What Is Necrotizing Fasciitis?

Necrotizing fasciitis, often referred to as the “flesh-eating disease,” is a rare but extremely serious bacterial infection that rapidly destroys the body’s soft tissues, including the fascia (a connective tissue surrounding muscles, nerves, fat, and blood vessels). This condition is characterized by its sudden onset, rapid progression, and high mortality rate, making early diagnosis and immediate treatment crucial for survival.

Caused primarily by Group A Streptococcus (GAS) bacteria, necrotizing fasciitis can also be caused by other bacteria, including Staphylococcus aureus, Clostridium, and various Gram-negative organisms. The infection typically enters the body through a break in the skin, such as a cut, scrape, burn, or surgical wound, although sometimes the entry point may not be evident.

Necrotizing fasciitis progresses swiftly, spreading along the fascial plane and causing severe tissue necrosis. The initial symptoms often resemble those of a mild infection, such as redness, warmth, and swelling at the site of infection, but rapidly escalate to severe pain, blistering, and systemic symptoms like fever and shock. Due to its aggressive nature, necrotizing fasciitis requires prompt medical attention, often involving surgical debridement of the affected tissue, broad-spectrum antibiotics, and supportive care in an intensive care setting.

Understanding the signs, risk factors, and treatment options for necrotizing fasciitis is vital for both healthcare professionals and the general public to ensure timely intervention and improve patient outcomes. This introduction outlines the critical aspects of this devastating condition, emphasizing the importance of awareness and rapid medical response in combating necrotizing fasciitis.

Types of Necrotizing Fasciitis

Necrotizing fasciitis encompasses several types, each characterized by the specific bacteria involved and the underlying conditions that contribute to the infection’s severity. While Group A Streptococcus (GAS) remains the most common cause, other bacterial pathogens can also lead to this life-threatening condition. Here are the primary types of necrotizing fasciitis:

1. Type I Necrotizing Fasciitis (Polymicrobial Necrotizing Infections)

• Description: Type I necrotizing fasciitis is typically caused by a combination of aerobic and anaerobic bacteria, including both Gram-positive and Gram-negative organisms.
• Bacteria Involved: Common pathogens include mixed flora such as Staphylococcus aureus, Streptococcus pyogenes (Group A Streptococcus), Enterococcus species, Bacteroides fragilis, Escherichia coli, and others.
• Risk Factors: Often associated with conditions like diabetes mellitus, peripheral vascular disease, immunosuppression, or recent surgery. Trauma and open wounds are common entry points for these infections.

2. Type II Necrotizing Fasciitis (Monomicrobial Necrotizing Infections)

• Description: Type II necrotizing fasciitis is caused by a single type of bacteria, most commonly Group A Streptococcus (GAS).
• Bacteria Involved: Group A Streptococcus (Streptococcus pyogenes) is the primary pathogen responsible for Type II necrotizing fasciitis. This bacterium produces potent toxins that contribute to tissue destruction and systemic toxicity.
• Risk Factors: Often occurs in healthy individuals without significant underlying health conditions, although recent trauma, surgery, or minor skin injuries can predispose individuals to infection.

3. Other Types and Variants

• Methicillin-Resistant Staphylococcus aureus (MRSA) Necrotizing Fasciitis: This variant is caused by Staphylococcus aureus strains resistant to methicillin and other beta-lactam antibiotics. MRSA necrotizing fasciitis poses challenges due to antibiotic resistance.
• Clostridial Necrotizing Fasciitis: Caused by Clostridium species, particularly Clostridium perfringens. These infections are associated with traumatic injuries, surgery, or conditions like diabetes that create an anaerobic environment conducive to Clostridium growth.
• Fournier’s Gangrene: A specific type of necrotizing fasciitis involving the perineum and genital area. It predominantly affects men and can result from infections with mixed aerobic and anaerobic bacteria.
• Gas Gangrene (Clostridial Myonecrosis): While technically not necrotizing fasciitis, gas gangrene involves similar tissue destruction caused by Clostridium species. It requires urgent surgical intervention and antibiotic treatment.

4. Necrotizing Soft Tissue Infections (NSTIs)

• General Term: NSTIs encompass all types of infections that involve necrotizing soft tissues, including necrotizing fasciitis and related conditions.
• Clinical Presentation: Regardless of the specific type, all NSTIs share rapid progression, severe pain, tissue necrosis, and systemic manifestations such as fever, hypotension, and organ failure.

