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Necrotizing fasciitis
Canadian Family Physician, 10/14/09
Puvanendran R et al. – Necrotizing fasciitis is a rare but potentially fatal disease; it can occur in all parts of the body, including the oral cavity and the perineum.
- Typically, patients who develop type 1 (polymicrobial) necrotizing fasciitis are immunocompromised in some way. However, with the type 2 (monomicrobial) variety, patients are usually immunocompetent with a history of trauma (sometimes minor).
- Diagnosis is often delayed because of a paucity of signs and a low index of suspicion.
- Necrotizing fasciitis is a clinical diagnosis. Blood tests and imaging, especially magnetic resonance imaging and computed tomography scans, can be helpful but are not diagnostic. Surgical exploration is advised if clinical suspicion is high.
- Management includes fluid resuscitation, if indicated, intravenous broad spectrum antibiotics, and early surgical debridement. Increasingly, community–acquired methicillin–resistant Staphylococcus aureus is being identified as the infective agent.
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