Necrotizing Fasciitis: Current Concepts, Pathogensand Management
Journal Title: IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) - Year 2017, Vol 16, Issue 1
Abstract
Necrotizing fasciitis (NF) is a severe disease of sudden onset that spreads rapidly. The disease is more common in the adults and is rare in the children. The infection enters the body through a break in the skin such as cut or burn. Majority of the cases involve methicillin resistant Staphylococcus aureus(MRSA),anaerobic species, Enterobacteriaceae, hemolytic streptococcus group A are isolated alone or in combination. Streptococcal infections also associated with toxic-shock syndrome. Symptoms include inflammation, fever, and fast heart rate, diarrhea, vomiting, and crepitus may be present, discharge of fluid said to resemble “dish water”. Fournier’s gangrene is a form of NF occurring about the male genitals. Gold standard for diagnosis is surgical exploration, with LRINECscore.Patient with a LRINEC score ≥6 have higher rate of mortality and amputation.Medical imaging is helpful to confirm diagnosis. Initial treatment includes a combination of intravenous antibiotics including piperacillin/tazobactam, vancomycin, and clindamycin or ampicillinsulbactam combined with metronidazole, clindamycin or carbapenems(imipenem).Aggressive surgical debridement is always necessary. Amputation of infected limb(s) may be necessary. Ancillary therapies, neither a substitute for surgical debridement nor proven efficacy have been described. Some studies recommend using intravenous immunoglobulin (IVIG).Nutritional support is imperative. High mortality rates if left untreated. High index of suspicion and knowledge is essential for early diagnosis and outcomes of NF.
Authors and Affiliations
Murtaza Mustafa, H. Firdaus, EM. Elllzam, AM. Sharifa, K. Fairrul, RK. Muniandy, A. Nornazirah, MZ. Hud
Keywords
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