Understanding the different types of necrotizing fasciitis is crucial for appropriate diagnosis and management. Treatment typically involves a combination of aggressive surgical debridement to remove infected tissue, broad-spectrum antibiotics, and intensive supportive care in a hospital setting. Early recognition and intervention are critical to improving outcomes for individuals affected by these severe infections.

Symptoms of Necrotizing Fasciitis

Necrotizing fasciitis is a rapidly progressing and potentially life-threatening bacterial infection that affects the soft tissues, particularly the fascia (connective tissue surrounding muscles, nerves, fat, and blood vessels). Recognizing the symptoms early is crucial for prompt medical intervention. The symptoms of necrotizing fasciitis can vary depending on the type of bacteria causing the infection and the location of the infection. Here are the key symptoms to watch for:

1. Localized Symptoms

• Severe Pain: Often starts as disproportionate pain compared to the visible signs of injury, such as a minor cut or insect bite. Pain may be out of proportion to the injury.
• Redness (Erythema): The affected area may appear reddish or purplish in color, indicating inflammation and infection.
• Swelling: Rapid swelling and inflammation of the skin and soft tissues around the affected area.
• Warmth: The skin around the infected area may feel warm to the touch due to inflammation.

2. Skin Changes

• Bruising: Spontaneous bruising or discoloration of the skin, which may progress rapidly.
• Blisters or Bullae: Formation of fluid-filled blisters, particularly in severe cases, as the infection progresses.
• Skin Necrosis: Skin may become discolored (blackened) as tissue necrosis (death) sets in, especially in advanced stages.

3. Systemic Symptoms

• Fever: Often high fever, usually above 38°C (100.4°F), accompanied by chills and sweating.
• Nausea and Vomiting: Systemic symptoms can include gastrointestinal disturbances, such as nausea, vomiting, and diarrhea.
• Malaise: General feeling of illness, weakness, and fatigue.

4. Progression of Symptoms

• Rapid Worsening: Symptoms progress quickly over hours to days, with increasing pain, swelling, and systemic signs of infection.
• Skin Crepitus: In severe cases, gas production by certain bacteria can cause a crackling sensation (crepitus) under the skin.

5. Advanced Symptoms

• Hypotension: Low blood pressure (hypotension) may develop as the infection spreads, leading to shock.
• Organ Failure: Severe cases can lead to multiple organ failure, including kidney failure (acute kidney injury), respiratory failure, and circulatory collapse.

6. Specific Types and Locations

• Fournier’s Gangrene: Necrotizing fasciitis affecting the genital and perineal area, particularly in men, presenting with severe pain, swelling, and tissue necrosis in the groin and genital region.
• Gas Gangrene (Clostridial Myonecrosis): Associated with rapid tissue destruction, gas production, and distinctive foul odor. Requires urgent surgical intervention.

7. Symptoms in Children

• In pediatric cases, symptoms may include irritability, refusal to eat, and lethargy in addition to localized signs of infection.

Early diagnosis of necrotizing fasciitis is critical to prevent complications and improve outcomes. Any suspicion of necrotizing fasciitis should prompt immediate medical attention and evaluation by a healthcare professional. Treatment typically involves surgical intervention to remove infected tissue (debridement), broad-spectrum antibiotics, and intensive supportive care in a hospital setting.

Causes of Necrotizing Fasciitis

Necrotizing fasciitis is primarily caused by certain bacteria that invade the body’s soft tissues, leading to rapid tissue destruction and necrosis (cell death). The infection typically occurs when these bacteria enter the body through a break in the skin, such as a cut, scrape, surgical wound, or insect bite. The following are the main causes and contributing factors associated with necrotizing fasciitis:

1. Bacterial Pathogens

• Group A Streptococcus (GAS): Also known as Streptococcus pyogenes, GAS is the most common cause of necrotizing fasciitis. It produces toxins that destroy tissues and evade the immune system, leading to rapid progression of the infection.
• Staphylococcus aureus: Including methicillin-resistant Staphylococcus aureus (MRSA), which can cause aggressive skin and soft tissue infections, sometimes progressing to necrotizing fasciitis.
• Other Bacteria: Less commonly, other bacteria like Clostridium species (Clostridial myonecrosis), including Clostridium perfringens, may cause gas gangrene with similar tissue necrosis.

