Disama dia Fasciitis Necrotizing Fasciitis ne Rapidly Spreading Skin Infection Bimanyinu Bikunze¶

Necrotizing fasciitis (udibu babikila misangu ya bungi ne: "disama dia mubidi") ne Necrotizing Soft Tissue Infections (NSTIs), kusangisha ne Fournier's gangrene wa mu tshiadi ne clostridial myonecrosis (gas gangrene), idi munkatshi mua masama adi afumina lukasa ne a tshimpitshimpi mu malu a luondapu. Bishilangane na disama dia cellulitis (didi dikuata anu bitupa bia dikoba dia pa mutu pa dikoba ne didi diandamuna bimpe anu ku manga a antibiotique), disama dia necrotisant fasciitis didi dienda dienda mu fascial planes muinshi mua dikoba ne mu mafuta muinshi mua dikoba ne mu mafuta ne lubilu lua 2 too ne ku 3 centimètres (0.8 too ne ku 1 inch) ku diambuluisha dia bactérie. bintu bidi bikuata mijilu ya mashi, bienza bua mubidi wikale ne mâyi, ne bifikisha ku lufu lua Toxic Shock Syndrome ne dinyanguka dia bitupa bia mubidi bia bungi mu mêba 12 too ne ku 36. Bu mudi mishipa ya mashi mikanga idi ikandika manga a antibiotique adibu bafila mu mishipa bua kufika mu tshitupa tshia mubidi tshidi tshifue, buondapi bumuepele budi mua kusungila muoyo ne tshitupa tshia mubidi mbua dipanda dia lukasa (dipanda dia bitupa bionso bia mubidi bidi ne disama) mu mêba makese panyima pa difika dia mu lupitadi, pamue ne manga a antibiotique adibu bafila mu mishipa ne proteyine idi ikandika toxique.

