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Introductions and conclusions are important components of any essay. They work to book-end the argument made in the body paragraphs by first explaining.

The team is also analysing patient records and samples from several countries to identify the best treatments. The Infect project studies severe soft tissue infections, such as necrotising fasciitis, to shed new light on the factors that cause them. They can be triggered by very common bacteria, which may be living on our skin or in our throat. Very minor injuries — a paper cut, or even a bruise — can enable the bacteria to make their way into the flesh.

What happens next depends both on the host and on the pathogen. Infection, if it does develop, may be mild. Then again, it could be disastrous. This is a general explanation, but there is still a lot to learn, Norrby-Teglund explains. Infect intends to generate new knowledge.

Information and biological material from patients identified by doctors involved in the project are enabling the team to study how the disease evolved in a large number of cases, in a bid to identify key specificities of pathogens and patients. In order to facilitate studies in the lab, the team has found a way to grow human tissue from skin cells.

Necrotizing Fasciitis: Early Detection May Save Your Patient's Limb | CE Article | NursingCenter

NSTIs are aggressive infections that rampage under the skin, gaining ground with every minute. And yet, in the initial stages, there may not be much to see.


  • Introduction.
  • passive voice in college essays.
  • Necrotizing Fasciitis Diagnoses and Therapy.
  • montaigne essays on vanity;
  • A case report and literature review.

Patients feel extremely unwell, but none of the symptoms are necessarily a clear indicator of the ongoing tissue destruction. When the patients come in, it can be hard to diagnose them as some only have vague flu-like symptoms. Other than that, doctors may not have a lot to go on.


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  • Necrotizing Fasciitis: Early Detection May Save Your Patient's Limb.
  • Current Concepts in the Management of Necrotizing Fasciitis.
  • Necrotizing Fasciitis: Background, Pathophysiology, Etiology.
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And yet, urgent treatment is needed to tackle an NSTI. Usually, it involves immediate antibiotic treatment and surgery to remove the infected flesh. Infect is developing diagnostic tests that can help hospitals to identify NSTIs much earlier than current approaches, pre-empting any delays to prompt treatment. These kits, which will test for all the various patient and pathogen specificities that Infect identifies as particular risk factors, will enable doctors to assess samples within 30 minutes, Norrby-Teglund notes.

With the current progress of the Infect project these powerful diagnostic tools are likely to be available by the time the project ends in December In addition, the partners intend to identify the most effective treatments and provide evidence-based guidelines. Greater awareness could also help to reduce the death toll, and Infect is doing its bit to spread the word. NSTIs may be rare, but they do exist, and patients and medical staff need to know more about them, Norrby-Teglund concludes.

You have selected several articles. The conversion to PDF could take some time Thank you for your patience. Notes : To restrict search results to articles in the Information Centre, i. After searching, you can expand the results to include the whole Research and Innovation web site, or another section of it, or all Europa, afterwards without searching again.

Please note that new content may take a few days to be indexed by the search engine and therefore to appear in the results. Skip to main content. Early-stage NF can be challenging for physicians due to a lack of typical cutaneous features and sometimes deceiving laboratory findings, and are therefore frequently misdiagnosed as cellulitis or abscess. This study describes a successfully treated case of NF after a routine clean surgery of right distal radius bone plate removal.

The extensiveness of NF's rapid progression in the present case has perhaps not been previously reported. The present study aims to emphasize the possible risk of NF after a minor sterile surgery and highlight that physicians must stay vigilant to make early diagnosis and timely treatment of this disease to ensure a successful outcome. This study discusses and summarizes the clinical experience in diagnosing and treating NF, supplemented by current concept and management in previous studies. The patient agreed with potential publication of his case and signed the patient consent.

A year-old man, who had no comorbidity and experienced no discomfort, underwent a clean removal of right distal radius bone plate for his personal demand in a regional hospital 66 days ago Fig. Preventive antibiotic drug was used preoperatively and no nonsteroidal anti-inflammatory drug NSAID was used postoperatively. However, 12 hours after the surgery, the patient claimed numbness and intense pain visual analogue scale [VAS] 9—10 , with redness and swelling observed in the operation area.

His vital signs were normal. He was diagnosed with compartment syndrome and underwent incision and decompression of his right forearm within 24 hours after the initial surgery Fig. During the surgery, few limpid liquids were observed subcutaneously, and the anterior muscular group was exposed, with no necrotizing tissue found. However, the patient did not get any relief from pain in his right forearm, and the swelling extended to his right arm. He was therefore transferred to the emergency department of our hospital on the third postoperative day.

His physical examination revealed a large surgical cut on the volar side by previous incision and decompression, exposing a slightly dark-colored anterior muscular group of forearms Fig. His right radius fingers presented passive dragalgia, with a palpable right radius artery. His right upper arm had swelling and redness but without pressing pain. The laboratory examination revealed an abnormal white blood cell count WCC of 1.