2. Entry Points

• Skin Breaks: Necrotizing fasciitis typically begins when bacteria enter the body through breaks in the skin, such as cuts, surgical wounds, puncture wounds, insect bites, or burns.
• Medical Procedures: Invasive medical procedures, surgeries, or injections can also provide entry points for bacteria to invade deeper tissues.

3. Predisposing Factors

• Weakened Immune System: Conditions that weaken the immune system, such as diabetes mellitus, HIV/AIDS, cancer, chronic kidney disease, or autoimmune disorders, increase susceptibility to infections like necrotizing fasciitis.
• Chronic Illnesses: Individuals with chronic illnesses or conditions that compromise blood flow to tissues, such as peripheral vascular disease or atherosclerosis, are at higher risk.
• Malnutrition: Poor nutrition and nutritional deficiencies can weaken the body’s defenses against infections.
• Alcoholism: Excessive alcohol consumption can impair the immune system and increase the risk of infections.

4. Environmental Factors

• Warm and Humid Climates: Certain environmental conditions may promote the growth and spread of bacteria associated with necrotizing fasciitis.

5. Nosocomial (Hospital-Acquired) Infections

• Healthcare Settings: Patients in hospitals or healthcare facilities may develop necrotizing fasciitis as a result of exposure to healthcare-associated pathogens or through surgical wounds.

6. Community Transmission

• Direct Contact: Necrotizing fasciitis can occasionally spread through direct contact with contaminated surfaces or through contact with an infected individual, although this is less common.

7. Rare Causes

• Viral Infections: In rare cases, viral infections like varicella-zoster virus (chickenpox) or herpes simplex virus (HSV) can lead to secondary bacterial infections that may progress to necrotizing fasciitis.

Understanding the causes and risk factors associated with necrotizing fasciitis is essential for early recognition and prompt treatment. Timely medical intervention, including aggressive surgical debridement and antibiotic therapy, is crucial to prevent complications and improve outcomes for individuals affected by this severe infection. Promptly seeking medical attention for any signs of infection or skin injury can help reduce the risk of necrotizing fasciitis and other serious bacterial infections.

Diagnosis of Necrotizing Fasciitis

Diagnosing necrotizing fasciitis can be challenging due to its rapid progression and potentially severe consequences. Early recognition and prompt intervention are crucial for improving outcomes and reducing morbidity and mortality. Here are the key aspects involved in diagnosing necrotizing fasciitis:

1. Clinical Evaluation

• Symptom Assessment: A thorough assessment of symptoms, including localized pain (often out of proportion to the visible signs), swelling, erythema (redness), and skin changes such as blisters or bullae.
• Systemic Signs: Monitoring for systemic signs of infection, such as fever, tachycardia (rapid heartbeat), hypotension (low blood pressure), and altered mental status.
• Rapid Progression: Necrotizing fasciitis typically progresses rapidly over hours to days, with worsening pain and systemic symptoms.

2. Laboratory Tests

• Blood Tests: Complete blood count (CBC) to assess for leukocytosis (elevated white blood cell count) or leukopenia (decreased white blood cell count), which may indicate systemic infection. Blood cultures to identify the causative organism.
• Inflammatory Markers: Measurement of inflammatory markers such as C-reactive protein (CRP) and procalcitonin, which are often elevated in severe infections.

3. Imaging Studies

• CT Scan: Computed tomography (CT) imaging is often used to evaluate the extent of tissue involvement, identify gas in tissues (gas gangrene), and assess for signs of deep tissue involvement.
• MRI: Magnetic resonance imaging (MRI) may be used for detailed evaluation of soft tissue involvement and to differentiate necrotizing fasciitis from cellulitis or abscesses.

4. Surgical Exploration

• Diagnostic Surgical Exploration: In cases where necrotizing fasciitis is suspected but not confirmed by other means, surgical exploration of the affected area may be necessary to directly visualize the extent of tissue necrosis and confirm the diagnosis.
• Tissue Biopsy: Biopsy of affected tissue for histopathological examination can provide definitive evidence of tissue necrosis and bacterial invasion.