Enza nunku mpindieu¶

1. Tangila diakamue bimanyinu 6 bia Necrotizing Fasciitis Red Flags ("PAIN, PURPLE, POPPING, PACE, PERINEUM, PULSE"). Bikila ku nimero ya lukasa ya muaba unudi anyi ndaku buludiludi ku Tshibambalu tshia lupitadi tshia lukasa tshia 24/7 General/Trauma Surgery pikala disama dia dikoba anyi disama dia mubidi didi dilonda:
2. Disama didi kadiyi dikumbane (anyi dipanga dia tshimpitshimpi): Disama dikole dia 10 pa 10 anyi dia kapia didi dimueneka bu dikole menemene bua dikoseka dikese anyi disama dia rose ditekete, ANYI disama didi difika ku santimetre 3 too ne ku 5 (1,2 too ne ku 2 inches) kupitshila ku muelelu mutoke udi umueneka NANSHA muaba udi usama bikole mu tshimpitshimpi udi ufua-mufue (anesthésie cutanée) bualu mijilu mikole mmifue.
3. PURPLE / Dusky Skin anyi Bullae (Blisters): Dishintuluka dia dikala dia bleu-griy, dia bronze, anyi dia purple-black (ecchymosis), anyi blisters miule tente ne mâyi (hemorrhagic bullae) miule tente ne mâyi a "dishwater" a violet mufike.
4. KUTUTA / Kututa Muinshi mua Dikoba (Subcutaneous Crepitus): Kututa, Kututa, anyi Kututa bu mudi Rice-Krispies padibu batenga dikoba bitekete bitekete, didi difumina ku bactérie idi yenza kapepe idi mikuate mu tshitupa tshia mubidi.
5. MUSHINDU wa ditangalaka: Dikala dikunze anyi disama dia mutshi didi divula bikole mupite pa santimetre 1 anyi 2 (0,4 too ne ku 0,8 inches) ku dîba, anyi kadiyi dilengejibua kunyima kua mêba 24 a manga a antibiotique a kudia.
6. PERINEUM / Groin Involvement (Fournier's Gangrene): Tshintu tshionso tshidi tshienda tshitangalaka lukasa, tshiuwuja, disama dikole, anyi mupuya mubi udi utangila scrotum, penis, labia, perineum, anyi perianal area.
7. PULSE & Systemic Sepsis Signs: Fast rate of heart (\(> 100\text{ to }120\text{ bpm}\)), kapia kakole anyi luya lukole (\(< 36.0^\circ\text{C}\) / \(96.8^\circ\text{C}\) / \(96.8^\circ\text{F}\)), tshiji tshikole, tshilema tshikole disama dia tshiadi, anyi dipueka dia mashi (tangila bulombodi bua disama dia sepsis).
8. Bikila 911 mu États-Unis ne mu Canada, 112 mu matunga a ku Mputu, 999 mu Royaume-Uni, anyi tangila bionso nomba ya tshimpitshimpi Shi tshipupu tshia mubidi anyi dikola dia lukasa didiku. Amba patoke ne: "Disama dia Necrotizing Fasciitis (anyi Fournier's Gangrene) didi ditangalaka lukasa ne sepsis."
9. Fola mulongo udi unyunguluka mukalu wa pambelu wa tshitoke tshidi tshimueneka ne mukalu mualabale wa butekete ku diambuluisha dia tshimanyinu tshia kashidi, ne funda dîba dia dîba pa dikoba. Enza mudimu ne tshiamu tshia kufunda natshi bua kuleja muelelu mutoke udi umueneka ne mulongo mukole ne muelelu wa pambelu udi usama bua kulenga ne mulongo mutoke, funda dîba dijalame (tshilejilu, "14:15"). Ebi bidi bipesha munganga wa mu nzubu wa lupitadi tshijadiki tshia lukasa tshia bungi bua santimetre ku dîba didi disama dienda mu tshikondo tshia dienda.
10. Kulama mubedi tshintu nansha tshimue ku mishiku (NPO: kakuyi biakudia, mayi, anyi manga a ku mishiku) ne KUPESHI nansha kakese ibuprofen anyi manga makuabu a NSAID. Bualu bua kuikala ne muoyo bidi bikengela kuya buludiludi mu nzubu wa lupitadi bua kuya mu nzubu wa dipanda bua kupanda muntu ne anesthesie wa bantu bonso, ikala ne tshifu tshitupu. Kupeshi nansha kakese manga adi kaayi a steroïde (NSAIDs bu mudi ibuprofen, naproxen, diclofenac, anyi ketoprofen) bua disama dia lukoba didi ditangalaka lukasa anyi mu tshikondo tshia tshipupu tshia nkutshi (varicella), bualu NSAIDs idi isokoka luya ne kanyinganyinga, idi inyanga dishipa dia globules blancs (neutrophiles), ne idi ipangisha bua kumanya disama dia bactérie ne lufu lua bungi mu tshisumbu tshia A Streptococcal necrotizing fasciitis.
11. Umbusha mpeta yonso, nsa, bifulu, bifulu bia ku makasa, ne bilamba bikole bia ku tshitupa tshidi tshisama diakamue. Necrotizing fasciitis ne severe cellulitis bidi bifikisha ku divula dia tshitupa tshinene tshia dibue mu dîba dimue; mpeta wa dibaka anyi tshiamu tshia kumona natshi dîba tshidibu bashiye pa munu anyi ku tshianza tshidi tshiuwule tshidi tshienza bu tshintu tshia kuela nabi mubidi ne tshidi tshikebesha dikosa dia mashi.
12. KUFINYI, kuela, kuela, anyi kuela bintu bia kapia pa tshilonda tshia dikoba tshidi tshikole, tshidi tshisama anyi tshia violet. Kufina tshitupa tshidi ne disama, tshilonda anyi tshitupa tshidi tshiuwule kudi kuenzeja exotoxins ya bactérie ne bactérie idi ne muoyo buludiludi kupitshila mu tshitupa tshia fascial ne mu mashi. Lekela bipumbishi kabiyi binyanguke ne ufuke dikoba didi dipatuka mâyi ne tshilamba tshikezuke ne tshiume tshidi katshiyi tshinyanguka.

Disama dia kikoba didi ditangalaka lukasa mutshi wa mapangadika¶

Ingidija tshikandakanda etshi bua kutapulula disama dia cellulite dia pa mutu didi kadiyi dikole ne disama dia fasciitis necrotisante didi mua kushipa muntu, gangrene wa Fournier, ne disama dia Vibrio anyi gangrene wa gaz.

flowchart TD
    Start["Mubedi udi ne dikoba dikole,<br/>divula, disama dia ku makasa, anyi disama dia mu tshiadi anyi dia mu tshiadi"] --> CheckRedFlags{"Kudiku bimanyinu bia disama dia tshiadi (NSTI) anyi?<br/>1. Disama didi kadiyi dikumbanangana ne tshimuenekelu tshia dikoba?<br/>2. Bulenga budi buenda bupita mikalu mikunze idi imueneka anyi?<br/>3. Dikoba dia violet/difiike/dia tshiamu tshia mitaku NANSHA bipumbishi bia violet bifiike (bullae)?<br/>4. Luya ludi lupueka muinshi mua dikoba (crepitus) anyi diumvua bu mutshi?<br/>5. Disama dia tshimpitshimpi pa dikoba divua disama kumpala anyi?<br/>6. Ditangalaka >1-2 cm/dîba anyi Sepsis (HR >100, dipanga dia lungenyi, dipueka dia mashi mu mashi)?"}

