Necrotizing fasciitis is a surgical emergency, requiring rapid debridement of the infected subcutaneous tissues, in combination with antibiotic therapy directed broadly at the likely etiologic agents. Because of its high mortality rate, prompt and aggressive management with immediate surgical intervention is crucial. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene. Early identification of fourniers gangrene and the decision for surgical debridement of gangrene and necrotizing fasciitis is a cornerstone of the treatment and better outcomes. Hyperbaric oxygen therapy providers and treatment centers in. The objective of this book is to provide a source of information and to assist the medical and paramedical team in the management of rare clinical entity called necrotizing fasciitis. We present a case of cnf and descending mediastinitis in a healthy young patient, caused by unilateral tonsillitis, with a successful outcome involving simple incision and drainage.
It can destroy muscles, skin and underlying tissue. Aggressive debridement is a cornerstone intervention in necrotizing fasciitis. Necrotizing fasciitis is a term that describes a disease condition of rapidly spreading infection, usually located in fascial planes of connective tissue that results in tissue necrosis dead andor damaged tissue. Guidelines for the treatment of necrotizing fasciitis nf. Fascial planes are bands of connective tissue that surround muscles, nerves, and blood vessels. The infection progresses rapidly, and septic shock may ensue. Group a betahaemolytic streptococci are the most common causative organisms. Necrotizing fasciitis occurring alone generally has lower associated rates of mortality around 30% than when seen with stss. Surgical exploration is the only way to definitively establish the diagnosis and distinguish necrotizing fasciitis from other entities. Recently, the term nsti has been accepted for all anatomic locations and depths of necrotic infections because of their similarity in approaches for diagnosis and treatment 4, 10.
Extensive necrotizing fasciitis from fourniers gangrene. Necrotizing soft tissue infection nsti targets skin, subcutaneous tissue, muscle or fascia and the infection may spread to involve adjacent tissue planes. Definitive treatment is surgical debridement, repeated as necessary. Symptoms include red or purple skin in the affected area, severe pain, fever, and vomiting. Necrotizing fasciitis rarely spreads between people. Necrotizing fasciitis is a life threatening infection with an insidious, occult presentation.
Wilson proposed the term of necrotizing fasciitis including both gas forming and nongas forming necrotizing infections in 1951, with fascial necrosis as a precondition of the infection. It is a severe disease of sudden onset that spreads rapidly. Known complications of cervical necrotizing fasciitis include airway compromise, arterial and venous occlusion and the extension of infection into the mediastinal and pleural spaces 5. Microbiology and factors affecting mortality in necrotizing fasciitis. The complex management is due to the combination of difficulties for. The choice of antibiotics will vary based on the suspected organisms. The editors, however, commanded us to further elaborate. Necrotising fasciitis the flesh eating infection youtube. Necrotizing fasciitis nord national organization for. Hemodynamic parameters should be closely monitored, and aggressive resuscitation initiated immediately if needed to maintain hemodynamic stability. Current concepts in the management of necrotizing fasciitis. This book will be an asset for acute care physicians, surgeons, intensivists and nursing.
Abscesses may develop anywhere within the abdomen, resulting from a myriad of conditions. Necrotizing fasciitis is a fairly common condition in surgical practice in the indian context resulting in a fairly large body of clinical experience. Necrotizing fasciitis may be prevented with proper wound care and handwashing. The treatment of necrotizing fasciitis involves wide surgical debridement, broadspectrum antibiotics, and hemodynamic support. Liu ym, chi cy, ho mw, chen cm, liao wc, ho cm, liu pc, wang js. Management of intraabdominal abscesses surgical treatment.
It is characterized by subtle, rapid onset of spreading inflammation and. It was probably a result of a streptococcal infection since nurses taking care of these patients occasionally developed erysipelas, but the exact organism remains unknown. Once the diagnosis of necrotizing fasciitis is confirmed, initiate treatment without delay. Unfortunately, due to the rarity of the disease as well as the fact that diagnosis is made in the operative theater, delay in diagnosis is common.
Practice guidelines for the diagnosis and management of skin and soft tissue infections. It is characterized by widespread fascial necrosis primarily caused by streptococcus hemolyticus. It is usually treated with surgery to remove the infected tissue, and intravenous antibiotics. Prognosis becomes poorer in the presence of comorbidities, such as.
Necrotizing fasciitis nf is a lifethreatening soft tissue infection a condition, often referred to in the press as the flesheating bug on account of necrotizing fasciitis is classically caused by group a betahemolytic streptococci streptococcus pyogenes, but. Classification systems vary based on tissue plane level or that of the microorganisms involved. In some cases, it is carried out on individuals as a preventive surgery for such problems. Cellulitis is an infection of the skin and deep underlying tissues. Necrotizing fasciitis is a topic covered in the johns hopkins abx guide to view the entire topic, please sign in or purchase a subscription official website of the johns hopkins antibiotic abx, hiv, diabetes, and psychiatry guides, powered by unbound medicine. Assoc prof patrick emanuel, dermatopathologist, auckland, new zealand, 20. Cervical necrotizing fasciitis cnf is an uncommon but aggressive infection with high morbidity and mortality. The literature addressed nf contains confusing information, inaccurate bacteriologic data, and antiquated antibiotic therapy.
