necrotizing fasciitis

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necrotizing fasciitis,

a quickly progressing infection of the skin that spreads along the fascia, the tissue that covers the muscles. (Necrotizing infections that spread along the outer skin layers are known as necrotizing cellulitis.) Necrotizing fasciitis is most commonly caused by toxins released by a strain of Group A streptococcal bacteria (S. pyrogenes; see streptococcusstreptococcus
, any of a group of gram-positive bacteria, genus Streptococcus, some of which cause disease. Streptococci are spherical and divide by fission, but they remain attached and so grow in beadlike chains.
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), but it also may be caused by Staphylococcus aureus (see staphylococcusstaphylococcus
, any of the pathogenic bacteria, parasitic to humans, that belong to the genus Staphylococcus. The spherical bacterial cells (cocci) typically occur in irregular clusters [Gr. staphyle=bunch of grapes].
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); other bacteria may also be present.

Popularly known as "flesh-eating disease," the infection typically begins as a warm, very painful red swelling, sometimes at the site of a minor injury. Patients usually have a high fever and may feel ill, dizzy, and confused; the infection spreads rapidly, and tissue in older infected areas turns purplish or black as it dies. Necrotizing fasciitis is treated with surgery (to remove infected tissue) and intravenous antibiotics (high-dose penicillin and clindamycin). If not treated promptly, the toxins produced by the bacteria can cause septic shock and lead to death within 24 hours; roughly 30% of infected patients die.

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Our literature research indicates that the fatality rate of necrotizing fascitis attributable to A hydrophila in a host with compromised immunity has been reported to be as high as 50% to 100% (1-5).
Two Korean doctors presented the cases of healing of the infected cystic mass in the submandibular area and the retroperitoneal necrotizing fascitis due to perforated acute appendicitis, with scientific and medical data confirming the healing cases.
Because necrotizing fascitis was suspected, intravenous ampicillin-sulbactam (12 g per day) was started, and surgical evaluation was requested.

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