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39 Cards in this Set
- Front
- Back
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What are type 1 risk factors for necrotizing fasciitis?
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recent surgery, trauma
diabetes |
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Where does type 1 necrotizing fasciitis usually occur?
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on the trunk, abdomen, or perineum
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What is fourniers gangrene?
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this is necrotizing fasciitis of the genitalia
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What usually causes type 2 necrotizing fasciitis?
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GABHS, GAS
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What M protein groups cause type 2 necrotizing fasciitis?
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M proteins 1/3
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What are the risk factors for type 2 necrotizing fasciitis?
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none- anyone can get it
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What are the clinical manifestations of necrotizing fasciitis?
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Pain out of proportion to clinical findings**
Hard, wooden feel to subcue tissues Erythema system toxicity |
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What type of necrotizing fasciitis causes gas in the tissues?
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Type 1
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What type of necrotizing fasciitis causes a putrid odor?
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ones caused by anaerobic bugs
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What is the first treatment of necrotizing fasciitis?
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debriedment in surgery
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What antibiotics are given for type I necrotizing fasciitis?
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ampiclillin, clindamycin, metronidazole
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What antibiotics are given for type II necrotizing fasciitis?
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clindamycin, penicillin G, Vancomycin
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What is the drug of choice for necrotizing fasciitis?
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Clindamycin
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How high is the mortality of necrotizing fasciitis?
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70-80%
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How fast can necrotizing fasciitis kill you?
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24-96 hours
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What is myonecrosis?
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this is a life threatening muscle infection
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how do you get myonecrosis?
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either from trauma
or spread from GI tract |
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What two bugs cause myonecrosis?
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Clostridium
GAS |
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How do you get spontaneous gangrenous myosisits?
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abrasions and blunt trauma
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What drugs predispose people to spontaneous gangrenous myosisits?
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NSAIDS because they masks the signs and symptoms
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What does injured muscle upregulate, and how does this lead to spontaneous gangrenous myosisits?
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this upregulates Vimentin- which increases the adherence of GAS to the tissue
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What are the clinical signs of spontaneous gangrenous myosisits?
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fever, exquisite pain, tenderness
Board like induration HEET |
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What are the surgical findings of spontaneous gangrenous myosisits?
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degeneration and necrosis of skeletal muscle
infiltration of granulocytes G+ streptococci |
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What is the Tx for spontaneous gangrenous myosisits?
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Clindamycin
surgical debriedment |
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What is the general morphology of the bug related to Gas Gangrene?
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endospore forming anaerobic bacilli
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What is Clostridial myonecrosis?
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gas grangrene
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What type of bug causes gas gangrene?
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clostridium perfringens type A
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What is the doubling time of the bug in Clostridial myonecrosis?
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8-10 min, very fast
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What is the usual method of entry for Clostridial myonecrosis?
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malignant spread from the GI tract via hematogenous routes
this is the spontaneous |
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Other than by cancers destroying the GI and bugs leaking out, how can you get Clostridial myonecrosis?
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Trauma/surgery innoculation
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What is the toxin responsible for Clostridial myonecrosis?
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Alpha Toxin ***
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What does alpha toxin of Clostridial myonecrosis do?
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this lyses tons of cells
Decreases cardiac inotropy Triggers histamine release, platelet aggregation, and thrombus formation (seals it off) |
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What cell type is destroyed by Clostridial myonecrosis, but NOT by GAS spontaneous gangrenous myositis?***
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PMN's are destroyed ONLY in Clostridial myonecrosis
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What toxin in Clostridial myonecrosis causes PMN destruction?
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Theta toxin
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in Clostridial myonecrosis, how does the gas cause damage?
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this separates fascial planes, allowing access to other sites
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What regions of the body usually get Clostridial myonecrosis?
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extremities make up 90% of cases
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What is the smell of C perfringens Clostridial myonecrosis?
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sweet mousy smell, which smells like fresh cut grass or fresh cut hay
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What are the key diagnostic factors for Clostridial myonecrosis?
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Gas pockets in tissues
G+ bacilli on culture ABSENT inflammatory cells** (kills PMN's) Double hemolysis zones on plating |
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What is the Tx for Clostridial myonecrosis?
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surgical debriedement
penicillin and clindamycin |
