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Fournier Gangrene: Causes, Symptoms, Risk factors, Treatment, And Prevention

Fournier Gangrene (FG) is a life-threatening flesh-eating disease of the genitals, often referred to as a form of necrotizing fasciitis [1] . The only difference between the two is that necrotizing fasciitis can occur in any part of the body tissue including the genitals but Fournier Gangrene is localized to the perineum or genitals.

This acute necrotic infection of the genitals is mostly found in men of age 60-70 than in women [2] and spreads rapidly infecting the nearby tissues along with it. It is characterised by redness, pain, and sloughing tissues. The first FG was identified in the year 1883 by a French dermatologist named Jean Alfred Fournier after he identified a rapidly growing gangrene in 5 healthy young men with no apparent cause.

Causes Of Fournier Gangrene

Due to excess of sugar in the urine, the genitals of a person become an inviting place for the bacteria. However, the infection doesn't spread right away and needs a cut or a wound to spread. After they find an entry, they enter through it and start spreading. Ultimately, they rot the tissues in the area causing Fournier Gangrene.

Other sources which can lead to the infection and cause FG are as follows:

  • Urinary tract infection
  • Hysterectomies
  • Bladder infections
  • Swollen body tissues containing pus
  • SGLT2 inhibitors, medications for diabetes
  • Chemotherapy
  • HIV
  • Insect bites, especially in children
  • Cirrhosis
  • Genital infections
  • Steroid drugs

Diabetes Drug Can Cause Flesh-Eating Genital Infection, New Study Reveals

Symptoms Of Fournier Gangrene

FG symptoms can range from mild to severe. They are as follows [3] :

  • Swelling in the genitals
  • Itching in the genitals [4]
  • Restlessness
  • Pain in the genitals
  • Foul smell from the genitals
  • Fever
  • Blood clots due to inflammation
  • Septic shock
  • Popping or crackling sound from the infected area

Risk Factors Of Fournier Gangrene

Several factors increase the risk of Fournier gangrene. They are as follows:

  • Diabetes
  • Lupus
  • Chemotherapy
  • Crohn's disease [5]
  • Malnutrition
  • Leukaemia
  • Extreme obesity
  • Immune-suppressing drugs
  • HIV [6]
  • Liver disease
  • Long use of corticosteroid drugs

Complications Of Fournier Gangrene

This disease of the genitals can be very fatal if not treated at an early stage. As the disease spreads, it can raise complications like

  • sepsis [7] ,
  • multiple organ failure, and
  • kidney failure [8] .

Diagnosis Of Fournier Gangrene

At first, the doctor will ask for the symptoms and medical history of the patient suffering from FG. Later, the diagnosis will be is carried out by the following processes:

  • Ultrasound: To rule out other conditions caused due to inflammation.
  • Computed tomography: To determine FG and the cause behind it [9]
  • X-ray: To confirm the location of the infection and quantity of gas distributed in the wound by the infection.
  • Ultrasonography: To detect fluid and gases in the infection.

Treatment Of Fournier Gangrene

Several treatment methods are suggested for FG which are as follows:

  • Antibiotic: Firstly, a strong intravenous antibiotic is prescribed to the patient to kill the bacteria responsible for the spread of the infection [3] .
  • Surgical debridement: A process of cleaning and removing the infected tissues [10]
  • Hyperbaric oxygen therapy: A process in which the infected body part is exposed to 100% oxygen to reduce the growth of bacteria, promotes wound healing, and reduce the damage of blood vessels.
  • Surgery: Surgeries like skin grafting and plastic surgery is recommended to replace the dead tissues via healthy ones [2] .

How To Prevent Fournier Gangrene

Precautionary measures to help prevent FG are as follows:

  • Check regularly for any signs of cuts or wounds on the genitals
  • Wash the genitals with mild soap and warm water if there's any sign of wound or cut
  • Control body weight as it will reduce the symptoms of diabetes which in turn will reduce the intake of SGLT2 inhibitors
  • Quit smoking [11]
  • If you are on SGLT2 inhibitors, talk to a doctor about its side effects
  • Maintain a regular checkup habit
View Article References
  1. [1] Singh, A., Ahmed, K., Aydin, A., Khan, M. S., & Dasgupta, P. (2016). Fournier’s gangrene. A clinical review. Archivio Italiano di Urologia e Andrologia, 88(3), 157-164.
  2. [2] Mallikarjuna, M. N., Vijayakumar, A., Patil, V. S., & Shivswamy, B. S. (2012). Fournier's Gangrene: Current Practices. ISRN surgery, 2012, 942437. doi:10.5402/2012/942437
  3. [3] Bersoff-Matcha, S. J., Chamberlain, C., Cao, C., Kortepeter, C., & Chong, W. H. (2019). Fournier Gangrene Associated With Sodium–Glucose Cotransporter-2 Inhibitors: A Review of Spontaneous Postmarketing Cases. Annals of internal medicine, 170(11), 764-769.
  4. [4] Taken, K., Oncu, M. R., Ergun, M., Eryilmaz, R., Demir, C. Y., Demir, M., & Gunes, M. (2016). Fournier's gangrene: Causes, presentation and survival of sixty-five patients. Pakistan journal of medical sciences, 32(3), 746–750. doi:10.12669/pjms.323.9798
  5. [5] Jiang, T., Covington, J. A., Haile, C. A., Murphy, J. B., Rotolo, F. S., & Lake, A. M. (2000, June). Fournier gangrene associated with Crohn disease. In Mayo Clinic Proceedings(Vol. 75, No. 6, pp. 647-649). Elsevier.
  6. [6] Ngugi, P., Magoha, G., & Nyaga, P. (2014). Fournier's ganrene in the HIV era. African health sciences, 14(4), 1063–1068. doi:10.4314/ahs.v14i4.38
  7. [7] Callaghan, M. A., Baggott, R., & D'Arcy, F. T. (2011). Septic shock due to Fournier's gangrene of the scrotum. BMJ case reports, 2011, bcr0820114634. doi:10.1136/bcr.08.2011.4634
  8. [8] Lee, J. J., Park, H. M., & Kim, J. H. (2016). Fournier's gangrene associated with chronic kidney disease in a dog. The Canadian veterinary journal = La revue veterinaire canadienne, 57(10), 1057–1061.
  9. [9] Amendola, M. A., Casillas, J., Joseph, R., Antun, R., & Galindez, O. (1994). Fournier's gangrene: CT findings. Abdominal imaging, 19(5), 471-474.
  10. [10] Ferretti, M., Saji, A. A., & Phillips, J. (2017). Fournier's Gangrene: A Review and Outcome Comparison from 2009 to 2016. Advances in wound care, 6(9), 289–295. doi:10.1089/wound.2017.0730
  11. [11] Ioannidis, O., Kitsikosta, L., Tatsis, D., Skandalos, I., Cheva, A., Gkioti, A., … Tsalis, K. G. (2017). Fournier's Gangrene: Lessons Learned from Multimodal and Multidisciplinary Management of Perineal Necrotizing Fasciitis. Frontiers in surgery, 4, 36. doi:10.3389/fsurg.2017.00036
  12. [12] Image reference from Woman'