Talk:Necrotizing fasciitis

Edit from 203.36.44.13
The last edit from 203.36.44.13 (replacing the entire article) sounds like a copyviolation. Can the author come out and state that there's no copyright violation involved? Thanks. Alex.tan 06:00, 9 Sep 2004 (UTC)

Question/challenge regarding reference to "Cabin Fever" movie
Can it be confirmed that the movie actually is intended to depict necrotizing fasciitis (NF), specifically, rather than just some NF-like virus or bacteria? Having a hard time documenting that in searching interviews with the director (Eli Roth) online; also, the movie's official site refers to it as a virus, and NF is actually a bacterial disease. (I'm a survivor of the disease myself, so am hoping to not add to some of the hysteria and hyperbole surrounding it; but, if that was the movie's/director's intent, so be it, though I'd lean toward referring to the movie as portraying a similar type of affliction [albeit sensationally].) Thanks; relatively new WP user here, so apologies if I'm out of line in any way.

Thanks for you comments, I changed the sentence to:
 * A fictional virus with symptoms like necrotizing fasciitis featured in the modern horror classic Cabin Fever.

--nixie 05:40, 11 May 2005 (UTC)

Thanks much. I can live with that; the real thing's bad enough, trust me. :-) --Mattsen 06:45, May 11, 2005 (UTC)

Mortality
This article states the mortality rate from infection as both 25% and 20%. Please clarify. --Outlander 21:01, 7 June 2006 (UTC) haha, that was my question too. --Mtxoracle 22:41, 1 July 2006 (UTC)

Deleted that distant relative of Brett Hart because nobody knows him and nobody cares.

The article says that the infection often starts with a sore throat. In fact, it RARELY starts as a sore throat.

I call to attention the use of the word "top-notch"

Prognosis This disease is one of the fastest-spreading infections known as it spreads easily across the fascial plane within the subcutaneous tissue. For this reason, it is popularly called the "flesh-eating disease" and although rare, it became well-known to the public in the 1990s. Even with top-notch care today, the prognosis can be bleak, with a mortality rate of around 25% and severe disfigurement common in survivors. Mortality is nearly 100% if not properly treated.

The word is unprofessional and colloquial.

I suggest, and will implement the following change.

Prognosis This disease is one of the fastest-spreading infections known as it spreads easily across the fascial plane within the subcutaneous tissue. For this reason, it is popularly called the "flesh-eating disease" and although rare, it became well-known to the public in the 1990s. Even with today's modern medicine, the prognosis can be bleak, with a mortality rate of around 25% and severe disfigurement common in survivors. Mortality is nearly 100% if not properly treated.

come on, give the word a break and look at the contents of the article

Rephrase?
"the antibiotics take a while to react to the bacteria" -- This phrasing strikes me as odd and possibly misleading, but I could be wrong. Are the medical professionals okay with this or should it be changed? -- 201.19.11.75 02:30, 26 August 2007 (UTC)

What does "this" refer to?
In the sentence: "With medical assistance, such as antibiotics, this doesn't take a long time to process." What does this mean?Derekawesome (talk) 16:46, 10 March 2008 (UTC)

Related Articles
--Parallelized (talk) 14:15, 8 May 2008 (UTC)
 * http://www.nzma.org.nz/journal/119-1247/2366/
 * http://www.medscape.com/viewarticle/429548_2
 * http://www.medscape.com/viewarticle/460909_3
 * http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijps/vol2n2/abdominal.xml
 * http://www.emedicine.com/EMERG/topic332.htm

Redlinked names (victims)
Those that are not notable else: time these were removed (of course, if later citations are given to establish notabilty and their own entries, they can be replaced in the list). NF is 'rare' but the term is relative when it comes to clinical incidence - as a senior nurse in an inner-city British NHS hospital, I've personally seen 4 cases in the last 10 years. These days, gas gangrene is encountered even less, yet survivors aren't in themselves notable. I'll give it a few days, then make the changes as necessary. In some sections the style and grammar also needs a bit of a seeing-to: I'll fix that too. Plutonium27 (talk) 11:32, 31 July 2008 (UTC)

Possible Vaccine?
Someone on a blog claimed a vaccine was in the works. Is there anything to the claim? —Preceding unsigned comment added by 71.134.42.129 (talk) 21:21, 26 May 2009 (UTC)

Technical Language
In the intro section, we have a section going: " Type I describes a polymicrobial infection, whereas Type II describes a monomicrobial infection. Many types of bacteria can cause necrotizing fasciitis". Now, I would have to agree that this is correct, but I suggest that we tone down the medical lingua for a more readible text. I do not think that my own vocabulary is capable of just that, so I am just leaving this as a suggestion - any thoughts? T-roland (talk) 15:12, 16 June 2009 (UTC)

