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Diagnosing Necrotising Fasciitis

Posted Sep 20 2012 5:59am

Flesh Eating Bugs need Faster Diagnosis

Although relatively rare, the condition caused by flesh eating bacteriaA group of organisms too small to be seen with the naked eye, which are usually made up of just a single cell., known as necrotising fasciitisInflammation of a layer of connective tissue causing pain and tenderness. It is usually caused by straining or injuring the tissue around a muscle and most commonly affects the soles of the feet., needs rapid diagnosisThe process of determining which condition a patient may have.. The difficulty is that symptoms are similar infections with less urgent implications - such as cellulitisA bacterial infection of the skin and the tissues beneath it, usually affecting the face, neck or legs. or synovitisInflammation of the membrane that lines a joint capsule.. If incorrectly diagnosed, or the diagnosis is too late the danger is that necrotizing fasciitis can lead to the need for amputation or death, as the infection has been reported to be able to spread at a rate of one centimetre an hour.

Patients diagnosed with necrotizing fasciitis need immediate surgery and debridementThe medical removal of dead or infected tissue to improve the health of the remaining tissue.. In order to rapidly recognise the condition a physical examination is necessary. The researchers report that X-rays, CTThe abbreviation for computed tomography, a scan that generates a series of cross-sectional x-ray images scans and other imaging tests may not detect the disease and are time-consuming.

Other symptoms include:

  • Pain out of proportion to physical findings,
  • feverThe raising of the body temperature above norma, which may be accompanied by symptoms such as shivering, headache and sweating.,
  • hypotension,
  • mental confusion,
  • loss of sensation,
  • skin discoloration,
  • crepitus or necrosisDeath of cells or tissue in the body due to disease, injury or impaired blood supply.

The types of bacteria that can cause necrotizing fasciitis, include:

  • Group A Streptococcus pyogenes 
  • Group B Streptococcus infections. 
  • Clostridium 
  • Methicillin-Resistant Staphylococcus Aureus (MRSA)
  • In some cases, patients can have more than one type of bacteria.

Although there are other predisposing factors around 50% of necrotising fasciitis cases occur in healthy people, and can result from cuts, insect bites, or blunt traumaA physical injury or emotionally painful event.. It has been reported in healthy children after having been hit playing football and then suddenly contracted necrotizing fasciitis. 45% of patients do not recall obvious injuries, such as cuts, scrapes, injections or bruises that may have led to the infections.

If a necrotizing infection is suspected, surgeons agree that immediate surgical exploration should be performed, with debridement of necrotic tissueA group of cells with a similar structure and a specialised function. and drainage of fluid collections, aggressive resuscitation, and broad spectrumHaving a wide range of activity. For example, broad-spectrum antibiotics are effective against a wide range of bacteria. antibioticsMedication to treat infections caused by microbes (organisms that can't be seen with the naked eye), such as bacteria. given. Wound vacuums, negative pressure wound therapy systems or hyperbaric oxygen may also help.

Dr. Russo suggests the development of a combination of tests to rapidly differentiateThe specialisation of cells or tissues for a specific function. between cellulitis and necrotizing fasciitis, and until then, an immediate ultrasoundA diagnostic method in which very high frequency sound waves are passed into the body and the reflective echoes analysed to build a picture of the internal organs – or of the foetus in the uterus. upon patient admission.

"I think if these patients are getting ultrasounds when they hit the door as one of the first tests, you can tell if there is a lot of fluid, pusA pale yellow or green,creamy fluid found at the site of bacterial infection. or gas underneath the skin quickly and rule out cellulitis vs. necrotising fasciitis relatively quickly without needing a CT, an MRIAn abbreviation for magnetic resonance imaging, a technique for imaging the body that uses electromagnetic waves and a strong magnetic field. or a bunch of labs [tests]," he said. "With this disease, time is serious."

source: Science referral

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