(Necrotizing fasciitis or cellulitis)
Necrotizing subcutaneous infection (NSI) is typically caused by an aerobic-anaerobic mixed flora, leading to the subcutaneous tissue necrosis, usually including the fascia. This infection usually occurs in the extremities and perineum. The affected tissue is flushed, overheated and swollen, reminiscent of a severe cellulitis (cellulitis) and the pain develop disproportionately to the clinical findings. Unless treated early, creating a gangrene. Patients are acutely ill. The diagnosis is made on history and physical examination and confirmed by the detection of an overwhelming infection. Treatment includes surgical removal and the administration of antibiotics. The prognosis is poor without early, aggressive therapy.
Necrotizing subcutaneous infection (NSI) is typically caused by an aerobic-anaerobic mixed flora, leading to the subcutaneous tissue necrosis, usually including the fascia. This infection usually occurs in the extremities and perineum. The affected tissue is flushed, overheated and swollen, reminiscent of a severe cellulitis (cellulitis) and the pain develop disproportionately to the clinical findings. Unless treated early, creating a gangrene. Patients are acutely ill. The diagnosis is made on history and physical examination and confirmed by the detection of an overwhelming infection. Treatment includes surgical removal and the administration of antibiotics. The prognosis is poor without early, aggressive therapy. Etiology The NSI is typically a result of infection with group A streptococci (z. B. Streptococcus pyogenes) or an aerobic-anaerobic mixed flora (z. B. Bacteroides sp.). These pathogens enter mostly of an ulcer, by an infection or after injury in the subcutaneous tissue. Streptococci can be spent on the blood from another site of infection there. The perineal participation (also called Fournier gangrene) is usually a complication of a recently conducted operation, a Perirektalabszesses, an infection of the periurethral glands or a Retroperitonealinfektion in organ perforation in the abdomen. In diabetic patients, there is a particularly high risk of NSI. Pathophysiology NSI performs extensive occlusion of small vessels subcutaneous tissue ischemia. The vascular occlusion leads to skin necrosis and infarction which favor the growth of obligate anaerobes (z. B. Bacteroides), while promoting the anaerobic metabolism leads the facultative organisms (eg., Escherichia coli) to gangrene. In the anaerobic metabolism hydrogen and nitrogen arise quite insoluble gases which may accumulate in the subcutaneous tissue. Symptoms and complaints main symptom is severe pain. In patients with normal sensation pain that is disproportionate to the clinical findings may represent an early indication. In areas that are denervated as part of a peripheral neuropathy, the pain can however be only slightly or completely absent. The affected tissue is flushed, overheated and swollen and discolored rapidly. Bullae, crepitus (caused by the gas in the soft tissue) and gangrene may develop. The subcutaneous tissue (incl. The adjacent fascia) necrosis with extensive undermining of the surrounding tissue. The muscles are initially spared. Patients are acutely ill with high fever, tachycardia, changes in vigilance from confusion to consciousness disturbance and hypotension. Bacteremia or sepsis may be present in the patients and require aggressive hemodynamic support. Streptococcal toxic shock syndrome can develop. Diagnosis Clinical examination of blood and wound cultures Diagnosis is made by history and physical examination and will be visible gas accumulation in soft tissue, the positive blood cultures and the deterioration of metabolic and hemodynamic status by leukocytosis, the x-ray. Necrotizing subcutaneous infection CHRIS BJORN BERG / SCIENCE PHOTO LIBRARY var model = {thumbnailUrl: ‘/-/media/manual/professional/images/m1600045_necrotizing_subcutaneous_infection_science_photo_library_high_de.jpg?la=de&thn=0&mw=350’ imageUrl: ‘/ – / media / manual / ? professional / images / m1600045_necrotizing_subcutaneous_infection_science_photo_library_high_de.jpg lang = en & thn = 0 ‘, title:’ Necrotizing subcutaneous infection ‘, description:’ u003Ca id = “v37894490 ” class = “”anchor “” u003e u003c / a u003e u003cdiv class = “”para “” u003e u003cp u003eBei this artificially colored X-ray image of the salient finding is the presence of “”soft tissue gas “”