Necrotizing fasciitis laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
Laboratory findings consistent with the diagnosis of necrotizing fasciitis include positive blood and tissue culture, elevated inflammatory markers, [[leukocytosis]] and elevated [[serum creatinine]]. | |||
==Laboratory Findings== | ==Laboratory Findings== | ||
Laboratory tests consistent with diagnosis of necrotizing fasciitis include: | Laboratory tests consistent with diagnosis of necrotizing fasciitis include:<ref name="pmid19826154">{{cite journal| author=Puvanendran R, Huey JC, Pasupathy S| title=Necrotizing fasciitis. | journal=Can Fam Physician | year= 2009 | volume= 55 | issue= 10 | pages= 981-7 | pmid=19826154 | doi= | pmc=2762295 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19826154 }} </ref> | ||
===Microbiology=== | ===Microbiology=== | ||
The following are the tests used to diagnose the causative organism: | The following are the tests used to diagnose the causative organism: | ||
*Gram stain and culture of tissues and aspirates | *[[Gram stain]] and [[culture]] of tissues and [[aspirates]] | ||
*Blood culture | *[[Blood culture]] | ||
*Culture of throat and vaginal swabs | *Culture of throat and vaginal swabs | ||
*Fungal culture (immunocompromised or trauma patients) | *Fungal culture ([[immunocompromised]] or trauma patients) | ||
*Enrichment cultures (patients with recent antibiotic use) | *Enrichment cultures (patients with recent [[antibiotic]] use) | ||
=== | ===Biochemistry=== | ||
The biochemistry findings consistent with diagnosis of necrotizing fasciitis include: | The biochemistry findings consistent with diagnosis of necrotizing fasciitis include: | ||
*Elevated C-reactive protein | *Elevated [[C-reactive protein]] | ||
*Elevated serum | *Elevated serum [[creatine kinase]] | ||
*Hypocalcemia (sign of severity in synergistic NF) | *[[Hypocalcemia]] (sign of severity in [[synergistic]] NF) | ||
*Hypoalbuminemia | *[[Hypoalbuminemia]] | ||
*Hyponatremia (<135mmol/L) | *[[Hyponatremia]] (<135mmol/L) | ||
*Elevated serum lactate levels (high serum lactate combined with low sodium levels may be predictive of mortality) | *Elevated [[lactate|serum lactate]] levels (high serum lactate combined with low sodium levels may be predictive of mortality) | ||
*Arterial blood gas analysis | *[[Arterial blood gas]] ([[ABG]]) analysis | ||
*Urine analysis | *Urine analysis | ||
*Elevated | *Elevated [[blood urea nitrogen]] ([[BUN]]) | ||
=== | ===Hematology=== | ||
The following are complete blood count with differential findings: | |||
:*Rapidly falling [[hemoglobin]] | |||
:*[[Leukocytosis]] (>14,000/µL) | |||
:*[[Leukopenia]] (if associated with [[STSS]]) | |||
:*[[Lymphopenia]] | |||
:*[[Thrombocytopenia]] | |||
:* | |||
:* | |||
|} | ===Tissue oxygen saturation=== | ||
Other diagnostic studies of necrotizing fasciitis include:<ref name="pmid15332062">{{cite journal| author=Wang TL, Hung CR| title=Role of tissue oxygen saturation monitoring in diagnosing necrotizing fasciitis of the lower limbs. | journal=Ann Emerg Med | year= 2004 | volume= 44 | issue= 3 | pages= 222-8 | pmid=15332062 | doi=10.1016/S0196064404003038 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15332062 }} </ref> | |||
*Tissue oxygen saturation monitoring: | |||
:*Occurs at the bedside. | |||
:*Is a noninvasive method to continuously monitor extremities at risk and avoid delayed diagnosis | |||
:**Tissue oxygen saturation is measured using near-infrared [[spectroscopy]]. | |||
:*In patients with necrotizing faciitis, oxygen saturation are often diminished in the lower extremities and return to normal after [[fasciotomy]]. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
[[Category:Emergency mdicine]] | |||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category: | [[Category:Up-To-Date]] | ||
[[Category:Infectious disease]] | [[Category:Infectious disease]] | ||
[[Category:Surgery]] | |||
[[Category:Orthopedics]] | |||
Latest revision as of 22:56, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Yamuna Kondapally, M.B.B.S[2]
Overview
Laboratory findings consistent with the diagnosis of necrotizing fasciitis include positive blood and tissue culture, elevated inflammatory markers, leukocytosis and elevated serum creatinine.
Laboratory Findings
Laboratory tests consistent with diagnosis of necrotizing fasciitis include:[1]
Microbiology
The following are the tests used to diagnose the causative organism:
- Gram stain and culture of tissues and aspirates
- Blood culture
- Culture of throat and vaginal swabs
- Fungal culture (immunocompromised or trauma patients)
- Enrichment cultures (patients with recent antibiotic use)
Biochemistry
The biochemistry findings consistent with diagnosis of necrotizing fasciitis include:
- Elevated C-reactive protein
- Elevated serum creatine kinase
- Hypocalcemia (sign of severity in synergistic NF)
- Hypoalbuminemia
- Hyponatremia (<135mmol/L)
- Elevated serum lactate levels (high serum lactate combined with low sodium levels may be predictive of mortality)
- Arterial blood gas (ABG) analysis
- Urine analysis
- Elevated blood urea nitrogen (BUN)
Hematology
The following are complete blood count with differential findings:
- Rapidly falling hemoglobin
- Leukocytosis (>14,000/µL)
- Leukopenia (if associated with STSS)
- Lymphopenia
- Thrombocytopenia
Tissue oxygen saturation
Other diagnostic studies of necrotizing fasciitis include:[2]
- Tissue oxygen saturation monitoring:
- Occurs at the bedside.
- Is a noninvasive method to continuously monitor extremities at risk and avoid delayed diagnosis
- Tissue oxygen saturation is measured using near-infrared spectroscopy.
- In patients with necrotizing faciitis, oxygen saturation are often diminished in the lower extremities and return to normal after fasciotomy.
References
- ↑ Puvanendran R, Huey JC, Pasupathy S (2009). "Necrotizing fasciitis". Can Fam Physician. 55 (10): 981–7. PMC 2762295. PMID 19826154.
- ↑ Wang TL, Hung CR (2004). "Role of tissue oxygen saturation monitoring in diagnosing necrotizing fasciitis of the lower limbs". Ann Emerg Med. 44 (3): 222–8. doi:10.1016/S0196064404003038. PMID 15332062.