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| '''For patient information on this page, click [[Necrotizing fasciitis (patient information)|here]]''' | | '''For patient information on this page, click [[Necrotizing fasciitis (patient information)|here]]''' |
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| {{CMG}} | | {{CMG}}; {{AE}} {{YK}}, {{CZ}} |
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| '''Associate Editor-In-Chief:''' {{CZ}}
| | {{SK}}NF; Phagadena; Phagadena gangrenosum; Meleney’s gangrene; Hemolytic streptococcal gangrene; Flesh eating bacteria; Hospital gangrene; Acute dermal gangrene; Suppurative fasciitis; Synergistic necrotizing cellulitis; Gangrenous ulcer; Malignant ulcer; Putrid ulcer; Necrotizing erysipelas; Nonclostridial gas gangrene; Bacterial synergistic gangrene |
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| ==[[Necrotizing fasciitis overview|Overview]]== | | ==[[Necrotizing fasciitis overview|Overview]]== |
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| ==[[Necrotizing fasciitis risk factors|Risk Factors]]== | | ==[[Necrotizing fasciitis risk factors|Risk Factors]]== |
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| | ==[[Necrotizing fasciitis screening|Screening]]== |
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| ==[[Necrotizing fasciitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== | | ==[[Necrotizing fasciitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| [[Necrotizing fasciitis history and symptoms| History and Symptoms]] | [[Necrotizing fasciitis physical examination | Physical Examination]] | [[Necrotizing fasciitis laboratory findings|Laboratory Findings]] | [[Necrotizing fasciitis other imaging findings|Other Imaging Findings]] | [[Necrotizing fasciitis other diagnostic studies|Other Diagnostic Studies]] | | [[Necrotizing fasciitis history and symptoms|History and Symptoms]] | [[Necrotizing fasciitis physical examination|Physical Examination]] | [[Necrotizing fasciitis laboratory findings|Laboratory Findings]] | [[Necrotizing fasciitis electrocardiogram|Electrocardiogram]] | [[Necrotizing fasciitis x ray|X Ray]] | [[Necrotizing fasciitis CT|CT]] | [[Necrotizing fasciitis MRI|MRI]] | [[Necrotizing fasciitis ultrasound|Ultrasound]] | [[Necrotizing fasciitis other diagnostic studies|Other Diagnostic Studies]] |
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| ==Treatment== | | ==Treatment== |
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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==
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| 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.
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| ==Other bacterial strains==
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| 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 [[Antibiotic resistance|resistant]] against [[methicillin]], the [[antibiotic]] usually used for treatment (see [[Methicillin-resistant Staphylococcus aureus|Methicillin-resistant ''Staphylococcus aureus'']] for details).
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| “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.
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| ==See also== | | ==See also== |
| * [[Mucormycosis]], a rare fungal infection which can present like necrotizing fasciitis | | * [[Mucormycosis]], a rare fungal infection which can present like necrotizing fasciitis |
| * [[Toxic shock syndrome]] | | * [[Toxic shock syndrome]] |
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| ==References==
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| {{reflist|2}}
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| {{Diseases of the musculoskeletal system and connective tissue}} | | {{Diseases of the musculoskeletal system and connective tissue}} |
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| [[Category:Bacterial diseases]]
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| [[Category:Diseases involving the fasciae]]
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| [[Category:Dermatology]] | | [[Category:Dermatology]] |
| [[Category:Infectious skin diseases]]
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| [[Category:Rheumatology]] | | [[Category:Rheumatology]] |
| [[Category:Infectious Disease Project]] | | [[Category:FinalQCRequired]] |
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| [[de:Nekrotisierende Fasziitis]]
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| [[es:Fascitis necrotizante]]
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| [[fr:Fasciite nécrosante]]
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| [[nl:Necrotiserende fasciitis]]
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| [[tr:Nekrotizan fasiit]]
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