Fourniers Gangrene: Causes, Symptoms & Treatment

Fournier’s gangrene is a disease associated with fasciitis in the genital and groin areas. Fournier’s gangrene represents a rarely occurring disease caused by infection. The pathologic changes are characterized by necrosis.

What is Fournier’s gangrene?

Fournier’s gangrene represents an infection in the genital area and groin associated with necrosis. It is a serious disease that endangers the life of the patient suffering from Fournier’s gangrene. The cause of the disease is an infection, which is usually a mixed infection. In this case, anaerobic and aerobic bacteria are responsible for the inflammation. The infection spreads from the anus, rectal area, skin or urinary tract. Fournier’s gangrene was first described by and named after the dermatologist Jean Fournier. Basically, Fournier’s gangrene is a specific manifestation of a so-called necrotizing fasciitis. It usually affects the genitalia as well as the perineum. Studies show that Fournier’s gangrene occurs about ten times more often in male patients than in females. In numerous cases, there are links to systemic diseases such as cirrhosis of the liver or diabetes mellitus.

Causes

The causes of Fournier’s gangrene are comparatively well understood. The triggering factor of the disease is usually infection with certain types of bacteria. These pathogens initially affect the urinary tract or colorectal area. Starting from the corresponding areas, the inflammation spreads to the fasciae. In the majority of cases, the causative bacterial germs are streptococci. In addition, mixed infections occur very frequently.

Symptoms, complaints, and signs

Fournier’s gangrene presents with various signs and symptoms of disease in affected individuals. However, a characteristic of Fournier’s gangrene is that the symptoms tend to be nonspecific, especially at the beginning of the disease. As a result, the diagnosis of Fournier’s gangrene may be significantly delayed, which has a negative impact on the prognosis of the disease. The initial signs of Fournier’s gangrene usually consist of pain in the genital and perianal areas. In addition, affected individuals experience uncomfortable itching in the corresponding areas. As Fournier’s gangrene progresses, swollen and reddened sections develop in the region of inflammation. Subsequently, the skin of the affected areas of the body changes, with edematous areas appearing, for example. In addition, gangrenous abnormalities become apparent. In the later course of Fournier’s gangrene, the diseased patients suffer sepsis. This phenomenon results in other general symptoms such as tachycardia and fever. Diagnosis of Fournier’s gangrene at this stage is urgent so that appropriate treatment can be initiated promptly.

Diagnosis

The diagnosis of Fournier’s gangrene is made by considering the presenting clinical symptoms of the individual case. Numerous patients wait too long to consult a physician despite clear symptoms. This makes a rapid diagnosis of Fournier’s gangrene all the more important, so that the course of the disease can be influenced as positively as possible. The first step in diagnosing Fournier’s gangrene is a patient interview. Here, the patient describes his or her symptoms and gives the doctor an insight into his or her general lifestyle. The indication of any existing chronic diseases, such as diabetes mellitus, corroborates the suspicion of Fournier’s gangrene. The physician also asks about and analyzes the patient’s other life circumstances. General risk factors such as obesity, smoking or the consumption of alcohol also play a role. The clinical examination usually begins with a visual examination by the attending physician. He examines the affected areas of the body and, under certain circumstances, takes tissue samples from the skin. In addition, the physician draws blood from the patient and arranges for laboratory analyses to identify specific inflammatory markers and other deviations from normal values. For example, an elevated blood glucose level indicates undetected diabetes mellitus, which in some cases promotes Fournier’s gangrene.

Complications

Complications can occur with Fournier’s gangrene primarily if the disease is not identified early. This occurs because the symptoms of the disease are very general, and in doing so, do not directly lead to Fournier’s gangrene. Delayed diagnosis can lead to secondary diseases. In most cases, patients suffer from pain in the genitals. The affected areas are very itchy and the skin is red. Due to the symptoms, the sexual activity of the patients is restricted, from which mood swings and depression can develop. The affected skin areas can become inflamed. Scratching usually makes the itching worse. If Fournier’s gangrene continues untreated, fever will develop. Treatment must be performed as soon as possible. This requires surgical intervention, during which the necroses are removed. After removal, there are usually no further complications. Usually, the patient has to take antibiotics even after the surgery to avoid inflammation. If Fournier’s gangrene is not treated, death occurs in many cases. If the disease progresses extensively, treatment is ineffective.

When should you see a doctor?

Medical treatment is necessary in any case of Fournier’s gangrene. As a rule, the disease does not heal itself, so an examination by a doctor is always necessary. However, since the symptoms are very unspecific at the beginning of the disease, early diagnosis and treatment often do not take place. A doctor should be consulted if the affected person suffers from pain in the genital area. This pain occurs suddenly and often without any particular reason. Unpleasant itching or redness in this region can also indicate Fournier’s gangrene and should also be examined if they occur over a longer period of time. These are also accompanied by swelling or inflammation. If Fournier’s gangrene is not treated, the affected person may die of blood poisoning in the worst case. Fever or general fatigue may also indicate the disease and should be investigated. Diagnosis and treatment of this condition can usually be done by a urologist. In emergencies or very severe pain, a general practitioner or hospital may also be consulted in this process.

Treatment and therapy

Once Fournier’s gangrene has been diagnosed with certainty, immediate treatment measures are required to counteract further spread of the disease. In the majority of cases, diseased patients undergo surgery to remove the areas of the body affected by necrosis. Often, several operations are possible in order to reach all the pathologically changed areas. At the same time, the individuals receive drug therapy with antibiotics. Clindamycin and meropenem are often the drugs of first choice. The prognosis of the disease depends largely on the stage at which Fournier’s gangrene is diagnosed and adequately treated. However, even for patients with adequate treatment, Fournier’s gangrene is fatal in about one-fifth of all individuals. Basically, mortality in unfavorable cases averages about 67 percent. In this case, rapid therapy with antibiotics and radical removal of the diseased areas by surgical intervention is nearly ineffective.

Outlook and prognosis

Existing Fournier’s gangrene is inflammation of the genital area. The outlook for complete recovery is very much dependent on whether medical or drug treatment is given. At the first symptoms of Fournier’s gangrene, an appropriate doctor should definitely be consulted. This can greatly facilitate the overall course of the disease. With anti-inflammatory drugs, Fournier’s gangrene can be alleviated within a short period of time. After two to three days, there should be a clear and visible improvement. The outlook and prognosis for a complete cure is completely different without professional help. In case of a complete lack of treatment, there is a risk of a dangerous or life-threatening inflammation. Under certain circumstances, the inflammation can spread to the entire genital area, so that it can even lead to the formation of an abscess.In particularly bad cases, this results in blood poisoning, which should urgently be treated by a doctor.

Prevention

Preventive measures of Fournier’s gangrene take into account the favor factors of the development of the disease. This involves, for example, an existing diabetes disease. Nevertheless, successful prevention of Fournier’s gangrene is not always possible, because individuals with weakened health are particularly susceptible to the bacterial germs that cause Fournier’s gangrene.

Follow-up

In most cases of Fournier’s gangrene, there are no measures or options for follow-up care available to the patient. For this reason, the affected person must first rely on direct and medical treatment of Fournier’s gangrene to prevent further necrosis or further complications. Early diagnosis with early treatment always has a positive effect on the course of Fournier’s gangrene and can prevent further complications. In some cases, surgical interventions are necessary, whereby the affected areas are removed. After such an operation, the patient should always rest and avoid unnecessary exertion. Therefore, strenuous activities or other stressful or athletic activities should be refrained from. Furthermore, in case of Fournier’s gangrene, it is also necessary to take antibiotics, and antibiotics should not be taken together with alcohol. Attention must be paid to the exact dosage and intake so that the infection is treated properly. As a rule, the patient with this disease also depends on the support and care of his own family or friends. Since the disease cannot always be cured, it is possible in some cases that there will be a reduced life expectancy of the affected person.

What you can do yourself

Since the triggers of Fournier’s gangrene are skin injury as well as poor immune defense, the affected person should be active in both areas. In everyday life, wounds on the skin should always be treated in a sterile manner. As soon as there are open wounds on the body, they should be cleaned and protected from intruders as well as pathogens. If this does not succeed to a comprehensive degree, a doctor should be consulted. The doctor cleans the wound and ensures sterile wound care. The patient then receives tips and important information on how to change the dressing correctly. To strengthen the body’s defenses, the organism needs a healthy lifestyle. A balanced diet rich in vitamins is necessary for this. Carbohydrates, sugar and animal fats should be reduced. Fiber, fish, and fresh fruits and vegetables support the body. The consumption of stimulants such as nicotine or alcohol should be avoided. Sufficient mineral water brings the fluid balance into equilibrium. In addition, good sleep hygiene and exercise in the fresh air are important for building a stable immune system. Sports activities should be done at regular intervals and overweight and heavy physical stress should be avoided. Since Fournier’s gangrene can have a fatal course, it is necessary for the affected person to contact a physician at the first signs of the disease.