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PubMed2002

Necrotizing fasciitis: pathophysiology and treatment.

Necrotizing fasciitis (NF) is a life-threatening bacterial infection causing necrosis of the fascia, underlying skin, and vasculature. NF spreads rapidly, making immediate diagnosis important for survival. Treatment may involve the administration of several broad-spectrum antibiotics, surgical debridement, and skin grafting. In the following two articles, the pathophysiology, medical management, and nursing care of patients are discussed. An in-depth model care plan illustrates the complexity of the disease and its treatment.

Anti-Bacterial Agents↗

PubMed2002

Necrotizing fasciitis: pathophysiology and treatment.

Anti-Bacterial Agents↗

PubMed2004

Necrotizing fasciitis and cardiac catheterization.

Necrotizing fasciitis (NF) is an uncommon, life-threatening soft tissue infection characterized by rapidly spreading inflammation and necrosis of the skin, subcutaneous tissue, and fascia. We report a case of NF as a complication of cardiac catheterization. Familiarity with this entity may lead to earlier diagnosis and initiation of appropriate therapy.

Anti-Bacterial Agents↗

PubMed1997

Necrotizing fasciitis: a case study.

Necrotizing fasciitis (NF) is a disease characterized by the destruction of the skin, subcutaneous fat, and fascia, with or without inflammation of the muscle tissue. NF carries a mortality rate in excess of 50 percent in neonates. Rapid diagnosis and initiation of antibiotics, along with meticulous nursing care, can provide an acceptable outcome for the neonate. This article reviews the pathophysiology, diagnosis, and treatment of NF; presents a case study; and provides a nursing care plan that supports treatment of this disease process.

Anti-Bacterial Agents↗

PubMed2002

Clinical characteristics of necrotizing fasciitis caused by group G Streptococcus: case report and review of the literature.

A 52-y-old diabetic male developed severe necrotizing fasciitis due to group G Streptococcus. A review of the English language literature revealed 8 additional cases. The mean age of the total of 9 cases was 65.5 y (range: 49-80 y) and the majority (n = 5; 55.6%) had no comorbid conditions. The duration of symptoms prior to presentation was 1-5 d (mean +/- SD = 2.5 +/- 1.5 d). Presenting manifestations were swelling with redness (6/6 cases; 100%), severe pain (5/6 cases; 83.3%) and blister formation (3/6 cases; 50%); blisters developed eventually in 5/6 (88.3%) patients. Muscle involvement was noted in 2 patients (22.2%). Progression to toxic shock-like syndrome occurred in 3 cases (33.3%). The organism was isolated from the involved sites in all cases. Bacteremia was documented in 1/3 patients. Treatment included antibiotics (n = 9) and varying degrees of surgical debridement (n = 8). The mortality rate was 33.3%; all patients who died developed toxic shock-like syndrome. These findings illustrate that, similar to Streptococcus pyogenes-induced fasciitis, necrotizing fasciitis due to group G Streptococcus can be severe and life-threatening. Early diagnosis, immediate surgical debridement and antibiotic therapy are essential in order to improve the outcome.

Aged↗

PubMed1992

[Severe necrotizing fasciitis].

The pathophysiology of necrotizing fasciitis remains unclear in patients with no apparent immunologic disorders. Between 1987 and 1990 we treated six patients with necrotizing fascitis and septic-toxic multiple organ failure, three patients survived. The mean age was 38 years (25-62). In all patients the primary bacteriological examination revealed streptococcus. Between the first symptoms and an adequate therapy were 4 days in surviving patients and 7 days in patients who died. Four patients showed spread of the gangrene into the adjacent tissue: muscles (n = 3), bowel (n = 2), mediastinum (n = 1). Adequate débridement was not possible or not performed in patients with spread into the abdominal cavity or the mediastinum. These patients did not survive. The duration of intensive care treatment in surviving patients were 14 to 78 days. We conclude that survival of patients with severe necrotizing fasciitis is influenced by the delay before adequate treatment, the localisation of the gangrene and intensive care facilities.

Adult↗

PubMed2005

[Necrotizing fasciitis of the head and neck].