>> I think people sometimes get overly senstive to jargon. While it can be a problem sometimes, Wikipedia auto-bots are often wrong for going overboard and flagging pages for having too much jargon / technical terms. Here, a live person is worried about it and I think the worry is misplaced. Any English major could see that the categorization is based on a simple difference in the suffix. To make the contrast more obvious to a general reader, I added a hyphen between poly-microbial and mono-microbial. I also moved the sentences to follow the statement that many kinds of baceteria can cause NF. You have to use actual terms because when people encounter them, they want to know that they mean. A lay reader might have glossed over those multi-syllable words, but by making this change, it preserves the technical terms but it puts the text in a form that a lay reader will see easily and recognize that they're not really scary words, but can be parsed and understood. —Preceding unsigned comment added by Lapabc (talk • contribs) 17:20, 8 October 2009 (UTC)

systemic causes
This article is written in a way that I find highly misleading...it seems to treat this as a mystery infection that comes up as a result of trauma...but a lot of unanswered questions arise--why is it a "rare" infection? No explanation is given to the role that the immune system plays in preventing such infections. The word stem "immun" didn't even occur in the article except in an oblique popular culture reference to Star Trek.

The reason is that these sorts of infections are normally kept in check in otherwise healthy people. I added a single reference that discusses this but there's a lot of stuff out there and I think this material needs to be written more prominently into this page. Cazort (talk) 15:54, 15 October 2009 (UTC)

nercotizing fasciitis is a flesh eating bacteria that eats ur face off then kills you because it stabs you in the brain with its many innteanea!!!! STAY INSIDEEEE!!!!! —Preceding unsigned comment added by 205.202.225.253 (talk) 15:55, 23 October 2009 (UTC)

Contextual References within the media
I recently just watched the episode of Grey's Anatomy that involves the Necrotizing fasciitis case and was quite surprised not to come across it within this article, (I was surprised the infection even had a dedicated section to its portrayal within the media). After believing that it was a rather significant depiction of the infection, I have therefore generated my own summary of the infections' diagnosis and treatment as represented in the said episode and do hope readers agree it to be insightful and interesting, providing further 'research' material regarding the subject.

Pete. 05:32 4th January 2010

Maggot Debridement Therapy
The article currently states "In necrotizing fasciitis, aggressive surgical debridement (removal of infected tissue) is always necessary to keep it from spreading and is the only treatment available. [Emphasis mine]" however, Maggot Therapy is another viable treatment, particularly in cases where physical debridement is unsuccessful. References: http://www.medscape.com/viewarticle/555303 http://www.woundsresearch.com/article/6981 http://onlinelibrary.wiley.com/doi/10.1002/hed.20092/abstract http://www.bterfoundation.org/indexfiles/MDT.htm —Preceding unsigned comment added by Omegamormegil (talk • contribs) 14:01, 20 September 2010 (UTC)

Notable Person Removed
I removed the reference to "Ricky Snotrag" on the list of notable persons. At the same time this info was added to the Wikipedia entry, it was posted on a "NO Ricky" Facebook page (http://www.facebook.com/pages/NO-Ricky/165263006865415) and was most likely vandalism. Clockster (talk) 07:57, 5 July 2011 (UTC)
 * Actually, this edit was all vandalism, I reverted it back. Regards, Comte0 (talk) 22:57, 8 July 2011 (UTC)

This needs fixing
We read:

"Mortality rates have been noted as high as 73 percent if left untreated.[6] Without surgery and medical assistance, such as antibiotics, the infection will rapidly progress and will eventually lead to death."

The former sentence contradicts the latter, and vice-versa.

108.219.38.25 (talk) 07:18, 16 January 2012 (UTC)

Possible Sources
This article is supposed to be about the disease necrotizing fasciitis not about MRSA. While MRSA is a possible source of necrotizing fasciitis a section on the possible sources of MRSA is not appropriate for this article. Misleading in that information about MRSA while peripherally related to NF and one of mulitple possible vectors for NF the content of the section is only relevant to MRSA and belongs in that article and not this one. Suggest rework of the section?162.111.235.36 (talk) 14:41, 3 May 2013 (UTC)

is necrotizing fasciitis related to leprosy
Is this bacteria any way related to the bacteria that caused leprosy? Doesn't it have the same characteristics? danadice4life@msn.com — Preceding unsigned comment added by 68.98.69.24 (talk) 17:48, 5 May 2013 (UTC)


 * No, it doesn't. Most NF is caused by Gram positive bacteria, not by M. leprae or other mycobacteriae. JFW &#124; T@lk  12:12, 15 December 2014 (UTC)

Historical review
GAS-NF and its relation to trauma. Lancet Infect Dis 10.1016/S1473-3099(14)70922-3 JFW &#124; T@lk  12:12, 15 December 2014 (UTC)

Bacteria/Possible Sources
The only bacteria listed are MRSA but as far as I know the most common bacteria group causing necrotizing fasciitis is invasive streptococcus A. Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2828232/ — Preceding unsigned comment added by 193.170.224.173 (talk) 17:46, 12 January 2015 (UTC)

External links modified
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 * Added archive https://web.archive.org/20120519032001/http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2012/05/16/national/a145331D94.DTL to http://www.sfgate.com/cgi-bin/article.cgi?f=/n/a/2012/05/16/national/a145331D94.DTL&tsp=1

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HBO for nec fash
I know hyperbaric O2 is controversial for nec fash, but I don't know a good citation off the top of my head to capture that point. Maybe someone else can fine one, and find a political way of saying that.

