Flustered By Fournier’s

Public Service Advisory: This post contains graphic images that may disturb some people. Reader discretion is advised.

Last week, I almost made somewhat of a bad call by being too biased towards a diagnosis of filariasis over one of Fournier’s gangrene. Thanks to research and a little of analysis, I came to the conclusion that the latter was the more likely disease entity. If you’re a med student (or somebody who has access to a medical book), a quick skim of the index wouldn’t yield much if you’re checking Harrisson’s Internal Medicine. The book only “discusses” the topic briefly. How brief? Try 2 sentences.

 

In 1883, the French venereologist Jean Alfred Fournier described a series in which 5 previously healthy young men suffered from a rapidly progressive gangrene of the penis and scrotum without apparent cause. This condition, now known as Fournier gangrene, is defined as a polymicrobial necrotizing fasciitis of the perineal, perianal, or genital areas. In contrast to Dr Fournier’s initial description, doctors today know that the disease is not limited to young or male patients, and a causative etiology usually is identified. Source

Yes, you read that right. It’s a disease entity that can potentially part a man from his real bestfriend in a matter of a few days.

Fournier’s disease is a fast-spreading and aggressive infection that eats its way through an immunocompromised body. The people at risk are people with problematic immune systems like people with Acquired Immune Deficiency Syndrome (AIDS), diabetes, those with a history of steroid use and those with certain cancers (i.e. colon, anorectal etc.). It’s a polymicrobial necrotizing fascitis. Let’s break it down to make it easier to grasp. Those three words look and sound pretty daunting when used consecutively.

polymicrobial - it’s an adjective that denotes the influence of multiple pathogens (bugs that make you sick) in a certain disease entity. If an infection is polymicrobial, that might mean that you need to use multiple drugs or those that have a broad spectrum effect to make sure that all of the harmful bacteria get eliminated.

necrotizing - it’s a gerund/adjective that can be used to refer to the process of cell death. Necrosis of course is the death of cells or tissues through injury or disease, especially in a localized area of the body. The prefix necro pertains to death, so if you’re a necrophiliac, that makes you someone who gets really excited in morgues.

fascitis - it’s the inflammation of a the fascia. As a rule of thumb, anything that ends in -itis has something to do with inflammation. Ergo, arthritis is the inflammation of the joints. Carditis is the inflammation of the heart and so on. Almost every solid organ will have it’s -itis term. What’s the fascia? Fascia is a a band or sheath of connective tissue investing, supporting, or binding together internal organs or parts of the body. You have a lot of fascia at the back of your legs - below the butt.

So, what’s polymicrobial necrotizing fascitis? It’s an infection that causes massive cell death due to the invasion of many pathogens in your fascia. This can cause swelling - most notably of the scrotum. In Fournier’s, it’s likely that fever will accompany the infection.

 

This is how Fournier’s gangrene begins. Due to a compromised immune system, opportunistic bacteria find it easy to invade and call the inside of your body home. If you have open lesions in your inguinal area (read: singit), you’re a prime candidate for getting this sort of infection. Once the bacteria gets hold of your fascia, muscles and other internal structure, it would be very hard to shake them off you. Their presence would trigger an immense level of swelling, pain, discomfort and foul smelling things that would ooze out of your open lesions.

The infection will travel fast and if not enough is done, you can easily lose your life in an instant due to septic shock (your body bogs down due to the amount of infection within the body). What can doctors do to save you? Aside from giving you the right antibiotics to fight off the disease-causing organisms, you have to remove the already rotting (necrotic) parts inside the patient’s body. This is done via debridement. The idea is fairly simple - open the patient up, scoop out all the pus and already-dead flesh and close it up to ensure that the infection doesn’t come back.

 

How can you make sure that you won’t get Fournier’s Gangrene?

• Don’t expose yourself to the possibility of being immunocompromised. Practice safe sex and don’t share needles when doing drugs.
• Don’t drink excessive amounts of alcohol. Too much drinking lowers your immune response.
• Don’t get diabetes. Make sure you don’t get fat. :p Get better genes if your family has a strong history of DM. If one of your parents have DM, you have a 50% chance of getting it to. If both Mom and Dad has it, your risk jumps to 80%. Diabetics have low immunity.
• Don’t get cancer. Um… Right. But there are cancers that can be prevented like colon cancer (don’t eat burnt meat) and anorectal cancer (this can also be caused by a sexually-transmitted virus). Chemotherapy and radiation therapy makes one more susceptible to infection.
• Don’t use steroids excessively. Steroids also depress one’s immunity. This might prove hard for asthmatics who depend on steroids as medication.
•  From Dr. Tess Termulo: Another advice would be to to consult a physician immediately if you notice that a wound is getting worse.

It’s essentially a flesh-eating infection. It’s a lot worse than my filariasis hunch.

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