Şiddetli Nekrotizan Fasiit: Olgu Sunumu

Yıl 2021, Cilt: 2 Sayı: 3, 218 - 223, 17.11.2021

Arda Şakir Yılmaz Bartu Badak Ahmet Ümit Cebeci

Öz

Nekrotizan fasiit (NF), cilt altı doku ve fasyaları etkileyen, hızla yayılan inflamasyon, tromboz ve nekrozla seyreden, nadir görülen, ciddi bir bakteriyel yumuşak doku enfeksiyonudur. Dokularda hızla yayılan nekroz sıklıkla sistemik sepsise, toksik şok sendromuna ve çoklu organ yetmezliğine neden olur. Mortalite ve morbidite oranlarının oldukça yüksek olduğu bu klinik tabloda erken başvuru, erken tanı ve erken etkin tedavinin bu oranları dramatik bir şekilde azalttığı daha önce yapılan çalışmalar ve sunumlar ile net bir şekilde ortaya konmuştur. Tekrarlayıcı debridmanlar ve zorlu bir yara bakım sürecinin gerekli olabileceği bu tabloda etkili bir yoğun bakım takibinin gerekli olduğu aşikardır. Yeterli ve uygun nekroze dokuların debridmanı ve uygun antibiyoterapinin en etkili tedavi yöntemi olarak görüldüğü bu süreçte çeşitli yara bakım tedavileri de kullanılabilmektedir. Bu olgu sunumunda dış merkezden merkezimize akut renal yetmezlik ön tanısı ile refere edilen ve yapılan tetkikler sonrası şiddetli nekrotizan fasiit tablosunu, bu denli yaygın ve şiddetli tablonun ağırlığını, resimler ve laboratuvar bulguları eşliğinde literatüre katkı sağlamayı amaçladık.

Anahtar Kelimeler

nekrotizan fasiit, yumuşak doku nekrozu, yumuşak doku enfeksiyonu

Severe Necrotizing Fasciitis: Case Report

Öz

Necrotizing fasciitis (NF) is a rare, serious bacterial soft tissue infection that affects the subcutaneous tissue and fascia and is characterized by rapidly spreading inflammation, thrombosis and necrosis. Rapidly spreading necrosis in tissues often causes systemic sepsis, toxic shock syndrome, and multiple organ failure. In this clinical picture where mortality and morbidity rates are quite high, it has been clearly demonstrated by previous studies and presentations that early admission, early diagnosis and early effective treatment reduce these rates dramatically. It is obvious that an effective intensive care follow-up is required in this situation where repetitive debridements and a difficult wound care process may be required. Various wound care treatments can also be used in this process, where debridement of adequate and appropriate necrosis tissues and appropriate antibiotic therapy are seen as the most effective treatment method. In this case report, we aimed to contribute to the literature with the severe necrotizing fasciitis picture, the severity of such a common and severe picture, accompanied by pictures and laboratory findings, which was referred to our center from another center with a preliminary diagnosis of acute renal failure and after the examinations performed. nary diagnosis of acute renal failure and after the examinations performed.

