Nekrotizirajuće infekcije mekih tkiva

master's thesis

• Title (english): Necrotizing soft-tissue infections
• Author: Damjan Ilić
• Mentor: Goran Augustin (mentor)
• Committee member: Ivan Dobrić (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Goran Augustin (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Nekrotizirajuće infekcije mekih tkiva (NSTI) su rijetka i smrtonosna infektivna stanja koja zahvaćaju potkožno tkivo i fasciju, s ili bez involviranja mišića. To je kirurška dijagnoza koja predstavlja širok spektar bolesti u kojoj teška bakterijska infekcija uzrokuje duboku nekrozu mekih tkiva. Obuhvaća sljedeće kliničke entitete: nekrotizirajući fasciitis, Fournierovu gangrenu, Ludwigovu anginu, klostridijsku mionekrozu (plinska gangrena), nekrotizirajući celulitis (klostridijski i neklostridijski), progresivnu bakterijsku sinergističku gangrenu (Meleneyeva sinergistička gangrena), nekrotizirajući miozitis te piomiozitis. U konačnici, sve se to smatra nekrotizirajućim infekcijama mekih tkiva nastalih bakterijskim prodorom kože, koje dovode do smrti tkiva. Mogu se pojaviti nakon velikih traumatičnih ozljeda, kao i nakon manjih defekata kože ili sluznice, infekcije varičelom, nepenetrirajućih ozljeda mekih tkiva ili rutinskih opstetričkih i ginekoloških postupaka, kao i kod nedavno operiranih i imunokompromitiranih pacijenta. Rana dijagnoza često je izazov zbog inkonzistentnih nalaza pri inicijalnoj prezentaciji, iako se karakteristike nekroze mogu razviti i za nekoliko sati. Postoje jasni čimbenici rizika i karakteristični bakteriološki nalazi, od kojih neki utječu na prognozu. U ovom preglednom radu se analizira incidencija, mortalitet, rizični čimbenici, klasifikacija, klinička slika, te terapija NSTI-a.

Abstract (english)

Necrotizing soft-tissue infections (NSTIs) are a rare and deadly infective condition affecting the subcutaneous tissue and fascia, with or without involvement of the muscle. It is a surgical diagnosis which represents a wide spectrum of diseases where a severe bacterial infection causes deep soft tissue necrosis. It encompasses clinical entities such as: necrotizing fasciitis, Fournier's gangrene, Ludwig's angina, clostridial myonecrosis (gas gangene), necrotizing cellulitis (clostridial and non-clostridial), progressive bacterial synergistic gangrene (Meleney's synergistic gangrene), necrotizing myozitis and pyomyositis. Ultimately, all of these are considered necrotizing soft-tissue infections caused by bacterial penetration of the skin defenses and leading to tissue death. They can occur after major traumatic injuries, as well as after minor breaches of the skin or mucosa, varicella infection, nonpenetrating soft-tissue injuries, or routine obstetrical and gynecologic procedures and also in postsurgical and immunocompromised patients. Early diagnosis of NSTI is often a challenge due to the inconsistent features of necrosis at presentation, even though features of necrosis can also develop within hours. Clear risk factors and patterns of bacteriology exist, some of which define prognosis. This paper is focused on incidence, mortality, risk factors, classification, clinical presentation and therapy of NSTIs.

• Keywords: nekrotizirajući fasciitis; Fournierova gangrena; miozitis; sindrom toksičnog šoka
• Keywords (english): necrotizing fasciitis; Fournier's gangrene; myositis; toxic shock syndrome
• Language: croatian
• URN:NBN: urn:nbn:hr:105:045396
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-01-10 09:34:49