    CheckRedFlags -->|"EYOWA: Dibendele dikunze dia NSTI dimue"| SurgicalEmergency["MUSHINDU WA KUPANDULA NE WA SEPSIS (Bidibu bela meji ne: udi ne disama dia Fasciitis Necrotisante):<br/>1. Bikila 911 / 112 / 999 anyi ndaku ku lupitadi lua Major Surgical ER NOW<br/>2. Leja muelelu mukunze + muelelu wa bupole ne peni ne funda DÎBA diakane<br/>3. Kulama tshintu nansha tshimue ku mishiku (NPO) bua diakamue OR debridement<br/>4. KUPESHI Ibuprofen/NSAIDS; umbusha bilenga bionso"]

    SurgicalEmergency --> HospitalPath["Mikenji isatu ya lupitadi:<br/>1. Dikebulula dia lukasa dia dipanda / Diumusha (KUENA MRI/CT to)<br/>2. IV Broad-Spectrum Antibiotics (Vancomycin/Linezolid + Pip-Tazo/Carbapenem)<br/>3. IV Clindamycin (anyi Linezolid) bua kuimanyika dienza dia toxine ya ribosome ya bactérie"]

    CheckRedFlags -->|"TO"| CheckLocation{"Tangila miaba ya mubidi idi ne njiwu mikole<br/>ne miaba ya pa buayi idibu mua kupeta masama"}

    CheckLocation -->|"Scrotum, penis, labia, perineum, anyi anus<br/>(Nangananga mu disama dia diabete anyi mu manga adi akandamija SGLT2)"| FournierAlert["MUTU WA FOURNIER'S GANGRENE:<br/>Tshibambalu tshia malu a lukasa tshia mu lupitadi<br/>Bidi bikengela dikonkonona dia lukasa dia malu a mu mashi/a mu tshibungi ne manga a antibiotique"]

    CheckLocation -->|"Muaba wa dîsu / bipese bia mêsu (disama padi mêsu enda)<br/>ANYI Mpala wa pankatshi ('Danger Triangle' muulu/mushiku wa kuulu)"| OrbitalAlert["Udi wela meji ne: udi ne disama dia orbital cellulite anyi dia cavernose sinus thrombose:<br/>Ndaku diakamue mu nzubu wa lupitadi bua kupeta manga a antibiotique ne CT Scan"]

    CheckLocation -->|"Mâyi a mu mbuu a kapia / oyster mubi / dibuela mu mayi a mutoyi<br/>ANYI mputa wa bukoya mukola / disuma dia nyama"| SpecialBug["Vibrio vulnificus, Aeromonas, anyi Clostridium:<br/>Ndaku mu nzubu wa lupitadi diakamue (udi mua kukufikisha ku lufu mu mêba <6)"]

    CheckLocation -->|"Kakuena nansha umue wa ku idi kulu eku: Tshitupa tshia rose-tshikunze tshidi tshienda tshitangalaka bitekete bitekete,<br/>tshitupa tshia butekete anyi tshia pa tshibidilu, malu a mubidi adi makane"| SimpleCellulitis["Disama dia pa mutu anyi dia erysipelas didi kadiyi dikole:<br/>- Dikumbula dia lukasa dia munganga dituku dimue bua kuangata manga a mukana anyi a mu IV<br/>- Muelelu wa tshimfuanyi ne pen + dîba; bandisha tshianza pa mutu pa mutshima<br/>- Ndaku ku ER diakamue pikala disama dienda dikola anyi dipita mulongo wa pen lukasa"]

Anatomie ne pathophysiologie: Bua tshinyi disama dia Necrotizing Fasciitis didi ditangalaka lukasa ne bua tshinyi antibiotics nkayayi itu ipanga¶

Bua kumvua bua tshinyi munganga udi mua kuondopa erysipelas anyi cellulitis ne manga a antibiotique a matuku 5 too ne ku 10, kadi necrotizing fasciitis udi ushipa bantu anu padi munganga kayi unzulula tshitupa tshia mubidi mu nzubu wa dipanda, tangila bitupa bia dikoba dia muntu ne bitupa bia mubidi bipepele kumbukila kuulu too ne kuinshi:

