necrotizing fasciitis
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Etiology
- bacterial infection
- risk factors
- varicella lesions
- intramuscular injections, injection drug use
- penetrating trauma
- omphalitis
- dental abscess
- toxic shock
- wound exposure to seawater (Vibrio vulnificus)
Pathology
- necrosis of skin & underlying fascia
- cutaneous nerve destruction[1]
- widespread tissue destruction[7]
* histopathology image[5]
Clinical manifestations
- fever/chills
- 'woody' induration or cellulitis
- pain out of proportion to examination
- edema
- skin discoloration, retiform purpura[1], bullae
- friable superficial fascia[7]
- gray exudate without pus[7]
- vesiculations, ecchymosis, crepitus, anesthesia & necrosis are signs of advanced disease
- in children, the abdominal wall & gluteal regions most commonly involved
- manifestations of sepsis may be present
* images[5]
Laboratory
- complete blood count (CBC) may show leukocytosis
- blood cultures
- chemistry panel may show
- metabolic acidosis
- abnormal liver function tests
- abnormal renal function tests
Radiology
Differential diagnosis
Management
- surgical debridement within 24 hours
- empiric antibiotic coverage:
- coverage for:
- vancomycin, linezolid or daptomycin plus
- pipericillin tazobactam
- imipenem or meropenem
- metronidazole + cetriaxone or a fluoroquinolone[1]
More general terms
Additional terms
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2021.
- ↑ Bingol-Kologlu M et al, Necrotizing fasciitis in children: Diagnostic and therapeutic aspects. J Pediatr Surg 2007 42:1892 PMID: https://www.ncbi.nlm.nih.gov/pubmed/18022442
- ↑ Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007 Mar 1;44(5):705-10. Epub 2007 Jan 22. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17278065
- ↑ Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004 Jul;32(7):1535-41 PMID: https://www.ncbi.nlm.nih.gov/pubmed/15241098
- ↑ 5.0 5.1 5.2 Edlich RF, Bronze MS (images) Medscape: Necrotizing Fasciitis http://emedicine.medscape.com/article/2051157-overview
- ↑ DermNet NZ. Necrotising fasciitis (images) http://www.dermnetnz.org/bacterial/necrotising-fasciitis.html
- ↑ 7.0 7.1 7.2 7.3 Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med 2017; 377:2253-2265. December 7, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29211672 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMra1600673