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<ul><li>68 years old male </li></ul><ul><li>Pain in leg for 1 day </li></ul><ul><li>Alter mental status and fever this mor...
 
 
<ul><li>What is the most appropriate therapy for this patient? </li></ul><ul><li>A. Ampicillin, Clindamycin and Gentamycin...
<ul><li>Answer:  </li></ul><ul><li>Penicillin ,Clindamycin and debridement </li></ul><ul><li>Diagnosis: </li></ul><ul><li>...
NF <ul><li>Caused </li></ul><ul><li>GAS </li></ul><ul><li>Mixed aerobic anaerobic organism </li></ul><ul><li>C. Perfringen...
Symptoms and Signs <ul><li>Starts with pain and fever </li></ul><ul><li>Swelling then edema and tenderness </li></ul><ul><...
GAS <ul><li>Absent of Hx of streptococcal infection is common. </li></ul><ul><li>Myositis occurs in 20-40% of cases which ...
Mixed aerobic-anaerobic <ul><li>Site of breach in the integrity of mucosa of GI or GU tract may be presented in question e...
Clostridium <ul><li>Hx of severe penetrating trauma with contamination by soil. </li></ul><ul><li>Spontaneous case can hap...
Treatment <ul><li>IVIG is not recommended. </li></ul>
Explanation <ul><li>Clinda is more effective than penicillin in terminating toxin production by bacteria (Inh. of protein ...
<ul><li>Same manifestation but different gram stain. Which antibiotic? </li></ul>
<ul><li>Same question but with history of penicillin allergy, which antibiotic? </li></ul><ul><ul><li>Depend on type of re...
<ul><li>2. NF with history of colon cancer and uncontrolled DM with following gram stain? </li></ul>
 
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Necrotizing fasciitis

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internal medicine board review question about necrotizing fasciitis

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Transcript of "Necrotizing fasciitis"

  1. 1. <ul><li>68 years old male </li></ul><ul><li>Pain in leg for 1 day </li></ul><ul><li>Alter mental status and fever this morning. </li></ul><ul><li>V/S BP 88/40 HR 126/min RR 28/min Temp 39.3 C O2Sat 92 % </li></ul><ul><li>Left leg: Diffuse swelling with brawny edema, pain on light palpation, several bullaes with dark purple fluid. </li></ul><ul><li>ABG pH 7.22 PaCO2 28 Pa02 93 </li></ul><ul><li>Cr 3.2 </li></ul><ul><li>WBC 22660 N 70% Band 28% L 2% </li></ul><ul><li>CPK 553 </li></ul><ul><li>Gram stain of fluid aspirated from bulla. </li></ul>
  2. 4. <ul><li>What is the most appropriate therapy for this patient? </li></ul><ul><li>A. Ampicillin, Clindamycin and Gentamycin </li></ul><ul><li>B. Clindamycin and Penicillin </li></ul><ul><li>C. Clindamycin, penicillin, and debridement </li></ul><ul><li>D. Penicillin and debridement </li></ul><ul><li>E. Vancomycin, penicillin, and debridement </li></ul>
  3. 5. <ul><li>Answer: </li></ul><ul><li>Penicillin ,Clindamycin and debridement </li></ul><ul><li>Diagnosis: </li></ul><ul><li>Septic shock secondary to NF with GAS. </li></ul>
  4. 6. NF <ul><li>Caused </li></ul><ul><li>GAS </li></ul><ul><li>Mixed aerobic anaerobic organism </li></ul><ul><li>C. Perfringens </li></ul><ul><li>Some strains of MRSA </li></ul>
  5. 7. Symptoms and Signs <ul><li>Starts with pain and fever </li></ul><ul><li>Swelling then edema and tenderness </li></ul><ul><li>Dark red induration of epidermis with bullae </li></ul><ul><li>In later stage, the skin will be friable and turn brownish grey accompanying with shock </li></ul>
  6. 8. GAS <ul><li>Absent of Hx of streptococcal infection is common. </li></ul><ul><li>Myositis occurs in 20-40% of cases which might cause elevation of CPK level. </li></ul>
  7. 9. Mixed aerobic-anaerobic <ul><li>Site of breach in the integrity of mucosa of GI or GU tract may be presented in question e.g. malignancy, diverticulum or hemorrhoid </li></ul><ul><li>Other possible comorbidities : DM, Peripheral vascular disease, Surgery or penetrating abdominal trauma </li></ul>
  8. 10. Clostridium <ul><li>Hx of severe penetrating trauma with contamination by soil. </li></ul><ul><li>Spontaneous case can happen in patient with neutropenia, GI cancer or recent RT to abdomen. </li></ul>
  9. 11. Treatment <ul><li>IVIG is not recommended. </li></ul>
  10. 12. Explanation <ul><li>Clinda is more effective than penicillin in terminating toxin production by bacteria (Inh. of protein synthesis VS Inh. of cell wall synthesis.) </li></ul><ul><li>Because clinda resistance in GAS, although rare, has been reported. Penicillin should be administered concomitantly until C/S result is available. </li></ul>
  11. 13. <ul><li>Same manifestation but different gram stain. Which antibiotic? </li></ul>
  12. 14. <ul><li>Same question but with history of penicillin allergy, which antibiotic? </li></ul><ul><ul><li>Depend on type of reaction </li></ul></ul><ul><ul><li>immediate reaction or life threatening manifestation : Vancomycin </li></ul></ul><ul><ul><li>minor reaction : 1 st gen cephalosporin </li></ul></ul>
  13. 15. <ul><li>2. NF with history of colon cancer and uncontrolled DM with following gram stain? </li></ul>
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