fournier gangrene female
Wet gangrene needs to be treated immediately because it spreads quickly and can be deadly. -, JAMA. Fournier gangrene is a type of necrotizing fasciitis or gangrene affecting the external genitalia or perineum. Necrotizing fasciitis destroys your soft tissues, including your: Fourniers gangrene affects the soft tissues of your scrotum, penis and perineum. The symptoms of Fourniers gangrene often begin with a general feeling of being unwell. While its more common in men, women and children also can get it. Your healthcare provider will evaluate your symptoms and examine your skin. Its a medical emergency that can be fatal without immediate treatment. (2017). Men are 10 times more likely than women to develop Fournier's gangrene. WebFournier gangrene is a type of necrotizing fasciitis or gangrene affecting the external genitalia or perineum. 88 (3): 157-164. It is more likely to occur in diabetics, alcoholics, or those who are immunocompromised. WebFournier gangrene is a polymicrobial, rapidly progressive necrotising fasciitis of the external genitalia, perineum, and perianal region. The infection spreads along the connecting tissue between your skin and underlying muscles. Seeking help without hesitation, as early as possible, can help keep the infection from spreading. Fournier gangrene may be subcategorised by the site of infection: Fournier gangrene of the penis It occurs when bacteria are in the bloodstream. Imaging can aid in defining the extent of disease but must not delay treatment 9. Methods: A few examples include an: Children sometimes get a bacterial infection from circumcision. Treatments for gangrene may include antibiotics, oxygen therapy, and surgery to restore blood flow and remove dead tissue. Female data and statistics are Deep tissue infection of the perineum: Case report and literature review of Fournier gangrene. A 54-year-old female with a significant medical history of hypertension, tobacco dependence, and Type II diabetes presents to the ED complaining of right groin pain. Rarely, the entire penis and scrotum get surgically removed. McGraw Hill; 2019. https://accessmedicine.mhmedical.com. Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. [2] X-rays and ultrasounds may show the presence of gas below the surface of the skin. sharing sensitive information, make sure youre on a federal Hesitating is a big risk. Gangrene often affects the fingers or toes. Fournier's gangrene: Current practices. The most common symptoms of Fournier's gangrene is the graying or blackening of the skin and a foul odor coming from the infection site. It usually affects men, but women also can get it. These organisms tend to make the blood clot, thus depriving tissue of necessary oxygen. Bacteria may invade these dead tissues, causing, Medical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. Conclusion: Other conditions that can initially appear similar to Fourniers gangrene include epididymitis and orchitis. Mallikarjuna, M. N., Vijayakumar, A., Patil, V. S., & Shivswamy, B. S. (2012, December 3). WebFourniers gangrene is an extremely rare but life-threatening bacterial infection of the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels of the perineum. The disease is one of the few urological emergencies and requires prompt surgical debridement as well as antibiotic therapy. Jean Alfred Fournier (1832-1914). It is defined as a necrotizing infection of the perineal, genital, or anorectal region. The longer you wait, the more tissues get infected. Swollen genitals or perineum. Mortality rate during initial admission was 6% for females. Would you like email updates of new search results? Erika Kube, Stanislaw P Stawicki, David P Bahner. DOI: Mallikarjuna MN, et al. The differential in the setting of acute scrotal pain includes: ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Gangrene is where your tissues die because of a lack of blood flow or a bacterial infection. can also occur in women and children. Uppot RN, Levy HM, Patel PH. The infection then progresses rapidly, and your skin develops a reddish-purple color or blue-gray patches. Its a medical emergency that can be fatal without immediate treatment. Bacteria gather in an injury or surgical wound that has no blood supply. The subcutaneous tissue is the deepest layer of your skin. People who are only treated with antibiotics and dont have debridement rarely survive. It is also known as Fournier disease and necrotising fasciitis of the perineum and genitalia. Prompt surgery to completely remove tissue and aggressive antibiotics can reduce the chance of death. The role of imaging, most commonly