overall mortality rate of 47.7%; patients with mucormycosis, 80%. A plea is made for an early diagnosis, utilizing tissue sampling and microbiological studies, so that prompt and radical treatment can be instituted. This is especially pertinent in situations of natural disasters resulting in massive numbers of casualties and seriously injured survivors.

Keywords

Fasciitis Necrotizing Fasciitis Parmi Soft Tissue Lesion Main Clinical Feature 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Résumé

En 1985, une terrible éruption volcanique, la quatrième en importance de perte de vie de toutes les catastrophes de l'histoire de l'humanité, a ravagé la ville de Armero en Colombie, provoquant plus de 23,000 morts et 4,500 blessés. Parmi les centaines de survivants qui ont été transportés dans les hôpitaux de Bogota, la capitale, il y a eu un nombre impressionnant d'individus qui ont développé une cellulite nécrosante. Ces patients constituent probablement le plus grand groupe de ce type de lésion jamais rapporté dans la littérature.

Trente huit patients, avec une cellulite nécrosante bien établie, ont été traités dans les quatre hôpitaux les plus importants de Bogota; 8 d'entre eux avaient une infection zygomycétique (mucormycosis), affection le plus souvent mortelle. D'autres cas ont été traités dans d'autres hôpitaux de Bogota et de plusieurs villes de Colombie. Les principaux traits cliniques de ces 38 patients avec cellulite nécrosante sont étudiés avec une mention spéciale pour les patients ayant une mucormycosis. Les patients ayant une cellulite nécrosante avaient un taux global de mortalité de 47.7%; les patients ayant une mucormycosis avaient un taux global de mortalité de 80%. Nous insistons sur un diagnostic précoce, basé sur des prélèvements avec étude microbiologique, de manière à pouvoir instaurer un traitement immédiat et efficace. Ceci est particulièrement valable en cas de catastrophe naturelle provoquant un nombre important d'accidentés et de survivants gravement blessés.

Resumen

Un cataclismo volcánico de proporciones mayores, el cuarto, en cuanto al número de víctimas, en la historia de la humanidad, arrasó con la ciudad de Armero, Colombia, causando más de 23,000 muertos y 4,500 heridos. Entre los cientos de sobrevivientes que fueron transferidos a hospitales en la ciudad de Bogotá, un número desproporcionadamente alto desarrolló fascitis necrotizante. Estos pacientes constituyen quizás el grupo único más numeroso que se registra en la literatura. Treinta y ocho de ellos fueron identificados en 4 hospitales seleccionados de Bogotá; 8 presentaban infección por zigomicetos (mucormicosis), una entidad altamente letal. Muchos casos adicionales fueron tratados en otros hospitales de Bogotá y de diversas ciudades de Colombia. Se revisan las características principales de estos 38 pacientes afectados por fascitis necrotizante, con especial énfasis en los que desarrollaron mucormicosis. Los pacientes con fascitis necrotizante tuvieron una tasa global de mortalidad de 47.7%; en aquellos con mucormicosis fue de 80%. Se preconiza la necesidad de un diagnóstico precoz, utilizando biopsia tisular y estudios microbiólogicos, para emprender prontamente tratamiento radical. Esto es especialmente pertinente en situaciones de desastres naturales que resultan en gran número de victimas y de sobrevivientes con lesiones graves de la piel y de los tejidos blandos.

