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| __NOTOC__ | | __NOTOC__ |
| {{SI}} | | '''For more information about necrotizing fasciitis click [[necrotizing fasciitis|here]] |
| | '''For patient information, click [[Fournier gangrene (patient information)|here]]''' |
| | {{Fournier gangrene}} |
| {{SCC}}; {{AE}} {{YK}}; {{JH}} | | {{SCC}}; {{AE}} {{YK}}; {{JH}} |
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| {{SK}} Idiopathic gangrene of scrotum; Periurethral phlegmon; Streptococcal scrotal gangrene | | {{SK}} Fournier's gangrene; Idiopathic gangrene of scrotum; Periurethral phlegmon; Streptococcal scrotal gangrene; Genito-perineal gangrene; Phagedena |
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| {{Search infobox}} | | {{Search infobox}} |
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| | MeshID = D018934 | | | MeshID = D018934 |
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| | ==[[Fournier gangrene overview|Overview]]== |
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| ==Overview== | | ==[[Fournier gangrene historical perspective|Historical Perspective]]== |
| '''Fournier gangrene''' is a type of [[necrosis|necrotizing]] [[infection]] ([[gangrene]]) of the perineal, genital or perianal regions usually affecting the male [[genital]]s but can also occur in female and children.<ref name="pmid9523650">{{cite journal| author=Smith GL, Bunker CB, Dinneen MD| title=Fournier's gangrene. | journal=Br J Urol | year= 1998 | volume= 81 | issue= 3 | pages= 347-55 | pmid=9523650 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9523650 }} </ref> It is a fulminant form of [[necrotizing fasciitis]]. It was first described by Baurienne in 1764 and is named after a French [[venereology|venereologist]], Jean-Alfred Fournier following five cases he presented in clinical lectures in 1883.<ref name="pmid9492752">{{cite journal| author=Nathan B| title=Fournier's gangrene: a historical vignette. | journal=Can J Surg | year= 1998 | volume= 41 | issue= 1 | pages= 72 | pmid=9492752 | doi= | pmc=3950066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9492752 }} </ref><ref name="pmid26445600">{{cite journal| author=Chennamsetty A, Khourdaji I, Burks F, Killinger KA| title=Contemporary diagnosis and management of Fournier's gangrene. | journal=Ther Adv Urol | year= 2015 | volume= 7 | issue= 4 | pages= 203-15 | pmid=26445600 | doi=10.1177/1756287215584740 | pmc=4580094 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26445600 }} </ref>
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| ==Historical Perspective== | | ==[[Fournier gangrene classification scheme|Classification]]== |
| *Fournier's gangrene was first described by in 1764 by Baurienne.<ref name="pmid9492752">{{cite journal| author=Nathan B| title=Fournier's gangrene: a historical vignette. | journal=Can J Surg | year= 1998 | volume= 41 | issue= 1 | pages= 72 | pmid=9492752 | doi= | pmc=3950066 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9492752 }} </ref>
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| *The detailed description of fournier's gangrene was given by Jean Alfred Fournier, who is a French venereologist in 1883.<ref name="pmid26445600">{{cite journal| author=Chennamsetty A, Khourdaji I, Burks F, Killinger KA| title=Contemporary diagnosis and management of Fournier's gangrene. | journal=Ther Adv Urol | year= 2015 | volume= 7 | issue= 4 | pages= 203-15 | pmid=26445600 | doi=10.1177/1756287215584740 | pmc=4580094 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26445600 }} </ref>
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| ==Classification== | | ==[[Fournier gangrene pathophysiology|Pathophysiology]]== |
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| ==Pathophysiology== | | ==[[Fournier gangrene causes|Causes]]== |
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| ==Causes== | | ==[[Differentiating Fournier gangrene from other diseases|Differentiating Fournier gangrene from other Diseases]]== |
| ===Aetiology===
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| In the majority of cases Fournier gangrene is a mixed infection caused by both [[aerobic]] and [[anaerobic]] bacteria.<ref>{{cite journal |author=Thwaini A, Khan A, Malik A, Cherian J, Barua J, Shergill I, Mammen K |title=Fournier's gangrene and its emergency management |journal=Postgrad Med J |volume=82 |issue=970 |pages=516-9 |year=2006 |id=PMID 16891442}}</ref>
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| ==Differentiating {{PAGENAME}} from Other Diseases== | | ==[[Fournier gangrene epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Epidemiology and Demographics== | | ==[[Fournier gangrene risk factors|Risk Factors]]== |
| ===Incidence===
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| Only 600 cases of Fournier gangrene were reported in the world literature in the ten years since 1996, with most patients in their 60s or 70s with other concurrent illnesses.<ref>{{cite journal |author=Vaz I |title=Fournier gangrene |journal=Trop Doct |volume=36 |issue=4 |pages=203-4 |year=2006 |id=PMID 17034687}}</ref> However, Fournier's gangrene is not a reportable illness, and the condition is not uncommon, especially among diabetic individuals. A similar infection in women has been occasionally described.<ref>{{cite journal |author=Herzog W |title=[Fournier gangrene--also in females?] |journal=Zentralbl Chir |volume=112 |issue=9 |pages=564-76 |year=1987 |id=PMID 2956804}} </ref>
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| In Turkey it was reported that 46% of patients had [[diabetes mellitus]]<ref name="Yanar2006">{{cite journal |author=Yanar H, Taviloglu K, Ertekin C, Guloglu R, Zorba U, Cabioglu N, Baspinar I |title=Fournier's gangrene: risk factors and strategies for management |journal=World J Surg |volume=30 |issue=9 |pages=1750-4 |year=2006 |id=PMID 16927060}}</ref> whilst other studies have identified approximately a third of patients having either diabetes, alcoholism or malnutrition, and 10% having medical immunosuppression (chemotherapy, steroids, malignancy).<ref>{{cite journal |author=Tahmaz L, Erdemir F, Kibar Y, Cosar A, Yalcýn O |title=Fournier's gangrene: report of thirty-three cases and a review of the literature |journal=Int J Urol |volume=13 |issue=7 |pages=960-7 |year=2006 |id=PMID 16882063}}</ref>