employing CT, includes: Radiolucent soft-tissue gas may be seen in the region overlying the scrotum or perineum. It often occurs in people with diabetes who unknowingly injure a toe or foot. The faster you get care, the better. Bacteria can spread quickly to other tissues and organs. The typical causes of death are spread of the infection into the bloodstream, which is known as sepsis, kidney failure, or multiple organ failure. There are arteries (blood vessels) within your subcutaneous tissue and muscle fascia. Female data and statistics are Objective: The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Emergency Medicine Residents Association. PMC Fourniers gangrene is rare. perianal abscess, fistula). McGraw Hill; 2019. https://accessmedicine.mhmedical.com. Go to the emergency department if youre experiencing the symptoms of Fourniers gangrene. You wont get this infection from anyone else, and they wont get it from you. Last reviewed by a Cleveland Clinic medical professional on 10/18/2021. Oftentimes, you can reduce your risk for future bruising by making sure you're getting the right. ", National Organization for Rare Diseases: "Fournier Gangrene. Go to the emergency department if your genitals or perineum are red, tender or swollen, and you have either a fever of at least 100.4 degrees Fahrenheit or you feel unwell in general. 12. You can learn more about how we ensure our content is accurate and current by reading our. Fournier's gangrene. Gas gangrene. You could be in the hospital for three to six weeks. This is known as debridement. Also, look back at the "Prevention" section of this article for ways to reduce your risk of Fournier's gangrene. Accessibility Rather, the superficial and deep layers of fibrous tissue, as well as the skin, are typically destroyed. Its a medical emergency that can be fatal without immediate treatment. We link primary sources including studies, scientific references, and statistics within each article and also list them in the resources section at the bottom of our articles. is unclear. Gangrene is referred to as wet if bacteria have infected the tissue. Fournier's gangrene often begins when bacteria enter the genitalia, perineum, or colorectal area through a wound and cause an infection that deprives the infected tissue of oxygen, thus leading to necrosis. [2], Fournier gangrene is a urological emergency requiring intravenous antibiotics and debridement (surgical removal) of dead tissue. Fournier is the name of the French physician who first identified this disease. -, Urol Int. The symptoms of Fourniers gangrene often begin with a general feeling of being unwell. Differences in male and female genital anatomy may be the reason for the rapid spread of infection to the The majority of people who develop Fourniers gangrene are male, but the infection can happen in women. Tender genitals or perineum. Also, a doctor will perform a procedure known as surgical debridement. When diagnostic tests are called for, they may include one or more of the following: Should a diagnosis not be made after these tests, a tissue sample may be taken and examined under a microscope to look for and determine the type of bacterial infection. Sterile technique needs to be followed when dealing with a person who has these wounds. Fournier's gangrene is a rare, life-threatening condition with a high mortality rate. European Journal of Vascular and Endovascular Surgery. [8], Fournier gangrene is usually diagnosed clinically, but laboratory tests and imaging studies are used to confirm diagnosis, determine severity, and predict outcomes. Gangrene occurs when blood flow to a certain area of the body is interrupted. Yoneda A, Fujita F, Tokai H, Ito Y, Haraguchi M, Tajima Y, Kanematsu T. MRI can determine the adequate area for debridement in the case of Fournier's gangrene. Federal government websites often end in .gov or .mil. It's usually a complication of surgery. But Fournier's gangrene is very rare. information and will only use or disclose that information as set forth in our notice of Gangrene commonly affects the arms and legs, including the toes and fingers. Gas gangrene is most commonly caused by bacteria called Clostridium perfringens. Imaging studies may be ordered to rule out other potential causes. Examples of these inhibitors include: Fourniers gangrene is a rare disease. Yeniyol CO, Suelozgen T, Arslan M, Ayder AR. People describe the pain as tender, moderate or severe. Death of your tissues releases bacteria and necrotic tissue byproducts into the bloodstream. Surgery to remove the dead and dying tissue and to confirm the diagnosis. (2012) International journal