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necrotizing fasciitis.ppt

Necrotizing fasciitis, also known as flesh-eating bacteria, is a life-threatening infection that rapidly spreads along the fascial plane. It is caused by bacteria entering through a break in the skin and can affect the fascia, subcutaneous tissue, and muscles. Risk factors include diabetes, immunosuppression, and poor wound care. Symptoms start as pain and swelling at the wound site and progress to tissue death. Aggressive surgical debridement and intravenous antibiotics are the primary treatments, but mortality rates are high without prompt care.

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NECROTIZING FASCIITIS [flesh eating bacteria]  Is a life-threatening,rapidly spreading infection of fascia with secondary necrosis of subcutaneous tissue  Also known as beta-hemolytic strep gangrene,meleney ulcer,acute dermal gangrene,synergistic necrotizing cellulitis  Moves along fascial plane -speed of spread directly proportional to thickness of subcutaneous layer
 Fournier’s gangrene-is a form of necrotising fasciitis localised to scrotum and perineum.  May spread to abdominal wall
 3 types of NF -Type 1-a polymicrobial flora -Type 2-GABS[group A beta hemolytic strep]most common -Type 3-gas gangrene or clostridial myonecrosis Causative agents can be aerobic,anaerobic or mixed flora
 Organisms involved may include; -bacteroides -clostridium -proteus -pseudomonas -klebsiella -coliforms eg e.coli -peptostreptococcus -enterobacteriaceae
ETIOLOGY  Caused by entry of bacteria through an opening on the skin  Opening can be as small as a paper cut or pinprick or as large as a surgical incision  Can also enter through weakened skin such as a contusion,bruise,blister,an abrasion or insect bite
EPIDEMIOLOGY  M;F ratio is 2-3;1  Age 38-44 years  Children rarely affected
RISK FACTORS  NF has increased frequency in immunocompromised patients eg -diabetes mellitus;20-40% 80 %-F.gangrene -malignancies-neutropenia -alcoholism-35% -vascular insufficiencies -organ transplants,autoimmune deficiency syndrome -HIV -severe illnesses of the heart,liver or lung -IV drug users -steroid use,TB,syph,poor personal hygiene
SIGNS AND SYMPTOMS  Early;within first 24 hrs of infection -increasing pain in general area of a minor cut,abrasion or other skin opening -pain worse than what would be expected from the appearance of the cut or abrasion -Redness and warmth around the wound -flu like symptoms eg fever,dizziness,nausea,diarrhoea,weakness and general malaise -intense thirst due to dehydration
 Advanced symptoms;3-4 days after infection,on site of infection -swelling sometimes accompanied with a rash - multiple discoloured patches develop to produce a large area of gangrenous skin -initial necrosis appears as massive destruction of skin and subcut tissue -normal skin and subcut tissue loosened -large dark marks that become blisters filled with a yellow-green necrotic fluid appear
 Critical symptoms,last stages of NF;4-5 days of infection -30 percent of patients develop hemorrhagic bullae which may cause them to become anaemic -vasculature of skin becomes inflammed and thrombosed resulting in necrotic wounds that look like deep thermal burns -without treatment,secondary involvement of deeper muscles may occur -patients may become numb bcz of nerve damage and progressing gangrene in the infected area
-unconsciousness occurs when the body becomes too weak to fight off infection along with a severe decrease in blood pressure -patient may go into septic shock due to toxin release while contracting high fever,high WBC count and becoming disoriented.This may result in resp,heart and renal failure
Exams and lab tests  Complete blood count  Test for elevated or lowered creatinine,glucose,creatinine phosphokinase,bicarbonate,albumin and calcium levels  X-ray  CT,MRI scanning  Antibiotic culture and sensitivity tests
TREATMENT  Early diagnosis and treatment vital -emergency debridement -amputation in some cases -IV antibiotic treatment,IV immunoglobulin -hyperbaric oxygen therapy for anaerobic organisms -morphine drip or analgesics for pain -soft tissue reconstruction -monitor nutrition,cardiac and resp function -in the case of sepsis,vasoconstricting medication should be administered -blood transfusion in cases of anaemia
PROGNOSIS  20-80% mortality rate depending on patient characteristics such as infection site,pre-existing conditions,time taken to seek medical attention  Strain of bacteria involved- MRSA[methicillin resistant staph aureus] dangerous
PREVENTION  Basic hygienic practices eg washing hands  Keeping all wounds clean  Watch out for signs of infection eg increase in pain,swelling,pus heat or fever  Seek immediate medical attention once you see signs  take precaution if in close contact with someone with the condition
Ddx  Cellulitis  DVT or thrombophlebitis  Osteomyelitis with soft tissue involvement  Pyoderma gangrenosum  Limb ischaemia  compartment syndrome