1. Epidermis ne Upper Dermis (Tshipatshila tshia Erysipelas): Tshitupa tshitekete tshia pa mutu tshia dikoba. Masama adi apa adi afila tshitupa tshikunze tshitoke, tshibandile ne muelelu wa nsongo.
2. Dikoba dia muinshi mua dikoba ne mafuta a muinshi mua dikoba (tshipatshila tshia disama dia selile): Didi ne mishipa mikese ya mashi. Bu mudi mashi enda bimpe mu tshitupa tshia dikoba, manga a antibiotique a mukana anyi a mu mishipa adi afika ku bactérie bipepele, ne dikoba didi dimueneka dikunze, dikole ne diuwule katshia anu ku ntuadijilu.
3. Fascia wa munda (Tshipatshila tshia Fasciitis udi ufua) ne Mifuba ya mifuba (Tshipatshila tshia Myonecrosis):
4. Muinshi mwa tshitupa tshia mafuta a muinshi mua dikoba mudi deep fascia, tshitupa tshikole, tshia nshinga, tshitoke tshia mubidi tshidi tshinyunguluka mifuba bu mudi tshilamba tshia sosise.
5. Muaba udi pa mutu pa tshitupa tshia muinshi mua buloba udi ne dikanda dikese dia ku tshilelelu ne mashi makese menemene. Padi bactérie idi mua kufua bantu babuela mu tshitupa etshi (nansha ku diambuluisha dia tshitupa tshikese tshia dikoba, dipanda dia mubidi, disuma dia nyunyi, NANSHA ku diambuluisha dia mashi adi abuela mu mubidi udi ne ditapuluka didi dimueneka mu dikoba), badi benda lubilu mu njila munene wa fascial bu kapia ka muitu kadi kapitshila mu bisonsa biume muinshi mua neje.
6. Padi bactérie ivula, idi ipatula exotoxins, streptolysins, collagenases, ne hyaluronidases idi ifila **thrombose (dibueja dia mashi) ya mishipa yonso mikese idi mimane kupitshila mu fascia bua kudisha mafuta ne kikoba bidi kulu.
7. Bua tshinyi bualu ebu budi buenza "Stage 1 Diagnostic Trap": Mu mêba 6 too ne ku 18 a kumpala, tshitupa tshia munda tshia mubidi tshidi tshibola ne mijilu ya munda idi idila mu kanyinganyinga (10/10 misanshi idi kayiyi mikumbane), eku dikoba dia pa mutu ditshidi anu dimueneka bu dia pa tshibidilu anyi anu dia rose mukese. Anu pashishe, kunyima kua mijilu idi mibuikila mashi mimane kushipa dikoba didi pa mutu pa mashi, ke padi dikoba dia pa mutu dilua tshitoke tshia bule, dipeta bipumbishi bia mashi bia violet, ne dilua dipanga bukole padi mijilu ya mubidi ifua.
8. Bua tshinyi manga a IV nkayawu kaena mua kuondopa to: Bualu mijilu yonso idi idisha tshitupa tshia munda tshia mubidi idi mikole (thrombose) ne tshitupa tshifue katshiena ne mashi adi enda bimpe to, malu adibu bafila mu mishipa adi endakana mu mashi kaena mua kubuela mu tshitupa tshia mubidi tshidi tshifua to. Anu tshiamu tshia mudimu tshia munganga ke tshidi mua kumbusha tshitupa tshia mubidi tshidi tshifue tshidi tshipatula buanga.

Difuanyikija dia mutu ne mutu: Necrotizing Fasciitis vs. Cellulitis vs. Gangrene vs. Deep Vein Thrombosis (DVT)¶

Ingidija tshibambalu etshi tshia dikonkonona dia masama (tshidi ne Infectious Diseases Society of America [IDSA], World Society of Emergency Surgery [WSES], ne UK NICE guidelines) bua kusunguluja masama a lufu ne adi atamba kuenzeka:

Bitupa bisatu bia disama dia Necrotizing Fasciitis¶

Bu mudi babedi kabayi batamba kuleja bimanyinu bionso bia mu mukanda wa tulasa mu dîba dia kumpala, baminganga batu balonda disama dia necrotizing fasciitis mu bikondo bisatu bia mushinga mukole:

Tshitupa 1: Tshitupa tshia kumpala / tshia kumpala kua lufu (mêba 0 too ne ku 12, DIDIDISHI DIA MUSHINDU WA KUSUMIJA MUOYO)¶