of critical illness and injury science. Ileus, the absence of normal muscle contractions in your intestines. Without prompt treatment, the infection can spread into the bloodstream and lead to organ failure and death. Youll likely need reconstructive plastic surgery and skin grafts to cover the areas where dead tissue was removed. Katusi J, Stimac G, Benko G, Grubisi I, Soipi S, Dimanovski J. Fournier's Gangrene: 10-Year Experience of a Plastic Surgery and Burns Department at a Tertiary Hospital. WebFourniers gangrene is rare. Necrotizing fasciitis is a serious condition that kills soft tissues, often quickly, including muscles, nerves, and blood vessels. The lack of blood flow causes tissue to die. The following risk factors are associated with Fournier's gangrene in women: A pus-producing bacterial infection (abscess) in the vaginal area A lab technician runs tests to identify microbes and look for signs that can rule out other types of infections. Often the testicles, urethra (tube that allows urine to exit the body), and the chamber inside the penis that fills with blood to produce an erection are not usually affected. You may need to have a body part removed (amputated) to save your life. Doctors will diagnose Fourniers gangrene by first asking a person about their symptoms. WebFourniers gangrene is rare. It is more likely to occur in diabetics, alcoholics, or those who are immunocompromised. 8600 Rockville Pike Can I catch it from a sexual partner? Get useful, helpful and relevant health + wellness information. If the germs that caused the gangrene spread through the body, a condition called septic shock can occur. Fourniers gangrene is a rapidly progressing, tissue-destroying infection on the genitals and nearby areas. Click here for an email preview. In some individuals, the cause of Fourniers gangrene is unknown. Fourniers gangrene is a rapidly progressing, tissue-destroying infection on the genitals and nearby areas. Its usually caused by organisms that are in the gastrointestinal tract. Fewer than two out of every 100,000 males should get this bacterial infection of the scrotum, penis or perineum. The site of the infection is often the external folds of tissue at the entrance to the vagina, known as the labia, and the area between the vagina and rectum, known as the perineum. (2009, July 8). DOI: Kim SY, et al. It is defined as a necrotizing infection of the perineal, genital, or anorectal region. See how one patient learned to manage her weight and diet. Most cases are sparked by a combination of aerobic (requiring air) and anaerobic (living without oxygen) bacteria. WebFournier's Gangrene in Females: Presentation and Management at a Tertiary Center Female patients with FG have greater BMI but similar clinical presentation, microbiologic characteristics and mortality rate compared to men. Any potential source of infection, such as perforated colorectal cancer needs to be sought and the presence or absence reported. Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. Depending on the aggressiveness of the gangrene, amputation may be required. often edematous, with linear hypoechoic fluid streaks interspersed 8, echogenic gas foci in the scrotum are pathognomonic, punctate, hyperechoic inclusions with posterior acoustic shadowing and reverberation artifacts, lacking clear margins, the acoustic shadowing from gas is often described as "dirty", testes and epididymidesspared (due to their separate blood supply), anechoic fluid collections common, represent reactive hydroceles, soft tissue stranding, fascial thickening, extent of disease may be assessed prior to surgery, cause of infection may be apparent (e.g. However, doctors have identified some risk factors that may make a person more likely to have Fourniers gangrene. At the time the article was created Frank Gaillard had no recorded disclosures. Save a life by knowing the signs and the most effective interventions. Female patients had a higher median BMI than males (42.1 vs 33.7 respectively; P = .003). Other studies determined that the number is as high as 50%. See additional information. How long the tissues have been infected or dead. Unauthorized use of these marks is strictly prohibited. 