Necrotizing fasciitis (NF) is a potentially lethal soft tissue infection characterized by cutaneous necrosis, suppurative fasciitis, vascular thrombosis and extreme systemic toxicity. It is a rare entity in the head and neck region, but occur most frequently in patients with diabetes and chronic alcoholism. Mostly involved are immunodeficient patients with banal infections of the upper aerodigestive tract, small traumas, but also after surgical procedures. Necrotizing fasciitis is an infection caused by aerobic or anaerobic microorganisms. A strong complication is a streptococcus-associated-toxic shock-syndrome which should be prevented because it is often associated with letal outcome. Septicemia and systemic toxic effects may lead to death within as short a time as 2 to 4 days. Necrotizing fasciitis is often misdiagnosed or the diagnosis is delayed with a mortality rate of approximately 30-70%. Once identified, treatment consists of antimicrobial therapy and surgical debridement followed at a later date with reconstructive surgery. We present a fatal case of craniofacial necrotizing fasciitis (NF) in a 63-year-old diabetic and chronic alcoholic man and discuss it's pathophysiology, clinical manifestations and the best therapeutic choice for this disease. A review of the literature with the clinical presentations, bacteriology diagnosis and treatment was presented.

Candida albicans↗

PubMed1985

[Necrotizing fasciitis following abdominal hysterectomy].

Necrotizing fasciitis is a rare disease with a high mortality and morbidity rate. The authors report the case of a 52 year old woman with necrotizing fasciitis following abdominal hysterectomy. The early diagnosis and the radical surgery saved her life from this serious type of infection. By describing this case, the authors wish to emphasize their opinion that early diagnosis is essential to survival and the most important aspect of management is early aggressive surgical intervention.

Fasciitis↗

PubMed1992

Fatal necrotizing fasciitis of dental origin.

Necrotizing fasciitis is a potentially fatal, acute bacterial infection characterized by extensive fascial and subcutaneous tissue necrosis. Four factors that contribute significantly to the morbidity and mortality of necrotizing fasciitis are: 1) delayed treatment, due to difficulty in recognizing the condition; 2) inappropriate treatment; 3) host debilitation; and 4) a polymicrobial infection.

Adult↗

PubMed1994

Necrotizing fasciitis arising from episiotomy.

Necrotizing fasciitis is a fatal, rapidly progressive, often initially unrecognized condition. Mortality rates range from 30% to 76%. Prognosis depends on the delay of diagnosis, antimicrobial treatment and surgical excision of all necrotic tissue. A case of postpartum perineal necrotizing fasciitis arising from episiotomy is presented. Prompt recognition and aggressive therapy resulted in a favorable outcome despite significant morbidity.

Adult↗

PubMed1991

Cervical necrotizing fasciitis of odontogenic origin.

Necrotizing fasciitis is a severe soft tissue infection caused by both aerobic and anaerobic bacteria and is characterized by a rapid extension along fascial planes and by necrosis of soft tissues. The disease rarely occurs in the head and neck. Three cases of necrotizing fasciitis of the neck after a dental infection are presented. The difficulty in diagnosing the early stage of this condition in relation to other soft tissue infections of odontogenic origin in the neck is discussed. The importance of an early diagnosis followed by an appropriate combination of medical, surgical, and dental treatment is emphasized.

Adult↗

PubMed1992

Necrotizing fasciitis of the neck.

Necrotizing fasciitis (N.F.) is a rare but serious infection of subcutaneous tissues and deep fascia with resulting skin gangrene and septicaemia. It is due to mixed anaerobic and aerobic organisms. It has been reported under a variety of synonyms. We describe two cases of necrotizing fasciitis of the neck probably secondary to chronic dental infection, one was diagnosed early and the other late with very different outcomes. We highlight the importance of early and aggressive surgical treatment to complement parenteral antibiotics covering both aerobic and anaerobic organisms.

Aged↗

PubMed1981

Necrotizing fasciitis.

Fourteen patients with necrotizing fasciitis seen over a 5 year period at a public hospital are reviewed. