Necrotizing fasciitis

Necrotizing fasciitis

Necrotizing fasciitis is serious bacterial infectious disease, which affects the fascia and dermis. It is relatively rare, but on the other hand it is a life-threatening disease with a very serious prognosis.

Pathogenesis

Streptococcus pyogenes

The causative agent is Streptococcus pyogenes group A. These are bacteria of the normal flora of the skin, rectum or urethra, which most often penetrate the subcutaneous tissue through a small skin lesion or surgical wound. Subsequently, extensive necrosis of the subcutaneous and superficial skin occurs. Necrosis of the subcutaneous tissue is deep and penetrates the fascia, which can also affect it. There is also necrosis of blood vessels and nerves. However, the muscles are affected. Lethality is about 50%, up to half of the patients have a limb amputations.

At-risk groups are:

• diabetics,
• immunocompromised and geriatric patients,
• patients with alcohol and drug abuse,
• patients on corticotherapy.

It is reported that necrotizing fasciitis can arise as a complication of Cellulite.

Clinical signs

Sudden pain in the affected area. There is redness, swelling and soreness around the wound, and purple to blue-gray spots develop rapidly. A bull with a dense red content will also form. The wound may gradually become insensitive. The general symptoms then point to sepsis, sometimes in addition to streptococcal toxic shock syndrome.

Physical finding

• Temperature,
• Wound pain and redness,
• Swelling of the skin
• Crepitus,
• Later skin necrosis imitating burns pf the III. degrees.

Diagnosis

Diagnosis is based on the clinical picture, laboratory findings (high inflammatory indicators and high creatine phosphokinase activity), microscopic and culture findings from Exudate, hemo-culture, might be positive. Of the imaging methods, CT examination has its irreplaceable application.

Therapy

Early and sufficient radical surgical treatment consisting of removing necrotic tissue - early debridement or amputation. Theoretically, it would be enough to treat the patient with crystalline penicillin IV, but other bacteria ( staphylococci and anaerobes) may also be involved in this disease. Therefore, we prefer "beta-lactam antibiotics" (co-piperacillin, co-ticarcillin, imipenem, meropenem) with clindamycin.

References

Related articles

• Celulitis
• Gangrene

Literature

• HAVLÍK, Jiří, et al. Infektologie. 2. vydání. Praha : Avicenum, 1990. 393 s. ISBN 80-201-0062-8.