7/26/2011

Left Lower Leg

First described by Hippocrates in 5 th centry as a complication from erysipelas "...the erysipelas would quickly spread widely in all directions. Flesh, sinews and bones fell away in large quantities...Fever was sometimes present and sometimes absent...There were many deaths. The course of the disease was the same to whatever part of the body it spread." NECROTIZING FASCIITIS

Incidence (low end) – per year nationally Predisposing factors – immunosuppression, DM, malignancy, drug abuse (IVDU), CKD 50% of patients have hx of skin injury 25% have blunt trauma 70% have one ore more chronic illnesses NECROTIZING FASCIITIS

Systemic signs – fever, tachycardia, hypotension NF more commonly seen in extremities; can be seen on any part of body Other findings include erythema, induration, tenderness, fluctuance, skin necrosis and bullae PHYSICAL DIAGNOSIS

Leukocytosis Elevated BUN and Cr Elevated CK Elevated CRP Hyponatremia commonly seen LAB FINDINGS

Type I – Polymicrobial infection with aerobic and anaerobic bacteria; tends to affect the chronically ill – DM, immuncompromised, etc. Type II – Tends to be Group A Strep and can affects people indiscriminately NECROTIZING FASCIITIS

Implicated organisms Group A Strep S. aureus A. hydrophila E. coli Klebsiella Clostridium perfringens Vibrio vulnificus NECROTIZING FASCIITIS

Immediate surgical consult If you suspect Type I Ampicillin/Sulbactam + Clinda/Metronidazole Can substitute Piperacillin/Tazobactam for Amp/Sul If you suspect Type II Clindamycin and/or Penicillin Vancomycin in areas where community-acquired MRSA is prevalent TREATMENTS

Understand the signs and symptoms that make one suspect necrotizing fasciitis Get appropriate specialists involved quickly – Surgery, ID Recognize higher risk of chronically ill patients to get this disease Know causative organisms and treatments TAKE HOME POINTS