Necrotizing fasciitis / myositis / cellultis

Necrotizing fasciitis 

Site- Muscle fascia and  subcutaneous fat, muscle tissue is spared

Lab- CK↑

CT- Blurring fascia

1.Polymicrobial (type I)

-Older adult, DM, comorbidities

-Anaerobic species (most commonly Bacteroides, Clostridium, or Peptostreptococcus) +  Enterobacteriaceae (eg, Escherichia coli, Enterobacter, Klebsiella, Proteus) + facultative anaerobic streptococci (other than group A Streptococcus [GAS])

-Fournier gangrene(Perineum)-  facultative organisms (E. coli, Klebsiella, enterococci) + anaerobes (Bacteroides, Fusobacterium, Clostridium, anaerobic or microaerophilic streptococci) 

-Necrotizing infection of the head and neck – mouth anaerobes (such as Fusobacteria, anaerobic streptococci, Bacteroides, and spirochetes). Ludwig’s angina (submandibular space infection, trismus) and Lemierre syndrome (septic thrombophlebitis of the jugular vein).

2.Monomicrobial infection (type II)

-GAS or other beta-hemolytic streptococci, Staphylococcus aureus, Vibrio vulnificus and Aeromonas hydrophila

Necrotizing myositis

Pathogen- Group A Streptococcus (and other beta-hemolytic streptococci)

Necrotizing cellulitis 

Pathogen- Anaerobic pathogens 

1.Clostridial- Clostridium perfringens, Clostridium septicum

2.Non-clostridial- Polymicrobial infection

Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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