[Ferocity]

Fournier's gangrene is classified as a "necrotizing fasciitis," which is an infection which necrotizes soft tissue.

Two bacteria are involved in this infection. Bacteria of the anaerobic and aerobic variety are to blame. Anaerobic Clostridia class of bacteria of one species or another is "always," involved along with it's other random bacterial aerobic culprit.

Fournier's is typically seen in the very young or the very old, diabetics, and those who are immunocompromised

When Fournier’s gangrene presents with the fulminating lesions on the scrotum, it'll come with extensive tissue destruction which must be debrided. Obviously, this may the expose the testis to the environment.


here's some additional information:


"Necrotizing fasciitis caused by mixed aerobic-anaerobic bacteria begins with a breach in the integrity of a mucous membrane barrier, such as the mucosa of the gastrointestinal or genitourinary tract. The portal can be a malignancy, a diverticulum, a hemorrhoid, an anal fissure, or a urethral tear. Other predisposing factors include peripheral vascular disease, diabetes mellitus, surgery, and penetrating injury to the abdomen. Leakage into the perineal area results in a syndrome called =====> Fournier’s gangrene, <===== characterized by massive swelling of the scrotum and penis with extension into the perineum or the abdominal wall and the legs. " (pg 1231; Harrison's principles)

"Clostridium perfringens in association with mixed aerobic and anaerobic microbes can cause aggressive life-threatening type I necrotizing fasciitis or Fournier’s gangrene. The treatment of mixed aerobic/anaerobic infection of the abdomen,perineum, or gynecologic organs should be based on Gram’s staining,culture, and antibiotic sensitivity information. Reasonable empiricaltreatment consists of ampicillin or ampicillin/sulbactam combined witheither clindamycin or metronidazole (Table 179-1). Broader gramnegative coverage may be necessary if the patient has recently been hospitalized or treated with antibiotics. Such coverage can be obtained by substituting ticarcillin/clavulanic acid, piperacillin/sulbactam, or apenem antibiotic for ampicillin or by adding a fluoroquinolone or anaminoglycoside to the regimen. Empirical treatment should be givenfor 10–14 days or until the patient’s clinical condition improves." (pg 1398; Harrison's principles)

"Fournier’s gangrene consists of cellulitis involve the scrotum, perineum,and anterior abdominal wall; with mixed anaerobic organisms spreading along deep external fascial planes and causing extensive loss of skin." (pg 1518; Harrison's principles)

“Hyperacute Necrotizing Fasciitis/Myositis (Flesh-Eating Disease) This a fulminant infectious disease, seen most often in the tropics or in conditions with poor hygiene, characterized by widespread necrosis of the superficial fascia and muscle of a limb; if the scrotum, perineum, and abdominal wall are affected, the condition is referred to as Fournier’s gangrene. It may be caused by group A β-hemolytic Streptococcus, methicillin-sensitive S. aureus, Pseudomonas aeruginosa, Vibrio vulnificus, clostridial species (gas gangrene; Chap. 179), or polymicrobial infection with anaerobes and facultative bacteria (Chap. 201); toxins from these bacteria may act as superantigens (Chap. 372e). The port of bacterial entry is usually a trivial cut or skin abrasion, and the source is contact with carriers of the organism. Individuals with diabetes mellitus, immunodeficiency states, or systemic illnesses such as liver failure are most susceptible. Systemic varicella is a predisposing factor in children. The disease presents with swelling, pain, and redness in the involved area followed by a rapid tissue necrosis of fascia and muscle that progresses at an estimated rate of 3 cm/h. Emergency debridement, antibiotics, IV immunoglobulin (IVIg), and even hyperbaric oxygen have been recommended. In progressive or advanced cases, amputation of the affected limb may be necessary to avoid a fatal outcome.” (pg 2958; Harrison's principles)

Works cited:
Kasper, Dennis L., and Tinsley Randolph Harrison. Harrison's Principles of Internal Medicine. McGraw Hill Education, 2015.

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[Noir666]

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