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Necrotizing soft tissue lesions after a volcanic cataclysm

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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.

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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Authors and Affiliations

  1. Department of Surgery, Centro Médico de los Andes, Fundación Santa Fe de Bogotá, Colombia

    José F. Patiño M.D., F.A.C.S. (Hon.), Daniel Castro M.D., Alvaro Valencia M.D. & Pedro Morales M.D.

  2. Department of Surgery, Hospital de La Samaritana, Colombia

    José F. Patiño M.D., F.A.C.S. (Hon.), Daniel Castro M.D., Alvaro Valencia M.D. & Pedro Morales M.D.

  3. Department of Pathology, Hospital San Juan de Dios and National Institute of Forensic Medicine, Bogotá, Colombia

    José F. Patiño M.D., F.A.C.S. (Hon.), Daniel Castro M.D., Alvaro Valencia M.D. & Pedro Morales M.D.

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  1. José F. Patiño M.D., F.A.C.S. (Hon.)
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  2. Daniel Castro M.D.
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  3. Alvaro Valencia M.D.
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  4. Pedro Morales M.D.
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Patiño, J.F., Castro, D., Valencia, A. et al. Necrotizing soft tissue lesions after a volcanic cataclysm. World J. Surg. 15, 240–247 (1991). https://doi.org/10.1007/BF01659059

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