Nekrotiserande fasciit

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  • Nekrotiserande fasciit symtom
  • Nekrotiserande fasciit dödlighet

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    Necrotizing fasciitis

    Infection that results in the death of the body's soft tissue

    Medical condition

    Necrotizing fasciitis
    Other namesFlesh-eating bacteria, flesh-eating bacteria syndrome,[1] necrotizing soft tissue infection (NSTI),[2] fasciitis necroticans
    Person with necrotizing fasciitis. The left leg shows extensive redness and tissue death.
    Pronunciation
    SpecialtyInfectious disease
    SymptomsSevere pain, fever, purple colored skin in the affected area[3]
    Usual onsetSudden, spreads rapidly[3]
    CausesMultiple types of bacteria,[4] occasional fungus[5]
    Risk factorsPoor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, peripheral artery disease[2][3]
    Diagnostic methodBased on symptoms, medical imaging[4]
    Differential diagnosisCellulitis, pyomyositis, gas gangrene, toxic chock syndrome or toxic shock-like syndrome, pyoderma gangrenosum, deep vein thrombosis, Mucormycosis, brown recluse spider bite[6]
    PreventionWound care, handwashing[3]
    TreatmentSurgery to remove

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    Necrotising fasciitis

    Necrotising fasciitis — extra information

    Infections


    Author: Vanessa Ngan, Staff Writer, Updated by Dr Jannet Gomez, Postgraduate Student in Clinical Dermatology, Queen Mary University London, United Kingdom; Chief Editor: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, February   

    Introduction
    Causes
    Pathophysiology
    Clinical features
    Diagnosis
    Treatment
    Outcome

    What is necrotising fasciitis?

    Necrotising fasciitis is a very serious bacterialinfection of the soft tissue and fascia. The bacteria multiply and release toxins and enzymes that result in thrombosis in the blood vessels. The result is the destruction of the soft tissues and fascia.

    The main types of necrotising fasciitis are:

    • Type I (polymicrobial ie, more than one bacteria involved)
    • Type II (due to haemolytic group A streptococcus, and/or staphylococci including methicillin-resistant strains/MRSA)
    • Type III (gas gangrene eg, due to clostridium)
    • Other: marine organisms (vibrio species, Aeromonas hydrophila, considered Type III in some reports) and fungal infections (candida and zygomycetes, type IV in some reports).

    Type I necrotising

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    Principer som beskrivs i behandlingsöversikten Sepsis och septisk chock tillämpas. Ofta krävs intensivvård initialt.

    Medicinsk behandling

    • Antibiotika skall sättas in omedelbart

      • Vid fokus från huden:
        bensylpenicillin 3 g x 3 + klindamycin (Dalacin) mg x 3 i.v. Fortsätt med denna behandling om snabbtest för streptokocker utfaller positivt.

      • Vid fokus från gastrointestinalkanalen, perianalt eller mediastinum:
        karbapenem (Meronem, Meropenem 0, g x 3, Tienam 0, g x ) eller piperacillin/tazobactam g x i.v.

      • Vid septisk chock tillägg av tobramycin (Nebcina) mg/kg x 1, i.v. (doserna och doseringsintervall anpassas till njurfunktionen och de högre doserna används vid septisk chock).

      • Om samband finns med utomhusbad på sensommaren och misstanke om badsårsfeber ges cefalosporiner, t ex cefotaxim 1 g x 3 eventuellt i kombination med ciprofloxacin eller doxycyklin.

    • Intravenöst gammaglobulin
      Vid misstanke om allvarlig streptokockinfektion ges gammaglobulin (Gammagard, Octagam, Kiovig, Privigen, Intratect, Gamunex, Flebogamma, Panzyga) 1 g/kg (vid vikt över 50 kg brukar jag rekommendera 50 g) i.v. vid inkomsten.

      Om kvarstående septisk chock och fortsatt behov av inot

    • nekrotiserande fasciit