title: An algorithm for early diagnosis of cervicofacial necrotising fasciitis.
abstract: Cervicofacial necrotising fasciitis (CNF) is a potentially fatal infection which can occasionally present in the head and neck. An early diagnosis and aggressive treatment is imperative for minimising the associated mortality and morbidity. The early clinical features are usually non-specific which makes it difficult to differentiate it from other less serious infections. Necrosis of the skin is a late feature. Although it is more common in the immunocompromised, it can also affect normal individuals. We discuss our experience of five patients with CNF, review of literature and algorithm for early diagnosis of CNF. With experience, we were able to diagnose the subsequent cases early and minimise the mortality and morbidity. In conclusion, the incidence of CNF has increased in the last decade partly due to an increased clinical awareness. Early intervention is essential to minimise the mortality and morbidity. It should be managed by a team of at least otolaryngologists, intensivist, microbiologist and plastic surgeons; cardiothoracic surgeons may be required. Treatment involves early aggressive surgical debridement/fasciotomy, intravenous antibiotics and general metabolic support in the intensive care unit.
authors.affiliation: Department of Otolaryngology, Royal Bolton Hospital, Royal Bolton Hospital NHS Foundation Trust, Minerva Road, Bolton BL4 0JR, UK. vikasmalik@doctors.org.uk
authors.forename: Vikas
authors.initials: V
authors.lastname: Malik
authors.forename: Chaitanya
authors.initials: C
authors.lastname: Gadepalli
authors.forename: Shailesh
authors.initials: S
authors.lastname: Agrawal
authors.forename: Claire
authors.initials: C
authors.lastname: Inkster
authors.forename: Christopher
authors.initials: C
authors.lastname: Lobo
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003646:Debridement; D003937:Diagnosis, Differential; D018450:Disease Progression; D004359:Drug Therapy, Combination; D042241:Early Diagnosis; D005141:Eyelid Diseases / Q000175:diagnosis / Q000601:surgery; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000601:surgery; D000071938:Fasciotomy; D017809:Fatal Outcome; D005260:Female; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000175:diagnosis / Q000601:surgery; D010038:Otorhinolaryngologic Diseases / Q000175:diagnosis* / Q000601:surgery; D013290:Streptococcal Infections / Q000175:diagnosis* / Q000601:surgery; D034364:Streptococcus milleri Group; D013297:Streptococcus pyogenes; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography
chemical_list: D000900:Anti-Bacterial Agents
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