XXXX in acute @entity788 .

@entity1 @entity788 @entity39 @entity149 @entity281
The clinical course of acute @entity788 varies from a mild, transitory illness to a severe, rapidly fatal disease. In about 80% to 90% of cases @entity788 presents as a mild, self-limiting disease with low morbidity and mortality. Unlike mild @entity788 , @entity788 develops in about 15% of @entity1 , with @entity281 of @entity39 representing the single most important risk factor for a fatal outcome. Infection of @entity39 in the natural course develops in the second and third week after onset of the disease and is reported in 40% to 70% of @entity1 with @entity788 . Just recently, prevention of @entity281 by prophylactic antibiotic treatment and assessment of the @entity281 status of @entity39 by fine-needle aspiration have been established in the management of severe @entity788 . Because medical treatment alone will result in a mortality rate of almost 100% in @entity1 with signs of @entity149 , @entity1 with infected @entity39 must undergo surgical intervention, which consists of an organ-preserving necrosectomy combined with a postoperative closed lavage concept that maximizes further evacuation of infected debris and exudate. However, intensive care treatment, including prophylactic antibiotics, reduces the @entity281 rate and delays the need for surgery in most @entity1 until the third or fourth week after the onset of symptoms. At that time, debridement of @entity39 is technically easier to perform, due to better demarcation between viable and @entity39 tissue compared with necrosectomy earlier in the disease. In contrast, surgery is rarely needed in the presence of sterile @entity39 . In those @entity1 the conservative approach is supported by the present data.
