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Necrotising fasciitis

Medicine > Infection

Background Knowledge 🧠

Definition

  • 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.

Epidemiology

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

Pathophysiology

  • 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.

Clinical Features 🌡️

Clinical Features

  • 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).

Investigations 🧪

Diagnostic Tests

  • 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.

Management 🥼

Management

  • 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.

Complications

  • Sepsis and septic shock.
  • Multi-organ failure.
  • Long-term morbidity due to extensive tissue loss.
  • High mortality rate, even with treatment.

Prognosis

  • Rapid diagnosis and aggressive treatment improve outcomes.
  • Mortality rate remains high, particularly in delayed diagnosis and treatment.

Key points

  • Necrotising fasciitis is a medical emergency due to a severe bacterial infection causing rapid necrosis of the fascia and subcutaneous tissues.
  • Rapid diagnosis and aggressive treatment is crucial to reduce the risk of mortality.
  • Early signs can be non-specific, often resembling cellulitis, but severe, disproportionate pain is a hallmark symptom.
  • Diagnosis is from clinical suspicion, with LRINEC score and imaging aiding diagnosis.
  • Management includes broad-spectrum IV antibiotics and urgent surgical debridement of necrotic tissue.

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Infection