5. Clinical Scoring Systems

• LRINEC Score: The Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) score combines various laboratory parameters (such as CRP, white blood cell count, hemoglobin, sodium, glucose, and creatinine) to help stratify the likelihood of necrotizing fasciitis. A higher score indicates a greater risk.
• FAST Score: The Fournier’s Gangrene Severity Index (FGSI) score is used specifically for Fournier’s gangrene, a type of necrotizing fasciitis affecting the genital area.

6. Microbiological Analysis

• Wound Cultures: Collection of wound specimens for culture and sensitivity testing to identify the causative bacteria and determine antibiotic susceptibility.
• Anaerobic Cultures: Necrotizing fasciitis caused by anaerobic bacteria may require specific anaerobic cultures to identify the pathogen.

7. Differential Diagnosis

• Cellulitis: Distinguishing necrotizing fasciitis from cellulitis, which is a less severe skin infection, is crucial. Necrotizing fasciitis typically involves rapid tissue necrosis and systemic symptoms, whereas cellulitis is more superficial and does not usually involve deeper tissues.

8. Multidisciplinary Approach

• Consultation: Collaboration with specialists such as infectious disease specialists, surgeons, radiologists, and intensive care physicians is essential for timely diagnosis and management of necrotizing fasciitis.

9. Early Intervention

• Immediate Treatment: Due to the aggressive nature of necrotizing fasciitis, empirical antibiotic therapy and surgical intervention (debridement) should be initiated promptly upon clinical suspicion, even before confirmation of diagnosis.

Early and accurate diagnosis of necrotizing fasciitis is critical to prevent complications such as tissue loss, sepsis, and organ failure. Healthcare providers must maintain a high index of suspicion, particularly in patients with risk factors or suggestive clinical findings, to facilitate timely intervention and optimize patient outcomes.

Treatments for Necrotizing Fasciitis

Necrotizing fasciitis is a severe and rapidly progressing bacterial infection that requires immediate medical intervention. Treatment typically involves a combination of surgical procedures, antibiotic therapy, and supportive care aimed at removing infected tissue, controlling the infection, and managing complications. Here are the key components of treatment for necrotizing fasciitis:

1. Surgical Debridement

• Purpose: Surgical removal (debridement) of necrotic (dead) tissue is the cornerstone of treatment. This helps to eliminate the source of infection, reduce bacterial load, and prevent further spread.
• Procedure: Surgeons perform multiple debridement procedures as needed to ensure all infected tissue is removed. This may require repeated surgeries until the infection is controlled.

2. Broad-Spectrum Antibiotics

• Empirical Therapy: Immediately upon suspicion of necrotizing fasciitis, broad-spectrum antibiotics are initiated to cover a wide range of potential bacterial pathogens.
• Intravenous Administration: Antibiotics are typically administered intravenously to achieve high blood concentrations and ensure effective penetration into infected tissues.
• Antibiotic Choice: Commonly used antibiotics include broad-spectrum beta-lactams (e.g., piperacillin-tazobactam, meropenem) combined with agents effective against methicillin-resistant Staphylococcus aureus (MRSA) if indicated.

3. Supportive Care

• Fluid Resuscitation: Patients often require intravenous fluids to support circulation and manage shock, particularly in cases of septic shock.
• Monitoring: Close monitoring of vital signs, fluid balance, and electrolyte levels is essential in an intensive care setting.

4. Hyperbaric Oxygen Therapy (HBOT)

• Adjunctive Therapy: In some cases, hyperbaric oxygen therapy (HBOT) may be considered as adjunctive treatment. HBOT involves breathing pure oxygen in a pressurized chamber, which can enhance tissue oxygenation and aid in wound healing.

5. Pain Management

• Analgesics: Pain management is crucial, and patients may require potent analgesics to control severe pain associated with necrotizing fasciitis and surgical interventions.

6. Wound Care and Reconstruction

• Wound Management: After surgical debridement, meticulous wound care is necessary to promote healing and prevent secondary infections.
• Reconstructive Surgery: In severe cases, reconstructive surgery may be required to repair tissue defects and improve function once the infection is controlled.

7. Nutritional Support

• Nutritional Assessment: Patients may require nutritional assessment and supplementation to support immune function and promote wound healing.

8. Multidisciplinary Approach

• Team Collaboration: Treatment of necrotizing fasciitis often involves a multidisciplinary team including infectious disease specialists, surgeons, intensivists, nurses, and other healthcare professionals to coordinate care and optimize outcomes.

