A wound infection which complicates apparently trivial injury or minor surgery but progresses to loss of limb or life. The victim or bereaved family member asks "Was there medical negligence?"
Flesh-eating Disease or Necrotising Fasciitis has been increasing in frequency worldwide since 1987[1], [2], [3]. The commonest causal agent is Group A Hemolytic Streptococcus. This bacterium, the cause of Strep Throat and Rheumatic Fever, is often found on the skin and in the throat and other orifices of many people who have no symptoms. A commensal, it may colonise without doing any harm.
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PRACTICE POINT Necrotising Fasciitis is becoming commoner, and usually occurs after trivial injury or minor surgery in the previously healthy |
If the host's immune system is compromised, for instance by viral infection, cancer or drugs however, devastating infection such as Necrotising Fasciitis may result from a minor break in the skin or mucous membrane[4]. More commonly the victim is previously healthy[3], and the germ is found to be one of the known virulent strains or serotypes, whether sporadic or epidemic[1], [2], [3].
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PRACTICE POINT The window of opportunity for intervention is a few hours |
Time to diagnosis and treatment is of the essence[3], [5], as the infection may cause irreversible damage within as little as 12 hours[6]. In the early stages, the infection has no symptoms or signs to distinguish it from trivial infections which may complicate any accidental or surgical cut. However, White Blood Cell Count (WBC) of greater than 15.4 x 10(9)/L and serum sodium less than 135mmol/L are useful discriminators[6a] and should arguably be measured in any case of cellulitis, as which it is usually misdiagnosed.
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Early, potentially reversible features: 1.
Redness painful |
The appearance of the characteristic features[4] of Necrotising Fasciitis signals a medical and surgical emergency. Community standards require that all physicians providing primary or surgical care recognise the tell-tale signs and institute appropriate intravenous antibiotics and aggressive surgical intervention without delay.
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Later, life-threatening developments: 1.
Low blood pressure |
Although the mortality rate has been reduced to about 33% in developed countries[1], [2], amputation or death are not a priori evidence of substandard care. In the previously healthy, and more commonly in those with immune compromise, disaster may result despite timely diagnosis and intervention.
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