Necrotizing Fasciitis ALTIN VESELI What is Necrotizing Fasciitis

Necrotizing Fasciitis ALTIN VESELI

What is Necrotizing Fasciitis? • Hippocrates in the 15 th century BC, spoke of it as a complication of erysipelas. • Flesh eating bacteria • Group A streptococcus(Streptococcus pyogenes), Staphylococcus aureus, Clostridium perfringens. • Type 1 (Polymicrobial), Type 2 (Monomicrobial)

Erysipelas: Red Skin

How does it work? • Bacteria enter the body through a break in the skin • Paper cuts, Scrape, Burn, Surgical wound. • Progresses very rapidly • Immunosuppressed individuals(diabetics, elderly, liver disease, AIDS, chemotherapy) • Healthy, strong immune system, practice good hygiene and proper wound care.

Diagnosis • The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score • It uses 6 serologic measures: C-reactive protein, total WBC count, hemoglobin, creatinine and glucose. • <6 indicates that necrotizing fasciitis should seriously be considered. • >6 Higher rate of mortality and amputation.

Symptoms • • Similar and difficult to differentiate from cellulitis Severe pain in the affected area. Redness, Swelling, Hot skin Fever, Chills, Fatigue may follow the initial wound or soreness. • Skin discoloration(violet), blisters, discharge of dish-water like fluid.

Patient developed rapidly progressive painful erythema and edema following a bee sting. Necrotizing fasciitis was diagnosed.

Patient in the healing process

Treatment • Early diagnosis=Early treatment • Intravenous antibiotic therapy(piperacillin/tazobactam, vancomycin, and clindamycin) • Intravenous immunoglobulin • Surgery(depridement) • Amputation of affected limb • Hyperbaric oxygen therapy

Notable cases • 2004: Eric Allin Cornell, winner of the 2001 Nobel Prize in Physics, lost his left arm and shoulder to the disease. • 2012: Aimee Copeland, a 24 -year-old graduate student, contracted necrotizing fasciitis after she fell from a zip-line into the Little Tallapoosa River which caused a deep cut in her leg. Copeland’s entire leg was amputated along with her other limbs as a side effect of the disease and treatment. Five of her organs also failed as a result of the ordeal.

References • https: //en. wikipedia. org/wiki/Necrotizing_fa sciitis • http: //www. cdc. gov/features/necrotizingfas ciitis/ • http: //www. medscape. com/viewarticle/444 061_4 • http: //www. medicinenet. com/necrotizing_f asciitis/page 3. htm