Diagnosis!!!!

THE INFECTION THAT EATS

PATIENTS ALIVE

“flesh-eating bacteria ”,

Case 5

Post AKA & debridement

Well-known victims

• David Walton, a leading economist in the UK and a member of the Bank of England’s Monetary Policy Committee which is responsible for setting interest rates, died of the disease within 24 hours of diagnosis on June 21, 2006.

• Lucien Bouchard, former premier of Québec, Canada, who became infected in 1994 while leader of the federal official opposition Bloc Québécois party. He lost a leg to the illness.[5]

• Eric Allin Cornell, winner of the 2001 Nobel Prize in Physics, lost his left arm and shoulder to the disease in 2004

• Jan Peter Balkenende, Prime Minister of the Netherlands since 2002, was infected in 2004. He was in the hospital for several weeks, but recovered fully

• Lana Coc-Kroft, a New Zealand television celebrity, was infected after she stepped on a coral reef in Fiji in 2005.

• Alexandru Marin, an experimental particle physicist, professor at MIT, Boston University and Harvard University, and researcher at CERN and JINR, died from the disease in 2005

• Tommy Kwok Chin, Detention Enforcement Officer, United States Department of Justice, Immigration and Naturalization Service, Detention and Deportation. In October 1999, Agent Lee died after contracting the bacteria while detaining 151 illegal Chinese immigrants on a remote island off the coast of Washington state

AORN journal, December 2005,82,No 6

Risk factors

AORN journal, December 2005,82,No 6

AORN journal, December 2005,82,No 6

High mortality rate

6 – 80 %

Why?

• Difficult in diagnosis• White Vs Black skin• Surgical management difficulty

• There is a significant economic burden is involved in treating necrotizing fasciitis.

• $3 208 664 with the per patient mean

64517$

Audi Widjaja et al Alfred Hospital, Melbourne, Victoria, Australia

ANZ journal of surgery2005;75:1059-1064

THE HOSPITAL COSTS OF TREATING NECROTIZING FASCIITIS

Studies about NF

• 15-year period, a consecutive series of 43 patients - Southern Medical Journal [South Med J] 1997 Nov; Vol. 90 (11), pp. 1065-8. Majeski J; Majeski E -

• Necrotizing fasciitis: a fourteen-year retrospective study of 163 consecutive patients. By: Childers BJ, The American Surgeon, 0003-1348, 2002 Feb, Vol. 68, Issue 2

• A retrospective review of the medical records of 68 patients between the years 1980 and 1996 with the diagnosis of necrotizing fasciitis

The American Surgeon, 0003-1348, 1998 May, Vol. 64, Issue 5

Diagnostic Criteria for Necrotizing Fasciitis

• Mental status changes• Generalized malaise, tachycardia• Systemic toxic reactions: fever, increased white blood cell count, positive blood

cultures • Focal necrosis, microvascular thrombosis, and leukocytes identified from

involved tissue samples• Extensive necrosis of the superficial; fascia in the absence of microvascular

occlusion • Pain that is out of proportion to the visual assessment• Little or no resolution of the signs and symptoms after treatment with antibiotics

Ruth-Sahd L, Gonzales M, Dimensions of Critical Care Nursing, 07304625, January 1, 2006, Vol. 25, Issue 1

GG Kihiczak, RA Schwartz,* R KapilaDermatology, New Jersey Medical School, Newark, New Jersey

JEAVD 2006, 365-369 European Academy of Dermatology & Venerology

Makkah criteria

in diagnosis

of Necrotizing

fasciitis

Al-Noor Practice

• Hajj 1426-1427• Total skin infections: 65 patient• Necrotizing fasciitis : 38 Pt• Others: 27 Pt

Necrotizing fasciitis

• Severe pain, Swelling, bullea• Leukocytosis ( >11) …. -- 78.5%• Leukopenia ( <4 ) • Elevated urea & creat 80%

Management

• Early aggressive debridement ( First surgery is ideal surgery ), tissue for histopath & C/S

• Adequate resuscitation with IV fluids• Broad spectrum Antibiotics ( Ampicillin,

gentamycin, flagyl) -Piperacillin\Sulbactam• Dressing with hony BID• Grafting once ready

THANK YOU