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Necrotizing Fasciitis

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What is Necrotizing Fasciitis and why would we have it on a website for lymphedema?

The most common name that it is known by is "flesh eating bacteria."  It is an infection that is becoming more common and as one of our members know all too well can lead to a secondary case of lymphedema.  Another member who has hereditary lymphedema also experienced this horrible infection and almost lost her leg and life.

Diagnosed as a soft tissue infection, this has been on the rise for several reasons.  These include increased cases of diabetes, cancer, vascular insufficiencies, organ transplants, HIV and or leukopenia./neutropenia which are themselves side affects of many conditions including cancer.

Because our lymphedema arms and legs are immunocompromised and because we are already so terribly susceptible to infections, we need to be aware of this very dangerous and potentially life threatening infection.

Related keywords:  

Fournier's gangrene, Fournier gangrene, Meleney's ulcer, Meleney ulcer, postoperative progressive bacterial synergistic gangrene, flesh-eating bacteria, Cullen's ulcer, Cullen ulcer, hemolytic streptococcal gangrene, acute dermal gangrene, hospital gangrene, suppurative fascitis, synergistic necrotizing cellulitis, group A hemolytic streptococci, Staphylococcus aureus, Bacteroides fragilis, Escherichia coli, nonclostridial myonecrosis, Vibrio vulnificus, diabetes mellitus, fascial necrosis. (1)

Causes:

Necrotizing fasciitis is caused by several kinds of bacteria. The most common cause is infection by a group A streptococcal (GAS) bacterium, most often Streptococcus pyogenes, which also causes other infections such as strep throat and impetigo. Usually the infections caused by these bacteria are mild. But in rare cases the bacteria produce poisons (toxins) that can damage the soft tissue below the skin and cause a more dangerous infection that can spread quickly along the tissue covering the muscle (fascia). The bacteria also can travel through the blood to the lungs and other organs. The disease also may be caused by Vibrio vulnificus. Infection with this bacterium can occur if wounds are exposed to ocean water or contact raw saltwater fish or oysters. Infection also may occur through injuries from handling sea animals such as crabs. These infections are more common in people who have chronic liver diseases such as cirrhosis.

Another type of necrotizing fasciitis may be caused by multiple bacteria found in the intestine. This type most often affects people with diabetes or peripheral arterial disease. Sometimes people who have gunshot injuries, intestinal surgery, or tumors in the lower digestive tract develop necrotizing fasciitis.

A break in the skin allows bacteria to infect the soft tissue. In some cases, infection can also occur at the site of a muscle strain or bruise, even if there is no break in the skin. It may not be obvious where the infection started, because the bacteria may travel through the bloodstream to other parts of the body.

Group A strep bacteria producing the toxins that cause necrotizing fasciitis can be passed from person to person. But a person who gets infected by the bacteria is unlikely to develop a severe infection unless he or she has an open wound, chickenpox, or an impaired immune system. (1)

Diagnoses:

IInitial suspected diagnosees can be achieved by general examination, specifically how the skin and tissues look, in conjunction with other related symptoms. Diagnoses can be achieved/confirmed through the blood cultures, pus cultures and/or surgical exploration.  Also, these tests will show the specific pathogen repsonsible.

X-rays may be needed to look for signs of lung damage or for gas or fluid buildup at the site of the infection.

Symptoms:

Treatment:

Treatment would include use of strong broad based antibiotics given through an IV.  Sugery or debridement might also be necessary. 

The best treatment info I found was in through Medscape in their article Necrotizing Fascitis: "Treatment, "The most effective treatment found to decrease mortality is early diagnosis and prompt surgical debridement.The gold standard of treatment for NF includes intravenous antibiotics with broad-spectrum antibacterial coverage, prompt surgical debridement, and supportive care in an intensive care unit (ICU). ICU care involving hemodynamic support, wound care, and nutritional support is critical. A combination of broad spectrum antibiotics, such as a penicillin, an aminoglycoside or third generation cephalosporin, and clindamycin or metronidazole, are typically employed to provide broad bacterial coverage. Once the gram stain and culture and sensitivity results are obtained, the antibiotic regimen can be adjusted."

Potential Complications:

Prevention: 

Be respectful to protect others from infection if you suspect that you may have a Strep infection, such as Strep throat, or have been exposed to someone with a known Strep infection. Symptoms do not have to be present for a person to be carrying the bacteria and infect others. One case of infection that comes to mind is a health care worker with two children at home with Strep throat. She had no symptoms, but innocently infected three people, one of whom died.