Early signs include flulike symptoms and redness and pain around the. Nf is caused by one or more bacteria that attacks the skin, the tissue just beneath the skin subcutaneous tissue, and the fascia causing these. Empiric antibiotics should cover major bacterial etiologic agents, and group a streptococcal toxin production that can accompany type ii necrotizing fasciitis. Necrotizing skin infections were first described by jones in 1871, although at the time the term hospital gangrene was used. Original article, clinical report by ear, nose and throat journal. Health, general antibacterial agents analysis health aspects antibiotics usage bacterial infections care and treatment development and progression cat scans congestive. Our experience with 11 cases and our technique for surgical debridement.
They can be defined as infections of any of the layers within the soft tissue compartment dermis, subcutaneous tissue, superficial fascia, deep fascia, or muscle that are associated with necrotizing changes. The bacteria enter your body when you get an injury such as a bruise, burn, surgical cut, or wound. The medical term necrosis actually refers to the death of the bodys cells or tissues. If youre healthy, have a strong immune system, and practice good hygiene and proper wound care, your chances of. Necrotizing fasciitis nf, a lifethreatening rare infection of the soft tissues, is a medical and surgical emergency. Shortly after the onset of the disease, patients become colonized with their own aerobic and anaerobic microflora from the gastrointestinal andor urogenital tracts. Necrotizing fasciitis is a type of bacterial skin infection which predominantly affects the skin but may also expand to include the subcutaneous tissue, muscle and fat. Necrotizing fasciitis is a rapidly progressing infection of the fascial tissues and overlying skin.
Medical and surgical care during the american civil war, 1861. Scientists reveal steps leading to necrotizing fasciitis. Necrotizing fasciitis nf is an uncommon soft tissue infection, usually caused by toxinproducing virulent bacteria. Despite dramatic advancement in the management of infectious diseases, casefatality rates remain as high as. Necrotizing fasciitis nf is a severe, rare, potentially lethal soft tissue infection that develops in the scrotum and perineum, the abdominal wall, or the extremities. Necrotizing fasciitis symptoms, diagnosis and treatment. The contents of this chapter could have been summarized only in a sentence. Necrotising fasciitis is a lifethreatening, rapidly progressive form of necrotizing cellulitis. Necrotizing fasciitis nf is uncommon and difficult to diagnose, and it cause progressive morbidity until the infectious process is diagnosed and treated medically and surgically.
Antibiotic therapy is crucial, but is considered adjunctive to surgical management. At onset, necrotizing fasciitis can be difficult to. Hernia repairs, operations for necrotizing fasciitis, drainage of subphrenic abscess. Necrotizing fasciitis nf is a rare but deadly infection that is a surgical emergency. Necrotizing fasciitis an overview sciencedirect topics. Although it can occur as a postoperative complication or as a primary infection, necrotizing fasciitis is more likely in immunocompromised patients. The list of treatments mentioned in various sources for necrotizing fasciitis includes the following list. Do not ignore pain out of proportion, sinus tachycardia or unexplained fever do not delay surgical exploration when necrotizing fasciitis is suspected. Fascial planes can bind structures together as well as allow body structures.
Necrotizing fasciitis nf, commonly known as flesheating disease, is an infection that results in the death of parts of the bodys soft tissue. Your health care provider may take a sample or culture from your skin or do a blood test to identify the. Group a strep streptococcal bacteria are the most common cause. Necrotizing fasciitis can be caused by several different types of bacteria, and the infection can arise suddenly and spread quickly. Necrotizing fasciitis europe pmc article europe pmc. Necrotizing fasciitis is commonly known as flesheating disease or flesheating bacteria syndrome, is a rare infection of the deeper layers of the skin and subcutaneous tissues. Based on the causative organism it is commonly categorized as type i or ii necrotizing fasciitis nf but some. Necrotizing fasciitis, rapidly spreading infection of the underlying skin and fat layers caused by a variety of pathogenic bacteria, principally streptococcus pyogenes, also known as the group a streptococcus.
A deep biopsy is generally required figure 1 for the diagnosis and shows an extensive acute inflammatory reaction involving the. To compound her troubles, she suffered from seizures, infantile spasms, and underwent several surgical procedures. Necrotizing fasciitis is a serious infection of the skin, the tissue just beneath the skin subcutaneous tissue, and the tissue that covers internal organs fascia. Wong et al 23 advocated 4 steps in their approach to surgical debridement of patients with necrotizing fasciitis, which include confirming the diagnosis and isolation of the causative organism. Hospital gangrene was a peculiar type of necrotizing fasciitis that was first seen in the larger general hospitals. Popularly known as the flesheating disease, necrotizing fasciitis is an uncommon condition, but it can lead to lifethreatening illness and death, with mortality rates approaching. Amputation is the removal of a limb by trauma, medical illness, or surgery. Necrotizing fasciitis nf is a rare infection that means decaying infection of the fascia, which is the soft tissue that is part of the connective tissue system that runs throughout the body. Various other bacteria have been implicated histology of necrotising fasciitis.