Fournier Gangrene - Causes, Symptoms, and Management

Introduction:

Fournier gangrene is a bacterial infection that can be life-threatening. It is seen among people residing worldwide. It more commonly occurs among males but also in women and children. This condition may occur secondary to perirectal or periurethral infections caused by local trauma, operative procedures, or urinary tract disease.

What Is Fournier Gangrene?

In 1883, Jean Alfred Fournier, a French venereologist, first identified Fournier gangrene. This condition is polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas. A rapidly progressing and tissue-destroying type characterizes this infection. This type of infection occurs in the genitals and nearby areas. It may be rare, but it may be fatal if not treated at the right time.

Gangrene means tissue death due to a lack of blood supply to the tissue or a bacterial infection. Fournier gangrene is considered necrotizing fasciitis (a flesh-eating disease). Necrotizing fasciitis can destroy soft tissues, including blood vessels, muscles, and nerves.

What Are the Causes of Fournier Gangrene?

Fournier gangrene (FG) was considered an idiopathic entity, but after thorough research, it was found that infection was responsible for the cause of this condition. This condition occurs mainly due to perineal or genital skin infections.

The bacteria, fungi, or viruses responsible for Fournier gangrene may enter the body through the colorectal, urogenital, or skin. Some conditions, like urinary tract infections, anorectal abscesses, and surgical instrumentations, may be responsible for causing Fournier gangrene. Occasionally, this condition is seen among those who suffer from everyday ailments, and the reason is still unknown.

There are many reasons and ways for infections to enter the body. Infections may quickly occur among those who have lowered immunity. Some toxins and enzymes produced by a combination of microorganisms may increase the chance of developing the condition.

This condition may occur in people aged eight to 90 years. This condition is more common among males than females. Physicians, especially women, need to recognize the reason.

What Are the Risk Factors for the Development of Fournier Gangrene?

The diseases that weaken the body's immune system are responsible for the development of Fournier gangrene. These are

• Use of immune suppressive drugs as a treatment.

• Lupus.

• Crohn’s disease.

• Human immunodeficiency virus (HIV) infection.

• Chemotherapy.

• Long-term usage of corticosteroid drugs.

• Leukemia.

• Liver disease.

• Malnutrition.

• Obesity.

• Increased age.

What Happens to the Body in Fournier Gangrene?

When bacteria enter the genital areas like the perineum, scrotum, or penis, they infect the subcutaneous tissue and muscle fascia. Subcutaneous tissue is a deeper layer of the skin, and fascia covers other organs, blood vessels, bones, and nerve fibers. The blood vessels in the subcutaneous tissue help transport nutrients and oxygen from the heart to body tissues. The blood vessel called the pudendal artery transports blood to the sexual organs and the skin.

When the bacteria enter the pudendal artery in the subcutaneous tissue, it causes the death of the pudendal artery. Then these bacteria move further and enter the skin and muscles of the perineum, scrotum, and penis. Here, they start destroying the arteries. They can enter other body parts, such as the thighs, stomach, and chest, through fascia. It should be identified and treated as early as possible; otherwise, it may lead to death. It may get worse quickly.

What Are the Symptoms of Fournier Gangrene?

The tissue in the affected area dies and decomposes. The skin may develop reddish-purple or blue-gray patches.

Symptoms of Fournier gangrene include

• Fever.

• Rapid heartbeat.

• General discomfort.

• Pain that is moderate to severe.

• Swelling in the genital and anal areas.

• The smell is observed in the affected tissues.

• Distinct sounds or crepitus can be observed when rubbing the affected area.

• Severe cases may show tissue death in the affected areas and extend to other body parts.

Dangerous symptoms are

• Infections that spread to deeper tissues. This type of infection may cause inflammation of the blood vessel lining, called obliterative endocarditis.

• The development of blood clots may be due to inflammation. Because of this, tissues lose blood supply and die.

• Releasing bacteria and necrotic tissues into the bloodstream leads to septic shock.

• In this condition, the body cannot maintain blood pressure, and organs begin to shut down. Septic shock may lead to death.

Early treatment helps reduce the severity of symptoms before they become worse. This disease is always accompanied by other diseases that weaken the immune system. The diseases that may predispose to Fournier gangrene are diabetes mellitus, obesity, cirrhosis, interference with the blood supply to the pelvis, and many malignancies.

How to Diagnose Fournier Gangrene?

Fournier gangrene can be diagnosed by

• Testing the affected tissue sample for microbes.

• Testing blood for complete blood count, differential, comprehensive metabolic panel (CMP), and lactate to check for increased white blood cells, electrolyte imbalances, septic shock, and arterial blood gas should be done.

• Medical imaging techniques used are

• X-rays are done to determine how far the gas has spread in the soft tissues.

• Ultrasound is done to differentiate Fournier gangrene from epididymitis, or orchitis.

• Computed tomography is done to learn about the body's gases and fluids and the source of infection.

• Magnetic resonance imaging is done to determine gangrene spread and check for blockages in blood vessels.

How to Treat Fournier Gangrene?

Treatment of Fournier gangrene includes

• Varieties of antibiotics to treat underlying bacterial infections.

• A debridement procedure is done to remove dead and dying tissue.

• Many surgeries may be required to remove all dead tissue and stop infection.

Individuals who are treated only with antibiotics rarely survive. Hence, debridement is important to do while treating Fournier gangrene. Other contributing factors like diabetes, the habit of alcohol consumption, and other diseases should also be treated.

Recovery After the Treatment:

Reconstructive plastic surgery may be required to cover the areas where the dead tissue has been removed.

• The use of grafts may have to be done.

• Chronic pain may occur among those who survive treatment for Fournier Gangrene.

• Men may experience sexual difficulties, like painful erections.

Fournier gangrene is a rare and fatal condition. 20 to 30 % of cases are estimated to be fatal. The cause of death may be the spread of infection into the bloodstream. These conditions include sepsis, kidney failure, and multiple organ failure. The chance of death may be reduced by completely removing the affected tissue, and strong antibiotics may be required.

Conclusion:

Fournier gangrene is a rare condition that mostly occurs in males. This condition is very dangerous if not treated early. This may cost a person's life if neglected. Hence, it becomes important to know more about Fournier gangrene. Knowing about it, its causes, symptoms, and management help an individual seek help from healthcare professionals early. Early diagnosis helps in achieving effective treatment. This, in turn, helps achieve a good quality of life.