Necrotising fasciitis

What is necrotising fasciitis? Necrotising fasciitis is a very serious bacterial infection of the soft tissue and fascia. The bacteria multiply and release toxins and enzymes that result in thrombosis in the blood vessels. The result is the destruction of the soft tissues and fascia. The main types of necrotising fasciitis are: • Type I (polymicrobial ie, more than one bacteria involved) • Type II (due to haemolytic group A • Type III (gas gangrene eg, due to clostridium) • Other: marine organisms (vibrio species, infections ( Type I necrotising fasciitis Bacteria causing type 1 necrotising fasciitis include aerobic and anaerobic strains ( Escherichia coli, Bacteroides fragilis). It is usually seen in older people or in patients affected by diabetes mellitus or other conditions. Type II necrotising fasciitis Type II necrotising fasciitis has been sensationalised in the media and is commonly referred to as a flesh-eating disease. It affects all age groups. Healthy people are also prone to infection with this group. Type III necrotising fasciitis Type III necrotising fasciitis is caused by Clostridium perfringens or less commonly Clostridium septicum. It usually follows significant injury or surgery and results in gas under the skin: this makes a crackling sound called crepitus. IV drug users injecting “black tar” heroin subcutaneously can also be infected with clostridia and develop necrotising fasciitis. Other organisms Necrotising fasciitis due to marine organisms is usua...

• Overview   • • Theory   • Epidemiology • Aetiology • Case history • Diagnosis   • Recommendations • History and exam • Investigations • Differentials • Management   • Recommendations • Treatment algorithm • Emerging • Prevention • Patient discussions • Follow up   • Monitoring • Complications • Prognosis • Resources   • Guidelines • Images and videos • Necrotising fasciitis is a life-threatening subcutaneous soft-tissue infection that requires a high index of suspicion for diagnosis. Always suspect necrotising fasciitis in a patient with a rapidly progressing soft-tissue infection and any of the following: severe pain (disproportionate to the clinical findings) or anaesthesia over the site of infection; oedema and erythema (oedema will typically extend beyond the erythema); systemic signs of infection. However, necrotising fasciitis can be easily missed because the patient may present earlier in the disease process with non-specific signs and symptoms. If you suspect necrotising fasciitis, immediately refer the patient for urgent surgical debridement; do not wait for the results of investigations before referral. Necrotising fasciitis is a clinical diagnosis. However, investigations can support the diagnosis if this is unclear. Surgical debridement should be repeated as necessary until the patient has no necrotic tissue remaining. Adjunctive antibiotic therapy and supportive care is crucial. Start intravenous empirical antibiotics as soon as you have obtained...