1 Immediate broad spectrum antibiotics and debridement are essential in management. Copyright 2020 Elsevier Inc. All rights reserved. WebThough women rarely develop Fournier's gangrene, destruction usually occurs in the fibrous tissue that makes up the vaginal wall, buttocks, abdominal wall, back, pelvis, and retroperitoneum. They create and support wound healing. The disease is one of the few urological emergencies and requires prompt surgical debridement as well as antibiotic therapy. Your skin might look reddish-purple, then turn to blue-gray and, finally, black when the tissues are dead. Symptoms can include: These symptoms will continue to worsen. MeSH From 1996 to 2008, we prospectively collected data from 38 patients with Fournier's gangrene (12 women, 26 men) and retrospectively analyzed relevant parameters. HIV or Crohn's disease). The female gender is a risk factor for mortality in patients with Fournier's gangrene and is associated with a higher incidence of inflammation of the retroperitoneal space and abdominal cavity. Necrotizing pancreatitis occurs when parts of the pancreas die from lack of blood and oxygen. Singh P, et al. [6], Fournier gangrene is a rare side effect of SGLT2 inhibitors (canagliflozin, dapagliflozin, and empagliflozin),[7] which increase the excretion of glucose in the urine. The Glickman Urological & Kidney Institute offers innovative treatments in urology and kidney medicine, including minimally invasive, scarless options for urologic procedures and medical management of kidney disease. Necrotizing fasciitis, necrotizing cellulitis, and myonecrosis. 6. WebFournier's Gangrene in Females: Presentation and Management at a Tertiary Center Female patients with FG have greater BMI but similar clinical presentation, microbiologic characteristics and mortality rate compared to men. Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health. This infection is fatal in a third or more of people who contract it. Do you have nausea, or have you been vomiting? Some studies concluded that 3% of people who get this type of necrotizing fasciitis will likely die. Take the early symptoms of Fourniers gangrene seriously. FOIA Removal of infected tissue can lead to scarring or the need for reconstructive surgery. WebThe first symptoms of Fourniers gangrene you might notice include: Red genitals or perineum. These include: Seeking quick treatment can reduce the chances of symptoms becoming even more severe. Fourniers gangrene is a rare, life-threatening bacterial infection of your scrotum, penis or perineum (the area between your genitals and rectum). The following risk factors are associated with Fournier's gangrene in women: Other associated conditions and/or events that involve both men and women include: Perineal abscess (when pus collects in the area between the scrotum and the anus in men or between the vulva and anus in women), Immune system deficiencies (e.g. Sorensen, M. D., & Krieger, J. N. (2016). Fournier's gangrene. Get an ambulance or take yourself to the emergency department if you observe symptoms. Signs and symptoms of septic shock include: Gangrene is a serious condition and needs emergency treatment. An infected Bartholin's gland, the two oval glands positioned on each side of the vaginal opening that secrete the fluid that lubricates the vagina. Peritonitis was present in seven group I patients (58.3%) and in two group II patients (7.7%). It is defined as a necrotizing infection of the perineal, genital, or anorectal region. (https://www.fda.gov/drugs/drug-safety-and-availability/fda-warns-about-rare-occurrences-serious-infection-genital-area-sglt2-inhibitors-diabetes), (https://rarediseases.org/rare-diseases/fournier-gangrene/), (https://radiopaedia.org/articles/fournier-gangrene?lang=us). Hospital admissions for Fourniers gangrene are rare, representing less than 0.02 percent of all hospital admissions in the United States. Huang, C.-S. (2017, March 23). Fournier gangrene is usually secondary to perirectal or periurethral infections associated with local trauma, Save a life by knowing the signs and the most effective interventions. Sometimes it's necessary to skip the diagnosis process and go straight to debridement (the removal of damaged tissues from your body). As the condition worsens, the skin may become pale and then turn other colors such as gray or purplish red. Fournier's gangrene is a necrotizing fasciitis that affects the perineal, genital, or perianal regions. Fournier gangrene is necrotizing fasciitis of the perineum. Meleney's gangrene. The tissues may also start to smell foul, which is the result of dying or rotting tissue. Epub 2020 Jun 30. [1] According to one estimate, about 1 in 7,500 people develop this condition, the majority of them men. [5] Another study reported that about one third of patients were alcoholic, diabetic, and malnourished, while another ten percent had been immunosuppressed through chemotherapy, steroids, or malignancy. It is also known as Fournier disease and necrotising fasciitis of the perineum and genitalia. Fournier gangrene is necrotizing fasciitis of the perineum. Fournier gangrene is a medical Hyperbaric oxygen therapy Unauthorized use of these marks is strictly prohibited. The disease is one of the few urological emergencies and requires prompt surgical debridement as well as antibiotic therapy. Fournier gangrene is often fatal. 