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Laboratory risk indicator for necrotizing fasciitis (LRINEC) score to help discriminate between necrotizing and nonnecrotizing soft-tissue infections.

Laboratory risk indicator for necrotizing fasciitis (LRINEC) score to help discriminate between necrotizing and nonnecrotizing soft-tissue infections.

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Necrotizing fasciitis or necrotizing soft-tissue infections (NSTIs) are infrequent but highly lethal infections. They can be defined as infections of any of the layers within the soft tissue compartment (dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle) that are associated with necrotizing changes. At onset, necrotizing fasci...

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... devised a scoring system (laboratory risk indicator for necrotizing fasciitis score) to discrimi- nate between NSTI and nonnecrotizing soft-tissue infec- tion (Table 6). They compared a set of laboratory variables between patients with and without NSTI and identified 6 independent variables associated with NSTI. ...

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Background: Necrotizing fasciitis (NF) is a lethal soft tissue infection involving skin and subcutaneous tissue with significant morbidity and mortality. Aim: To validate the diagnostic and prognostic role of the Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scoring system for NF in patients who present with soft tissue infections...
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Resumo A fasceite necrotizante é caracterizada como um subconjunto das infecções agressivas da pele e tecidos moles que causam necrose da fáscia muscular e dos tecidos subcutâneos. Tem origem polimicrobiana e apresenta extensa necrose que exibe uma formação gasosa no tecido subcutâneo e fáscia superficial. É fundamental um rápido diagnóstico, segui...
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... NF is managed ASM Science Journal, Volume 19, 2024 5 with supportive therapy and antimicrobial therapy. A broadspectrum antimicrobial therapy is used early to cover for gram-positive, gram-negative, and anaerobic organisms (Vijayakumar et al., 2014). A surgical wound debridement will be done if indicated. ...
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... So, it is always necessary to have a high index of suspicion based on risk factors, history of insect bite or history of animal bite, rapidly progressive systemic sepsis. If clinical features are out of proportion of pain, one should consider the differential diagnosis of NF. [4] Early detection and extensive debridement along with fasciotomy are the cornerstones of the management of NF. Since when the debridement is done within 12 h of the onset of symptoms, the mortality rate falls <6%, whereas when the debridement is done after 24 h, the mortality rate is more than 30%. ...
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Necrotising fasciitis (NF) is rapidly spreading bacterial infection of a facial plane. It has a higher mortality rate in patients with diabetes and immunocompromised state. The initial presentation mimics cellulitis and most of the cases are misdiagnosed. Delayed diagnosis and treatment increase mortality by nearly 100%. Our patient had developed NF with septic shock following a monkey bite. The patient underwent prompt fasciotomy along with extensive wound debridement. Later patient underwent secondary suturing with a skin graft for wound cover. NF following money bite is not reported in the literature till now. Hence, early diagnosis and prompt surgical debridement in monkey bites will reduce the incidence of mortality due to NF.
... So, it is always necessary to have a high index of suspicion based on risk factors, history of insect bite or history of animal bite, rapidly progressive systemic sepsis. If clinical features are out of proportion of pain, one should consider the differential diagnosis of NF. [4] Early detection and extensive debridement along with fasciotomy are the cornerstones of the management of NF. Since when the debridement is done within 12 h of the onset of symptoms, the mortality rate falls <6%, whereas when the debridement is done after 24 h, the mortality rate is more than 30%. ...
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Necrotizing fasciitis (NF) is rapidly spreading bacterial infection of a facial plane. It has a higher mortality rate in patients with diabetes and immunocompromised state. The initial presentation mimics cellulitis and most of the cases are misdiagnosed. Delayed diagnosis and treatment increase mortality by nearly 100%. Our case developed NF with septic shock following a monkey bite. The patient underwent prompt fasciotomy along with extensive wound debridement. Later, the patient underwent secondary suturing with a skin graft for wound cover. NF following money bite is not reported in the literature till now. Hence, early diagnosis and prompt surgical debridement in monkey bites will reduce the incidence of mortality due to NF.
... The term "Necrotizing Fasciitis" was first coined by Wilson in the year 1952 [1]. It usually has very nonspecific presentation and may include mild cellulitis, edema, and occasionally crepitation [2]. The rate of accurate diagnosis of of NF is only 15% to 34% on admission [3]. ...
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... 5 Challenges in the diagnosis of NF is enhanced on patients with comorbidities. 6,7 One of the rare comorbidities ever reported in NF is leprosy. 8 Leprosy enhances diagnostic challenges in NF due to its hypoesthesia clinical features that mask severe localized pain, a characteristic feature of NF. 7 We report a case of NF with the history of prior leprosy with marked hypoesthesia in the limited resources. ...
... 6,7 One of the rare comorbidities ever reported in NF is leprosy. 8 Leprosy enhances diagnostic challenges in NF due to its hypoesthesia clinical features that mask severe localized pain, a characteristic feature of NF. 7 We report a case of NF with the history of prior leprosy with marked hypoesthesia in the limited resources. ...
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p class="abstract">Necrotizing fasciitis (NF) is a life-threatening soft tissue infection with a high misdiagnosis rate. Here, we present the case of NF with hypoesthesia due to prior leprosy in a limited resource area. Laboratory risk indicator for NF (LRINEC) score was used to determine the diagnosis of NF. Resuscitation and broad-spectrum antibiotic were initiated, followed by surgical debridement due to lack of wound improvement and skin graft to cover the wound was done. This case report highlights the usage of LRINEC score to reduce misdiagnosis, ensure early diagnosis, and improve patient management in NF with masking effect.</p
