Necrotising Fasciitis following Intramuscular Injection in a Nigerian Neonate: A case report
Necrotizing fasciitis (NF) is a rare but severe, life-threatening bacterial infection of the fascia, with secondary necrosis of the subcutaneous tissues. Necrotizing fasciitis is caused by an infection of the skin, subcutaneous tissue, and fascia by one or more bacterial organisms, resulting in the death of these tissues. NF is rare in neonates, but it has been reported following omphalitis, balanitis, mastitis, and postoperative complications. The mortality in neonates with necrotizing fasciitis has been reported to be as high as fifty per cent. We report a case of NF in a term male neonate with an intramuscular injection at the left shoulder at birth under suspected septic conditions. The wound swab yielded Escherichia coli and Pseudomonas species, while the blood culture yielded Staphylococcus aureus and Pseudomonas species. The infant received antibiotics, and the wound was debrided. He was discharged after sixteen days of hospitalization. This case is reported to highlight the possible role of injections under septic conditions as a risk for necrotizing fasciitis in the newborn. Health workers are encouraged to ensure aseptic skin preparation before injections.
Mahoning County Public Health: Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy.2014 Available at https://www.mahoninghealth.org/health/necrotizing-fasciitis-a-rare-disease-especially-for-the-healthy/ Accessed on 13 April 2022.
Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg 2014; 1: 36. https://doi.org/10.3389/fsurg.2014.00036
Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg 2014; 51: 344-362. https://doi.org/10.1067/j.cpsurg.2014.06.001
Tang WM, Ho PL, Yau WP, Wong JW, Yip DK. Report of 2 fatal cases of adult necrotizing fasciitis and toxic shock syndrome caused by Streptococcus agalactiae. Clin Infect Dis 2000; 31: E15-17. https://doi.org/10.1086/318148
Hsieh WS, Yang PH, Chao H C, Lai J Y. Neonatal necrotizing fasciitis: a report of three cases and review of the literature. Pediatrics 1999; 103: e53. https://doi.org/10.1542/peds.103.4.e53.
Farrell LD, Karl SR, Davis PK. Postoperative necrotizing fasciitis in children. Pediatrics 1988. 82(6):874-9
Iwata Y, Sato S, Murase Y. Five cases of necrotizing fasciitis: Lack of skin inflammatory signs as a clinical clue for the fulminant type. J Dermatol 2020; 35: 719-725. https://doi.org/10.1111/j.1346-8138.2008.00556.x
Kihiczak GG, Schwartz RA, Kapila R. Necrotizing fasciitis: a deadly infection. J Eur Acad Dermatol Venereol 2006; 20: 365-369. https://doi.org/10.1111/j.1468-3083.2006.01487.x
Sawin RS, Schaller RT, Tapper D, Morgan A, Cahill J. Early recognition of neonatal abdominal wall necrotizing fasciitis. Am J Surg 1994; 167: 481-484. https://doi.org/10.1016/0002-9610(94)90239-9
National Organization for Rare Disorders (NORD). 2018 Rare Disease database. Available at https://rarediseases.org/rare-diseases/necrotizing-fasciitis/ Accessed 10 July 2022
Bakleh M, Wold LE, Mandrekar JN Harmsen WS, Dimashkieh HH, Baddour LM. Correlation of histopathologic findings with clinical outcome in necrotizing fasciitis. Clin Infect Dis 2005; 40: 410-414. https://doi.org/10.1086/427286
Dimitrios V, Charis M, Christina K, Vassilios K, Kriton F, Menelaos K. Sepsis requiring intensive care following intramuscular injections: two case reports. Cases J 2009; 2: 7365. https://doi.org/10.4076/1757-1626-2-7365
Rossi L, Conen D. [Intramuscular injections--an outdated form of administration? 6 cases of Staphylococcus aureus sepsis following intramuscular injections]. Schweiz Med Wochenschr. 1995; 125: 1477-1482.
Moss RL, Musemeche CA, Kosloske AM. Fasciitis in children: prompt recognition and aggressive therapy improve survival. J Pediatr Surg 1996; 31: 1142-1146. https://doi.org/10.1016/s0022-3468(96)90104-9
Hasham DS, Matteucci P, Stanley PRW, Hart NB. Necrotizing fasciitis. BMJ 2005; 330; 830-833. https://doi.org/10.1136/bmj.330.7495.830
Copyright (c) 2022 Annals of Health Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The articles and other materials published in the Annals of Health Research are protected by the Nigerian Copyright laws. The journal owns the copyright over every article, scientific and intellectual materials published in it. However, the journal grants all authors, users and researchers access to the materials published in the journal with the permission to copy, use and distribute the materials contained therein only for academic, scientific and non-commercial purposes.