title: The initial outpatient-physician encounter in group A streptococcal necrotizing fasciitis.
abstract: Of 15 patients in whom the diagnosis of streptococcal necrotizing fasciitis was missed at initial outpatient evaluation, 8 died. Although influenza-like and gastrointestinal symptoms were common, the most consistent clinical clue was unrelenting pain out of proportion to the physical findings. Necrotizing fasciitis should be considered in patients presenting with the latter complaint, even if there is only mild or no fever or erythema.
authors.affiliation: Department of Medicine, University of Miami School of Medicine, and Veterans Affairs Medical Center, Miami, Florida 33125, USA. abisno@med.miami.edu
authors.forename: A L
authors.initials: AL
authors.lastname: Bisno
authors.forename: F R
authors.initials: FR
authors.lastname: Cockerill
authors.forename: C T
authors.initials: CT
authors.lastname: Bermudez
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology / Q000503:physiopathology; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D013297:Streptococcus pyogenes / Q000302:isolation & purification*