Necrotizing fasciitis NF is a group of relatively rare infections, usually caused by two or more pathogens.
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This article has been cited by other articles in PMC. Abstract Necrotizing fasciitis NF is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall, or the extremities.
The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high median mortality Prognosis becomes poorer in the presence of co-morbidities, such as diabetes mellitus, immunosuppression, chronic alcohol disease, chronic renal failure, and liver cirrhosis.
NF is classified into four types, depending on microbiological findings. Most cases are polymicrobial, classed as type I.
The clinical status of the patient varies from erythema, swelling, and tenderness in the early stage to skin ischemia with blisters and bullae in the advanced stage of infection.
In its fulminant form, the patient is critically ill with signs and symptoms of severe septic shock and multiple organ dysfunction. The clinical condition is the most important clue for diagnosis. Computed tomography or ultrasonography can be helpful, but definitive diagnosis is attained by exploratory surgery at the infected sites.
Management of the infection begins with broad-spectrum antibiotics, but early and aggressive drainage and meticulous debridement constitute the mainstay of treatment. The vacuum-assisted closure system has proved to be helpful in wound management, with its combined benefits of continuous cleansing of the wound and the formation of granulation tissue.
The majority of cases present anaerobic bacteria that proliferate in a hypoxic environment and produce gas, which accumulates in the soft tissue spaces, giving the characteristic image of gas gangrene on plain X-rays and computed tomography CT scans 3. Early diagnosis of NF is mandatory.
Any delay could prove fatal, given its association with more extensive surgery, higher rates of amputation, and higher mortality rates. Furthermore, if left untreated, the infection could lead to systemic inflammatory response syndrome SIRS.
Necrotizing fasciitis was first recognized in BC, when Hippocrates reported a clinical description of a complication of erysipelas disease, resembling the current description of NF 4.
InMeleney reported an association with beta-hemolytic streptococcus A in a study of a series of hospitalized cases in Beijing. The late s witnessed a renewed interest in this pathology.
Stevens reported that, among 20 patients who presented with streptococcal shock, 11 were diagnosed as having NF. Epidemiology The annual incidence of NF is estimated at —1, cases annually, and its prevalence globally has been reported to be 0.
It is seen to have a predilection for men, with a male-to-female ratio of 3: The disease affects all age groups, although middle-aged and elderly patients over 50 years of age are more likely to be infected 1. The median mortality ratio of NF is a controversial issue.
In their review of the literature, Goh et al. However, its range in the literature is extensive, varying from 8. In regard to NF of the extremities, the mortality rate is slightly lower than that recorded for abdominal and perineal infections 14 NF of the upper limbs is rare compared to that of the lower limbs Etiology Trauma is the most common identifiable etiology.
The majority of patients have a history of minor or major traumas, generally involving external injuries and surgical wounds. Appendicitis with perforation, infection following the repair of an incarcerated hernia, perforated diverticulitis, necrotic cholecystitis, gastroduodenal perforation, small bowel perforation, and obstructive colon cancer with perforation rank among the most frequent causes of complicated intra-abdominal infections that can lead to NF.
Notably, the incidence of NF resulting from a surgical wound in the chest wall is greater than that recorded from analogous wounds in the lower abdominal wall. Such cases present a high risk of osteomyelitis, which substantially increases the mortality of these patients. It can also present as a complication of colorectal disease due to anorectal infection, ischiorectal abscesses, and colon perforations.
Other causes include a possible urethral stricture and a trauma from an indwelling Foley catheter. In women, it has commonly been ascribed to Bartholin abscesses or vulval skin infections. In Asia, consumption of raw or undercooked seafood or injury by fish fins can lead to NF In this group of infections, bacteria such as Vibrio spp.
Co-morbidities and risk factors The most frequent co-morbidity in patients with NF is diabetes mellitus. A septic condition and hypotension at the time of admission are significant predicting factors for mortality and outcome.
Chronic renal failure is another indisputable predisposing factor for higher mortality in patients with NF.
Elevated serum creatinine, along with elevated blood urea, is also strongly associated with higher mortality rates Necrotizing fasciitis spreads quickly and aggressively in an infected person. It causes tissue death at the infection site and beyond.
Every year, between and cases are diagnosed in the U.S. Necrotizing fasciitis is a life threatening soft-tissue infection with a high morbidity and mortality. Prompt treatment based on extensive surgical debridement and antibiotic therapies are the therapeutic principles. The medical records of patients with necrotizing fasciitis (n = .
Diagnosis of Myositis. A doctor may suspect myositis based on a person’s symptoms of muscle weakness or other evidence of myositis. Tests for myositis include: Blood tests. ATOTW – Diagnosis and Management of Necrotising Fasciitis 11/11/ Page 1 of 7 This work is licensed under the Creative Commons Attribution-NonCommercial Unported License.
To view a copy of this license, visit. Necrotizing Fasciitis Treatment. Treating Necrotizing Fasciitis in initial stages is usually done with the aid of antibiotics. Intravenous antibiotic drugs like Penicillin, Clindamycin and Vancomycin are often used in combination as soon as the first symptoms are detected.
Tissue culture is carried out to . Sep 29, · Necrotizing fasciitis (NF) is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall, or the extremities.
The infection progresses rapidly, and septic shock may ensue; hence, the mortality rate is high (median mortality %).