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| ==Case Studies== | | ==Case Studies== |
| [[Necrotizing fasciitis case study one|Case#1]] | | [[Necrotizing fasciitis case study one|Case#1]] |
| ==Treatment==
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| The diagnosis is confirmed by either [[blood culture]]s or aspiration of [[pus]] from [[Biological tissue|tissue]], but early medical treatment is crucial and often presumptive; thus, antibiotics should be started as soon as this condition is suspected. Initial treatment often includes a combination of intravenous antibiotics including [[penicillin]], [[vancomycin]] and [[clindamycin]]. If necrotizing fasciitis is suspected, surgical exploration is always necessary, often resulting in aggressive [[debridement]] (removal of infected tissue). As in other maladies characterized by massive wounds or tissue destruction, hyperbaric oxygen treatment can be a valuable adjunctive therapy, but is not widely available. [[Amputation]] of the affected organ(s) may be necessary. Repeat explorations usually need to be done to remove additional necrotic tissue. Typically, this leaves a large open wound which often requires skin grafting. The associated systemic inflammatory response is usually profound, and most patients will require monitoring in an [[intensive care unit]].
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| ===Antimicrobial regimen===
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| * Necrotizing fasciitis<ref name="pmid24947530">{{cite journal| author=Stevens DL, Bisno AL, Chambers HF, Dellinger EP, Goldstein EJ, Gorbach SL et al.| title=Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the infectious diseases society of America. | journal=Clin Infect Dis | year= 2014 | volume= 59 | issue= 2 | pages= 147-59 | pmid=24947530 | doi=10.1093/cid/ciu296 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24947530 }} </ref>
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| :* 1. '''Mixed infections'''
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| ::* 1.1 '''Adults'''
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| :::* Preferred regimen (1): [[Piperacillin-tazobactam]] 3.37 g IV q6–8h {{and}} [[Vancomycin]] 30 mg/kg/day IV q12h
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| :::* Note: In case of severe pencillin allergy, use clindamycin or metronidazole with an aminoglycoside or fluoroquinolone
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| :::* Preferred regimen (2): [[Imipenem]]-[[cilastatin]] 1 g IV q6–8h
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| :::* Preferred regimen (3): [[Meropenem]] 1 g IV q8h
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| :::* Preferred regimen (4): [[Ertapenem]] 1 g IV q24h
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| :::* Preferred regimen (5): [[Cefotaxime]] 2 g IV q6h {{and}} [[Metronidazole]] 500 mg IV q6h
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| :::* Preferred regimen (6): [[Cefotaxime]] 2 g IV q6h {{and}} [[Clindamycin]] 600–900 mg IV q8h
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| ::* 1.2 '''Pediatrics'''
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| :::* Preferred regimen (1): [[Piperacillin-tazobactam]] 60–75 mg/kg/dose of the [[Piperacillin]] component IV q6h {{and}} [[Vancomycin]] 10–13 mg/kg/dose IV q8h
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| :::* Note: Severe pencillin allergy, use clindamycin or metronidazole with an aminoglycoside or fluoroquinolone)
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| :::* Preferred regimen (2): [[Meropenem]] 20 mg/kg/dose IV q8h
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| :::* Preferred regimen (3): [[Ertapenem]] 15 mg/kg/dose IV q12h for children 3 months-12 years
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| :::* Preferred regimen (4): [[Cefotaxime]] 50 mg/kg/dose IV q6h {{and}} [[Metronidazole]] 7.5 mg/kg/dose IV q6h
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| :::* Preferred regimen (5): [[Cefotaxime]] 50 mg/kg/dose IV q6h {{and}} [[Clindamycin]] 10–13 mg/kg/dose IV q8h
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| :* 2. '''Streptococcus infection'''
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| ::* 2.1 '''Adults'''
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| :::* Preferred regimen: [[Penicillin]] 2–4 MU IV q4–6h {{and}} [[Clindamycin]] 600–900 mg IV q8h
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| :::* Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
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| ::* 2.2 '''Pediatric'''
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| :::* Preferred regimen: [[Penicillin]] 0.06–0.1 MU/kg/dose IV q6h {{and}} [[Clindamycin]] 10–13 mg/kg/dose IV q8h
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| :::* Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
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| :* 3. '''Staphylococcus aureus'''
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| ::* 3.1 '''Adults'''
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| :::* Preferred regimen (1): [[Nafcillin]] 1–2 g IV q4h
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| :::* Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
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| :::* Preferred regimen (2): [[Oxacillin]] 1–2 g IV q4h
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| :::* Preferred regimen (3): [[Cefazolin]] 1 g IV q8h
