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Necrotizing fasciitis is an infectious disease that affects the superficial and deep fascia and subcutaneous tissue


Necrotizing fasciitis is an infectious disease that affects the superficial and deep fascia and subcutaneous tissue
Necrotizing fasciitis (hereinafter for convenience NF) is an infectious disease that affects the superficial and deep fascia and subcutaneous tissue.

Pathogens are the bacteria Streptococcus pyogenes or Clostridium perfringens.

If this infection is the destruction of tissue directly under the skin. It can develop into gas gangrene.

The disease was discovered Welch and Nutall in 1892. Most commonly the disease attacks the limbs and the area of the perineum, occurs when damage to the skin of these areas of the body due to injury or purulent processes.

Statistics shows a frequency of 4 cases of NF per 10,000, with 33% of mortality cases.

Some doctors call this disease "eater of flesh", due to its ability to rapidly destroy all types of tissue in the affected area.
The content of the article

The causes of the disease
Symptoms and signs
Diagnostic methods
The treatment of the disease
Complications of the disease
Preventive measures
Video: Necrotizing fasciitis is a dangerous disease
The causes of the disease


As already mentioned, one of the ways of penetration of infection may be the resulting wound or other skin damage.

In other cases, among the reasons that cause necrotizing fasciitis can become internal ulcers, from which the bacteria penetrate into the subcutaneous tissue with streptococcal infection bacterium is frequently transferred with the bloodstream.

At the beginning of NF leads to local tissue ischemia (blood blockade), followed by necrosis of this area due to the breeding of bacteria in the wound. The infection spreads through the subcutaneous adipose tissue.

Factors that may contribute to NF:

the age of 50;
excess body weight;
observed the defeat of peripheral vessels.
immunodeficiency;
alcoholism in the chronic form;
you have diabetes;
you are undergoing treatment with corticosteroids;
you are an addict, "sitting" on the needle;
postoperative complications.
Symptoms and signs
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cell death
The photo shows how dangerous necrotizing fasciitis

To diagnose necrotizing fasciitis in the early stages is extremely difficult, as its only manifestation is fever and local pain.

Then the skin becomes red from going under her blood and there is swelling, palpation painful.

The skin of the affected area gradually darkens to a dark red color, sometimes with a bluish tint, then bubbles appear, after them comes the stage of necrosis of the skin will become purple, rarely purple or black.

In surface vessels, extensive thrombosis occurs, with the affected fascia becoming dirty-brown color.

From this point the bacteria start to spread rapidly via the blood, lymph and fascial casings. Against this background, the patient"s temperature rises, there is increased heart rate, consciousness from confused to full coma.

Due to the outflow of fluid in the affected area may experience a drop in blood pressure.


Diagnostic methods
The diagnosis is based on test results — signs of inflammation — leukocytosis left shift, erythrocyte sedimentation rate increased.

Additionally studying the contents of the bubbles to determine sensitivity to antibiotics.

The treatment of the disease
Operation autodermoplasty

Surgery is used to remove dead tissues, until the amputation in severe cases.

When dressing wounds using ultrasonic cavitation, in conjunction with the use of antiseptic ointments and proteoliticheskie enzymes. Actively apply etiotropic treatment determine the type of bacteria and then there are the focused products.

Additionally, use a broad-spectrum antibiotics to reduce the risk of destruction by other microorganisms.

Complications of the disease
To the disease should be treated extremely seriously, so how can you get rid of in the case of a light scar on the skin, but if neglected, it could end up very sad — from amputation to death.
A common cause of complications is the lack of removal of diseased tissue during surgery if need surgery, repeat every 1-2 days.

Preventive measures
A thorough treatment of all bruises and wounds, especially contaminated with street dust or dirt. If redness, swelling should immediately seek medical attention.

In General, the doctor should contact if the wound is deep enough and polluted — this will avoid the risk of infection or bacteria to fight the infection at an early stage.



People older than 50 years — is even more careful to treat all sorts of abrasions and damage to the skin and mucous membranes, such as fissures hemorrhoids.

Cases lesions can even be very exotic American doctors Louisiana describe a case of NF, where the woman 34 years of age contracted the infection while taking a hot salt bath, through a puncture in the skin remaining after injection with a thick needle.

