Disease Information for Necrotizing fasciitis/Streptococcus

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Clinical Manifestations
Signs & Symptoms
Tachycardia/Fast heart rate
Cutaneous ulcer/Skin ulcer
Local Rubor/Redness
Painful skin ulcer
Spreading edema/skin infection
Bruised/purple extremity
Edema of Arm
Edema of one arm
Edema Upper Extremity
Lower leg pain/unilateral
Swollen Limb
Unilateral arm swelling
Unilateral Arm Swelling in Children
Unilateral Arm Swelling in Elderly
Upper extremity swelling
Numbness one hand
Acutely ill patient/signs
Constitutional symptoms
Large local swollen/red/painful area sign
Localized Edema Swelling
Clinical Presentation & Variations
Presentation/Large Local hot red Swollen extremity/Toxic
Disease Progression
Course/Acute
Course/Acute only
Course/Catastrophic presentation/onset
Course/Fulminant/Precipitous
Course/Slow curve/fast break over 24 hrs
Laboratory Tests
Microbiology & Serology Findings
Microlab/Beta streptococcus/group A isolation/culture
Microlab/Gram positive bacteria
Microlab/Gram positive cocci
Abnormal Lab Findings (Non Measured)
Renal function abnormalities (Lab)
Abnormal Lab Findings - Increased
BUN/Blood urea nitrogen (Lab)
Hemoglobin (Lab)
URINE Hemoglobin
Diagnostic Test Results
Pathology
BX/Muscle biopsy/Fascia thickened/inflammed
X-RAY
Xray/Air/gas in soft tissues
Associated Diseases & Rule outs
Rule Outs
Cellulitis
Erysipelas
Associated Disease & Complications
Anemia
Azotemia/Acute
Hemoglobinuria
Hemolysis anemia/acute/active
Hemolytic anemia of infection/acute
Necrotizing fasciitis syndrome/Streptococcus invasive
Acute Lymphangitis
Disease Synergy - Causes
Synergy/Beta-hemolytic streptococcus
Disease Mechanism & Classification
Specific Agent
AGENT/Anaerobic bacteria (ex)
AGENT/Bacteria (category)
AGENT/Gram positive bacteria (ex)
AGENT/Gram positive cocci (ex)
AGENT/Infection/Purulent/pyogenic/suppurative (ex)
Class
CLASS/Reportable/CDC/National list infection (ex)
CLASS/Subcutaneous/Panniculus tissue disorder
CLASS/Fascia involvement/disorder (ex)
CLASS/Muscle/tendon/extremities (category)
Pathophysiology
Pathophysiology/Anaerobic infection setup
Pathophysiology/Polymicrobial infection process
Pathophysiology/Gangrene/skin/subcutaneous tissue
Pathophysiology/Hemolysis
Pathophysiology/Hemolytic process/effect
Process
PROCESS/Complicating disorder (ex)
PROCESS/Degenerative/necrosis disorder (category)
PROCESS/Infection/agent specific (category)
PROCESS/Inflammatory/infection (ex)
PROCESS/Necrosis (ex)
PROCESS/Reference organ/system (category)
Synonyms
Synonym
Necrotising fasciitis streptococcal, Necrotizing fasciitis streptococcal, Synonym/Invasive Streptococcal disease/group A, Synonym/Synergistic necrotizing cellulitis
Treatment
Drug Therapy - Indication
RX/Ampicillin/sublactam (Unasyn)
RX/Antibiotic
RX/Antibiotic/Combinations
RX/Clindamycin (Cleocin)
RX/Hyperbaric oxygen therapy
RX/Imipenem-cilastin (Primaxin)
RX/Methicillin (Staphcillin)
SX/Fasciotomy/filleting
Surgical Procedures or Treatments
SX/Surgery
SX/Surgical emergency
Other Treatments
TX/Medical/surgical emergency
Definition

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); [Hospital Medicine 2000].

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External Links Related to Necrotizing fasciitis/Streptococcus
Google
Wikipedia
Merck
Images
PubMed (National Library of Medicine)
NGC (National Guideline Clearinghouse)
Medscape (eMedicine)
Harrison's Online (accessmedicine)
NEJM (The New England Journal of Medicine)
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