Select a Community
Are you sure you want to trigger topic in your Anconeus AI algorithm?
You are done for today with this topic.
Would you like to start learning session with this topic items scheduled for future?
Bacteroides fragilis
0%
0/4
Vibrio vulnificus
Group A streptococcus
Methicillin-resistant Staphylococcus aureus
50%
2/4
Clostridium perfringens
Select Answer to see Preferred Response
This patient's presentation is consistent with necrotizing fasciitis. The most common agent for rapidly spreading cellulitis and necrotizing fasciitis is group A streptococcus (GAS). Necrotizing fasciitis is an infection of the skin and subcutaneous tissues that spreads along fascial planes. Most cases are polymicrobial, often involving multiple aerobic and anaerobic organisms. Patients present with severe pain and fever and physical exam is often notable for crepitus if gas-producing bacteria are present (e.g. Clostridium perfringens which would cause gas gangrene). Usatine and Sandy review several dermatological emergencies, including necrotizing fasciitis. They state that necrotizing fasciitis carries a poor prognosis, with an overall mortality rate of 25 percent and 70 percent in those with sepsis. Patients at risk include those with co-morbidities such as diabetes mellitus, vascular disease, alcohol or IV drug abuse, NSAID use, and a history of trauma. They describe that pain that is out of proportion to other physical findings is a classic finding that helps to differentiate necrotizing fasciitis from cellulitis. Misiakos et al. describe the management of necrotizing fasciitis. They state that treatment should include medical management with broad spectrum IV antibiotics as well as surgical intervention with early drainage and debridement. The IV antibiotics chosen depend on the microbiological classification of necrotizing fasciitis however in general the treatment geared to the most common cause, Group A Strep is penicillin. The use of a vacuum-assisted closure system improves recovery by promoting granulation tissue formation and aiding in the cleansing of the wound. Figure A shows an erythematous lower leg that represents an early stage of necrotizing fasciitis. Illustration A shows a more severe presentation of necrotizing fasciitis with widespread erythema and necrosis. Illustration B represents an H&E stained micrograph of tissue with necrotizing fasciitis with necrotic connective tissue between fat lobules. Incorrect answers: Answer 1, 2, 4, 5: Although these are all possible causes of necrotizing fasciitis, group A streptococcus is the most common causative organism.
2.3
(3)
Please Login to add comment