- Discussion:
- necrotizing fascitits is any necrotizing soft tissue infection spreading along fascial planes, with or without overlying cellulitis;
- also called Meleney ulcer, NF is severe manifestation of lymphangitis that progresses in a frightening manner within a few hours;
- tissue necrosis develops rapidly behind advancing wall of inflammation that limits penetration by antibiotics;
- desquamation followed by gangrene may be relentless;
- clinical signs of pain, hyperyrexia, and chills are severe;
- skin lesions are incised and drained or aspirated to obtain fluid for culture;
- initial findings are localized pain and minimal swelling, often w/ no visible trauma or discoloration of the skin;
- dermal induration and erythema eventually become evident;
- eventually the patient has limited range of motion, chills, fever;
- dx is confirmed when a probed can be passed laterally along fascial cleft in a open wound;
- blistering of the epidermis is a late finding;
- Organisms:
- may be caused by single organism -
streptococci pyogenes or
vibrio, or may be caused by a combination of organisms;
- anaerobic or microaerophilic
streptococci are believed to be the usual cause, but these microorganisms are difficult to culture;
-
clostridium perfringes
-
vibrio (vulnificus):
- typically the patient is exposed to sea water
- course is measured in hours esp in alcoholics and diabetics;
- despite in vitro sensitivity to tetracycline, response to ATB is poor;
- immediate wide excision and amputation may be necessary;
-
streptococci pyogenes infections:
- most superficial form is impetigo which affects stratum corneum;
- ecthyma contagiosum describes shallow superficial dermal ulcers caused by a slightly deeper infectios;
- erysipelas is the term for
streptococcal dermal cellulitis, often
associated with lymphangitis as it spreads along dermal lymphatics;
- cellulitis can spread to the dermal lymphatics as classical lymphangitis, commonly causeced by strep pyogenes;
- necrotizing streptococal infections:
- acute gangrene: at level of fascia,
streptococci pyogenes, produces acute gangrene, a form of necrotizing fascitis;
- initially there is rapid onset of marked tissue edema and redness w/ little pain, progressing to local cyanosis
& skin blistering;
- lymphangitis and lymphadenopathy are absent;
- soft tissue gas may be uncommon;
- treatment is parental penicillin, debridement, and measures to prevent edema;
- before antibiotics were available this was a surgical emergency mandating immediate amputation to prevent
streptococcal septicemia and death;
- Gram Stain:
-
Gram Negative Bacilli:
-
Gram Negative Cocci:
-
Gram Positive Bacilli:
-
Gram Positive Bacilli
- Bacterial Menu:
- IV infusion of aqueous penicillin must be instituted immediately;
- typically ATB is given without response, unless concomitant radical debridement is also performed;
Necrotizing fasciitis in contused areas.
Gas gangrene: A discussion of 3 cases and review of the literature.
Infections caused by halophilic marine Vibrio bacteria.
Early diagnosis, nutritional support, and immediate extensive debridement improve survival in necrotizing fasciitis.
Necrotizing Fasciitis of the Extremities.
Necrotizing fasciitis. Review of the literature and case report.
All That Is Gas Is Not Gas Gangrene: Mechanical Spread of Gas in the Soft Tissues. A Case Report.
Caused by Vibrio vulnificus Compared with Those Caused by Aeromonas Species.
Necrotizing Fasciitis of the Shoulder Following Routine Rotator Cuff Repair. A Case Report
Necrotizing Fasciitis: Clinical Presentation, Microbiology, and Determinants of Mortality
Necrotizing Fasciitis Caused by Methicillin-Resistant Staphylococcus aureus Resulting in Death. A Report of Three Cases
