Fournier gangrene

Overview
Fournier gangrene is a type of necrotizing infection (gangrene) usually affecting the male genitals. It is a type of necrotizing fasciitis.

It was first described by Baurienne in 1764 and is named after a French venereologist, Jean-Alfred Fournier following five cases he presented in clinical lectures in 1883.

Aetiology
In the majority of cases Fournier gangrene is a mixed infection caused by both aerobic and anaerobic bacteria.

Incidence
Only 600 cases of Fournier gangrene were reported in the world literature in the ten years since 1996, with most patients in their 60s or 70s with other concurrent illnesses. However, Fournier's gangrene is not a reportable illness, and the condition is not uncommon, especially among diabetic individuals. A similar infection in women has been occasionally described.

In Turkey it was reported that 46% of patients had diabetes mellitus whilst other studies have identified approximately a third of patients having either diabetes, alcoholism or malnutrition, and 10% having medical immunosuppression (chemotherapy, steroids, malignancy).

Treatment
Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of necrotic (dead) tissue. Despite such measures, the mortality rate overall is 40%, but 78% if sepsis is already present at the time of initial hospital admission.