CELLULITIS AND NECROTIZING FASCIITIS

Question 1

Acute spreading infection involves the deeper dermis and

superficial subcutaneous tissues. ?

Answer 1

Cellulitis

Question 2

most common organisms?

Answer 2

• Group A streptococci
• S. aureus : commonly causes cellulitis- penetrating trauma.
• Haemophilus influenzae: periorbital cellulitis in children

Question 3

commonly causes cellulitis- penetrating trauma. ?

Answer 3

• S. aureus

Question 4

Cause periorbital cellulitis in children ?

Answer 4

Haemophilus influenzae

Question 5

Cellulitis Risk factors?

Answer 5

1. Obesity
2. preexisting skin infections-
   ulceration, or eczema,
   • CA-MRSA
   -More sensitive to antibiotics
   -Can lead to sever skin and soft tissue infection or septic shock

Question 6

Diagnosis of Cellulitis?

Answer 6

1. Clinical diagnosis Symptoms and Signs
2. Laboratory investigation :
   -High WBCs, blood culture rarely needed
   -Observe for progression to sever infection(increased in size with systemic
   manifestation :fever, leukocytosis)

Question 7

Treatment of Cellulitis?

Answer 7

Vancomycin

Question 8

• It is a rare deep skin and subcutaneous tissues infection ?

Answer 8

Necrotizing fasciitis(Flesh-eating disease)

Question 9

an uncommon but rapidly progressive and life
-threatening infection of the deep dermis, adipose tissue and
subcutaneous fascia.?

Answer 9

Necrotising fasciitis (NF)

Question 10

monomicrobial (Type II) or (polymicrobial Type I) infection ?

Answer 10

Necrotizing fasciitis(Flesh-eating disease)

Question 11

Most common in the arms, legs, and abdominal wall and is fatal ?

Answer 11

Necrotizing fasciitis(Flesh-eating disease)

Question 12

Risk factors

Of Necrotizing fasciitis(Flesh-eating disease)

Answer 12

Immune-suppression • Chronic diseases: ( diabetes, liver and kidney diseases, malignancy • Trauma:(laceration, cut, abrasion, contusion, burn, bite, subcutaneous
injection, operative incision) • Recent viral infection rash (chickenpox) • Steroids • Alcoholism • Malnutrition • Idiopathic

Question 13

Most common organisms of Necrotizing fasciitis(Flesh-eating disease)
?

Answer 13

1. Monomicrobial
   • Group A streptococcus (Streptococcus pyogenes)
   • Staphylococcus aureus or CA-MRSA

2.Polymicrobial
• Caused by aerobic and anaerobic bacteria

• Gram-negative bacteria (synergy).

Question 14

Classification of necrotizing fasciitis

? Very imp

Answer 14

Type 1: polymicrobial
Type2: monomicrobial
Type3: marine vibrio vulnifius
Type4: MRSA

Question 15

Pathophysiology of necrotizing fasciitis

?

Answer 15

Destruction of skin and muscle by releasing toxins • Streptococcal pyrogenic exotoxin • Superantigen • Non-specific activation of T-cells • Overproduction of cytokines • Severe systemic illness (Toxic shock syndrome)

Question 16

Signs and symptoms of necrotizing fasciitis

?

Answer 16

• Rapid progression of sever pain with fever , chills (typical) • Swelling , redness, hotness, blister, gas formation, gangrene and necrosis • Blisters with subsequent necrosis , necrotic eschars • Diarrhea and vomiting (very ill) • Shock organ failure • Mortality as high as 73 % if untreated

Question 17

Diagnosis of Necrotising fasciitis ?

Answer 17

• A delay in diagnosis is associated with a grave prognosis and
increased mortality • Clinical-history and examination • Blood tests • CBC-WBC , differential , ESR • BUN (blood urea nitrogen) • Surgery debridement- amputation • Radiographic studies • X-rays : subcutaneous gases • Doppler CT or MRI • Microbiology • Culture &Gram’s stain • ( blood, tissue, pus aspirate) • Susceptibility tests

Question 18

NF should be suspected in the following scenarios: ?

Answer 18

If the level of pain and tenderness, or systemic upset, is out of proportion to
the physical signs • Dusky-violaceous areas along with erythema • Crepitus • Over a short period of time blisters develop, the affected area becomes
necrotic, and the patient very toxic

Question 19

Treatment of NF?

Answer 19

• If clinically suspected patient needs to be hospitalized OR require admission
to ICU • Start intravenous antibiotics immediately • Antibiotic selection based on bacteria suspected • broad spectrum antibiotic combinations against: • methicillin-resistant Staphylococcus aureus (MRSA)

Antibiotics combinations