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Necrotizing Fasciitis

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SYMPTOMS AND SIGNS
The symptoms of necrotizing fasciitis usually occur within the first 24 hours of infection. They often include a combination of the following: Increasing pain in the general area of a minor cut, abrasion, or other skin opening. Pain that is worse than would be expected from the appearance of the cut or abrasion. Redness and warmth around the wound, though symptoms can begin at other areas of the body. Flu-like symptoms such as diarrhea, nausea, fever, dizziness, weakness, and general malaise. Intense thirst due to dehydration.
More advanced symptoms occur around the painful infection site within three to four days of infection. They include: Swelling, possibly accompanied by a purplish rash. Large, violet-colored marks that transform into blisters filled with dark, foul-smelling fluid. Discoloration, peeling, and flakiness as tissue death (gangrene) occurs.
Critical symptoms, which often occur within four to five days of infection, include: severe drop in blood pressure toxic shock unconsciousness
HOW IS IT DIA GNOSED ?
Necrotizing fasciitis progresses very rapidly, making early diagnosis crucial.Unfortunately, that does not always occur. The early symptoms of an infection with flesh-eating bacteria are similar to other conditions like the flu or a less serious skin infection. The early symptoms are also similar to common post-surgical complaints, such as: severe pain , inflammation , fever, and nausea. Diagnosis is often based on advanced symptoms, such as the presence of gas bubbles under the skin. Laboratory analysis of fluid and tissue samples is done to identify the particular bacteria that are causing the infection. Treatment, however, begins before the bacteria are identified. Household members and others who have had close contact with someone with necrotizing fasciitis should be evaluated if they develop symptoms of an infection

TREATMENT

Patients infected with flesh-eating bacteria will undergo several types of treatment. The extent of treatment depends on the stage of the disease when treatment is started. The treatment includes: Intravenous antibiotic therapy. Surgery to remove damaged or dead tissue in order to stop the spread of infection. Medications to raise blood pressure. Amputations of affected limbs, in some cases. Hyperbaric oxygen therapy may be recommended to preserve healthy tissue. Cardiac monitoring and breathing aids. Blood transfusions. Intravenous immunoglobulin. This supports the body's ability to fight infection. HOW IS IT PREVENTED Necrotizing fasciitis does not begin unless an infection has already started in tissue; immediate effective treatment of any infection is likely to prevent the disease. Further, anything that can help prevent infections will help prevent necrotizing fasciitis. Practices such as hand washing, checking extremities for cuts or wounds if you have diabetes, avoiding physical contact with people who carry MRSA, and good hygiene practices help prevent initial infections that may lead to flesh-eating disease. Immunosuppressed patients should be very careful not to get infections, and people with liver disease should avoid eating seafood that may be contaminated with Vibrio vulnificus. People with liver disease should not have any infections or cuts in the skin exposed to warm seawater to avoid necrotizing fasciitis caused by Vibrio vulnificus. Physicians, surgeons, and other caregivers play an important role in prevention. Cases of necrotizing fasciitis may occur when surgical sites become infected. Consequently, physicians need to use sterile techniques when doing surgery and adhere to hospital practices such as glove and gown coverage to help prevent infection spread in hospitalized patients. Careful surgical techniques in sites that can easily become contaminated are required. Some examples of such sites are bowel surgery, episiotomy (surgically enlarging the vaginal outlet), and debridement with closure of traumatic wounds. |
IS IT CONTAGOIUS

Necrotizing fasciitis is not usually contagious. However, it is possible for uninfected people to physically come into contact with some patients with the disease and become infected with an organism that may eventually cause necrotizing fasciitis. For example, a person could come in contact with a lesion containing MRSA organisms causing or contributing to the disease in another person and then become infected with MRSA. Transmission from one person to another usually requires direct contact with a patient or some item that can transfer organisms like MRSA to another person's skin; infection usually requires a skin break (cut or abrasion) for the organisms to establish an infection. |
THE PROGNOSIS

The prognosis for patients with necrotizing fasciitis depends on many factors, including patient age, underlying medical problems, the causative organisms, extent and location of infection, as well as the time course of diagnosis and initiation of treatment. Early diagnosis and aggressive surgical and medical treatment are the most important factors in determining outcome. Necrotizing fasciitis is a life- and limb-threatening condition that carries a poor prognosis if left untreated. Complications and potential results may include limb loss, scarring, disfigurement, and disability, with many patients going on to develop sepsis, multisystem organ failure, and death. Combined morbidity and mortality rates have been reported to be between 70%-80%. Mortality rates may range anywhere between 6%-76%. |…...

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