Necrotizing fasciitis - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Necrotizing fasciitis is a life-threatening subcutaneous soft-tissue infection that requires a high index of suspicion for diagnosis.
Infection may be polymicrobial in etiology (type I) due to mixed anaerobic/facultative anaerobic organisms, or due to a single organism (type II), most commonly Streptococcus pyogenes, also called group A streptococcus.
Necrotizing fasciitis should be suspected in any patient with a rapidly progressing soft-tissue infection and any of the following: severe pain (disproportionate to the clinical findings) or anesthesia over the site of infection; edema and erythema (edema will typically extend beyond the erythema); systemic signs of infection. However, necrotizing fasciitis can be easily missed because the patient may present earlier in the disease process with nonspecific signs and symptoms.
No laboratory or imaging studies, alone or in combination, are sufficiently sensitive and specific to definitively diagnose or rule out necrotizing fasciitis.
An urgent surgical consultation should be obtained as soon as the diagnosis is suspected. Treatment should not be delayed while awaiting microbiologic and imaging investigations.

Late signs of necrotizing fasciitis with extensive cellulitis, induration, skin necrosis, and formation of hemorrhagic bullae

From: Hasham S, Matteucci P, Stanley PRW, et al. Necrotising fasciitis. BMJ. 2005 Apr 9;330(7495):830-3

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Images

Late signs of necrotizing fasciitis with extensive cellulitis, induration, skin necrosis, and formation of hemorrhagic bullae
Split thickness skin grafting after surgical debridement
Necrotizing fasciitis on the right abdomen of a 2-year old girl following varicella infection
Small areas of skin necrosis in a young woman with cellulitis and necrotizing fasciitis of her lower abdomen 5 days after a cesarean section

Citations

Key Articles

Sartelli M, Guirao X, Hardcastle TC, et al. 2018 WSES/SIS-E consensus conference: recommendations for the management of skin and soft-tissue infections. World J Emerg Surg. 2018 Dec 14;13:58.[Abstract][Full Text]
Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.[Abstract][Full Text]

Referenced Articles

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