2003;70(4):286-90 The first symptoms of Fourniers gangrene you might notice include: Additionally, if you have diabetes and notice your glucose is elevated despite taking your insulin as instructed, please contact your healthcare provider. This is a rare type of gangrene. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, http://www.tandfonline.com/doi/abs/10.1080/00365540410017086, https://rarediseases.org/rare-diseases/fournier-gangrene/, http://www.nejm.org/doi/full/10.1056/NEJMicm1609306#t=article, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3518952/, https://www.karger.com/Article/FullText/445695, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2585703/, A safer blood thinner? Here are the signs you may need to see a doctor. Inflammation of your blood vessel linings caused by the infection spreading to the deeper tissues. Swelling, blistering and a wet appearance are common features of wet gangrene. National Organization for Rare Disorders. Urethral obstruction is a blockage somewhere in your urinary tract. The retroperitoneum was involved in seven female patients (58.3%) and four male patients (15.4%). WebAcute cellulitis and erysipelas in adults: Treatment concern is Fournier gangrene, a polymicrobial necrotizing fasciitis of the perineum that can involve the lower abdominal wall, the penis and scrotum in men, and the labia in women. Fourniers gangrene gets worse (progresses) quickly. Additionally, if you have diabetes and notice your glucose is elevated despite taking your insulin as instructed, please contact your healthcare provider. 2. While its more common in men, women and children also can get it. This sound is due to the friction of gas and tissues moving against each other. This site needs JavaScript to work properly. The most common anatomic region of gangrene involvement in females was labia (76%) followed by perineum (55%) and gluteus/buttocks (42%). Check the skin of your genitals and perineum regularly for any redness, tenderness or swelling. Let's look at symptoms and treatments. What you need to know about nail fungal infection. Ideally, the description should reference relevant facias: Critical findings to assess and report is extension of disease into deeper tissues such as intraperitoneal involvement or extension into space of Retzius, as these will alter therapy and require a laparotomy 12. Clostridial diseases. Of the 143 patients treated for FG at our institution, 33 (23%) were female. The pudenal artery that takes blood to your sex organs, to the skin of your perineum and to your scrotal skin. Fournier's gangrene (FG) is a rare and potentially life-threatening surgical condition. Things that can increase the risk of gangrene include: Gangrene can lead to serious complications if it's not immediately treated. WebThough women rarely develop Fournier's gangrene, destruction usually occurs in the fibrous tissue that makes up the vaginal wall, buttocks, abdominal wall, back, pelvis, and retroperitoneum. An official website of the United States government. Talk to your healthcare providers about a timeline. This site needs JavaScript to work properly. Fournier's gangrene as a high-risk disease in females should attract exceeding attention. Fourniers gangrene is a type of necrotizing fasciitis (flesh-eating disease) that affects your scrotum, penis or perineum. A ruptured spleen can be a life threatening condition and requires immediate attention. Urinary extravasation is where your urine fills cavities in your body other than your bladder. 2003;226 (1): 115-7. health information, we will treat all of that information as protected health An official website of the United States government. Again, do your best to notice the symptoms early and get care right away. If you are a Mayo Clinic patient, this could (1998) Journal of neurology, neurosurgery, and psychiatry. WebFournier gangrene is a polymicrobial, rapidly progressive necrotising fasciitis of the external genitalia, perineum, and perianal region. AJR Am J Roentgenol. (2012). Singh A, Ahmed K, Aydin A, Khan MS, Dasgupta P. Fournier's gangrene. Female data and statistics are Fourniers gangrene is most commonly seen in men in their 60s or 70s. People with Fourniers gangrene can have various symptoms, including: You should see a doctor immediately. Disseminated intravascular coagulation: A devastating