Disease Information for Necrotizing fasciitis/mixed: Definition

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  • NECROTIZING FASCIITIS; Patients with NF in whom the diagnosis is obvious generally have a history of the rapid onset of severe pain in a limb, along with malaise and fever; The affected area is red, hot, shiny, swollen, and exquisitely tender, and there may be blue–black discoloration indicative of superficial necrosis near the center, blistering or bullae formation, and edema that extends beyond the margins of skin erythema; Crepitus may be palpable or audible in those patients with NF resulting from gas-forming organisms such as Clostridium spp; The margins of erythema may progress visibly over a matter of hours; Unfortunately, a significant percentage of patients with NF do not present classically, and more than one-third of patients with NF do not have the diagnosis made on their initial visit to a physician or emergency department; In some patients, NF may present as cellulitis; However, the diagnosis of NF is most difficult in the patient who presents with pain but no superficial evidence of infection; Such patients may have severe pain for several days before developing signs of infection at the site; Once evident, necrosis may progress to involve an entire limb within hours; The most important symptom that may aid in diagnosis is pain; Patients with NF often complain of pain out of proportion to that expected on examination, even for those patients who report previous trauma to the area; Depending on the location of the infection, patients with NF without signs of cellulitis may be diagnosed as having muscle strain, gout (or other arthritides), early herpes zoster reactivation, or deep venous thrombosis; Signs and symptoms that should increase the suspicion of NF in the setting of undiagnosed pain are repeat visits to physicians or emergency departments with worsening pain in the absence of a diagnosis, fever, and malaise (“flu-like” symptoms); A left shift in the differential neutrophil count also suggests infection, even if the overall count is normal; Occasionally, usually in patients with erysipelas, severe pain may be present in cellulitis without NF; In this circumstance, abnormal creatine kinase is a useful indicator of deep tissue damage and of the need for surgery to make a diagnosis and debride involved tissue; [Hospital Medicine 2000].

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