| | ==[[Fournier gangrene screening|Screening]]== |
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| ==Risk Factors== | | ==[[Fournier gangrene natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| Common risk factors in the development of fournier's gangrene are:<ref name="pmid2294630">{{cite journal| author=Clayton MD, Fowler JE, Sharifi R, Pearl RK| title=Causes, presentation and survival of fifty-seven patients with necrotizing fasciitis of the male genitalia. | journal=Surg Gynecol Obstet | year= 1990 | volume= 170 | issue= 1 | pages= 49-55 | pmid=2294630 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2294630 }} </ref><ref name="pmid12516849">{{cite journal| author=Morpurgo E, Galandiuk S| title=Fournier's gangrene. | journal=Surg Clin North Am | year= 2002 | volume= 82 | issue= 6 | pages= 1213-24 | pmid=12516849 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12516849 }} </ref><ref name="pmid10584624">{{cite journal| author=Vick R, Carson CC| title=Fournier's disease. | journal=Urol Clin North Am | year= 1999 | volume= 26 | issue= 4 | pages= 841-9 | pmid=10584624 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10584624 }} </ref><ref name="pmid10584624">{{cite journal| author=Vick R, Carson CC| title=Fournier's disease. | journal=Urol Clin North Am | year= 1999 | volume= 26 | issue= 4 | pages= 841-9 | pmid=10584624 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10584624 }} </ref>
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| *Comorbid systemic disorders
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| :*Diabetes mellitus
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| :*Alcohol misuse
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| :*Immunosupression
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| :*Chemotherapy
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| :*Chronic corticosteroid use
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| :*HIV
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| :*Leukemia
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| :*Liver disease
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| :*Debilitating illness
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| :*Malignancy
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| :*Cytotoxic drugs
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| The most common foci of fournier's gangrene include:
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| {| style="border: 0px; font-size: 90%; margin: 3px;" align=center
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| ! style="background: #4479BA; width: 175px;" | {{fontcolor|#FFF|Type of Bursitis}}
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| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Physical examination}}
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| ! style="background: #4479BA; width: 400px;" | {{fontcolor|#FFF|Maneuver}}
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| | style="padding: 5px 5px; background: #F5F5F5;" | '''Subacromial bursitis'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *[[Redness]], [[swelling]], and warmth over the shoulder
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| *Shoulder stiffness
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| *Lateral or anterior shoulder [[tenderness]] on palpation
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| *Reduced active [[range of motion]] (ROM) with decreased elevation, internal rotation and abduction
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Speed’s test (not specific)
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| *Neer’s test (not specific)
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| *Empty beer can test (help to differentiate from supraspinatus [[tendinitis]])
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| *Impingement test (also positive in [[rotator cuff tear|rotator cuff injury]])
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| *Glenohumeral abduction
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| | style="padding: 5px 5px; background: #F5F5F5;" | '''Olecranon bursitis'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *[[Abrasion]] or [[contusion]] of skin (in a case of trauma)
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| *[[Swelling]], at the posterior elbow
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| *Goose egg appearance over the olecranon process
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| *[[Tenderness]] for palpation at the affected site
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| *Systemic inflammatory processes
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| **[[Fever]]
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| **[[Rheumatoid nodules]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| | style="padding: 5px 5px; background: #F5F5F5;" | '''Trochanteric bursitis'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *[[Tenderness]] at lateral hip, aggravated by active and passive external rotation and abduction
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| *Lateral hip pain on direct palpation
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| *Weakness of the hip-abductors
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *Ober's Test (reduced [[range of motion]] was significant)
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| *Resistance test (pain and tenderness with resisting at external rotation)
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| | style="padding: 5px 5px; background: #F5F5F5;" | '''Prepatellar bursitis'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *[[Erythema]] at the affected site (knee)
