Teška forma streptokoknog nekrotizujućeg fasciitisa ruke – dijagnostički i terapijski izazov

  • Dragan Mikić Clinic for Infectious and Tropical Diseases, Military Medical Academy, Belgrade, Serbia; †Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Tatjana Takić-Radovanović Clinic for Infectious and Tropical Diseases, Military Medical Academy, Belgrade, Serbia
  • Milan Luković Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, Belgrade, Serbia
  • Milomir Košutić Clinic for Orthopedic Surgery and Traumatology, Military Medical Academy, Belgrade, Serbia
  • Srdjan Starčević Clinic for Infectious and Tropical Diseases Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Zoran Bjelanović Clinic for Vascular Surgery, Military Medical Academy, Belgrade, Serbia
  • Dragan Djordjević Clinic for Anesthesiology and Intensive Care, Military Medical Academy, Belgrade, Serbia
  • Darko Nožić Clinic for Infectious and Tropical Diseases, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/6503
Ključne reči: fasciitis, necrotizing||, ||fasciitis, nekrotizujući, streptococcus||, ||streptococcus, arm||, ||ruka, amputation||, ||amputacija, anti-bacterial agents||, ||antibiotici,

Sažetak


Uvod. S obzirom na to da kašnjenje sa postavljanjem dijagnoze i lečenjem nekrotizujućeg fasciitisa (NF) uzrokovanog invazivnim streptokokom grupe A povećava smrtnost i invaliditet, rana dijagnoza i lečenje ove bolesti esencijalni su za bolji ishod. Prikazali smo bolesnika sa teškom formom streptokoknog NF leve ruke kod koga je urađena amputacija, kako bi se spasio život. Prikaz bolesnika. Muškarac, star 65 godina i prethodno zdrav, zadobio je povredu leve šake ubodom na riblju kost. Dva dana kasnije on je dobio visoku temperaturu, crvenilo, otok i bol u levoj ruci. Klinički pregled bolesnika nakon prijema ukazao je da se radi o NF koji se brzo širio na celu levu ruku, levu pazušnu jamu i levu stranu trupa. Uprkos agresivnoj primeni antibiotske terapije i hiruškog lečenja, kod bolesnika je došlo do razvoja teške destrukcije kože i potkožnih tkiva sa razvojem gangrene leve ruke. U ovoj situaciji konzilijum specijalista odlučio je da se kod bolesnika mora uraditi amputacija leve ruke u ramenu u cilju spašavanja života. Posle amputacije i debridmana mekih tkiva na levoj strani trupa, kod bolesnika je došlo do potpunog oporavka. Iz kože i mekih tkiva dobijenih tokom operacije izolovan je β hemolitički streptokok grupe A. Zaključak. U najtežim formama nekrotizujućeg fasciitisa ekstremiteta, adekvatan multidisciplinaran tretman, uključujući i amputaciju ekstremiteta, može spasiti život obolelog.

 

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Objavljeno
2015/11/02
Broj časopisa
Vol. 72 Br. 8 (2015)
Rubrika
Prikaz bolesnika