Anahtar Kelimeler

nekrotizing fasciitis, soft tissue necrosis, soft tissue infection

Kaynakça

• Referans1. Yagmur O, Erkocak EU, Sonmez H Alparslan A, Demircan O,Dalay C. Necrotizing fasciitis. Dig Surg 1995;12:106-10.ALTINTOP ve ark.Nekrotizan Fasiit Olgu Bozok Tıp Derg 2016;6(4):68-71 Bozok Med J 2016;6(4):68-71.
• Referans2.Napolitano LM. Severe soft tissue infections. Infect Dis Clin North Am 2009; 23: 571-591.
• Referans3. Fichev G, Kostov V, Marina M ve ark. Fornier’s gangrene: a clinical and bacteriological study. Anaerobe 1997;3:195-7.
• Referans4. Swartz MN, Pasternack MS. Cellulitis, necrotizing fasciitis, and subcutaneous tissue infections. In: Mandell GL, Bennett JE, Dolin R (Eds). Principles and practice of infectious diseases. 7th ed. New York: Churchill Livingstone; 2010: p. 1289-1312.
• Referans5. Liu YM, Chi CY, Ho MW ve ark. Microbiology and factors affecting mortality in necrotizing fasciitis. J Microbiol Immunol Infect 2005;38: 430-435.
• Referans6. Trent JT, Kirsner RS. Diagnosing necrotizing fasciitis. Adv Skin Wound Care 2002;15:135-8.
• Referans7. File TM Jr, Tan JS, DiPersio JR. Group A streptococcal necrotizing fasciitis. Diagnosing and treating the “flesh-eating bacteria syndrome”. Cleve Clin J Med 1998;65:241-9.
• Referans8. Kuncir EJ, Tillou A, Hill CR ve ark. Necrotizing soft tissue infections, Emerg Med Clin North Am 2003;21:1075-87.
• Referans9. Addison WA, Livengood CH 3rd, Hill GB ve ark. Necrotizing fasciitis of vulvar origin in diabetic patients. Obstet Gynecol 1984;63:473-9.
• Referans10. Kaul R, McGeer A, Low DE ve ark. Population-based surveillance for group A streptococcal necrotizing fasciitis: clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases.Ontario Group A Streptococcal Study. Am J Med 1997;103:18-24.
• Referans11. Levine EG, Manders SM. Life-threatening necrotizing fasciitis.Clin Dermatol 2005;23:144-7.
• Referans12. Ripley DL. Necrotizing fasciitis. Prim Care Update Ob Gyns 2001; 7:142-147.
• Referans13. Lichtenstein D, Stavorovsky M, Irge D. Fournier’s gangrene complicating perianal abscess: report of two cases. Dis Colon Rectum 1978; 21: 377-379.
• Referans14. Carter PS, Banwell PE. Necrotizing fasciitis: a new management algorithm based on clinical classification. Int Wound J 2004;1:189-98.
• Referans15.Levine EG, Manders SM. Life-threatening necrotizing fasciitis. Clin Dermatol 2005;23:144-7.
• Referans16.Wong CH, Khin LW, Heng KS ve ark. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med 2004;32:1535-41.
• Referans17. Mulla ZD. Treatment options in the management of necrotizing fasciitis caused by Group A Streptococcus. Expert Opin Pharmacother 2004;5:1695-700.
• Referans18. Taviloglu K, Yanar H. Necrotizing fasciitis: strategies for diagnosis and management. World J Emerg Surg 2007;2:19.
• Referans19. Dufel S, Martino M. Simple cellulitis or a more serious infection? J Fam Pract 2006;55:396-400.
• Referans20. Sudarsky LA, Laschinger JC, Coppa GF ve ark. Improved results from a standardized approach in treating patients with necrotizing fasciitis. Ann Surg 1987;206:661-5.
• Referans21.Cox NH. Streptococcal necrotizing fasciitis and the dermatologist. Br J Dermatol 1999;141:613-4.
• Referans22. Young MH, Aronoff DM, Engleberg NC. Necrotizing fasciitis: pathogenesis and treatment. Expert Rev Anti Infect Ther 2005;3:279-94.
• Referans23.Wang YS, Wong CH, Tay YK. Staging of necrotizing fasciitis based on the evolving cutaneous features. Int J Dermatol 2007;46:1036-41.
• Referans24.Wong CH, Wang YS. The diagnosis of necrotizing fasciitis. Curr Opin Infect Dis 2005;18:101-6.
• Referans25. Oelbrandt B, Krasznai A, Bruyns T, Duinslaeger L, Reper P, Vanderkelen A, et al. Surgical treatment of Fournier’s gangrene: use of cultured allogeneic keratinocytes. Eur J Plast Surg 2000;23:369-372.
• Referans26. Bellapianta JM, Ljungquist K, Tobin E, Uhl R. Necrotizing fasciitis. J Am Acad Orthop Surg 2009;17:174-82.
• Referans27.Wysoki MG, Santora TA, Shah RM, Friedman AC. Necrotizing fasciitis: CT characteristics. Radiology 1997;203:859-63.
• Referans28.Young MH, Aronoff DM, Engleberg NC. Necrotizing fasciitis: pathogenesis and treatment. Expert Rev Anti Infect Ther 2005;3:279-94.
• Referans29.Unalp HR, Kamer E, Derici H, Atahan K, Balci U, Demirdoven C, et al. Fournier’s gangrene: evaluation of 68 patients and analysis of prognostic variables. J Postgrad Med 2008;54:102-5. Nekrotizan fasiit Cilt - Vol. 18 Sayı - No. 6 513.
• Referans30. Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis 2007;44:705-10.
• Referans31. Saxena V, Hwang CW, Huang S ve ark. Vacuum-assisted closure: microdeformations of wounds and cell proliferation. Plast Reconstr Surg 2004; 114: 1086-1096.