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| *Ususally very large swelling over the knee
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| *[[Tenderness]] aggravated by bending and stretching the knee
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| *Reduced active [[range of motion]] (ROM)
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| | style="padding: 5px 5px; background: #F5F5F5;" | '''Retrocalcaneal bursitis'''
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| *[[Swelling]] at the back of heel
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| *[[Tenderness]] at the back of heel
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| *Painful ankle [[dorsiflexion]]
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| | style="padding: 5px 5px; background: #F5F5F5;" |
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| |}
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| ==Screening==
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| ==Natural History, Complications, and Prognosis==
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| ==Diagnosis== | | ==Diagnosis== |
| ===Diagnostic Criteria===
| | [[Fournier gangrene diagnostic criteria|Diagnostic criteria]] | [[Fournier gangrene history and symptoms|History and Symptoms]] | [[Fournier gangrene physical examination|Physical Examination]] | [[Fournier gangrene laboratory tests|Laboratory Findings]] | [[Fournier gangrene electrocardiogram|Electrocardiogram]] | [[Fournier gangrene x ray|X-Ray Findings]] | [[Fournier gangrene CT|CT-Scan Findings]] | [[Fournier gangrene MRI|MRI Findings]] | [[Fournier gangrene ultrasound or echocardiography|Echocardiography and Ultrasound]] | [[Fournier gangrene other diagnostic studies|Other Diagnostic Studies]] | [[Fournier gangrene other imaging findings|Other Imaging Findings]] |
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| ===History and Symptoms===
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| ===Physical examination===
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| ====Gallery====
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| =====Genitourinary system=====
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| <gallery>
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| Image: Fournier's_gangrene_01.jpeg|Fournier's gangrene. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=157>
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| Image: Fournier's_gangrene_02.jpeg|Fournier's gangrene. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=157>
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| Image: Fournier's_gangrene_03.jpeg|Fournier's gangrene. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=157>
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| Image: Fournier's_gangrene_04.jpeg|Fournier's gangrene. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=157>
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| Image: Fournier's_gangrene_05.jpeg|Fournier's gangrene. <SMALL><SMALL>''[http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=12 With permission from Dermatology Atlas.]''<ref name="www.atlasdermatologico.com.br">{{Cite web | title = Dermatology Atlas | url = http://www.atlasdermatologico.com.br/disease.jsf?diseaseId=157>
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| </gallery>
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| ===Laboratory Findings===
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| ===Imaging Findings===
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| ===Other Diagnostic Studies===
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| ==Treatment== | | ==Treatment== |
| ===Medical Therapy===
| | [[Fournier gangrene medical therapy|Medical Therapy]] | [[Fournier gangrene surgery|Surgery]] | [[Fournier gangrene primary prevention|Primary Prevention]] | [[Fournier gangrene secondary prevention|Secondary Prevention]] | [[Fournier gangrene cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Fournier gangrene future or investigational therapies|Future or Investigational Therapies]] |
| Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if [[sepsis]] is already present at the time of initial hospital admission.<ref name="Yanar2006"/> | |
| ====Antimicrobial Therapy====
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| * Fournier gangrene<ref>{{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>
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| :* '''If caused by streptococcus species or clostridia'''
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| ::* Preferred regimen: [[Penicillin G]]
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| :* '''Polymicrobial'''
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| ::* Preferred regimen: [[Doripenem]] {{or}} [[imipenem]] {{or}} [[meropenem]]
| | ==Case Studies== |
| :* '''MRSA (methicillin resistant staphylococcus aureus) suspected''' | | [[Fournier gangrene case study one|Case #1]] |
| | | [[Category:Emergency mdicine]] |
| ::* Preferred regimen: [[vancomycin]] {{or}} [[daptomycin]]
| | [[Category:Disease]] |
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| ===Surgery===
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| ===Prevention===
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| ==External links==
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| * {{WhoNamedIt2|synd|2521|Fournier gangrene}} and {{WhoNamedIt|doctor|2209|Jean Alfred Fournier}}
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| ==References==
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| {{reflist|2}}
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| | [[Category:Up-To-Date]] |
| | [[Category:Infectious disease]] |
| | [[Category:Surgery]] |
| | [[Category:Orthopedics]] |
| [[Category:Dermatology]] | | [[Category:Dermatology]] |
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| {{WH}}
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| {{WS}}
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