Seal D V
Department of Diagnostic Medical Microbiology, St Mary's Hospital, Medical School, London, UK.
Curr Opin Infect Dis. 2001 Apr;14(2):127-32. doi: 10.1097/00001432-200104000-00003.
Necrotizing fasciitis continues to occur due to beta-haemolytic streptococci but is now also recognized as being due to Vibrio spp. in fishermen and those in contact with warm water in the Gulf of Mexico and South-East Asia, including Hong Kong. Magnetic resonance image scanning has identified the extent of fasciitis and soft tissue oedema infiltrating fascial planes prior to necrosis presenting clinically and is a useful tool in early diagnosis. Surgical debridement or incisional drainage remains essential. An enhanced bactericidal response against beta-haemolytic streptococci has been found with a combination of penicillin and clindamycin. Intravenous immunoglobulin has been shown to reduce mortality if the necrotizing fasciitis is associated with the toxic shock syndrome, by decreasing the superantigen activity of the beta-haemolytic streptococci on cytokine release by T cells.
坏死性筋膜炎仍可由β溶血性链球菌引起，但现在也被认为与弧菌属有关，见于渔民以及接触墨西哥湾和东南亚（包括香港）温暖海水的人群。磁共振成像扫描已能在临床上出现坏死之前识别筋膜炎症和软组织水肿浸润筋膜平面的范围，是早期诊断的有用工具。手术清创或切开引流仍然至关重要。已发现青霉素和克林霉素联合使用可增强对β溶血性链球菌的杀菌反应。如果坏死性筋膜炎与中毒性休克综合征相关，静脉注射免疫球蛋白已显示可通过降低β溶血性链球菌对T细胞释放细胞因子的超抗原活性来降低死亡率。