The most common causes of necrotizing fasciitis are the group A hemolytic step bacteria or the staph aureus bacteria.  However, there are several other pathogens that can cause it.  These include Bacteroides, Clostridium, Peptostreptococcus, Enterobacteriaceae, coliforms, Proteus, Pseudomonas, and Klebsiella.

Prognosis:

"The prognosis for patients with necrotizing fasciitis depends on many factors, including patient age, underlying medical problems, the causative organism(s), extent and location of infection, as well as the time course of diagnosis and initiation of treatment. Early diagnosis and aggressive surgical and medical treatment are the most important factors in determining outcome.

The prognosis for patients with necrotizing fasciitis depends on many factors, including patient age, underlying medical problems, the causative organism(s), extent and location of infection, as well as the time course of diagnosis and initiation of treatment. Early diagnosis and aggressive surgical and medical treatment are the most important factors in determining outcome.

Necrotizing fasciitis is a life- and limb-threatening condition that carries a poor prognosis if left untreated. Sequelae may include limb loss, scarring, disfigurement and disability, with many patients going on to develop sepsis, multisystem organ failure, and death. Combined morbidity and mortality rates have been reported to be between 70%-80%. Mortality rates may range anywhere between 6%-76%." (eMedicinehealth)

Pat O'Connor

June 5, 2008

Since our last update, I was in a hospital where one of the patients had necrotizing fascitis. Through the course of the diseases, she lost both hands, and half of both arms to this.  I can no emphasis enough, how imperative it is for those of us with lymphedema to get urgent prompt treatment.

Jan. 12, 2012

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Necrotizing soft tissue infection

Alternative names 

Necrotizing fasciitis; Fasciitis - necrotizing; Flesh-eating bacteria; Soft tissue gangrene; Gangrene - soft-tissue

Definition  

Necrotizing soft-tissue infection is a severe type of tissue infection that can involve the skin, subcutaneous fat, the muscle sheath (fascia), and the muscle. It causes gangrenous changes, tissue death, systemic disease, and frequently death.

Causes, incidence, and risk factors   

Necrotizing subcutaneous infection or fasciitis can be caused by a variety of bacteria including oxygen-using bacteria (aerobic) or oxygen-avoiding bacteria (anaerobic). A very severe and usually fatal fasciitis is caused by a virulent species of streptococcus that is often referred to as the "flesh-eating bacteria" by the press.

This type of infection develops when bacteria enter the body, usually through a minor skin injury or abrasion. The bacteria begin to grow and release toxins that:

Infection may begin as a small reddish painful spot or bump on the skin. This quickly changes to a painful bronzed or purplish patch that expands rapidly. The center may become black and dead (necrotic). The skin may break open. Visible expansion of the infection may occur in less than an hour.

Symptoms may include fever, sweating, chills, nausea, dizziness, profound weakness, and finally shock. Without treatment death can occur rapidly.

Symptoms  Signs and tests 

The appearance of the skin and underlying tissues and presence of gangrenous changes (black or dead tissue) indicates a necrotizing soft tissue infection. Imaging tests, such as CT scans, are sometimes helpful.

Often a patient will need to go to the operating room so a surgeon can diagnose such an infection. A Gram stain and culture of drainage or tissue from the area may reveal the bacteria to blame.

Treatment   

Powerful, broad-spectrum antibiotics must be administered immediately. They are given in a vein to attain high blood levels of the antibiotic in an attempt to control the infection. Surgery is required to open and drain infected areas and remove dead tissue.

Skin grafts may be required after the infection is cleared. If the infection is in a limb and cannot be contained or controlled, amputation of the limb may be considered. Sometimes pooled immunoglobulins (antibodies) are given by vein to help fight the infection.

If the organism is determined to be an oxygen-avoiding bacteria (anaerobe) the patient may be placed in a hyperbaric oxygen chamber, a device in which the patient is exposed to 100% oxygen at several atmospheres of pressure.

Expectations (prognosis)

Outcomes are variable. The type of infecting organism, rate of spread, susceptibility to antibiotics, and how early the condition was diagnosed all contribute to the final outcome.

Scarring and deformity are common with this type of disease. Fatalities are high even with aggressive treatment and powerful antibiotics. Untreated, the infection invariably spreads and causes death.

Complications    Calling your health care provider    This disorder is severe and may be life-threatening, so consult your health care provider immediately.

Call your health care provider if signs of infection occur around a skin injury: pain, swelling, redness, drainage of pus or blood, fever, or other similar symptoms.