• Bimanyinu bia muaba: Dikala dia rose ditekete, didi kadiyi diumvuika bimpe anyi disama, dikoba dia luya, ne dikolesha dia mutshi muinshi mua buloba.
• Tshimanyinu tshinene: Disama dikole, didi kadiyi dijika ne dibungama dia kutenga kakese didi difika ku santimetre ya bungi kupita muelelu udi umueneka wa dikala dikunze, kabiyi bikumbanangana ne mudi dikoba dimueneka dikese to.
• Bimanyinu bia mubidi: Disama dia buena dia grippe, mashika, mashika, dikuma dia muoyo dia lukasa didi kadiyi diumvuika (\(> 100\text{ bpm}\)), disama dia mutshima, disama dia nsukadi, anyi disama dia munda dia mâyi (difumina ku streptococcal superantigène exotoxins). Njiwu ya dipanga dia disama: Misangu ya bungi batu bayipeta bibi bu "grippe ne muscle mukoka," "gout mubi," anyi "celulite mutekete wa kumpala."

Tshitupa 2: Tshitupa tshia pankatshi / tshia ischemique (mêba 12 too ne ku 24)¶

• Bimanyinu bia muaba: Dikala dia kikoba didi dishintuluka kumbukila ku rose too ne ku bule-mukunze, tshia ardoise, tshia bronze, anyi tshia violet tshinyanguke ne mikalu kayiyi mimanyike bimpe. Blisters (bullae) bidi bipatuka pa mutu, bia kumpala biuwule tente ne mayi a serose a jaune ne biuwuja lukasa ne mayi a mashi adi apatuka mu tshitoke tshikunze anyi maroon.
• Bimanyinu bia mubidi: Kapia kakole (anyi dipueka dia luya), dipanga dia lungenyi, dipanga dia mâyi mu mubidi, dibandila dia lactate mu mashi, ne dipueka dia tension.

Tshitupa 3: Tshikondo tshia ndekelu / tshia lufu ne tshia gangrene (mêba 24 too ne ku 48+)¶

• Bimanyinu bia muaba: Bipupu bia violet bidi bipatuka, bishiya tshitupa tshifiike, tshia tshiseba tshia necrotic eschar ne tshidi tshipatuka mupuya mubi, tshitekete tshia mashi a "dishwater".
• Dipanga dia lungenyi: Disama dikole dia mu tshitupa tshia kumpala didi dikudimuka mu tshimpitshimpi dipanga dia lungenyi (anesthésie cutanée) bualu mijilu ya ku dikoba idi ipitshila mu fascia mmifue bionso. Crepitus wa muinshi mua dikoba (gaz udi ulenga) udi mua kumvuika muinshi mua minu.
• Bimanyinu bia mubidi: Dipanga dia bukole tshipupu tshia septic, dinyanguka dia mashi mu mishipa (DIC), dipanga dia mifuba, disama dia dipanga dia mupuya (ARDS), ne disama dia mutshima.

Kujingulula mishindu inayi ya misongo ya mubidi idi ifua¶

Kumanya mushindu wa disama anyi disama didi difikishe baminganga ba mu nzubu wa lupitadi bua kusungula manga adi mua kusungila muoyo mu minite 15 ya kumpala:

Didimuija dia pa buadi: Disama dia Fournier's Gangrene (Perineal, Genital, and Groin NSTI) ne SGLT2 Inhibitor Link¶

Disama dia Fournier's gangrene i disama dia lukasa dia polymicrobial (Type I) necrotizing fasciitis dia perineum, perianal region, scrotum, penis, anyi vulva/labia. Bu mudi bipese bia mu tshifu (Colles' fascia, Buck's fascia, ne Dartos fascia) bipetangana buludiludi ne Scarpa's fascia wa tshimanu tshia kumpala tshia difu, disama didi dituadija pabuipi ne tshitupa tshikese tshia mu tshifu, tshifu tshia bartholin, anyi disama dia mu njila wa mashi didi mua kupitshila mu tshifu anyi mu tshifu too ne ku tshifu mêba.

Nnganyi udi mu njiwu mikole ya disama dia Fournier?¶

1. Babedi badi ne disama dia diabete, dikuatshika dia maluvu, dikola dia mubidi, disama dia tshiadi, anyi dipanga dia makanda a mubidi.
2. Babedi badi banua manga adi akandamija SGLT2: Madimuija a bukubi a kudi FDA wa mu États-Unis, tshibambalu tshia manga tshia ku Mputu (EMA), ne MHRA wa mu UK adi adimuija ne: babedi badi banua manga adi akandamija SGLT2** (empagliflozin [Jardiance], dapagliflozin [Farxigazin/Farxigazin], anyi [Invokazin] ertugliflozin [Steglatro]) bua disama dia diabete wa mushindu 2, disama dia mutshima, anyi disama dia mifuba badi ne njiwu mikole ya gangrene wa Fournier (bualu bungi bua nsukadi budi bupatuka mu mashi budi bufila biakudia bia mu tshiadi ne bikunyibua).