Remember the later treatment is started, the worse the prognosis. Better to run to the doctor and learn that there is nothing wrong than to miss a really dangerous infection that can lead to life disaster.

Video: Necrotizing fasciitis is a dangerous disease


Necrotizing fasciitis
Necrotizing fasciitis is an infectious disease that rapidly spreading necrosis affects subcutaneous tissue, superficial and deep fascia (connective tissue sheath). Usually caused by gram-positive bacteria Streptococcus pyogenes or mixed aerobic and anaerobic microflora.

ICD-10 M72.6
ICD-9 728.86
DiseasesDB 31119
MeSH D019115
eMedicine emerg/332
MedlinePlus 001443

General information
The first case of the disease was recorded in 1871 in the United States, and the first description of the disease made in 1892, belongs to Welch and Metallo. The modern name of the disease proposed by Nielson in 1952

The disease is relatively rare — since 1883, the medical literature has recorded about 500 cases of necrotizing fasciitis, but recently the incidence has increased. According to statistics, to date, the prevalence of necrotizing fasciitis is 0.4 cases per 100,000 people.

The average age of the patients is 38-44 years. The disease is twice more common in men than in women and rarely occurs in children (such cases are noted in countries where there is poor hygiene).

Death is 33% of the patients.

Form
Giuliano and co-authors there are two forms of necrotizing fasciitis depending on the causative agent:

The disease is caused by beta-hemolytic streptococci group A (Streptococcus pyogenes). This form is sometimes referred to as hemolytic streptococcal gangrene.
Disease that caused by mixed infection. Pathogens are not related to the group A and hegemonically hemolytic Streptococcus, Escherichia coli, rod-shaped bacterium Enterobacter, various enterobacteria, and Pseudomonas, as well as Citrobacter freundi, Klebsiella pneumonia, Proteus mirabilis and other anaerobic bacteria and facultative anaerobes.
The location of necrotizing fasciitis isolated form affecting primarily the perineum, scrotum and penis, in which perhaps the spread of infectious process in the thigh and anterior abdominal wall (Fournier gangrene).

Depending on the clinical picture of the disease necrotizing fasciitis can be:

Primary. Begins to damage the fascia, pain and swelling at the site of lesion.
Secondary.

The disease occurs on the background running of purulent skin diseases. The symptoms of necrotizing fasciitis superimposed on the clinical picture of the underlying disease, and the necrotic symptoms observed in the primary purulent focus.
The reasons for the development
The disease develops as a result of the spread of infection streptococcal group or aerobic and anaerobic bacteria. The infection can spread to the fascia as a complication:


at puncture and lacerations, abrasions, blunt trauma;
after surgery in the abdomen, gastrointestinal tract, urinary tract and perineum;
superinfection chickenpox;
subcutaneous injections.
Strep can spread through the bloodstream when a distant source of infection.

Cause gangrene Fourier are:

abscess;
infection of periurethral glands;
retroperitoneal infection, perforation of internal organs of the abdominal cavity.
In children the infection usually extends to the fascia when omphalitis (bacterial inflammation of the umbilical ring, the subcutaneous fat around it and the bottom of the umbilical wound) and balanitis (inflammation of the glans penis, which occurs at a circumcision).



The disease develops in the presence of confounding factors, which include:

The weakening of the immune system (local or General). The risk groups are individuals with diabetes, peripheral vascular disease, malignant neoplasm, and persons who have recently been corticosteroid immunosuppressive therapy, or surgery.
Injection drug use and chronic alcoholism.
Immunodeficiency States.
Age more than 50 years.
The extra weight of the body.
In some cases, the development of the disease provoke insect bites, nonsteroidal anti-inflammatory drugs and fungal diseases.

Pathogenesis
The pathogenesis of necrotizing fasciitis is associated with thrombosis of the microcirculatory bed of the skin lesion and the adjacent tissues. This explains the rapid progression of necrosis, exciting not a separate area of the fascia, and a broad region that corresponds to the zone of microvascular circulation.

Morphologic changes in fascia are originally gangrenous nature – the diseased tissue is not inflamed, and die.