Prevention   

Clean any skin injury thoroughly. Watch for signs of infection such as redness, pain, drainage, swelling around the wound, and consult the health care provider promptly if these occur.

Update Date: 1/16/2004

http://www.nlm.nih.gov/medlineplus/ency/article/001443.htm

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What is Necrotizing fasciitis?

Necrotizing fasciitis is a severe bacterial infection. It is most commonly caused by Group A Strep or a mixture of bacteria including anærobic bacteria. Anærobic bacteria thrive in environments that are poor in oxygen, like wounds. Rarely, bacteria get into the thin membranes called fascia that connect the skin and underlying muscle tissues. In this environment, the bacteria destroy surrounding tissues and can spread rapidly through the body. Such an infection can quickly become deadly.

Necrotizing fasciitis sometimes occurs in people who skin pop or muscle drugs and, more rarely, among intravenous users. The bacteria may come from contaminated dope, from using dirty injection equipment, or from bacteria on your skin. If the bacteria are in the drug itself, you can't depend on "cooking" to kill the bacteria.

This type of infection has been popularized in the press as "flesh-eating" bacteria. While cases are rare in King County, over the past couple years doctors at Harborview Medical Center report treating one to two cases at any given time. Most local cases happen among injection drug users

How to protect yourself

You can reduce your risk for bacterial infections and abscesses.

What does Necrotizing fasciitis look and feel like?

If Necrotizing fasciitis is caught early, it can be successfully treated. But it is very important to catch it early and begin treatment immediately.

This infection is nothing to play around with. If you do not get medical care early, you run the risk of losing skin, losing an arm, or even death. 

Link no longer available

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Necrotizing Fasciitis/Myositis
("flesh-eating disease")

Necrotizing fasciitis (nek-roe-tie-zing fah-shee-eye-tis) is more commonly known as "flesh-eating disease". It is a rare illness that causes extensive tissue destruction and can lead to death. In Canada, there are 90-200 cases of necrotizing fasciitis each year.

Definition and Symptoms
Symptoms of necrotizing fasciitis include fever, severe pain, and a red, painful swelling which spreads rapidly. Death can occur in 12 to 24 hours. When the disease spreads along the layers of tissue that surround muscle (the fascia), it is called necrotizing fasciitis. When the disease spreads into the muscle tissue, it is called necrotizing myositis.

Cause
Necrotizing fasciitis can be caused by a number of different bacteria, one of them being the group A streptococcus. This is a common bacteria which causes infections, such as sore or strep throat, in children and young adults. Ten to 15 per cent of school age children may carry group A streptococcus in their throat and have no symptoms. It is normally spread through close, personal contact with an infected person, for example, through kissing or sharing cutlery. This same bacteria also causes scarlet fever, impetigo and rheumatic fever.

Sometimes group A streptococcus causes serious diseases such as pneumonia, streptococcal toxic-shock syndrome, and necrotizing fasciitis and myositis. In instances where serious disease develops, the presence of sore throat is very unusual.

While group A streptococcus is passed from person to person, necrotizing fasciitis is not.

Background
The disease was first discovered in 1783, in France. Doctors noted that it occurred sporadically throughout the 19th and 20th centuries. The disease was usually restricted to military hospitals, especially in war times. However, there have been some outbreaks in civilian populations. The disease appeared to markedly decrease in frequency during the 1940s, and reemerged worldwide in the 1980s.

In October 1998, serious group A streptococcal infections, such as necrotizing fasciitis, were reportable to public health officials in Newfoundland, Prince Edward Island, Quebec, Ontario, and Saskatchewan only. However, it was agreed that serious group A streptococcal infections would be under national surveillance from January 2000. In 1996, Health Canada's Laboratory Centre for Disease Control studied serious group A streptococcal infections in nine Canadian health units across the country. These health units, called the Sentinel Health Unit Surveillance System (SHUSS), were used to periodically monitor rare diseases in selected populations.

The SHUSS study and some provincial data showed that necrotizing fasciitis from group A streptococcus occurred in roughly 3 to 7 persons per 1,000,000 population per year. The study also confirmed that, while rare, necrotizing fasciitis is fatal in approximately 20-30% of cases. The fatality rate may be higher if it occurs with the toxic shock syndrome.

Research and Treatment
Treatment for necrotizing fasciitis usually involves surgically removing infected tissue - including amputation if necessary - and giving antibiotics such as penicillin and other drugs.

