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Nekrotiserande mjukdelsinfektioner

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Definition:
Nekrotiserande mjukdelsinfektioner kännetecknas av nekrosutveckling i samband med snabbt progredierande infektion i till exempel subkutan vävnad (cellulit/flegmone), fettväv (panniculit), fascia (fasciit) och muskulatur (myosit).
Förekomst:
Ovanligt tillstånd.
Symtom:
Ofta svår smärta (out of proportion), med andra lokala eller allmänna infektionstecken. 
Kliniska fynd:
Lokal rodnad, missfärgning, värmeutveckling och allmänna tecken på infektion. Eventuellt tecken på organsvikt.
Diagnostik:
I första hand klinisk misstanke. CRP dock ofta kraftigt förhöjt. Vid misstanke bör patienten remitteras till akutsjukhus utan fördröjning.
Behandling:
Stödjande behandling vid organsvikt. Kirurgisk revision och antibiotikabehandling bör genomföras så snart som möjligt. 
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  • Hakkarainen TW, Kopari NM, Pham TN, et al. Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care and outcomes. Curr Probl Surg. 2014 Aug; 51(8): 344–362. 17
  • Goh T, Goh LG, Ang CH, Wong CH. Early diagnosis of necrotizing fasciitis. Brit J Surg 2014;101:e119-e125 15
  • Nasser W, Beres SB, Olsen RJ, et al. Evolutionary pathway to increased virulence and epidemic group A Streptococcus disease derived from 3,615 genome sequences. Proc Natl Acad Sci USA 2014;111(17):E1768-76 22
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  • Bertil Christensson, professor och överläkare, Infektionskliniken, Skånes universitetssjukhus
  • Remy Waardenburg, specialist i allmänmedicin, Vårdcentralen Hökarängen