Bimanyinu bikunze bia disama dia Fournier's Gangrene (Bidi bikengela kupanda diakamue mu nzubu wa lupitadi)¶

• Disama dia tshimpitshimpi, dikole, dibungama, disama, anyi diosha mu tshifu, mu tshifu, mu mishiku, mu tshifu, anyi pabuipi ne tshifu.
• Divulangana dia lukasa ne dikala dikunze (anyi bitupa bia tshiamu tshia mitaku/bifiike) bia dikoba dia mu bitupa bia lulelu.
• Luya lukola muinshi mua dikoba dia mu tshiadi anyi dia mukana (crepitus) anyi mupuya mubi, mubi, mubi.
• Kapia, mashika, dikuma dia lukasa dia mutshima, tshiji, anyi divulangana dia sukadi mu mashi/DKA.
• Tshienzedi tshia lukasa: Lekela tshintu tshionso tshidi tshipangisha SGLT2 diakamue ne uya buludiludi ku tshibambalu tshia malu a mpukapuka tshia lupitadi. (Bualu disama dia Fournier dia ku ntuadijilu kudi balume didi difikisha ku disama dia tshimpitshimpi dia tshifu ne difu, baminganga ba lupitadi lua lukasa badi ne bua kukonkonona bionso bibidi dinyanguka dia tshifu ne disama dia Fournier diakamue.)

Diambuluisha dia kumpala dia tshitupa ku tshitupa: Mushindu kayi wa kuenza "Pen Border & Time Test" ne kudilongolola bua ER¶

Paudi muindile ambulanse anyi wenda uya ku tshibambalu tshia malu a mpukapuka, londa malu adibu ne bua kuenza kumpala kua kuya ku lupitadi:

Tshitupa 1: Diteta dia tshimanyinu tshia kashidi tshia milongo ibidi (ne tshimanyishilu tshia dîba)¶

1. Angata peni anyi tshimanyishilu tshia kashidi tshia nsongo mikese.
2. Funda mulongo mukola ku muelelu wa pambelu udi umueneka wa dishintuluka dia dikoba dia rose/tshikunze.
3. Fina bitekete bitekete ne munu umua mukezuke utuadije ku bule bua santimetre ya bungi pa dikoba dia pa tshibidilu ne uya munda mutangile ku dikala dikunze; funda mulongo mutoke muaba udi mubedi umvua bulenga bua bungi. (Bikala mulongo wa disama dia nsongo musombe **2 anyi 5 santimetre pambelu pa mulongo wa dikala dikunze, ambila munganga wa ER triage diakamue ne: "disama dia kupita erythema" edi ntshimanyinu tshia ditangalaka dia tshitupa tshia mubidi tshidi tshitangalake bikole.)
4. Funda dîba dijalame (tshilejilu, 16:30) buludiludi pa dikoba dia pa tshibidilu ku luseke lua mulongo.

Tshitupa 2: Diteka ne dipangisha¶

• Bikala mubedi ne disama dia Necrotizing Fasciitis anyi Sepsis (mutshima udi wenda lubilu, kapia, disama dikole dia 10/10, tshiji): Lama mubedi mulale mupole anyi muimpe ne tshianza tshiende tshiikisha pa mutu pa muoyo (kubandishi tshianza tshiende mulu pa mutu pa muoyo wewa wela meji ne: udi ne disama dia necrotizing fasciitis anyi dia elevation udi upuekesha bukole bua dibuela dia mashi mu mishipa idi mimane kuikala ne ischémie).
• Bikala mubedi mujadike ne: udi ne disama dia cellulite dia pa mutu didi kadiyi dikole (didibu bakonkonone kudi munganga, disama dia mubidi didi dimpe, disama dikese): Kubandisha dikasa anyi diboko didi diuwule pa matadi pa mutu pa mutshima kudi kuambuluisha bukole budi bukokela bintu panshi bua kumbusha mâyi a mubidi adi kaayi ne disama bua kuenza mudimu ne lukasa.