... Necrotizing fasciitis (NF) is a rare but serious infection of the subcutaneous tissue and fascia that may progress to affect the overlying skin, the underlying muscle, deep fascia, and bone [1][2][3]. With atypical presentation or delayed diagnosis, late-stage findings of tense edema, bullae, grayish-brown discharge, and crepitation could manifest and are commonly associated with poor prognosis [3]. ...
... Necrotizing fasciitis (NF) is a rare but serious infection of the subcutaneous tissue and fascia that may progress to affect the overlying skin, the underlying muscle, deep fascia, and bone [1][2][3]. With atypical presentation or delayed diagnosis, late-stage findings of tense edema, bullae, grayish-brown discharge, and crepitation could manifest and are commonly associated with poor prognosis [3]. ...
... The incidence of S. agalactiae associated with NF is increasing in nonpregnant adults [1,3,8,9]. This has been linked mostly with the increase in prevalence of chronic diseases, particularly diabetes and malignancy rather than increased virulence of S. agalactiae [9,11]. ...
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Patient: Female, 24-year-old Final Diagnosis: Necrotizing fasciitis Symptoms: Chest pain • chills • fatigue • fever • neck pain • range of motion limitation • right shoulder pain Medication: — Clinical Procedure: — Specialty: Infectious Diseases • General and Internal Medicine • Obstetrics and Gynecology Objective Unusual clinical course Background We present a case of a 24-year-old woman with type 1- diabetes mellitus who developed necrotizing fasciitis (NF) due to Streptococcus agalactiae after a recent colposcopy. Literature review suggests this as the first case to be reported. Case Report The patient initially presented to the emergency department (ED) with right lower neck pain and spasm of the right sternocleidomastoid muscle (SCM), with decreased range of motion. She was diagnosed with torticollis and was sent home on a nonsteroidal anti-inflammatory drug and spasmolytic. She returned 5 days later because of a lack of response. Magnetic resonance imaging of her neck revealed edema and inflammatory changes in the distal portion of her right SCM; an oral-systemic steroid was added to her treatment. However, she presented to the ED 3 days after her second visit with worsening symptoms. Her complaints of severe pain involving the right chest wall, development of fever, and the findings on imaging studies prompted the diagnosis of necrotizing soft-tissue infection and NF. She promptly underwent successful surgical debridement. Tissue cultures grew abundant Streptococcus agalactiae. Her antibiotics were readjusted and she was discharged to rehabilitation. Retrospective analysis of the case was notable for colposcopy with cervical biopsy and endocervical curettage for chronic cervicitis and low-grade squamous intraepithelial lesion within a week of her first ED visit. Conclusions NF caused by Streptococcus agalactiae should be suspected in patients who have had recent genitourinary/gastrointestinal procedures.
... Clinical features of necrotizing fasciitis. [4] Erythema with ill-defined margins of the skin involved, Tense edema with grayish or brown discharge, Lack of lymphangitis or lymphadenopathy, Vesicles or bullae, hemorrhagic bullae, necrosis and crepitus. severe pain, which is out of proportion to physical findings and that extends past the margin of apparent infection. ...
... Necrotizing soft tissue infections are uncommon but lifethreatening soft tissue infection characterized by a fulminant course and a high mortality. 10 However, early clinical recognition of necrotizing fasciitis is difficult, as the disease is often indistinguishable from cellulitis or abscesses early in its evolution. ...
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Background: Necrotizing fasciitis (NF) is a devastating soft tissue infection associated with potentially poor outcomes. The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score has been introduced as a diagnostic tool for NF. We aimed to correlate the clinical features of NSTI with the LRINEC score, its application to distinguish Necrotizing Fasciitis (NF) from other non NSTI and its utility in early surgical management of NSTI.Methods: Patients were evaluated for various symptoms and signs at the time of admission and certain laboratory parameters were assessed. LRINEC score was then calculated. Correlation of the management and severity of infections with respective LRINEC score was then found out.Results: LRINEC score for predicting conservative management of NSTI has a sensitivity of 81.8% and specificity of 98% while for predicting amputation and mortality shows a sensitivity of 100% and specificity of 84.5%.Conclusions: The LRINEC score is a robust score capable of detecting even clinically early cases of necrotizing fasciitis.
... High index of suspicion is needed for early diagnosis. Appearance of swelling, tachycardia, tense oedema, ecchymosis, blister or bullae, crepitus and hypotension are late signs [4] . ...
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Necrotizing fasciitis is a rare complication of chemotherapy, however, few reports were published as a specific complication of taxanes. We are reporting this rare complication of a lady who was treated with taxanes as an adjuvant therapy for her breast cancer who was referred to us from the medical department and turned out to be necrotizing fasciitis in her right thigh. We are also presenting the literature review of this type of complication.
... Fournier's gangrene (involving the scrotum and perineum) and Ludwig's angina (involving submandibular and sublingual spaces) and Meleney's synergistic gangrene (involving abdominal wall) are examples. These infections were named after the physicians who first described them [2]. In 1952, the term "necrotizing fasciitis" was proposed by Wilson, as a more accurate description of this disease [3]. ...
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Meleney’s ulcer or post-operative synergistic bacterial gangrene is a rare form of necrotizing infection of the abdominal wall which develops following intra-abdominal surgery. If not promptly identified and treated, it can lead to extensive gangrene leading to fatal complications. We report a case of Meleney’s gangrene with superadded aspergillosis which rapidly progressed to gangrene of a large area of the anterior abdominal wall leading to mortality of the patient. We also discuss the difficulties in the management of such cases highlighting the need of early and aggressive debridement besides other measures.