fasciitis

Inflammation of fascia Etiology: 1) contaminated trauma 2) etiologic agents (bacterial fasciitis) a) Clostridium perfringens b) group A streptococcus c) mixed anaerobic & aerobic organisms (trauma) - Staphylococcus aureus d) gram negative rods in diabetics e) Bacillus cereus f) Vibrio vulnificus Pathology: 1) occurs together with localized myositis 2) necrotizing fasciitis involves deep tissue planes Clinical manifestations: 1) patient may appear extremely toxic 2) rapid deterioration of clinical status may occur 3) severe pain & swelling 4) early signs of necrotizing fasciitis may not be apparent on the surface of the skin 5) crepitus occurs with gas gangrene Laboratory: 1) complete blood count: leukocytosis 2) gram stain of deep tissue Radiology: 1) plain radiographs may show gas tracking into muscle if there is associated myonecrosis 2) computed tomography (CT) or magnetic resonance imaging (MRI) show: a) muscle swelling b) fluid collections in muscle compartments c) gas Management: 1) antibiotics - penicillin plus clindamycin 2) surgical debridement 3) hyperbaric oxygen for anaerobes

Specific

eosinophilic fasciitis (Shulman's syndrome) Fournier's gangrene gas gangrene (anaerobic cellulitis) necrotizing fasciitis plantar fasciitis

General

inflammation musculoskeletal disease/disorder

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998