1/8. Infectious disease emergencies in primary care.Infectious disease emergencies can be described as infectious processes that, if not recognized and treated immediately, can lead to significant morbidity or mortality. These emergencies can present as common or benign infections, fooling the primary care provider into using more conservative treatment strategies than are required. This review discusses the pathophysiology, history and physical findings, diagnostic criteria, and treatment strategies for the following infectious disease emergencies: acute bacterial meningitis, ehrlichiosis, rocky mountain spotted fever, meningococcemia, necrotizing soft tissue infections, toxic shock syndrome, food-borne illnesses, and infective endocarditis. Because most of the discussed infectious disease emergencies require hospital care, the primary care clinician must be able to judge when a referral to a specialist or a higher-level care facility is indicated.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/8. Necrotizing fasciitis secondary to group A streptococcus. morbidity and mortality still high.OBJECTIVE: To update physicians on Group A streptococcal necrotizing fasciitis, including current methods of diagnosis and treatment. QUALITY OF EVIDENCE: Current literature (1990-1998) was searched via medline using the MeSH headings necrotizing fasciitis, toxic shock syndrome, and streptococcus. Articles were selected based on clinical relevance and design. Most were case reports, case series, or population-based surveys. There were no randomized controlled trials. MAIN MESSAGE: The hallmark of clinical diagnosis of necrotizing fasciitis is pain out of proportion to physical findings. Suspicion of underlying soft tissue infection should prompt urgent surgical examination. Therapy consists of definitive excisional surgical debridement in conjunction with high-dose intravenous penicillin g and clindamicin. risk factors for mortality include advanced age, underlying illness, hypotension, and bacteremia. CONCLUSION: Necrotizing soft tissue infections due to Group A streptococcus might be increasing in frequency and aggression. overall mortality remains high (20% to 34% in larger series). Clinical diagnosis requires a high level of suspicion and should prompt urgent surgical referral.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/8. patients with acute skin loss: are they best managed on a burns unit?patients who are critically ill and have large areas of skin loss or breakdown present a difficult management problem. They require the combination of intensive therapy facilities to support failing organs and specialized skin care, sometimes including extensive debridement and reconstruction. The expertise required for both aspects of treatment are found uniquely on a burns unit. We present five patients with large areas of cutaneous loss or damage secondary to a variety of non-burn aetiologies who were managed on a burns unit. We suggest that a burns unit may be the most appropriate place for such patients to be treated during both the acute phase of their illness and the later stages of surgical reconstruction and physical rehabilitation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/8. Deep soft tissue infections in the neutropenic pediatric oncology patient.PURPOSE: Necrotizing fasciitis and myonecrosis can be rapidly fatal without prompt and aggressive medical and surgical therapy. We reviewed our experience with necrotizing fasciitis and myonecrosis in neutropenic pediatric oncology patients to describe associated clinical characteristics and outline therapeutic interventions. patients AND methods: A retrospective chart review was performed for all cases of deep soft tissue infection found in neutropenic pediatric oncology patients during an 11-year period. RESULTS: Seven cases of necrotizing fasciitis and/or myonecrosis associated with chemotherapy-induced neutropenia were diagnosed during the study period. Deep soft tissue infection was diagnosed a median of 14 days after the initiation of chemotherapy. All of the patients presented with fever and pain, generally out of proportion to associated physical findings. Most patients (86%) also had tachycardia and subtle induration at the site of soft tissue infection. The pathogenic organism in four of seven patients originated in the gastrointestinal tract. patients were treated with antibiotics, surgical debridements, granulocyte colony-stimulating factor, and hyperbaric oxygen. Granulocyte transfusions were administered if there were no signs of neutrophil recovery. Five patients survived their deep soft tissue infection. CONCLUSIONS: The diagnosis of necrotizing fasciitis and/or myonecrosis should be considered in any neutropenic patient with fever, tachycardia, and localized pain out of proportion to the physical findings. Appropriate therapy includes broad-spectrum intravenous antibiotics and urgent surgical intervention. granulocyte colony-stimulating factor should be administered to all patients to enhance neutrophil recovery. Granulocyte transfusions should be considered if a prolonged period of neutropenia is anticipated.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
5/8. Necrotizing fasciitis following liver and small intestine transplantation.Necrotizing fasciitis is a rare, subcutaneous infection. It can occur in patients after solid-organ transplantation. We herein report two patients who developed necrotizing fasciitis following combined liver and small intestine transplantation. The first patient experienced this infection 4 yr after transplantation and 1 yr after the closure of the ileostomy. The second patient suffered from necrotizing fasciitis 2 days after the transplant. Both cases were diagnosed on the physical findings, culture of subcutaneous lavage, and the computed tomography findings. The site of entrance of the organism was not clear in either case. Both patients had a fulminant course and died within 1 week from the onset, despite aggressive surgical intervention. Therefore, necrotizing fasciitis has to be recognized as a potential complication of intestinal transplantation.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/8. When pain is out of proportion.What happened to each of the patients? On re-examination, the first person was in tears and unable to lie still, even after 20 mg of i.v. morphine sulfate. Capillary refill was still intact, but he had lost sensation to the dorsum of the foot and was unable to dorsiflex his toes. He had a marked elevation of compartment pressure, and his creatinine phosphokinase (see below) was twice normal. In the OR, a fasciotomy was performed. Some muscle necrosis had occurred. In the second patient, fluids were infused rapidly on arrival at the ED via the i.v. route. He was given morphine sulfate for pain control while we awaited laboratory results. After about 45 minutes, he produced dark red urine. His creatinine phosphokinase (diagnostic muscle enzyme test) was 190,000--nearly 1,000 times above normal. He also had evidence of liver and kidney damage, but no electrolyte abnormalities. With aggressive treatment, including furosemide and sodium bicarbonate, his kidney and liver function returned to normal, he survived the ordeal and was discharged. The group leaders took the third patient to a local ED, where cellulitis was diagnosed and oral antibiotics were prescribed. The pain and fever increased, and significant discoloration began spreading up her hand over the next 24 hours. The second ED visit resulted in an admission. When the findings progressed despite i.v. antibiotics, surgical exploration was performed with drainage, debridement of devitalized tissue and a change in i.v. antibiotics. The common feature of all of these conditions is pain out of proportion to few, if any, findings on physical examination. Swelling that causes much of the damage in each condition is frequently not appreciated clinically until the condition is well advanced. Remember, what you see is not necessarily what you get.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
7/8. Necrotising fasciitis: a life-threatening complication of acupuncture in a patient with diabetes mellitus.acupuncture is used for some conditions as an alternative to medication or surgical intervention. Several complications had been reported, and they are generally due to physical injury by the needle or transmission of diseases. We report a case of life-threatening necrotising fasciitis that developed after acupuncture treatment for osteoarthritis of the knee in a 55-year-old diabetic woman. She presented with multiple discharging sinuses over the right knee. As the patient did not respond to intravenous antibiotics, extensive debridement was performed. She made a good recovery. Since many old diabetic patients with degenerative joint diseases may consider this mode of treatment, guidelines on cleanliness and sterility of this procedure should be developed and practiced.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/8. A case series of group A streptococcus necrotizing fasciitis in military trainees.We describe a case series of group A streptococcus (GAS) necrotizing fasciitis occurring over a 10-week period in military recruits undergoing intense physical training. These cases highlight that GAS may cause life-threatening infections in addition to mild diseases such as pharyngitis. This series suggests that the incidence of severe GAS infections may be increasing in certain populations and it emphasizes the importance of considering prophylactic measures against GAS in high-risk populations.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |