70 Flashcards
(26 cards)
Types of Necrotizing Cellulitis
Anaerobic (clostridial & nonclosteridial)
Meleney’s Synergistic Gangrene
Clostridial Necrotizing Cellulitis caused by
Clostridum pefringens (+)
Nonclostridial Necrotizing Cellulitis caused by
Bacteroides + or peptostretococcus +
**alone or mixed c Coliform bacilli, staph, strep
Caliform Bacilli are?
All enterics
Cytrobacter (-)
E. coli (-)
Enterobacter (-)
Klebsiella (-)
How do you get anaerobic necrotizing Cellulitis?
Introduced into SUPERFICIAL fascia or sub Q
-surgery, trauma, spread from bowel
S&S of anaerobic necrotizing Cellulitis
thin, dark, wound drainage, foul smelling (nonclostridium), tissue gas (clostridium), crepitus in skin
Spares deeper tissue (deep fascia & muscle)
Clinical manifestations of Meleney’s Syndergistic Gangrene
Rare postop complication
Interaction of staph & strep
Slow expanding ulceration in SUPERFICIAL fascia
Type 1 Necrotizing Fasciitis is poly or monomicrobic?
Poly
Type 1 Necrotizing Fasciitis caused by
At least 1 anaerobic (Bacteriodes -, clostridium +, peptostreptococcus +)
At least 1 fac. anaerobic strep (not GAS)
Members of enterobacteriaceae -
Enterobacteriaceae Bacteria
PESSKEY Strains (All gram -) Proteus Enterobacter Shigella Salmonella Klebsiella E. coli Yersinia Serratia
Type 1 Necrotizing Fasciitis Risk Factors
Recent surgery, trauma, DM, PVD
Site of infectino of Type 1 Necrotizing Fasciitis in…
DM/PVD
Neonates
Lower extrem
Abd & perineum
Fourneir’s Gangrene
Subtype of Type 1 necrotizing fasciitis
- in genitalia/perineum
- caused by breach in GI or urethral mucosa
Type 2 Necrotizing Fasciitis is poly or monomicrobic?
Mono
Causes of Type 2 Necrotizing Fasciitis
ONE of the following
GABHS + (sometimes has some S. aureus)
Aeromonas hydrophila - (fresh water trauma)
Vivrio vulnificus - (salt water trauma)
How do you get Type 2 Necrotizing Fasciitis Streptococcal Type
Only need microabrasion (unlike Type 1)
- blunt trauma, bug bit, IVDU, varicella, sx, childbirth
- *If no visable portal, hematogenous translocation
Type 2 Necrotizing Fasciitis Risk Factors
Immunocompetent, no sig hx, any age
skin injury predisposes
Clinical Manifestations Necrotizing Fasciitis
Acute -HEET -Pain out of proportion to PE -Rapid prog. -Red to purple to blue to gray 3-5 days -bullae c purple/pink fluid -cutaneous gangrene -cutaneous anesthesia Advanced -fever, tachy, systemic toxicity -putrid odor (only Type 1 - anaerobic bacteria)
Clue of developing Necrotizing Fasciitis
Cutaneous anesthesia precedes skin necrosis
Causative agent of Necrotizing Myositis
S. pyogenes (or other GABHS)
Vimentin
Upregulated skeletal muscle protein in strains (prev. trauma) or strenuous exercise that can bind GAS
Causative agent of Necrotizing Myositis
S. pyogenes (or other GABHS)
Vimentin
Upregulated skeletal muscle protein in strains (prev. trauma) or strenuous exercise that can bind GAS
Causative Agent of Clostridial Myonecrosis
Clostridium perfringens Type A +
(C. septicum)
-endospore forming anaerobic bacilli
