David Bliss

Necrotizing fasciitis after Plastibell circumcision

Necrotizing fasciitis is a potentially life-threatening infection of subcutaneous tissues and Scarpas fascia that rarely affects neonates. We report the occurrence of this devastating infection in two neonates after routine Plastibell circumcision. These case reports highlight the presentation and management of this complication after a relatively routine and frequently performed operation. This report also emphasizes the differences between cellulitis and necrotizing fasciitis and suggests strategies for management.

Syndromic surveillance using automated collection of computerized discharge diagnoses

The Syndromic Surveillance Information Collection (SSIC) system aims to facilitate early detection of bioterrorism attacks (with such agents as anthrax, brucellosis, plague, Q fever, tularemia, smallpox, viral encephalitides, hemorrhagic fever, botulism toxins, staphylococcal enterotoxin B, etc.) and early detection of naturally occurring disease outbreaks, including large foodborne disease outbreaks, emerging infections, and pandemic influenza. This is accomplished using automated data collection of visit-level discharge diagnoses from heterogeneous clinical information systems, integrating those data into a common XML (Extensible Markup Language) form, and monitoring the results to detect unusual patterns of illness in the population. The system, operational since January 2001, collects, integrates, and displays data from three emergency department and urgent care (ED/UC) departments and nine primary care clinics by automatically mining data from the information systems of those facilities. With continued development, this system will constitute the foundation of a population-based surveillance system that will facilitate targeted investigation of clinical syndromes under surveillance and allow early detection of unusual clusters of illness compatible with bioterrorism or disease outbreaks.

Necrotizing Fasciitis After Plastibell Circumcision

Necrotizing fasciitis is a potentially life-threatening infection of subcutaneous tissues and Scarpas fascia that rarely affect neonates. We report the occurrence of this devastating infection in two neonates after routine Plastibell circumcision. These case reports highlight the presentation and management of this complication after a relatively routine and frequently performed operation. This report also emphasizes the differences between cellulitis and necrotizing fasciitis and suggests strategies for management. (J Pediatr 1997;131:459-462) Necrotizing fasciitis is a surgical emergency resulting from infection of the subcutaneous tissue and superficial fascia by a variety of bacteria. In the neonatal age group it may have a mortality rate greater than 70% 1 Successful treatment requires accurate diagnosis with early and aggressive debridement of the involved tissue, broad-spectrum intravenous antibiotic coverage, and intensive support care. We report two cases in newborn male infants in whom necrotizing fasciitis developed after Plastibell (Hollister, Libertyville, Ill.) circumcision. These cases illustrate the devastating nature of this type of infection and show how aggressive treatment can lead to a satisfactory outcome. CASE REPORTS