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| :::* Preferred regimen (4): [[Vancomycin]] 30 mg/kg/day IV q12h
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| :::* Preferred regimen (5): [[Clindamycin]] 600–900 mg IV q8h
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| ::* '''Pediatrics'''
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| :::* Preferred regimen (1): [[Nafcillin]] 50 mg/kg/dose IV q6h
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| :::* Note: In case of severe pencillin allergy, use vancomycin, linezolid, quinupristin/dalfopristin, daptomycin
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| :::* Preferred regimen (2): [[Oxacillin]] 50 mg/kg/dose IV q6h
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| :::* Preferred regimen (3): [[Cefazolin]] 33 mg/kg/dose IV q8h
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| :::* Preferred regimen (4): [[Vancomycin]] 15 mg/kg/dose IV q6h
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| :::* Preferred regimen (5): [[Clindamycin]] 10–13 mg/kg/dose IV q8h (bacteriostatic; potential cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA)
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| :* 4. '''Clostridium species'''
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| ::* 4.1 '''Adults'''
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| :::* Preferred regimen: [[Clindamycin]] 600–900 mg IV q8h {{and}} [[Penicillin]] 2–4 MU IV q4–6h
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| ::* 4.2 '''Pediatrics'''
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| :::*Preferred regimen: [[Clindamycin]] 10–13 mg/kg/dose IV q8h {{and}} [[Penicillin]] 0.06-0.1 MU/kg/dose IV q6h
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| :* 5. '''Aeromonas hydrophila'''
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| ::* 5.1 '''Adults'''
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| :::* Preferred regimen (1): [[Doxycycline]] 100 mg IV q12h {{and}} [[ciprofloxacin]] 500 mg IV q12h
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| :::* Preferred regimen (2): [[Doxycycline]] 100 mg IV q12h {{and}} [[ceftriaxone]] 1 to 2 g IV q24h
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| ::* 5.2 '''Pediatrics'''
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| :::* Not recommended for children but may need to use in life-threatening situations
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| :* 6. '''Vibrio vulnificus
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| ::* 6.1 '''Adults'''
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| :::* Preferred regimen (1): [[Doxycycline]] 100 mg IV q12h {{and}} [[ceftriaxone]] 1 g IV qid
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| :::* Preferred regimen (2): [[Doxycycline]] 100 mg IV q12h {{and}} [[cefotaxime]] 2 g IV tid
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| ::* 6.2 '''Pediatrics'''
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| :::* Not recommended for children but may need to use in life-threatening situation
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| ==Prognosis== | | ==Prognosis== |
| This disease is one of the fastest-spreading infections known, as it spreads easily across the [[fascia]]l plane within the [[subcutaneous]] tissue. For this reason, it is popularly called the “flesh-eating disease,” and, although rare, it became well-known to the public in the 1990s. Even with today's modern medicine, the [[prognosis]] can be bleak, with a [[mortality rate]] of approximately 25% and severe disfigurement common in survivors. | | This disease is one of the fastest-spreading infections known, as it spreads easily across the [[fascia]]l plane within the [[subcutaneous]] tissue. For this reason, it is popularly called the “flesh-eating disease,” and, although rare, it became well-known to the public in the 1990s. Even with today's modern medicine, the [[prognosis]] can be bleak, with a [[mortality rate]] of approximately 25% and severe disfigurement common in survivors. |
For patient information on this page, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Future or Investigational Therapies
Case Studies
Case#1
Prognosis
This disease is one of the fastest-spreading infections known, as it spreads easily across the fascial plane within the subcutaneous tissue. For this reason, it is popularly called the “flesh-eating disease,” and, although rare, it became well-known to the public in the 1990s. Even with today's modern medicine, the prognosis can be bleak, with a mortality rate of approximately 25% and severe disfigurement common in survivors.
Other bacterial strains
In February 2004, a rarer but even more serious form of the disease has been observed in increasing frequency, with several cases found specifically in California. In these cases, the bacterium causing it was a strain of Staphylococcus aureus (i.e. Staphylococcus, not Streptococcus as stated above) which is resistant against methicillin, the antibiotic usually used for treatment (see Methicillin-resistant Staphylococcus aureus for details).
“Super Strep” appeared in Ohio and Texas in 1992 and 1993 and was contracted by approximately 140 people. It took under 12 hours to incapacitate most and caused 3 days of very high fevers. The death rate in 1993 was reported to be 10%, with a majority of the victims having mild to severe brain damage.
See also
References
Template:Diseases of the musculoskeletal system and connective tissue
de:Nekrotisierende Fasziitis
nl:Necrotiserende fasciitis
Template:WikiDoc Sources