Researchers do not know why the normally mild group A streptococcus bacteria sometimes becomes a more serious threat. They are unsure exactly why group A streptococcus may cause minor infections, such as strep throat, in some people, and very serious infections, such as toxic shock syndrome or necrotizing fasciitis, in others. Bacteria have many different characteristics that can change over generations, keeping in mind that a generation for bacteria can be as short as 20 minutes.

An apparent change in the level of disease activity (number of cases of infection) can be due to changes in one or several of these bacterial characteristics, a change in the type of person(s) exposed to the bacteria or a greater awareness of these infections. It is likely that all of these possibilities have played a role in our perception of serious group A streptococcal infections.

Many scientists believe the bacteria makes proteins that cause the body's immune system to destroy both the bacteria and body, in addition to proteins that destroy tissue directly.

There is no vaccine available to prevent group A streptococcal infections. Since there are many types of group A streptococci, one of the biggest problems facing researchers has been how to make one vaccine against all the different types.

Canadian researchers are working on a new strategy that could help in the treatment of flesh-eating disease.

What Health Canada is Doing
Health Canada works with provincial and local public health officials to monitor infectious diseases. If requested, the Department will assist in the investigation of clusters of these infectious diseases using our human and technical resources.

The Department's Health Protection Branch through its Laboratory Centre for Disease Control works with the National Streptococcus Centre in Edmonton and other public health officials to develop new strategies and treatments to combat these diseases.

http://www.phac-aspc.gc.ca/publicat/info/necro_e.html

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Necrotizing Fasciitis

aka Flesh-Eating Bacteria

The really scary thing about flesh-eating bacteria is that you've already been exposed to it.

Necrotizing fasciitis is the name for a group of diseases which will painfully liquefy all the meat on a victim's body, unless all affected areas are amputated.

The most frequent cause of necrotizing fasciitis is Streptococcus A, which you may know better as "strep throat," an extremely common infection that almost everyone in America has suffered at one time or another. (There are other causes of necrotizing fasciitis, but they're even more rare than the already rare strep version).

The strep bacteria is spread through direct contact, and occasionally through coughing, kissing , and other body contact.  You can be a carrier of strep without showing any symptoms, but a 24-hour round of antibiotics is usually enough to render a victim non-contagious.

The most common effect of a strep infection is a sore throat. The next-most severe version of strep is called impetigo, a minor outbreak of skin blisters. According to the National Library of Medicine, impetigo "begins as an itchy, red sore that blisters, oozes and finally becomes covered with a tightly adherent crust. It tends to grow and spread. ... The infection is carried in the fluid that oozes from the blisters."

Strep throat almost never becomes necrotizing fasciitis, at least from a statistical viewpoint (and you know what they say about statistics). But when your impetigo is impetigo-going-gone, you just might have a case of streptococcal toxic shock syndrome (if you're lucky) or necrotizing fasciitis (if you're not).

STSS, the disease which killed Muppets creator Jim Henson, usually begins with a skin infection or an infected wound.. Within 48 hours of infection, the victim's blood pressure drops dangerously low, and she may experience dizziness, fever, labored breathing, confusion, rapid pulse and peeling skin rash. You can die within two or three days, unless treated with antibiotics and amputation of affected areas.

But STSS is still a step down from the king of all strep infections: necrotizing fasciitis.

By now, you're probably wondering, "How can I tell if I this annoying rash is really necrotizing fasciitis?" The good news is that if you're in any kind of shape to ask the question, you probably don't have necrotizing fasciitis.

The first thing to look for is when your itchy red sores quickly change into yellow-purple swaths of flesh, which grow rapidly leaving a dead black spot in the center, while your pustulent and gangrenous skin excruciatingly cracks open and oozes various liquids, which might be yellow-clear, yellow-cloudy, pus-like, bloody, puslike-bloody, yellow-bloody, or bloody-yellow. Your skin may become cold and pale and bleed uncontrollably.

You may also develop a fever or, as referenced in the list of official symptoms, "a generalized feeling of discomfort ... accompanied by a sensation of exhaustion or inadequate energy to accomplish usual activities." Gee, ya think? As if all this wasn't bad enough, expect diarrhea, vomiting, dehydration and kidney shutdown.

Fortunately, all this pain and suffering won't last long! Left untreated, necrotizing fasciitis will kill you in less than a week, sometimes much less. Treated incorrectly, it will take longer and be more painful. Treated correctly, it will take what seems like forever, be excruciatingly painful and leave you permanently scarred. About 20% of those infected with necrotizing fasciitis die from the disease.