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References

  1. 1.
    Fernández, G., Gómez Martínez, P., Malagón, V., Múnera, I., Patiño, J.F., editors: Aspectos Médicos de la Catástrofe Volcánica del Nevado del Ruiz, Academia Nacional de Medicina y RESUR-GIR, Bogota, Escorpio Editores, 1989Google Scholar
  2. 2.
    Patiño, J.F., Holguín, F., Escallón, J., García, C.F., Gutiérrez, M.T., Fernández, G.: tNecrotizing soft tissue infections in the volcanic cataclysm of Colombia. Poster presentation. 18th Int. Cong. Intern. Med., Bogotá, July 29–August 2, 1986Google Scholar
  3. 3.
    Patiño, J.F., Mora, R., Guzmán, M.A., Rodríguez-Franco, E.: Mucormycosis: A fatal case by Saksenaea vasiformis. World J. Surg.8:419, 1984Google Scholar
  4. 4.
    Patiño, J.F.: Infecciones necrotizantes de tejidos blandos. La experiencia con los heridos en el cataclismo volcánico de Armero, Colombia. In Infección Quirúrgica, J.F. Patiño, editor, Bogotá, Fundación Santa Fe de Bogotá y Editorial Presencia, 1989, pp. 91–108Google Scholar
  5. 5.
    Haas, D.W., Dharmaraja, P., Morrison, J.G., Potts, III, J.R.: Necrotizing fasciitis following percutaneous endoscopic gastrostomy (letter). Gastrointest. Endosc.34:487, 1988Google Scholar
  6. 6.
    Farrell, L.D., Karl, S.R., Davis, P.K., Bellinger, M.F., Ballantine, T.V.: Postoperative necrotizing fasciitis in children. Pediatrics82:874, 1988Google Scholar
  7. 7.
    Bearman, D.M., Livengood, III, C.H., Addison, W.A.: Necrotizing fasciitis arising from a suprapubic catheter in situ. A case report. J. Reprod. Med.33:411, 1988Google Scholar
  8. 8.
    Guirgms, E.M., Taylor, G.A., Chadwick, C.D.: Femoral appendicitis: An unusual case. Can. J. Surg.32:380, 1989Google Scholar
  9. 9.
    Schwarz, G., Sagy, M., Barzilay, Z.: Multifocal necrotizing fasciitis in varicella. Ped. Emerg. Care5:31, 1989Google Scholar
  10. 10.
    Falcone, P.A., Pricolo, V.E., Edstrom, L.E.: Necrotizing fasciitis as a complication of chickenpox. Clin. Pediatr.27:339, 1988Google Scholar
  11. 11.
    Majeski, J.A., Rajagopalan, P.R., Fitts, C.T., Eddy, G.L., Holtz, G.L., Turner, W., Henry, R., Hearn, H.B.: Necrotizing fasciitis in a renal transplant patient. South. Med. J.81:1315, 1988Google Scholar
  12. 12.
    Wojno, K., Spitz, W.U.: Necrotizing fasciitis: A fatal outcome following minor trauma. Case report and literature review. Am. J. Forensic Med. Pathol.10:239, 1989Google Scholar
  13. 13.
    Balcerak, R.J., Sisto, J.M., Rosack, R.C.: Cervicofacial necrotizing fasciitis: Report of three cases and literature review. J. Oral Maxillofac. Surg.46:450, 1988Google Scholar
  14. 14.
    Svensson, L.G., Broostone, A.J., Wallsted, M.: Necrotizing fasciitis in contused areas. J. Trauma25:260, 1985Google Scholar
  15. 15.
    Hung, L.K., Kinninmonth, A.W., Woo, H.: Vibrio vulnificus necrotizing fasciitis presenting with compartmental syndrome of the hand. J. Hand Surg.13:337, 1988Google Scholar
  16. 16.
    Falender, L.G., Barbieri, D., Leban, S.G.: Gas-producing necrotizing fasciitis following mandibular fracture. J. Oral Maxillofac. Surg.47:856, 1989Google Scholar
  17. 17.
    Hoffman, M.S., Turnquist, D.: Necrotizing fasciitis of the vulva during chemotherapy. Obstet. Gynecol.74:483, 1989Google Scholar