Tshitupa 3: Bua tshinyi baminganga ba mu lupitadi kabena ne bua kulekela dipanda bua MRI anyi CT scan to¶

Kujingulula mikenji ya lupitadi kudi kuambuluisha mêku bua kulomba diambuluisha dia lukasa dia dipanda: - Bilondeshile mikenji ya Infectious Diseases Society of America (IDSA) ne World Society of Emergency Surgery (WSES), necrotizing fasciitis i disama dia mu lupitadi ne dia dipanda. - Nansha mudi ultrason wa lukasa ku luseke lua bulalu anyi CT scan wa minite 5 mua kumona imue misangu bipese bia gaz bidi bilonda mu tshitupa tshia munda tshia fascia, dipanga dia gaz ku X-ray anyi ku CT scan kadiena dipangisha necrotizing fasciitis to (nangananga Type II Group A Strep ne Type III Vibrio, idi kayiyi ipatula gaz misangu mikese). - Kuindila meba 2 to ne ku 4 bua kuenza tshikebelu tshia MRI mu mubedi udi umueneka patoke anyi udi kayi mushindame kudi kuvudija lufu misangu ibidi. Pamutu pa nanku, munganga udi uya ne mubedi buludiludi mu nzubu wa dipanda (anyi wenza "Finger Test" wa minite 2 ku bulalu muinshi mua anesthesie wa pa muaba: wenza \(2\text{\)} decision too ne ku fascia; mashi adi apatuka, adi apatula mayi a "dishwater" a gris, ne adi alekela munu udi ne tshianza bua kuendakana kakuyi lutatu mu bitupa bia mubidi kakuyi ditantamana dia pa tshibidilu, necrotizing fasciitis udi ujadika ne diumusha dijima didi dituadija diakamue). - Bua tshinyi Clindamycin (anyi Linezolid) udi mubuela mu manga a IV: Ma antibiotics a mu tshimanu tshia selile bu mudi penicillin anyi piperacillin-tazobactam adi ashipa anu bactérie idi itapuluka; Dîba didi miliyare ya bactérie ya Strep ya mu kasumbu A idisangisha bikole mu fascia, idi ilekela kuditapulula ne ipatula anu bintu bidi bishipa bantu (** the "Eagle Effect"**). Kusakidila clindamycin (\(600\text{ too ne ku }900\text{ mg}\) IV kunyima kua mêba 8) anyi linezolid mu mashi kudi kulamakaja buludiludi ku 50S ribosome wa bactérie, ne kukanga diakamue tshiapu tshidi tshienza bintu bidi bidia munyinyi ne bipupu bia toxique.

Mukanda wa dimanyishangana wa 911 / 112 / 999 ne disungula dia lupitadi¶

Paudi ufika mu tshibambalu tshia malu a mpukapuka tshidi ne bantu ba bungi, kuena ne bua kuamba anu ne: "Ndi ne tshipupu tshia nsongo" anyi ne: "Lukasa luanyi nduvume." Enza mudimu ne script wa mushinga mukole eu:

"Ndi dijinga ne dipanda dia lukasa. Dikoba edi dikunze dia [dikasa / diboko / tshiadi] divua dimanyibua ne pen ku [Tshikondo] ne nditangalake [X centimètres] mu dîba dishale. Mubedi udi ne disama dikole dia 10 pa 10 didi dipita ku muelelu mutoke [ne/anyi bipumbishi bia violet / dikoba didi dinyanguka / dinyanguka dia dikoba muinshi mua dikoba pa tshintu tshidi tshipangisha SGLT2] ne tshitupa tshia muoyo tshia [BPM]. Tudi ne dibungama bua disama dia Necrotizing Fasciitis [anyi Fournier's Gangrene] ne tudi balame mubedi Nothing by Mouth (NPO) bua kumupandabu ne lukasa."

Nkonko itubu bela misangu ya bungi¶

Mmunyi mundi mua kumanya dishilangana pankatshi pa disama dia selulite dia pa tshibidilu ne disama dia fasciitis necrotisante kumpala kua bipumbishi bia violet kumueneka?¶

Mu disama dia selulite dia pa tshibidilu, dikoba didi dimueneka bu dikala dia rose anyi dikunze ne didi diumvuika bu dia luya ne dia bupole, kadi bupole budi bushala anu munda mua tshitupa tshikunze ne muntu utu umvua bimpe. Ku ntuadijilu kua tshitupa tshia 1 tshia necrotizing fasciitis, disama didi dienda dienda muinshi mua mafuta mu tshitupa tshia fascia, nunku dikoba dia pa mutu didi mua kumueneka ditoke anyi anu dia rose mukese eku muntu umvua kanyinganyinga kakole ka 10 pa 10, kanyinganyinga kakole kadi kafika ku santimetre ya bungi kupita muaba udi umueneka mukunze, disama dia nsukadi, ne bimanyinu bia mubidi bu mudi dipuekesha dia mashi, kapepe, nsukadi, anyi disama dia tshiadi.

