Necrotising Fasciitis

• Necrotising fasciitis is a rare but severe bacterial infection causing rapid necrosis of the fascia and subcutaneous tissues.

• It can affect any part of the body but commonly the extremities, abdominal wall, and perineum.

Higher risk in immunocompromised individuals, diabetics, and those with chronic health conditions.

• Caused by a mix of aerobic and anaerobic bacteria; commonly Group A Streptococcus, Staphylococcus aureus, and Clostridium species.

• Bacteria enter through a break in the skin and release toxins that cause extensive tissue damage and systemic toxicity.

• Rapid progression and high mortality rate if not promptly treated.

• Early signs can be non-specific, often resembling cellulitis.

• Severe, disproportionate pain is a hallmark symptom.

• Progression to swelling, erythema, and warmth of the affected area.

• Development of bullae, necrosis, and crepitus.

• Systemic symptoms: Fever, tachycardia, hypotension (indicative of sepsis).

• High index of suspicion in patients with severe pain and systemic symptoms.

• Laboratory Risk Indicator for Necrotising Fasciitis (LRINEC) score can aid in diagnosis.

• Imaging (CT, MRI) may show gas formation and tissue necrosis.

• Surgical exploration is both diagnostic and therapeutic.

• Medical emergency requiring immediate intervention.

• Broad-spectrum IV antibiotics (e.g., carbapenems, clindamycin, vancomycin).

• Urgent surgical debridement of necrotic tissue.

• Supportive care for sepsis and multi-organ failure.

• Hyperbaric oxygen therapy may be considered.

• Rapid diagnosis and aggressive treatment improve outcomes.

• Mortality rate remains high, particularly in delayed diagnosis and treatment.

• Sepsis and septic shock.

• Multi-organ failure.

• Long-term morbidity due to extensive tissue loss.

• High mortality rate, even with treatment.