Computerized tomography CT displayed swelling of soft tissue in right thoracic walls and fluid collection in the muscle space Fig. Compartment syndrome was excluded. Initial diagnoses were skin infection such as cellulitis and abscess, whereas NF was also suspected, and the patient received an empirical antibiotic therapy of intravenous cefonicid sodium 2 g BID for 3 days.

NSAID was added but his pain relief is only temporary. Other supporting management included treatment to prevent septic shock, anemia, metabolic acidosis, electrolyte imbalance, and multiple organ failure. On the fourth day, surgical debridement was performed to remove the obviously swollen tissue in his right forearm under local anesthesia, with vacuum sealing drainage VSD applied to the wound surface to help drain the fluid.

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During the operation, few light-colored liquids were observed, without pus. The fascia was noted to be slightly grayish. These finding suggested fasciitis, whereas cellulitis was less likely.

Postoperatively, the patient's condition continued to deteriorate. The swelling and redness extended to his right neck, thorax, and dorsum, accompanied with prominent local tension blisters. Laboratory tests exhibited continuous declination of the PLT and increasing inflammatory markers. On the fifth day, the swelling continued to extend. Laboratory examinations exhibited a further declined PLT and increased inflammatory markers. Serum lactate was tested 4. The magnetic resonance imaging MRI displayed obvious soft tissue swelling in the right forearm and thoracic walls, as well as emphysema in the neck and mediastinum Fig.

Group consultation of multisector doctors concluded a high possibility of NF, based on the evidences so far: clinical manifestations including alarming sign of disproportionately strong pain, local tension blisters, and rapid progression; laboratory examinations including an increased serum lactate despite a lesser LRINEC score; and CT and MRI showing soft tissue swelling. The antibiotic drug was changed to vancomycin 1 g TID and meropenem 1 g BID , with the use of intravenous gamma globulin 10 g QD for 2 day and methylprednisolone hormone 80 mg QD for 3 days.

An incision and subsequent decompression were performed in the area of the right neck, subclavius, thoracic walls, and hypochondrium. During the operation, limpid and light-colored yellow liquid between fascia and subcutaneous tissue was observed, without obvious gas, pus, or necrotizing tissue. The catheter was retained in place for head and neck drainage and VSD for other regions.

The patient was transferred to the surgical intensive care unit SICU postoperatively for a hour monitoring. The follow-up debridement was well prepared. On the sixth day, the cutaneous swelling appeared in the head and neck despite incision and decompression performed on the previous day. He experienced intense pain VAS 8—10 in the region, a hoarse throat, and dyspnea, with difficulty in opening his eyes and mouth.


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  • Necrotizing Fasciitis: Early Detection May Save Your Patient's Limb;
  • Highlights.

An urgent surgical debridement was performed in the infraorbital, buccal, and submental space areas, along with tracheotomy to prevent apnea. Postoperatively, the swelling stopped expanding and the patient's condition gradually improved and stabilized. Previous wound bacterial culture from the first debridement on the fourth day exhibited gram-positive Streptococcus pyogenes , which was sensitive to methicillin, vancomycin, and meropenem.

Meropenem usage maintained the same, whereas vancomycin was changed to 1 g BID since the patient's condition improved. Both antibiotic drugs were used until the 39th day for 35 days. Also, the histological examination result of the right forearm confirmed NF, which exhibited necrotizing subcutaneous tissue with inflammatory leukocyte infiltration Fig.

Necrotising fasciitis: diagnosis and management

Several other local debridements were performed from the 14th day, and new wound culture revealed fungal infection caused by Candida glabrata ; therefore, antifungal drug fluconazole Diflucan; mg QD for 16 days was added according to the antibiotic sensitivity test on the 24th day. On the 52nd day, the wounds in maxillofacial region and thoracic walls were healed. The wound in the right forearm was dry with healthy granulation Fig.

On the 55th day, free pedicled skin flap graft from his left anterolateral thigh was performed in his right forearm. He was discharged from the hospital on the 66th day. He has been followed up every 3 to 6 months Fig. Currently, his right forearm functions normally, with no hand inactivity or rigidity. Figure 5 summarizes the clinical course of this disease.

Researchers unlock potential pathway to treat flesh-eating bacteria

Early-stage NF lacks typical cutaneous features, which can often be deceitful for physicians to realize the severity of subcutaneous infection. Several signs and symptoms are indicative of NF diagnosis, including disproportionately strong pain, extreme inflammation, and ecchymosis. Disproportionate pain is presented in almost every case of NF. The patient in the present study presented an intense pain VAS 9—10 , out of proportion of his original physical findings, due to the fact that he received only preoperative antibiotics after the initial radius plate removal surgery, without pain-relief drugs in the early phases of his hospitalization day 1—3.