Necrotizing Fasciitis - Diagnosis

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How do health-care professionals diagnose necrotizing fasciitis?

Often a preliminary diagnosis of necrotizing fasciitis is based on the patient's symptoms, including the medical and exposure history as described above. For example, a diabetic patient with a rectal fistula who develops pain, swelling, and scrotal skin changes may be preliminarily diagnosed with Fournier's gangrene, while another diabetic patient with liver failure and skin changes (bullae) and exposure to seawater may be preliminarily diagnosed with a Vibrio vulnificus infection. Initial treatment is often begun based upon a preliminary diagnosis because waiting for a definitive diagnosis can delay treatment and result in increased morbidity and mortality. Gram staining of exudates (fluid from the infection site) or biopsied tissue may provide the physician clues to determine what organism(s) are causing the infection. For example, the stain can distinguish between Gram-negative and Gram-positive organisms and further distinguish their shapes (coccus or round, rod, or comma-shaped like Vibrio). Definitive diagnosis depends on isolation of the organism(s) from the patient using both aerobic and anaerobic isolation techniques, and rarely, fungal culture methods.

Organisms isolated from necrotizing fasciitis need to have studies done to determine antibiotic resistance, because many organisms causing the disease are multidrug resistant. A surgeon needs to be consulted early to help obtain tissue samples and to be involved with potential treatment protocols (debridement, amputation). Although X-rays occasionally show gas in tissues, investigators suggest doing Doppler ultrasound, CT, or MRI studies to help show gas in tissues and to help delineate the extent of the infection. Most physicians run additional tests such as white blood cell (WBC) counts (elevated in necrotizing fasciitis), BUN (blood urea nitrogen), sodium (decreased in necrotizing fasciitis), and other tests to monitor the patient.

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Comment from: Bren, 45-54 Female (Patient) Published: March 08

I got necrotizing fasciitis from a small sore on the back of the leg. In January 2013 I started flu like symptoms so that's what I thought it was. Within two days I was going into the hospital and on my death bed. I was put on life support and they operated that night. I was in the hospital for 18 months. I lost 80 percent of my bowel. I lost my right leg and I lot of my buttocks. I had over 100 surgeries, a lot of skins grafts and I'm still battling this, but I have been home 6 months and getting my dressing done on my bottom. But I'm grateful to be alive.

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