The high morbidity and mortality of necrotizing fasciitis (NF) supports the need for epidemiological studies to characterize the disease and identify patient factors associated with adverse outcomes. A multi-site medical record review of patients diagnosed with NF was performed (n=80, mortality 15%). Variables collected were hypothesized to have association with adverse outcomes from NF, and multivariable analysis was used to detect any such association in this population. Select factors associated with mortality included evidence of underlying conditions (P=0.002), advanced age (P=0.04), young age (P=0.03), and evidence of sepsis (P=0.006). Select factors associated with amputation included diabetes mellitus (P=0.006), evidence of underlying conditions (P=0.03), and cutaneous gangrene noted on admission (P=0.006). These findings demonstrate the important association of NF and extremes of age with mortality and morbidity and support the value of early suspicion with prompt diagnosis and treatment in order to prevent adverse outcomes since the associated risk factors are not immediately modifiable.
"Previous studies have shown that patients with NF tend to have a number of underlying medical comorbidities or risk factors such as diabetes mellitus, underlying malignancy, smoking, intravenous drug use, renal impairment, and/or obesity   . "
[Show abstract][Hide abstract] ABSTRACT: Paroxysmal nocturnal hemoglobinuria (PNH) is a rare, progressive, and life-threatening hematopoietic stem cell disorder characterized by complement-mediated intravascular hemolysis and a prothrombotic state. Patients with PNH might have slightly increased risk of infections due to complement-associated defects subsequent to CD59 deficiency. Here, we report a rare case of a 65-year-old male patient with necrotic ulcers on both legs, where the recognition of pancytopenia and microthrombi led to the diagnosis of PNH based on FLAER (FLuorescent AERolysin) flow cytometric analysis. He was subsequently started on eculizumab therapy, with starting and maintenance doses set as per drug labelling. Progression of the patient’s leg ulcers during follow-up, with fulminant tissue destruction, purulent discharge, and necrotic patches, led to a later diagnosis of necrotizing fasciitis due to
infection. Courses of broad-spectrum antibiotics, surgical debridement, and superficial skin grafting were applied with successful effect during ongoing eculizumab therapy. This case highlights the point that it is important to maintain treatment of underlying disorders such as PNH in the presence of life-threatening infections like NF.
[Show abstract][Hide abstract] ABSTRACT: Flux analysis (FA) is a means of organizing data to show flux through the central metabolic pathways (CMPs). It quantifies flux from uptake of carbon to the outputs of the CMPs, which are the precursors used for biosynthesis, acetate excretion and CO2. Fluxes to precursors reflect the commands of the genome and acetate excretion balances fluxes to precursor supply when uptake exceeds the capacity of the CMPs to allocate carbon in exactly the correct amount to each precursor. No other products have been detected in 11 phenotypes of Escherichia coli ML308. FA of each of these 11 phenotypes (with some additional variations in culture conditions, some selected mutations and one genetic construct) are shown as flux (mol (kg dry weight biomass)-1 h-1) and are the starting point for further exploration of the physiology of E. coli: FAs suggest the possibility of four strategies to reduce acetate excretion and these have been tested in two of the phenotypes (glucose and pyruvate). All are successful to some degree but results are not always what were expected. FA of such interventions suggest that some 'global' control mechanisms operate in E. coli ML308 independent of carbon source. There is a division in the CMPs between those pathways that use phosphorylated intermediates and those that do not and these, in turn, are divided into the Krebs cycle and the C2 and C3 monocarboxylic acids. Altogether, there are four 'compartments' and each contains intermediates that are also precursors.
[Show abstract][Hide abstract] ABSTRACT: Invasive group A streptococcus (iGAS) is the most common cause of monomicrobial necrotising fasciitis. Necrotising infections of the extremities may present directly to orthopaedic surgeons or by reference from another admitting specialty. Recent epidemiological data from the Health Protection Agency suggest an increasing incidence of iGAS infection in England. Almost 40% of those affected had no predisposing illnesses or risk factors, and the proportion of children presenting with infections has risen. These observations have prompted the Chief Medical Officer for the Central Alerting System in England to write to general practitioners and hospitals, highlighting the need for clinical vigilance, early diagnosis and rapid initiation of treatment in suspected cases. The purpose of this annotation is to summarise the recent epidemiological trends, describe the presenting features and outline the current investigations and treatment of this rare but life-threatening condition.
The Bone & Joint Journal 06/2010; 92(6):763-9. DOI:10.1302/0301-620X.92B6.23447 · 3.31 Impact Factor
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