Necrotizing Fasciitis

ALTIN VESELI

What is Necrotizing Fasciitis?

• Hippocrates in the 15th 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_fasciitis

• http://www.cdc.gov/features/necrotizingfasciitis/

• http://www.medscape.com/viewarticle/444061_4

• http://www.medicinenet.com/necrotizing_fasciitis/page3.htm