The good news is necrotizing fasciitis is extremely rare. The bad news is that there's no way to prevent it. You can improve your odds slightly by becoming a hygiene freak and treating even the smallest scratches with antibiotic ointment, although if everyone did this, the bacteria would eventually evolve to become resistant to antibiotics, which would be much, much worse for humanity. But if you don't give a shit about humanity -- hey, go for it.

Unlike leprosy, which was long believed to be highly contagious, necrotizing fasciitis isn't a good reason to shun your neighbors or make them live in special colonies. (Actually, leprosy is no longer a good reason to do that either.) Necrotizing fasciitis isn't especially contagious, but it's good sense to wash out any open wounds on your skin after playing with your necrotized friends. Once the regimen of treatment is completed, there isn't any further risk of contagion.

No one knows exactly how common necrotizing fasciitis might be, and it's frequently misdiagnosed. Although reported cases have sharply increased in recent years, it's possible they were there all along. Currently, about 600 Americans per year are diagnosed with the disease, and it's believed that Third World countries have much higher rates of outbreak.

http://www.rotten.com/library/medicine/necrotizing-fasciitis/

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Necrotizing Fasciitis Caused by Community-Associated Methicillin-Resistant Staphylococcus aureus in Los Angeles

Loren G. Miller, M.D., M.P.H., Francoise Perdreau-Remington, Ph.D., Gunter Rieg, M.D., Sheherbano Mehdi, M.D., Josh Perlroth, M.D., Arnold S. Bayer, M.D., Angela W. Tang, M.D., Tieu O. Phung, M.D., and Brad Spellberg, M.D.

ABSTRACT

Background Necrotizing fasciitis is a life-threatening infection requiring urgent surgical and medical therapy. Staphylococcus aureus has been a very uncommon cause of necrotizing fasciitis, but we have recently noted an alarming number of these infections caused by community-associated methicillin-resistant S. aureus (MRSA).

Methods We reviewed the records of 843 patients whose wound cultures grew MRSA at our center from January 15, 2003, to April 15, 2004. Among this cohort, 14 were identified as patients presenting from the community with clinical and intraoperative findings of necrotizing fasciitis, necrotizing myositis, or both.

Results The median age of the patients was 46 years (range, 28 to 68), and 71 percent were men. Coexisting conditions or risk factors included current or past injection-drug use (43 percent); previous MRSA infection, diabetes, and chronic hepatitis C (21 percent each); and cancer and human immunodeficiency virus infection or the acquired immunodeficiency syndrome (7 percent each). Four patients (29 percent) had no serious coexisting conditions or risk factors. All patients received combined medical and surgical therapy, and none died, but they had serious complications, including the need for reconstructive surgery and prolonged stay in the intensive care unit. Wound cultures were monomicrobial for MRSA in 86 percent, and 40 percent of patients (4 of 10) for whom blood cultures were obtained had positive results. All MRSA isolates were susceptible in vitro to clindamycin, trimethoprim–sulfamethoxazole, and rifampin. All recovered isolates belonged to the same genotype (multilocus sequence type ST8, pulsed-field type USA300, and staphylococcal cassette chromosome mec type IV [SCCmecIV]) and carried the Panton–Valentine leukocidin (pvl), lukD, and lukE genes, but no other toxin genes were detected.

Conclusions Necrotizing fasciitis caused by community-associated MRSA is an emerging clinical entity. In areas in which community-associated MRSA infection is endemic, empirical treatment of suspected necrotizing fasciitis should include antibiotics predictably active against this pathogen.

Source Information

From the Divisions of Infectious Diseases and HIV Medicine (L.G.M., G.R., A.S.B., B.S.) and the Department of Internal Medicine (L.G.M., G.R., J.P., A.S.B., B.S.), Harbor–UCLA Medical Center and the Los Angeles Biomedical Institute at Harbor–UCLA, Torrance; the University of California, San Francisco (F.P.-R.); and St. Mary Medical Center, Long Beach (S.M., A.W.T., T.O.P.) — all in California

http://content.nejm.org/cgi/content/short/352/14/1445?query=TOC

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External Links

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National Necrotizing Fasciitis Foundation

http://www.nnff.org/

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The 'Lee Spark' NF Foundation 