  18. 18.
    Kusne, S., Eibling, D.E., Yu, V.L., Fitz, D., Johnson, J.T., Kahl, L.E.: Gangrenous cellulitis associated with gram-negative bacilli in pancytopenic patients: Dilemma with respect to effective therapy. Am. J. Med.85:490, 1988Google Scholar
  19. 19.
    Rimailho, A., Riou, B., Richard, C., Auzepy, P.: Fulminating necrotizing fasciitis and nonsteroidal antiinflammatory drugs. J. Infect. Dis.155:143, 1987Google Scholar
  20. 20.
    Umbert, I.S., Winkelmann, R.K., Oliver, G.F., Peters, M.S.: Necrotizing fasciitis: A clinical, microbiologic, and histopathologic study of 14 patients. J. Am. Acad. Dermatol.20:774, 1989Google Scholar
  21. 21.
    Riefler, III, J., Molavi, A., Schwartz, D., DiNubile, M.: Necrotizing fasciitis in adults due to group B streptococcus. Arch. Intern. Med.148:1727, 1988Google Scholar
  22. 22.
    Stevens, D.L., Tanner, M.H., Winship, J., Swarts, R., Ries, K.M., Schlievert, P.M., Kaplan, E.: Severe group A streptococcal infections associated with toxic shock-like syndrome and scarlet fever toxin A. N. Engl. J. Med.321:1, 1989Google Scholar
  23. 23.
    Dobbeling, B.N., Wenzel, R.P.: Spontaneous streptococcal gangrenous myositis: Survival with early debridement. South. Med. J.87:900, 1989Google Scholar
  24. 24.
    Seal, D.V., Kingston, D.: Streptococcus necrotizing fasciitis: Development of an animal model to study its pathogenesis. Br. J. Exper. Pathol.69:813, 1989Google Scholar
  25. 25.
    Patiño, J.F.: Infección por mucormicosis. In Infección Quirúrgica, J.F. Patiño, editor, Bogota, Centro Médico de los Andes y Editorial Presencia, 1989, pp. 109–126Google Scholar
  26. 26.
    Johnson, P.C., Satterwhite, T.K., Monheit, J.E., Parke, D.: Primary cutaneous mucormycosis in trauma patients. J. Trauma27:431, 1987Google Scholar
  27. 27.
    Gordon, G., Indeck, M., Bross, J., Kappoor, D.A., Brotman, S.: Injury from silage wagon accident complicated by mucormycosis. J. Trauma28:866, 1988Google Scholar
  28. 28.
    Vainrub, B., Macareno, A., Mandel, S., Musher, D.M.: Wound zygomycosis (mucormycosis) in otherwise healthy adults. Am. J. Med.84:546, 1988Google Scholar
  29. 29.
    Ryan-Poirier, K., Eiseman, R.M., Beaty, J.H., Hunt, P.G., Burghe, G.A., Leggiadro, R.J.: Post-traumatic cutaneous mucormycosis in diabetes mellitus. Short-term antifungal therapy. Clin. Pediatr.27:609, 1988Google Scholar
  30. 30.
    Padhye, A.A., Koshi, G., Anandi, V., Ponniah, J., Sitaram, V., Jacob, M., Mathai, R., Ajello, L., Chandler, F.W.: First case of subcutaneous zygomycosis caused by Saksenaea vasiformis in India. Diagn. Microbiol. Infect. Dis.9:69, 1988Google Scholar

Copyright information

© Société Internationale de Chirurgie 1991

Authors and Affiliations

  • José F. Patiño
    • 1
    • 2
    • 3
  • Daniel Castro
    • 1
    • 2
    • 3
  • Alvaro Valencia
    • 1
    • 2
    • 3
  • Pedro Morales
    • 1
    • 2
    • 3
  1. 1.Department of Surgery, Centro Médico de los AndesFundación Santa Fe de BogotáColombia
  2. 2.Department of SurgeryHospital de La SamaritanaColombia
  3. 3.Department of PathologyHospital San Juan de Dios and National Institute of Forensic MedicineBogotáColombia

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