9. Long-Term Monitoring

• Follow-Up: Long-term monitoring is essential to assess wound healing, manage complications such as wound infections or scarring, and support recovery.

10. Prevention of Complications

• Complications Management: Prompt identification and management of complications such as sepsis, organ failure, and deep vein thrombosis are crucial to improve patient outcomes.

11. Patient Education and Support

• Rehabilitation: After recovery, patients may require physical therapy and rehabilitation to regain function and mobility affected by the infection and surgical interventions.

Prognosis

The prognosis for necrotizing fasciitis depends on early diagnosis, prompt initiation of treatment, and the extent of tissue involvement. Despite aggressive treatment, necrotizing fasciitis can be associated with significant morbidity and mortality, especially in cases of delayed presentation or advanced disease. Therefore, awareness of symptoms and rapid medical intervention are critical to improving outcomes for individuals affected by this life-threatening infection.

Prevention of Necrotizing Fasciitis

Preventing necrotizing fasciitis involves strategies to reduce the risk of bacterial infections and promptly treat any skin injuries or infections that could potentially lead to this serious condition. Here are key preventive measures individuals can take:

1. Maintain Good Hygiene Practices

• Handwashing: Regular and thorough handwashing with soap and water helps prevent the spread of bacteria, including those that can cause necrotizing fasciitis.
• Clean Wounds: Promptly clean and disinfect any cuts, scrapes, or other skin injuries with soap and water. Keep wounds covered with clean, dry bandages until healed.

2. Manage Chronic Conditions

• Control Diabetes: Properly manage diabetes through medication, diet, and regular monitoring of blood sugar levels to reduce the risk of infections.
• Address Peripheral Vascular Disease: Manage conditions like peripheral vascular disease to improve blood flow and reduce the risk of skin ulcers and wounds.

3. Avoid Sharing Personal Items

• Avoid Sharing Towels: Do not share towels, razors, or other personal items that may harbor bacteria and increase the risk of skin infections.

4. Protective Measures in Healthcare Settings

• Infection Control: Healthcare providers should adhere strictly to infection control practices, including hand hygiene and sterile techniques during medical procedures and wound care.

5. Prompt Medical Attention

• Early Treatment: Seek medical attention promptly for any signs of skin infection, such as redness, swelling, warmth, or pain that seems disproportionate to the injury.
• Know the Symptoms: Be aware of the symptoms of necrotizing fasciitis and seek immediate medical care if you suspect an infection is progressing rapidly.

6. Vaccination

• Streptococcal Vaccination: Certain populations may benefit from vaccinations against streptococcal infections, particularly those at higher risk due to chronic illnesses or immunosuppression.

7. Care in High-Risk Situations

• Be Cautious in Water: Avoid swimming or entering hot tubs or natural bodies of water if you have open wounds or skin infections, as these environments can harbor bacteria that cause necrotizing fasciitis.

8. Healthy Lifestyle

• Maintain a Healthy Immune System: Eat a balanced diet, exercise regularly, get adequate sleep, and avoid smoking and excessive alcohol consumption to support overall immune function.

9. Awareness and Education

• Educate Yourself: Learn about necrotizing fasciitis and its symptoms to recognize early signs and seek medical attention promptly if needed.
• Community Awareness: Educate your community, especially those at higher risk, about preventive measures and the importance of early treatment for skin infections.

10. Follow Medical Advice

• Follow-Up Care: If you have a chronic condition or have had necrotizing fasciitis in the past, follow your healthcare provider’s recommendations for ongoing care and preventive measures.

By practicing good hygiene, promptly treating skin injuries, managing underlying health conditions, and seeking early medical attention for infections, individuals can reduce their risk of necrotizing fasciitis. Prevention efforts are crucial in minimizing the incidence and severity of this potentially life-threatening condition.

Complications of Necrotizing Fasciitis

Necrotizing fasciitis is a severe and rapidly progressing bacterial infection that can lead to significant complications, especially if not promptly diagnosed and treated. The complications can be life-threatening and may include:

1. Sepsis and Septic Shock

• Description: Necrotizing fasciitis can cause the infection to spread rapidly into the bloodstream (bacteremia), leading to sepsis. Sepsis can progress to septic shock, a life-threatening condition characterized by low blood pressure, multiple organ dysfunction, and potentially death.