I amputated someones leg for nec fash last week. Bad disease.

BakerStMD 03:36, 4 April 2016 (UTC)
 * Here are a few reviews that might help with this point and discuss HBOT's role as ill-defined and poorly investigated for nec fasc:

1. http://www.ncbi.nlm.nih.gov/pubmed/21767158 2. http://www-ncbi-nlm-nih-gov.liboff.ohsu.edu/pubmed/20668422 3. http://www-ncbi-nlm-nih-gov.liboff.ohsu.edu/pubmed/25879088 (2015 Cochrane review found no RCTs or pseudo-RCTs investigating HBOT's role in treatment of nec fasc) TylerDurden8823 (talk) 03:51, 4 April 2016 (UTC)

✅

External links modified
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 * Added archive http://web.archive.org/web/20130312155645/http://www.southhealthdistrict.com:80/content.asp?nst=1&pid=227&id=107 to http://www.southhealthdistrict.com/content.asp?nst=1&pid=227&id=107

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Why not mention Africans and Indians feel this disease is needed?
And do have ways to spread it out? It has always occurred in their natural ambiences and they all seem to miss it overtly. Treatment is hard to come by, diagnosis is omitted, it is treated as cellulitis and there is a downright negative to actually do anything other than amputation because of African and Indian and Arab (Shariah) pressures. Mentioning antibiotic resistance organisms and not mentioning any useful medication link also adds to the primitive, final atmosphere. — Preceding unsigned comment added by 64.134.150.166 (talk) 15:22, 8 August 2016 (UTC)

Hypochlorous acid irrigation
"Super oxidized waters" (SOW) refers to a new class of broad spectrum disinfectants that inhibit a wide range of essential microbial process, while causing relatively little damage to human cells. Most SOWs (that I've looked at, anyway) use hypochloruos acid and some form of electro-chemical processing to maintain a ph neutral, highly oxidizing solution. A number of such agents, sold under brand names including (but not limited to) Microcyn, Dermacyn, and NeutroPhase are already FDA approved for cleaning/debriding wounds.

There's in vitro evidence that a solution of 0.01% pure hypochlorous acid (NeutroPhase) can deactivate many of the superantigens and toxins necrotizing fasciitis bacteria produce and provide protection to human lung epithelial cells exposed to bacterial toxins. There are also several case reports of hypochloruos acid irrigation combined with negative pressure wound therapy (NPWT described here: https://www.youtube.com/watch?v=oz8ppbbc6aw) providing benefit to patients with necrotizing fasciitis. Note that reference 9 isn't a full case report, but a video of a surgeon describing his experience with Microcyn in a case of necrotizing fasciitis. refs 7 & 9 did not use NPWT. It's also the only case where Dermacyn was used, rather than NeutroPhase.

All in all, I don't think this is great evidence that SOWs containing hypochlorous acid are particularly effective for treating NF, but given that many of the agents in question are approved by the FDA for surgical debridement, it seems like the worst that can happen is nothing. Given the state of the evidence as it appears to me and my estimate of the potential risk/reward for the therapy, I think it reasonable to add a small blerb about hypochlorous acid in the "Other" part of the "Treatment" section.

A few questions:

Most of the NF-specific evidence concerns NeutroPhase, rather than SOWs in general. However, the vast majority of SOWs contain hypochlorous acid, which is the only ingredient in NeutroPhase. To what degree should the evidence about NeutroPhase be taken as evidence of SOW effectiveness?

Also, can I cite the youtube video in the article, alongside the other case reports? Qupope (talk) 23:48, 8 November 2017 (UTC)

Nevermind. I came across the secondary/primary source requirements while reading the talk page of another article. Everything here is a primary source, so I've unmade my edits to the article. — Preceding unsigned comment added by Qupope (talk • contribs) 00:09, 9 November 2017 (UTC)

NEJM
Review 10.1056/NEJMra1600673 JFW &#124; T@lk  09:22, 7 December 2017 (UTC)

Role of CB4P
Initial edit here. Some additional sources:
 * Human IgG Increases Virulence of Streptococcus pyogenes through Complement Evasion.
 * Biochemists’ Discovery Could Lead to Vaccine Against ‘Flesh-Eating’ Bacteria

Not sure whether that's enough, if not I'll look for more sources Genetics4good (talk) 17:42, 31 May 2018 (UTC)

Medical imaging
Ref says "Imaging is very useful to confirm the diagnosis", not sure why this was changed to " Medical imaging is seldom helpful in confirming the diagnosis"? Doc James (talk · contribs · email) 07:56, 24 May 2020 (UTC)

Page Image
Remember that page images show up even if just hovering over a blue text link. This particular page (among others) has required us to blacklist wikipedia in our school for images. Please consider changing the top level page image to something less... disturbing - even if it is accurate.