NF Support in England/UK

http://www.nfsuk.org.uk/

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NECROTIZING FASCIITIS:
A Survivor's Story by Doreen Mulman

http://doreen.mkbmemorial.com/NF/

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Overcoming Necrotizing Fasciitis

http://www.flesheatingbacteria.net/

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Necrotizing Fasciitis Clinical Resources

http://www.mdconsult.com/recommended-results/NECROTIZINGFASCIITIS.lp

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Necrotizing Fasciitis

eMedicine

http://www.emedicine.com/EMERG/topic332.htm

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Necrotizing Fasciitis (Flesh-Eating Bacteria) (1)

http://my.webmd.com/hw/health_guide_atoz/hw140408.asp

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http://www.nnff.org/

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Google Diagnostic Images

http://images.google.com/images?q=Necrotizing+Fasciitis&hl=en&lr=&ie=UTF-8&sa=N&tab=wi

Yahoo

http://images.search.yahoo.com/search/images;_ylt=At4xTxEaudlLn56QVFvJvFObvZx4?p=Necrotizing+Fasciitis&toggle=1&cop=mss&ei=UTF-8&fr=yfp-t-70

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External Codes and Classifications:

ICD-10

M72.6 Necrotizing fasciitis
Use additional code, if desired, to identify infectious agent

ICD-9

2008 ICD-9-CM Diagnosis 728.86

Necrotizing fasciitis

  • A fulminating group A streptococcal infection beginning with severe or extensive cellulitis that spreads to involve the superficial and deep fascia, producing thrombosis of the subcutaneous vessels and gangrene of the underlying tissues. A cutaneous lesion usually serves as a portal of entry for the infection, but sometimes no such lesion is found. (Dorland, 28th ed)
  • 728.86 is a specific code that can be used to specify a diagnosis
  • 728.86 contains 1 index entry
  • View the ICD-9-CM Volume 1 728.* hierarchy

Use additional code to identify:

  • infectious organism (041.00-041.89)
  • gangrene (785.4), if applicable

MedlinePlus 001443

MeSH D019115

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Related Lymphedema People Medical Blogs and Pages:

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Bacterial Infections

http://bacteriainfections.blogspot.com

Antibiotics

http://antibioticinformation.blogspot.com/

Cellulitis

http://cellulitisinfections.blogspot.com/

MRSA Information

http://mrsainformation.blogspot.com/

Antibiotic Glossary

http://www.lymphedemapeople.com/phpBB2/viewforum.php?f=34

Antibiotic Therapy, Types of Antibiotics

http://www.lymphedemapeople.com/thesite/lymphedema_antibiotics.htm

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Information and support for rare and unusual disorders affecting the lymph system. Includes lymphangiomas, lymphatic malformations, telangiectasia, hennekam's syndrome, distichiasis, Figueroa
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http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_people_online_support_groups 

Lipedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=lipedema 

Treatment 

http://www.lymphedemapeople.com/wiki/doku.php?id=treatment 

Lymphedema and Pain Management 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pain_management 

Manual Lymphatic Drainage (MLD) and Complex Decongestive Therapy (CDT)

http://www.lymphedemapeople.com/wiki/doku.php?id=manual_lymphatic_drainage_mld_complex_decongestive_therapy_cdt 

Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=infections_associated_with_lymphedema 

How to Treat a Lymphedema Wound 

http://www.lymphedemapeople.com/wiki/doku.php?id=how_to_treat_a_lymphedema_wound 

Fungal Infections Associated with Lymphedema 

http://www.lymphedemapeople.com/wiki/doku.php?id=fungal_infections_associated_with_lymphedema 

Lymphedema in Children 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_in_children 

Lymphoscintigraphy 

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphoscintigraphy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Extraperitoneal para-aortic lymph node dissection (EPLND) 

http://www.lymphedemapeople.com/wiki/doku.php?id=extraperitoneal_para-aortic_lymph_node_dissection_eplnd 

Axillary node biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=axillary_node_biopsy

Sentinel Node Biopsy 

http://www.lymphedemapeople.com/wiki/doku.php?id=sentinel_node_biopsy

 Small Needle Biopsy - Fine Needle Aspiration 

http://www.lymphedemapeople.com/wiki/doku.php?id=small_needle_biopsy 

Magnetic Resonance Imaging 

http://www.lymphedemapeople.com/wiki/doku.php?id=magnetic_resonance_imaging 

Lymphedema Gene FOXC2

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_foxc2

 Lymphedema Gene VEGFC

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_vegfc

 Lymphedema Gene SOX18

 http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_gene_sox18

 Lymphedema and Pregnancy

http://www.lymphedemapeople.com/wiki/doku.php?id=lymphedema_and_pregnancy

Home page: Lymphedema People

http://www.lymphedemapeople.com

Jan. 16, 2012