Necrotizing Fasciitis - Essay Example

Lecturer Essay # Necrotizing Fasciitis Introduction Necrotizing Fasciitis (NF) is a rare but life threatening condition that causes inflammatory infection of the fascia, leading to secondary necrosis of subcutaneous tissues. This disease is commonly referred to the ‘flesh eating disease.’ Other names include killer bug disease, fasciitis necrotans and synergistic necrotizing cellulitis (Shariat, et al, 106). History and current status Historically, according to an article by Korhan Taviloglu and Yanar Hakan (2007), the disease was first detected in 1871 by an army surgeon named Joseph Jones during the Civil War. However, literature also suggests that the disease was initially discovered in France in 1783 by a surgeon named Claude Colles (Misiakos, et al, 1). He was working at the Hotel Dieu located in Lyon, and described a condition that has similar symptoms to the current descriptions of NF (Misiakos, et al, 1). During the 19th and 20th centuries, cases of NF were rare. It was mainly restricted to military hospitals, although civilian outbreaks were also recorded. However, during the mid 1980s and early 1990s, there was an increase in NF cases worldwide, according to the Center for Disease Control and Prevention (CDC). As of 1999, 600 cases of this disease were reported in the United States. Currently, the number of cases of this disease is 0.4 cases for every 100000 people every year. The incidence rate in children is put at 0.08 cases for every 100000 children every year. In the United States, it is estimated that between 9000 and 11500 cases of NF occur annually with close to 2000 deaths very year. in general, the prevalence of NF is put at 0.4 cases for every 100000 people (Misiakos, et al, 2). Statistics show that the disease mostly affects men compared to women, standing at a ratio of 3:1 (Misiakos, et al, 2). Research has demonstrated that the high prevalence rates in men are as a result of the higher cases of Fournier’s gangrene in men. The mortality rate remains high, standing at between 20 and 40 per cent. It is difficult to give the exact recent case of the disease. However, in America, the recent reported case occurred in February 2014. This was reported in the article by Jackie Farwell (2014) appearing in the Bangor Daily News. The victim was an 18-year old Benjamin LaMontagne from Maine. In general, it is difficult for the CDC and other health organizations to keep track of the occurrences of this disease. As noted in the article by Farwell (2014), the CDC recognizes that there are many cases of NF that go unreported or undetected, and this makes it difficult to give accurate figures and statistics relating to the disease. Causes The cause of this disease was first identified in 1918 as bacteria. The name Necrotizing Fasciitis was coined in 1952 by Wilson without giving the exact bacteria that caused the disease. However, in later years, it was identified that NF is caused by a number of bacteria. NF has been classified into four major groups. The first is Type I, which is observed in 80% of the practice. It mainly affects persons who have a low immune system, and is caused by a combination of aerobic, anaerobic and facultative anaerobic bacteria. Some of these bacteria are Psuedomonas spp and Escherichia Coli (Machado, 108). The second type is Type II which accounts for about 20% of the NF cases. This is usually caused by monomicrobial gram positive organism, and the common example is group A Streptococcus (GAS) (Machado, 108). The third is Type III caused by the gram negative monomicrobial NF. One of the most common organisms causing Type III NF is V vulnificus (Machado, 108). This type of NF is rare. Finally, there is the Type IV which is caused by fungal infection. This is usually as a result of traumatic wound and burns (Machado, 109). The disease usually comes about as a result of surgical procedures that lead to local tissue injury, leading to invasions by bacteria. In addition, intramuscular injections may also lead to NF. Research has also shown that major insect bites can also cause necrotizing infections. Local ischemia and hypoxia may occur in patients with diseases such as diabetes. This leads to a lowering of the defense system, and this may cause the development of infections causing NF. In fact, according to the article by Edlich (2014), between 20 and 40% of all patients diagnosed with NF are diabetic. In addition, conditions such as obesity and cancer also pay a significant role in the development of this condition. The table below gives the characteristic features of the four types of NF. The table also gives the common causes and the mortality rates for the four different types of NF. As shown in the table, Type I is the most common and can be easily identified. Source: Machado, Norman. ‘Necrotizing fasciitis: The importance of early diagnosis, prompt surgical debridement and adjuvant therapy.’ P. 109 Symptoms and diagnosis The presentation or symptoms of NF are difficult to diagnose, especially during the early stages. However, the major symptoms of NF are strong pain as well as tenderness over the skin affected and the muscle underneath. However, the symptoms might manifest at a site far away from the initial traumatic point. Other common symptoms include dehydration, flu, extreme pain and dropping of blood pressure. In some cases, some patients may become unconscious. There are laboratory diagnostic procedures that might help reveal the disease. The common test involves serum biochemistry where some patients of NF exhibit high levels of serum creatinine kinase (CK). However, not all patients suffering from NF exhibit increased volumes of CK (Machado, 113). Imaging tests may also be used in detecting the disease. Through imaging, physicians might identify gas formation in soft tissues (Misiakos, et al, 5). This is usually a string indicator if NF and nearly half of all patients exhibit this symptom. In many cases, CT and MRI are used in the imaging process because they are more sensitive and provide accurate results compared to other methods (Misiakos, et al, 5). Treatment The primary treatment of NF is surgery. This however requires early intervention by the surgeons in order to remove the necrotic tissue. This is because this is a rapidly spreading disease, usually with progression rates of up to 3cm per hour (Shariat, et al, 106). The three main aspects of surgical treatment are surgical debridement, necrosectomy and fasciotomy (Misiakos, et al, 5). Research has shown that surgery is life saving, especially for patients with intense pain and extreme color change. Surgery helps to reduce the overall loss of the tissue since it helps to stop the spread of the infection to the adjacent tissues (Misiakos, et al, 5). The picture below shows a surgical procedure to remove the infected tissue Source: Misiakos Evangelos P. et al. Current Concepts In The Management Of Necrotizing Fasciitis. Frontiers in Surgery p. 4 Antimicrobial treatment is also used where a variety of antibiotics are given to patients. These antibiotics target bacteria such as streptococci and staphylococci (Machado, 113). It is usually recommended that the initial antimicrobial therapy or treatment should be broad based in order to cover a wide variety of micrograms and anaerobes. However, ischemia and hypoxia affect the delivery of the antibiotics to the infected site. This greatly reduces the effectiveness of this treatment approach (Misiakos, et al, 5). However, they have been found to play an important role in the surgical procedures. Since the disease is associated with massive loss of fluids, patients are supposed to be given adequate fluids. Furthermore, proper nutritional support is needed. NF also causes a great reduction in proteins through the large wounds, and this further call for early and adequate nutritional support. Risk Factors Persons aged 50 year and above are at risk of getting NF. Although increasing age is a risk factor, NF can affect persons of any age. In addition, people with chronic debilitating conditions and intra-venous drug use are likely to get NF. According to scientific research, non-steroidal anti-inflammatory drugs (NSAIDs) may cause the development of NF. Children who are immunocompromised may also end up with the disease. Since its occurrence in children is rare, misdiagnosed of the disease within this population is common (Machado, 108). Spread and Prevention Although the rate of spread of this disease is generally low, people still contact it because they continue to come into close contact with the affected persons. One of the main reasons for the spread is because people fail to recognize that the persons they are in contact with are suffering from NF. NF is spread mainly facilitated by the Group A streptococcus bacteria. These are usually spread through contact through contact with nasal and mouth secretions of the affected patient. In addition, the bacteria may spread when an infected person sneezes or coughs. Kissing and sharing of personal items can also lead to the spread of the bacteria. People who are a very high risk of getting the disease are those who live in the same house with infected persons. The risk is further enhanced if a person shares the same bed with an infected person. Overall, persons are required to look out for the symptoms of NF in patients and avoid contact whenever necessary. According to the article by Taviloglu and Hakan (2007), there are several strategies that can be used to prevent the disease. First, proper hygiene, especially the washing of hands can help stop the spread of Group A Streptococcus. Secondly, patients who have sore throats are advised to see a doctor. Thirdly, persons are advised to keep wounds clean, and any signs of any infection should be closely monitored. This requires that a person with any wound should seek medical assistance as soon as they can. Finally, it is important that one keeps his/her skin intact. In conclusion, NF is a rare yet extremely deadly condition that requires persons and clinicians to do their best in detecting and treating this condition. If left untreated, NF can be fatal. It is advised that people should always look out for any symptoms of the disease and seek immediate attention. Works Cited Edlich, Richard. ‘Necrotizing Fasciitis.’ Medscape (August, 2014). Web. 21 Nov. 2014. Farwell, Jackie. ‘Flesh-Eating’ Infection Claims 2 Maine Lives In 6 Months, Advocacy Group Calls Treatment ‘Tragically Inadequate’. Bangor Daily News 2014. Web. 21 Nov. 2014. Machado, Norman. ‘Necrotizing fasciitis: The importance of early diagnosis, prompt surgical debridement and adjuvant therapy.’ North Am J Med Sci 2011; 3: 107-118 Misiakos, Evangelos P. et al. Current Concepts In The Management Of Necrotizing Fasciitis. Frontiers in Surgery 1.36 (2014): 1-10 Shariat, M et al. ‘Necrotizing Fasciitis - the Flesh Eating Bacterial Disease - of the Neck.’ Shiraz E Medical Journal, 9.2 (2008): 105-112 Taviloglu, Korhan, and Hakan Yanar. “Necrotizing Fasciitis: Strategies for Diagnosis and Management.” World journal of emergency surgery. WJES 2 (2007): 19. PMC. Web. 21 Nov. 2014. Read More