2. Tissue Necrosis and Loss

• Description: The infection destroys soft tissues, including skin, muscle, and underlying fat. Extensive tissue necrosis may require surgical removal (debridement), leading to significant tissue loss and potential functional impairment.
• Complications: Severe cases may result in amputation of affected limbs or extensive reconstructive surgery to restore function and appearance.

3. Organ Failure

• Description: Necrotizing fasciitis can lead to organ failure, such as acute kidney injury (from septic shock or nephrotoxic effects of antibiotics), respiratory failure (from systemic inflammation and fluid overload), or liver dysfunction.
• Management: Intensive care and supportive measures are necessary to manage and potentially reverse organ dysfunction.

4. Long-Term Disabilities

• Description: Survivors of necrotizing fasciitis may experience long-term disabilities, including chronic pain, reduced mobility, and psychological effects due to the trauma of severe illness and surgical interventions.
• Rehabilitation: Physical therapy and rehabilitation may be necessary to regain strength, mobility, and functionality after treatment.

5. Secondary Infections

• Description: Wounds left after surgical debridement are vulnerable to secondary bacterial infections, which can delay healing, exacerbate tissue damage, and prolong recovery.
• Prevention: Strict wound care protocols and antibiotic therapy are essential to prevent and manage secondary infections.

6. Gangrene and Amputation

• Description: In severe cases, necrotizing fasciitis can lead to gangrene, where tissue death is extensive and irreversible. Gangrene may necessitate surgical amputation of affected limbs to prevent further spread of infection and save the patient’s life.
• Prognosis: The prognosis after amputation depends on the extent of tissue loss and the patient’s overall health status.

7. Psychological Impact

• Description: Survivors of necrotizing fasciitis may experience psychological distress, including anxiety, depression, post-traumatic stress disorder (PTSD), and fear of recurrence.
• Support: Psychological support and counseling may be beneficial for patients and their families during recovery and rehabilitation.

8. Mortality

• Description: Despite aggressive treatment, necrotizing fasciitis carries a high mortality rate, especially in cases of delayed diagnosis or inadequate initial treatment. Mortality rates can range from 20% to 80%, depending on factors such as the virulence of the infecting bacteria, the patient’s overall health, and the timeliness of medical intervention.
• Early Recognition and Treatment: Early recognition of symptoms, prompt medical evaluation, and aggressive treatment are crucial to improve outcomes and reduce mortality.

Understanding the potential complications of necrotizing fasciitis underscores the importance of early diagnosis, rapid intervention, and comprehensive medical care. Healthcare providers must remain vigilant, especially in high-risk patients, to minimize the devastating consequences of this life-threatening infection.

Conclusion

In conclusion, necrotizing fasciitis is a rare but extremely serious bacterial infection that demands swift and decisive medical intervention. Characterized by its rapid progression and potential for severe complications, including tissue necrosis, organ failure, and even death, necrotizing fasciitis underscores the critical importance of early recognition and prompt treatment.

The condition typically begins with seemingly minor skin trauma or surgical wounds through which bacteria invade deeper tissues, leading to rapid tissue destruction. Early symptoms such as severe pain, redness, swelling, and systemic signs like fever and malaise should prompt immediate medical attention. Diagnostic measures include clinical evaluation, imaging studies like CT scans, and sometimes surgical exploration to confirm the extent of tissue involvement.

Treatment revolves around aggressive surgical debridement to remove infected tissue, coupled with broad-spectrum antibiotics to combat bacterial spread. Supportive care in an intensive care setting may include fluid resuscitation, pain management, and, in some cases, hyperbaric oxygen therapy to aid in tissue healing.

Preventive measures such as maintaining good hygiene, promptly treating skin injuries, managing chronic health conditions, and seeking early medical care for any signs of infection are crucial in reducing the risk of necrotizing fasciitis.

Despite advancements in medical care, necrotizing fasciitis remains a formidable challenge due to its rapid onset and potential for devastating outcomes. Continued education, awareness, and adherence to preventive strategies are essential to mitigating the impact of this life-threatening infection and improving patient outcomes.

In facing necrotizing fasciitis, vigilance, early intervention, and multidisciplinary collaboration are paramount in providing the best possible care and support for those affected by this critical condition.

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