Bua tshinyi bidi ne njiwu bua kunua ibuprofen (Advil, Motrin) anyi naproxen bua disama dia lukoba didi ditangalaka lukasa anyi mu tshikondo tshia disama dia nkutshi?¶

Maluvu adi kaayi a steroïde adi ambuluisha bua kujikija disama dia nsukadi (NSAIDs) bu mudi ibuprofen adi asokoka kapia kakole ne kanyinganyinga kakole kadi kamanyisha ba munganga bua disama dia fasciitis necrotisante dia kumpala, adi akebesha dipanga dia njiwu dia kuya mu lupitadi. Kabidi, makebulula a mu lupitadi ne a mu laboratware adi aleja ne: NSAIDs idi inyanga bukole bua globules blancs (neutrophiles) bua kulonda ne kubutula bactérie ya Streptococcus ya mu kasumbu A eku ivudija dienza dia cytokines idi isama idi itangila disama dia Streptococcal Toxic Shock Syndrome.

Bua tshinyi kanyinganyinga kakole ka mu dikasa divua dijuke ne disama diakajimina diakamue ne kuluaye mutshioke?¶

Padi disama dia kikoba dikole, didi divula lukasa dilekela kusama ne umvua bu udi kayi ne bukole padibu bawulenga (anesthésie cutanée), tshidi tshimanyishilu tshia tshimpitshimpi tshia Stage 3, ki ntshia kuondopibua to. Bidi biumvuija ne: disama dia lufu didi mu tshitupa tshia muinshi mua dikoba ndikuate mijilu yonso ya mashi ne dishipe bikole mijilu idi ifila bukole ku dikoba didi pa mutu pa dikoba; Dipanda dia lukasa didi dikengedibua bua kusungila muoyo wa muntu.

Bua tshinyi manga a antibiotique nkayawu kaena mua kuondopa disama dia necrotisant fasciitis kakuyi dipanda?¶

Ma antibiotique adibu bafila mu mijilu adi apitshila mu mubidi munda mua mijilu idi ipita mashi. Mu disama dia necrotisant fasciitis, bintu bidi bifumina ku bactérie bidi bienza bua mishipa yonso idi ifila mashi mu tshitupa tshia muinshi mua dikoba ne mu tshitupa tshia muinshi mua dikoba; bualu mashi kaena apita mu tshitupa tshifue tshidi tshibola, manga a antibiotique adibu bafila mu mijilu kaena mua kufika ku bactérie idi munda mua fascia to, ke bualu kayi bidi bikengela kumbusha diakamue tshitupa tshidi tshifue (debridement).

Miaba mifumina¶

• Infectious Diseases Society of America (IDSA, United States): Practice Guidelines for the Diagnostic and Management of Skin and Soft Tissue Infections (Stevens et al., Clinical Infectious Diseases, diagnostic differentiation of necrotizing fasciitis, chirurgical tissuming, and empirically/vancomline piperacillin-tazobactam/carbapenem + clindamycin antitoxin regimens).
• World Society of Emergency Surgery (WSES) and Surgical Infection Society Europe (SIS-E): WSES/GAIS/SIS-E/WSIS/AAST Global Clinical Pathways for Patients with Skin and Soft Tissue Infections (Sartelli et al., World Journal of Emergency Surgery Stage, NS-TI Recognition Gangrène wa Fournier, ne mikenji ya diteta dia munu mu tshikondo tshia dipanda).
• Tshisumbu tshia ku Est tshia dipanda dia mputa (EAST) ne Tshisumbu tshia bena Amerike tshia dipanda dia mputa (AAST, États-Unis): Mibelu ya dilama dia masama a mubidi adi afua.
• Centres for Disease Control and Prevention (CDC, United States) and UK Health Security Agency (UKHSA / NICE, United Kingdom): Clinical Guidance on Invasive Group A Streptococcal (iGAS) Infections, Necrotizing Fasciitis, and Vibrio vulnificus Marine Wound Infections.
• Tshibambalu tshia bidia ne manga tshia mu États-Unis (FDA) ne tshibambalu tshia manga tshia ku Mputu (EMA): Malu adi atangila bukubi bua manga pa disama dia SGLT2 Inhibitor-Associated Necrotizing Fasciitis of the Perineum (Fournier's Gangrene).

Malu adi apetangana¶

• Disama dia sepsis ne dia septic shock
• Diambuluisha dia kumpala dia kusukula mputa, dikosa, ne disukula dia mputa
• Disama dia tshiadi ne disama dia tshitupa tshia mubidi
• Disuma dia nyama ne dikuba dia masama
• Nsongo ya stingray, misongo ya mbuji ya mu mbuu, ne dilama dia mputa ya mu mbuu