Necrotizing fasciitis (NF), commonly known as flesh-eating disease, is an infection that results in the death of the body's soft tissue.
It is a severe disease of sudden onset that spreads rapidly
The most commonly affected areas are the limbs perineum.
2. Necrotizing fasciitis
Necrotizing fasciitis (NF), commonly known
as flesh-eating disease, is an infection that results
in the death of the body's soft tissue.[3]
It is a severe disease of sudden onset that spreads
rapidly
The most commonly affected areas are
the limbsand perineum.
Necrotizing fasciitis may be prevented with
proper wound care and hand washing.[3] It is
usually treated with surgery to remove the infected
tissueand intravenous antibiotics.[2][3] Often a
combination of antibiotics are used such
as penicillin G, clindamycin, vancomycin,
and gentamicin.
3. CAUSES
Common organisms include Group
A Streptococcus (group A
strep), Klebsiella, Clostridium, Escherichia
coli, Staphylococcus aureus, and Aeromonas
hydrophila, and others. Group A strep is considered the
most common cause of necrotizing fasciitis.
More than 70% of cases are recorded in people with at
least one of the following clinical
situations: immunosuppression,diabetes,
alcoholism/drug abuse/smoking, malignancies, and
chronic systemic diseases. For reasons that are
unclear, it occasionally occurs in people with an
apparently normal general condition.
Vibrio vulnificus, a bacterium found in saltwater, is a
rare cause.
4. Type II is caused by Group
A streptococci (often with a co-
infection of S. aureus), and usually
occurs on the head, neck, arm or legs.
Type III is caused by Vibrio vulnificus,
which enters the skin via puncture
wounds from fish or insects in
seawater.
Type four is due to a fungal infection.
5. Signs and symptoms
inflammation
fever
skin becomes discolored
develops blisters-(a small bubble on the
skin filled with serum)
fast heart rate
Diarrhea and vomiting
Severe pain
purple colored skin in the affected area
6.
7. Pathophysiology
Trauma
Tissue hypoxia
Polymorphonuclear neutrophils or
leukocytes dysfunction
Decreased in oxidation
Proliferation of anaerobic bacteria
Angiothrombotic microbial invasion
Liquefactive necrosis
8. SUBJECTIVE
PT NAME : XXXX
AGE : 48/F
OP : 1709281013
DOA : 4/10/18
CHIFE COMPLINTS : C/O swelling of RT ankle
extending till knee since 5day with pain,dullache,
h/o trauma to 4th toe since 7 days
C/O discharge from swelling since back 7days
On examination :
Necrotic patch present over RT ankle,
surrounding skin is erythromatous(redness of the skin)
swelling extend from ankle to below knee,
clear discharge fluid noticed
Tenderness(pain when an affected area is touched)
12. Day to day progress
DAY -1 : 4/10/2018
Slough covering outerline Wound
Day -2: 5/10/2018
No fresh complaints and amputation of 4th toe
Day-3: 6/10/18
No fresh complaints, debridement With regular aseptic dressing
Day-4: 7/10/18
No fresh complaints
Day-5 : 8/10/18
Slough present, no active discharge
Day-6: 9/10/18
Granulation tissue present and no active discharge, with mild slough
Day -7 : 10/10/18
Same. As on 9/10/18
13. Follow up details
Date Temp Bp PR RS
4/10/18 Af 120/80m
mHg
100/min RR:18/mi
n
5/10/18 Af 110/80m
mHg
96/min BAE+,
NVBS+
6/10/18 Af 120/70m
mHg
90/min “
7/10/18 Af 120/80m
mHg
90/min “
8/10/18 Af 120/80m
mHg
90/min “
9/10/18 Af 110/70m
mHg
80/min “
10/10/18 Af 110/70m
mHg
75/min “
14. Treatment chart
Brand name Generic
name
indications dose ROA Frequ
ency
dates
INJ.
AGUMENTIN
Amoxacillin,
clavulanic
Acid
antibacterial 1.2gm IV 12th hr 4/10-
9/10/18
INJ,TRAMADO
L
Tramadol Relives pain 100mg IV 3hrs 4/10-
10/10/18
T.PAN pantaprazol Gastric
reflex
40mg po OD 4/10-
10/10
INJ Amikacin amikacin Bacteriral
inh
300mg IV 12th hr 6/10-
9/10/18
T.HIFENAC-P Acelofenac inflammation 200mg po OD 4-
6/10/18
CAP. A-Z multivitm Vit D 1.25 PO OD 4-
10/10/18
T.LIZOFOTE Linezolid Inflamation 500mg po OD 8/10-
9/10
15. Pharmacist interventions
LINEZOLID + TRAMADOL
Linezolid and tramadol both increases serotonin levels.
Avoid using.
Linezolid may increses serotonin as a result of MAO-A inhn.
So this drug should be discontinue immediately due to
serotonergic drug and monitor for CNS toxicity.
This drug inc the toxicity of tramadol.
Risk of hypotension, hyperpyrexia, somnolence, or death.
Replacement of that drug suggestion is :
CHYMORAL FORTE
Trypsin+chymotrypsin1TAB 6:1 PO,OD
Indication : this drug used to treat a swelling, blood
clots,pain etc Necrotic tissues, anti-INFLAMMATION,
anti-oxidition,muscle and joint injuries.
![Necrotizing fasciitis
Necrotizing fasciitis (NF), commonly known
as flesh-eating disease, is an infection that results
in the death of the body's soft tissue.[3]
It is a severe disease of sudden onset that spreads
rapidly
The most commonly affected areas are
the limbsand perineum.
Necrotizing fasciitis may be prevented with
proper wound care and hand washing.[3] It is
usually treated with surgery to remove the infected
tissueand intravenous antibiotics.[2][3] Often a
combination of antibiotics are used such
as penicillin G, clindamycin, vancomycin,
and gentamicin.](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)