Necrotizing+Faciitis+Sp14

= Necrotizing Fasciitis (Flesh- Eating Disease/Flesh Eating Bacterial Infection) =

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**Motivation and Background:**
Necrotizing fasciitis (NF), also known as Flesh-Eating Disease is one of the most intense and radical infections a Medical Doctor or Surgeon must deal with. The difficulty in managing this problem is caused from a combination of diagnosis’s, and also of early as well as late detection of the disease. For the patient, this will cause a prolonged hospital stay, painful dressings, an extended recovery, and in some unfortunate cases even loss of a limb or their life. NF is a rapidly progressive disease which destroys muscles, fat, and skin tissue (2), and although it is very rare one in four people who get NF die from it (4). The disease is contracted by bacteria and can be categorized based on how many types of bacteria are found in the wounds. Type 1 is either caused by more than two bacterial genera (polymicrobial), Type 2 is caused by Streptococcus bacteria, and type 3 (or termed type 3 gas gangrene) is caused by Clostridium bacteria. One example of clinical findings (gas in tissues) is more often found in type 3 but can be found in types 1 and 2 also. Many investigators elect not to use this typing system and simply identify the organism(s) causing the necrotizing fasciitis (5). These bacterial infections can be both aerobic and anaerobic (5). NF has been around for many years and can be traced to many parts of the globe in history, but the more prominent and deadly encounter for the United States was during the civil war. This condition occurred in 2642 soldiers during the civil war with a mortality of 46 percent. The head corpsman (M.D. in U.S. Navy) termed it “Hospital Gangrene,” a rapidly progressing fascial necrosis of bacterial causes. Since his description, it has been variously labeled as “necrotizing erysipelas,” “hemolytic streptococcal gangrene,” “suppurative fasciitis” and “acute dermal gangrene” (4). NF has many symptoms that often start immediately after an injury/infection of the bacteria. Many patients report that the pain sometimes gets better over 24 to 36 hours and then suddenly gets worse (6). The most commonly reported symptoms are skin that is red, swollen, and hot to the touch, fever, chills with nausea and vomiting, and diarrhea. Figure 1: NF is being displayed; showing some symptoms such as redness, swelling and missing tissue(7).

**Target Information:**
Penicillin Binding Proteins (PBPs) are enzymes in many bacteria that have an affinity to Penicillin because they are similar in structure. The targets for Penicillin are these PBP’s, which are enzymes that catalyze the production of the “cell wall” for bacteria which is peptidoglycan. PBPs bind β-lactam antibiotics (Penicillin) because they are similar in chemical structure to the modular pieces that form the peptidoglycan. When they bind to penicillin, the β-lactam amide bond is ruptured to form a covalent bond with the catalytic serine residue at the PBPs active site. This is an irreversible reaction and inactivates the enzyme //(6)//. This causes the bacteria to stop its replication and thus stopping the infection as well as the further spreading of the infection. In the case of NF, this would stop the common bacteria listed above such as // Streptococcus // and //Clostridium//.

Penicillin G (Pfizerpen) or Penicillin.


Figure 2: Penicillin G Potassium in a 20 millionunitrecon solution form; used to make pills.

Penicillin G is used in defense against bacteria because it stops the reproduction of bacteria, inhibiting the reconstruction of the bacterial wall. It was originally noticed by a French medical student in 1896, and later was discovered by Alexander Fleming that it killed/destroyed the bacteria Staphylococcus aureus. The drug was first introduced in the market in 1942 called Penicillin G Procaine. Later it was discovered that Penicillin can only be diagnosed to people are not allergic to it because many people had allergic reactions in the beginning, so therefore its coverage is limited to the population who has a resistance to it. Taking penicillin when allergic can be fatal //(5).// The maker of this drug is Pfizer, penicillin has many forms and therefore has many patents. “Penicillin” is a general term that covers many types of a variant of penicillin such as Penicillin G, Penicillin V, etc. These drugs are derived from “Penicillium fungi” which is in the kingdom //Fungi//. Figure 3: The molecular shape of Penicillin G which is monopotassium 3,3-dimethyl-7-oxo-6-(2-phenylacetamido)-4-thia-1-azabicyclo (3.2.0) heptane-2-carboxylate //(3).// Penicillin is fairly “heavy” with a molecular weight of 372.48 g/mol, the molecular formula is C16H17KN2O4S and its CAS number is 69-57-8 (1). Penicillin G potassium is a colorless or white crystal, or a white crystalline powder which is odorless, or practically so, and moderately hygroscopic. Penicillin G potassium is very soluble in water. The pH of the reconstituted product is between 6.0–8.5 pH. Penicillins are very effective against bacteria and have a 65 percent chance of adhering to the enzymes it’s designed to inhibit. Therefore it is used against many types of diseases aside from NF; these include Chlamydia, Abscesses, Leptospirosis, Lyme disease, Typhoid Fever, and Gangrene.

= References =

** [1] ** ChemIndustry. Chemical Information Search; Penicillin. [] (accessed on Feb 2, 2014). http://www.ncbi.nlm.nih.gov/pubmed/327844(accessed Jan 31, 2014). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1153830/ (accessed Feb 2, 2014).
 * [2]** Centers for Disease Control and Prevention, Group A Streptococcal (GAS) Disease. // National Center for Immunization and Respiratory Diseases: Division of Bacterial Diseases // ** 2008 **.
 * [3] ** Drug Information Online; Penicillin G Potassium. [] (accessed on Feb 2, 2014).
 * [4]** //Endnote Basic//, Version 2014; Sadasivan, J.; Maroju, N. K.; Balasubramaniam, A., Necrotizing Fasciitis. //Indian J Plast Surg// **2013,** //46// (3), 472-478.
 * [5]** Giuliano A, Lewis F, Jr, Hadley K, Blaisdell FW. //Bacteriology of necrotising faciitis.// Am J Surg.n [Online] **1977**; 134:52 –7.
 * [6]** Nguyen-Distèche M, Leyh-Bouille M, Ghuysen JM. Isolation of the membrane-bound 26 000-Mr penicillin-binding protein of Streptomyces strain K15 in the form of a penicillin-sensitive D-alanyl-D-alanine-cleaving transpeptidase // Biochem J // . (Online) ** 1982 ** October 1; 207(1): 109–115
 * [7] ** Medicnet. Images; Necrotizing Fasciitis. http://images.medicinenet.com/images/centers/promo/necrotizing-fasciitis.jpg (accessed on Feb 2, 2014).