Various other forms of NF have been described including that caused by Panton-Valentine leukocidin (PVL) staphylococcus, Klebsiella pneumoniae, and also a number of cases of necrotizing cutaneous mucormycosis following injuries incurred during a tornado.

Both GG and, particularly, NF are strongly associated with numerous underlying, premorbid risk factors (Table 22.2), each of which requires medical management in order to improve the prognosis of an individual patient.

Again, both conditions may be caused by one bacterial organism, or commonly, they may be polymicrobial and require treatment with broad-spectrum or multiple antibiotics.

Necrotizing fasciitis (NF)

Diagnosis of NF

NF is an uncommon, but severe infection with a fulminant course and high mortality often following a history of trauma or surgery. The patient may go into rapid decline with necrosis of soft tissue and multisystem organ failure. The latter would appear to result from superantigenic overstimulation of the immune system and excessive production of cytokines.

NF can affect any part of the body, but has a predilection for the limbs, abdominal wall, perineum, and occasionally the neck and periorbital area. Although to begin with, there may be only slight redness, or other discoloration, and swelling, the clue to the patient having NF is often the disproportionate severity of pain as well as systemic upset. The condition is rapidly progressive, with systemic inflammatory responses, shock, and multiorgan failure. Early diagnosis is crucial in optimizing outcome. The diagnosis is predominantly clinical with surgical confirmation, but noncontrast CT and ultrasound may be of use in supporting such a diagnosis. These tests as well as plain x-ray may sometimes show gas or a localized abscess in the soft tissue. Differentiating early NF from the more common cellulitis may be difficult; one clue may be the severe pain that often accompanies early NF. Occasionally, one may find an area of anesthetic skin overlying the inflamed and indurated area, although this is usually a late feature. One report suggests tissue oxygen saturation of the affected limb may help distinguish between cellulitis and NF.

If left untreated, there is progressive discoloration and darkening of the tissue with subcutaneous hemorrhage accompanied by tachycardia, hypotension, acidosis, and fever or occasionally a fall in body temperature.

Some authorities have used a laboratory scoring system: the Laboratory Risk Indicator for NEC

Related posts:

Peritonitis Diverticulitis Bordetella Syphilis and other treponematoses Hantavirus cardiopulmonary syndrome in the Americas Esophageal infections

Stay updated, free articles. Join our Telegram channel

Join