Necrotizing fasciitis in sub-Saharan Africa: A study of 224 cases

Abstract

Background: The aim of this study was to describe the epidemiological, clinical aspects, and outcome of necrotizing fasciitis (NF) in sub-Saharan Africa. Patients and Method: We conducted a descriptive study in hospital dermatology departments in five sub-Saharan African countries over a two-year period (April 2017 to July 2019). Patients over fifteen years of age received for NF were included. Results: During the study period, 224 patients with NF were included. Their mean age was 51.9 ± 18.3 years and their sex ratio (M/F) was 1.3. NF was present in the lower limbs in 88.8% (n = 199) of the patients. The main local signs of NF were cutaneous necrosis (83.9%; n = 188) and spontaneous intense pain (75.9%; n = 170). NSAIDs (32.6%; n = 73), obesity (16.5%; n = 65), the use of decoctions/poultices (21.4%; n = 48), diabetes (16.5%; n = 37), nicotine addiction (11.6%; n = 26), alcoholism (8%; n = 18), voluntary cosmetic depigmentation (6.7%; n = 15), and HIV infection (3.8%; n = 8) were the main comorbidities. We recorded 14.7% (n = 33) of deaths. Conclusion: This study shows that NF of the lower extremities is the most often observed clinical form in sub-Saharan Africa. Some factors or comorbidities (diabetes, obesity, alcoholism, nicotine addiction) seem to be relatively frequent.