Cervicofacial necrotizing fasciitis among patients attending the Muhimbili National Hospital, Dar es salaam, Tanzania.

Abstract

Background: Cervicofacial Necrotizing Fasciitis (NF) is a rare life threatening infection which characteristically spreads along the fascial planes to involve subcutaneous tissues, fascia, and fat and in late stages it can involve muscles and skin in the head and neck region. The disease carries high rates of morbidity and mortality, and is not frequently initially suspected due to its rarity and misleadingly innocuous presentation. Since the clinical presentations of the disease in the early stages are not specific, it may not be properly diagnosed.

Objective: The main objective of this study was to determine the occurrence, clinic pathological presentation, and management and treatment outcomes of Cervicofacial Necrotizing Fasciitis (NF) among patients attending treatment at the Muhimbili National Hospital (MNH).

Materials and methods: This Prospective descriptive cross-sectional hospital based study was carried at Muhimbili National Hospital (MNH) for one year from May 2012 to April 2013. A total of 42 patients with Cervicofacial NF were included in the study. They were interviewed for demographic information, chief complaints, nature of the symptoms, the duration of the symptoms and the treatment they got before reporting at MNH. Afterwards the patients were examined to assess the general health condition then management was given according to MNH protocol. Data obtained from these patients was analyzed using Statistical Package for Social Sciences SPSS 19.

Results: During this study period, 151 patients reported at MNH with odontogenic infections. Out of these a total of 42 (27.8%) patients met our diagnosis criteria for Cervicofacial NF. Their age ranged from15 to 83 years (mean 43.95, SD ¬+/-16.16). Greater proportion of participants 15 (35.7%) were in the age group 30-39 years. Considering gender, greater proportion of participants were males 31 (73.8%) followed by females 11 (27.2%) with a male to female ratio of 2.8:1. The majority of the patients 26 (61.9%) came from municipals of Dar es Salaam city (Ilala 8, Kinondoni 9, and Temeke 9), whereas 16 (38.1%) of the patients were from upcountry. About 15 (35.7%) patients had one co-existing systemic conditions, which included anemia 5 (11.9%) patients, followed by diabetes mellitus (DM) and malnutrition 4 (9.5%) patients each and HIV positive 2 (4.8%) patients. Three patients had more than one systemic conditions namely HIV + ve and malnutrition 1(2.4%) patient, HIV + ve and anemia 1(2.4%) patient and Diabetes mellitus and anemia 1(2.4%) patient. The study had a mortality rate of 42.9% comprising of 14 (33.3%) males and 4 (9.6%) females.

Conclusion: In this study cervicofacial NF affected all age groups above 10 years with the highest frequency in the 30-39 years age group. More males were affected compared to females. Anaemia, diabetes mellitus and malnutrition were the main co-existing systemic conditions that were found. Cervicofacial NF is a polymicrobial infection that required a combination of antibiotics, surgical measures and management of co-existing systemic conditions to control it. The rather high mortality in this group of patients was mainly attributable to late reporting for appropriate care.