NF is caused by one or more bacteria that attacks the skin, the tissue just beneath the skin subcutaneous tissueand the fascia causing these tissues to die necrosis. These infections can be sudden, vicious, and fast-spreading. They include high fever, sore throat, stomach ache, nausea, diarrhea, chills, and general body aches. Around the same time, patients may notice redness erythema and pain or tenderness around the red area.
Pain that extends past margin of apparent infection Fever with toxic appearance Tense edema with grayish or brown discharge Severe pain that appears disproportionate to physical findings Altered mental state Lack of lymphangitis or lymphadenopathy Decreased pain or anesthesia at apparent site of infection Tachycardia Vesicles or bullae, hemorrhagic bullae Tachypnea due to acidosis Presentation with DKA or HHNK Crepitus Open in a separate window DKA—diabetic ketoacidosis, HHNK—hyperosmolar hyperglycemic non-ketotic acidosis.
This is thought to be due to infarction of cutaneous nerves in necrotic subcutaneous fascia and soft tissue. The patient with a hyperacute course presents with sepsis and rapidly progresses to multiorgan failure.
Diagnosis of sepsis is obvious, and these patients are hospitalized. Several authors have described a subacute variation of NF. After the infection reaches a certain threshold, sudden deterioration is an important clinical feature.
Aggressive surgical debridement is the cornerstone of treatment in these cases. Progression of disease is invariable in this group, and a delay in diagnosis can lead to greater soft tissue loss and mortality.
At the time of surgery, histologic features are consistent with NF. Hospitalization Primary care physicians have to use clinical judgment to decide which patients who present with evidence of skin inflammation should be hospitalized or receive further evaluation.
Studies of patients with soft tissue infection showed that a history of diabetes mellitus, pyrexia, hand infections, and an area of inflammation greater than 70 cm2 are independent predictors of hospitalization.
Diagnosis and decision for surgical exploration The criterion standard for diagnosis of NF is histology of tissue specimens obtained during surgical exploration, which was demonstrated in our case description.
During surgical exploration, tissue integrity and depth of invasion can be assessed. Fascial necrosis and loss of fascial integrity indicate a necrotizing infection.
Muscle involvement and necrosis are indicative of an advanced stage. To help decide which patients require surgical exploration, particularly in those with equivocal clinical signs, laboratory and radiologic tests might sometimes be useful.
Leukocytosis with neutrophilia, acidosis, altered coagulation profile, impaired renal function, raised creatinine kinase levels, and raised inflammatory markers, such as C-reactive protein levels, are all helpful if viewed within the whole of the clinical context.
Clinical scores like the laboratory risk indicator for NF LRINEC score are available to help diagnose NF and differentiate it from other skin and soft tissue infections Tables 3 1422 — 26 and 4 9 A score of 6 and above intermediate or high risk suggests NF.
The patient in our case scored 7. It has not been validated in patients for whom the diagnosis of NF is not apparent in the initial assessment. Further, certain tests, such as the C-reactive protein test, are not readily available in the primary care setting, where patients present with infection in the early stages and where laboratory support is limited; therefore, this score is not easily ascertained.
Blood cultures are usually part of the workup in hospital and might yield up to Asymmetrical fascial thickening, fat stranding, and gas tracking along fascial planes are important imaging findings.
However, when there is deep fascia involvement with fluid collection, thickening, and enhancement after contrast administration, necrotizing infections must be considered.
This has been disputed, and other authors have argued that in early cases of NF, MRI might not show fascial involvement. Additional bedside tests include needle aspiration and incision biopsy.
Negative results, however, cannot exclude NF. Surgical exploration is preferable. Physicians should have a high index of suspicion and low threshold for surgical referral. First, surgical consultations should be urgently requested with the intention of early wound debridement for collection of tissue cultures, excision of all nonviable tissue, and delineation of the extent of the disease.
This is also important as tissue hypoxia limits the efficacy of intravenous antibiotics, which was demonstrated in our patient—her fever did not break despite intravenous antibiotics until the wound debridement and fasciotomy were complete. Patients are often incredulous at the preoperative briefing when told they need an extensive operation for their skin infection; it is important to educate them about the gravity of their condition and the risk of increased mortality if surgical debridement is not performed.
Until blood culture results are available, wide spectrum coverage with intravenous antibiotics with an awareness of resistance in the patient population being treated is started.Necrotizing fasciitis is a rare infection that's often described in media reports as a condition involving "flesh-eating bacteria." It can be fatal if not treated promptly.
It can be fatal if not treated promptly.
The trick is to recognize and respond to the rare but life-threatening necrotizing soft tissue infections, in particular necrotizing fasciitis. Table 1: Classification of Necrotizing Fasciitis (1) Necrotizing fasciitis is a rapidly progressive bacterial infection that tracks along the fascia and is associated with severe sepsis and a deadly.
Necrotizing fasciitis is a type of soft tissue infection. It can destroy the tissue in your skin and muscles as well as subcutaneous tissue, which is the tissue beneath your skin. Necrotizing. Necrotizing fasciitis: microbiological characteristics and predictors of postoperative outcome. Necrotizing fasciitis is a rare but aggressive soft-tissue infection, which involves the fascial layers and the subcutaneous tissue, while skin and muscle initially remain intact.
Necrotizing fasciitis (NF) is a rare but potentially fatal infection involving the subcutaneous tissue and fascia. It is commonly known as flesh-eating disease. Deaths from NF can be sudden and sensational and often make headline news.
Necrotizing fasciitis is a rare infection that's often described in media reports as a condition involving "flesh-eating bacteria." It can be fatal if not treated promptly. It can be fatal if not.