systemic disorder of special concern with. It was first described by a French professor of dermatology at the University of Paris, and director of the renowned venereal Hospital of St Louis,Jean Alfred Fournier(1832-1914) 6 in 1883. Healthline Media does not provide medical advice, diagnosis, or treatment. Part of your healthcare providers process to diagnose Fourniers gangrene is to ask you questions. It is primarily a clinical diagnosis and definitive treatment, typically consisting of surgical debridement and antibiotics. Decreased quality of life, which can contribute to clinical. It begins as cellulitisthat causes an endarteritis with thrombosis followed by a necrotizing infection that spreads through the fascial planes. The source of infection can usually be identified, most commonly anorectal (such as from a perianal fistula or abscess) and less commonly genitourinary or perineal trauma. Fascia is a type of connective tissue. Originally coined by Jean-Alfred Fournier in the 19th century, FG is noted to affect young men in good health. How long it takes to recover after that is unclear. Fourniers gangrene is a rapidly progressing, tissue-destroying infection on the genitals and nearby areas. When bacteria enter the subcutaneous tissue and muscle fascia, they kill the branches of your pudendal artery. Crepitus (a popping or crackling sound when you rub the sore area). Finally, you might go through hyperbaric oxygen therapy. Thwaini A, et al. Call your health care provider immediately if you have persistent, unexplained pain in any area of your body along with one or more of the following signs and symptoms: There is a problem with Its so dangerous that just a few hours can mean the difference between life and death. Its estimated that 97 people a year develop this condition. It is characterized by scrotum pain and redness with rapid progression to gangrene and sloughing of tissue. Know the symptoms and what to do if you experience them. This is a rare type of gangrene. 61st ed. WebThe female gender is a risk factor for mortality in patients with Fournier's gangrene and is associated with a higher incidence of inflammation of the retroperitoneal space and abdominal cavity. Fournier gangrene is an acute necrotic infection of the scrotum; penis; or perineum. Furr J, et al. Treatments associated with Fourniers gangrene involve immediately starting a person on strong intravenous (IV) antibiotics in an attempt to kill off the infection. Fourniers gangrene is a rapidly progressing, tissue-destroying infection on the genitals and nearby areas. Learn more about these serious fractures, how theyre treated, and what to expect. Differences in male and female genital anatomy may be the reason for the rapid spread of infection to the You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. This content does not have an Arabic version. It is unclear how many females and children get this disease. The https:// ensures that you are connecting to the This type of gangrene involves the genital organs. (2016) Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. It's usually a complication of surgery. Anaerobic microorganisms particularly flourish in oxygen-poor environments and generate enzymes that cause the infection to spread. About 1.6 out of 100,000 males will get Fourniers gangrene. 2019; doi:10.1016/j.ejvs.2019.05.006. There will be an open wound in this region, and bacteria will be present. The extra oxygen helps to keep bacteria from growing, reduces blood vessel damage, and promotes wound healing. -. Fournier's gangrene. Stevens D, et al. Conte MS, et al. Female patients had a higher median BMI than males (42.1 vs 33.7 respectively; P = .003). The bacteria damage blood vessels and produce toxins and enzymes that destroy tissue. MNT is the registered trade mark of Healthline Media. But you can reduce your risk of getting it and, if you do get Fourniers gangrene, there are treatments. WebFourniers gangrene is an extremely rare but life-threatening bacterial infection of the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels of the perineum. Surgery is sometimes the only other option. Simple reconstructive procedures following wound debridement yield satisfactory outcomes in majority of the cases..mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}html.client-js body.skin-minerva .mw-parser-output .mbox-text-span{margin-left:23px!important}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}, While recent case series (n=980) studies have found a mortality rate of 2040%, a large (n=1641) 2009 study reported a mortality rate of 7.5%.
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