Devastating and rapid course of the disease is due to polymicrobial infection — when necrotizing fasciitis in the majority of necrotic tissue are present:

Anaerobic bacteria that multiply in the tissues, deprived of sufficient oxygen as a result of injury, surgery or other disorders.
Aerobic bacteria that multiply in the tissues due to the decrease in the function of polymorphonuclear neutrophils (polymorphonuclear neutrophils to play a key role in providing innate immunity, and their functions are reduced during hypoxia of the wound). The reproduction of aerobic bacteria further decreases the redox potential, and this accelerates the spread of infection.
The end products of the metabolism of aerobic organisms are water and carbon dioxide. If mixed infection in the soft tissues to accumulate nitrogen, hydrogen, methane and sulfide, which are poorly soluble in water.

Organisms spread along the fascia from the affected subcutaneous tissue. The deep infection causes occlusion (violation of patency) of blood vessels, ischemia and necrosis of deep tissues. There is also damage to superficial nerves, which manifests itself in a localized numbness.



If untreated, it develops sepsis.

Symptoms
A distinctive feature of the necrotizing fasciitis – local swelling, erythema, increased skin temperature, and intense pain does not correspond to local changes of the skin (looks like a muscle injury or tear).

The primary form of necrotizing fasciitis immediately begins with the defeat of fascia and appears:

swelling of the skin in an isolated area;
pain in the affected area;
hyperemia.
In streptococcal infection appear quickly:

dark spots the formation of blisters that are filled with dark liquid;
areas of superficial necrosis of the skin, which may merge.
When descriptoraccess infection the disease develops slowly, the symptoms are less pronounced. Observed presence in the site of the lesion:

swelling and woody seals the skin;
erythematous and pale spots on the seal place.
In the wound area observed dirty gray shade fascia, there is the murky, often brownish exudate, and subcutaneous tissue instrumental examination can be easily separated from the fascia.

Necrotizing fasciitis is accompanied by:

the high temperature at which any sharp UPS and downs for 3-5 S;
tachycardia;
leukocytosis;
General weakness.


The muscular layer is usually not affected, but if untreated, can develop myositis or monegros.

In some cases, the symptoms appear on the site, which was removed from the injury.

Cases have also been described progression of fulminant necrotizing fasciitis, and death in the absence of changes in color and temperature of affected areas.

Diagnosis
The diagnosis is based on:

The history of the disease. Specified patient complaints, presence of injury or other precipitating factors.
The General survey. At the initial stage appearance of the patient may not correspond to the degree of discomfort, but the intoxication develops quite quickly.
Lab tests. The main symptom of inflammation increased erythrocyte sedimentation rate and leukocytosis with shift of leukogram to the left, which are detected when the expanded blood test. Also measured the level of gases in arterial blood.
To clarify the diagnosis used incisional biopsy, which examines a tissue section obtained during the removal of the necrotic areas. The studies carried out using the freezing microtome, which allows to obtain results in a short period of time.

For determination of the pathogen using microscopy of the slice stained by gram.

Additionally, we study the exudate to determine antibiotic sensitivity.

Treatment
The only effective treatment for necrotizing fasciitis is surgical intervention, which is to conduct necrectomy (removal of affected tissues). In the surgical process:

define the boundaries of necrosis;
appreciate the nature of the affected tissues (smell, gas, etc.);
excised the affected tissue.
With extensive lesions and blurred boundaries are a landmark necrectomy.

Mechanical removal of the tissue is accompanied by the application:
ultrasonic cavitation;
chemical necrectomy (uses sodium hypochlorite, proteolytic enzymes).
Also assigned antibacterial therapy:

the penicillin every 4 hours for streptococcal infection;
the broad-spectrum antibiotics and antibacterial bactericidal drugs, active against anaerobic microflora (dioxidine, metrogyl).
Detoxification therapy is conducted according to General principles of treatment of purulent-inflammatory diseases.Sponso
United States. Colorado

Tel: (386) 328-0000-0000


day: 27.08.2017
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Necrotizing fasciitis is an infectious disease that affects the superficial and deep fascia and subcutaneous tissue

All blood tests shall be in the morning on an empty stomach
WOUND MANAGEMENT SERVICES INC LONGWOOD

A blood test

All blood tests shall be in the morning on an empty stomach (between the last Prim foods and taking of blood must be at least 8 hours).
For 24 h before the study to exclude the admission of alcohol.

Tree medication must only be carried out after blood sampling.
Blood for determination of lipid profile: holstein, HDL, LDL, triglycerides should be taken strictly on an empty stomach (after 12-God).
Physical and mech load exercise, exercise should be excluded for at least 3 days before blood sampling.
Analysis of moi

For biochemical research and analysis according to Nechyporenko MOU harvested in the morning after waking (preferably previous urination was not later than in 2 hours of the night).

The collection of such moi – patient coat MOU within 24 hours on normal TV mode (1,5-2,0 litres per day). In the morning (8 hours) to empty the bladder (this share moi), and then during the day to gather all the MOU into a clean wide-mouthed vessel with a tight-fitting crash with a capacity of not less than 2Sponso
United States. Colorado

Tel: (386) 328-0000-0000


day: 27.08.2017
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Necrotizing fasciitis is an infectious disease that affects the superficial and deep fascia and subcutaneous tissue

Sh7.5bn plant set to cut medicine prices - 3,500 jobs
A Bangladeshi firm has announced the construction of a Sh7.5 billion pharmaceutical plant in Athi River, Kenya. FILE PHOTO | NATION MEDIA GROUP

A Bangladeshi firm has announced the construction of a Sh7.5 billion pharmaceutical plant in Kenya.

Situated on a 16-acre plot at the Export Processing Zone (EPZ) in Athi River, the pharmaceutical plant will manufacture up to two billion tablets and 60 million bottles of liquid medicines annually for the local and export market in Africa.

The drugs will be used to treat diseases such as HIV and Aids, malaria, tuberculosis, diabetes, cardiovascular diseases and anti-psychotic disease within five years of the start of manufacturing.

IMPORTED DRUGS

Mr Tapan Chowdhury, the managing director of Square Pharmaceuticals Ltd, said the factory will help Kenya to reduce its dependence on imported drugs.

“We recognise the opportunity to address obstacles limiting access to quality, affordable drugs and promote public health in the region and a local pharmaceutical manufacturing plant will ensure Kenya and the region can easily access quality and affordable medicine,” he said.

He added: “We believe that local pharmaceutical production has a potential to drastically reduce the cost of drugs by 40 per cent.”

In addition to other benefits such as creating jobs, the World Health Organisation believes the local production of medicine in developing countries could be a solution to the lack of affordable drugs.

EMPLOYMENT

Construction of the plant in Kenya comes after the 2017 approval of the East African Regional Manufacturing Plan of Action 2017-2027 which requires national procurement agencies of the East African Community (EAC) member states to buy at least half of their medicines locally.

“We expect the plant to be operational by mid-2019 and by then some 1,500 Kenyans will have benefited from direct employment opportunities. A total of 50 per cent of our products will be exported to the EAC and other African markets,” said Mr Chowdhury.

Industry Cabinet Secretary Adan Mohamed said foreign direct investment, such as that of Square Pharmaceuticals, will play a key role in development of the local manufacturing sector.

NEW FACTORY

“The new factory will bring significant industrial benefits such as technology transfer and demand for education and training,” said Mr Mohamed.

Currently, the local manufacturers can only meet 28 per cent of Kenya’s drugs demand, according to Dr Jacinta Wasike, the director of inspection-surveillance and enforcement at the Pharmacy and Poisons Board.

Speaking at the event, she said the remaining 72 per cent is covered by imports worth an estimated $600 million (Sh61.9 billion) with a regular import growth of 11.5 per cent in the last three years on average.

“We will be involved in quality assurance and overseeing the production to ensure the entire process is carried out according to accepted global and local specifications and guaranteed maximum safety levels for patients when used,” she said.

Even as pricing pressure on its diabetes portfolio led Eli Lilly to cut 3,500 jobs by year-end, the drugmaker today said it is moving forward with a $72 million upgrade to its insulin manufacturing, part of an $850 million outlay it had expected to make this year on capital projects.

Lilly will replace an existing insulin vial filling line at its site in Indianapolis, where it has its headquarters. It said the project will help it meet demand for Humalog, Humulin and other insulins, and put in place new technology for pipeline projects.

“As technology and science continually advance, it is important that our manufacturing facilities are recapitalized and modernized regularly to ensure we can continue to provide a reliable supply of safe and high-quality medicines to people around the world," Maria Crowe, president of Lilly global manufacturing operations, said in a statement.Sponso
United States. Colorado

Tel: (386) 328-0000-0000


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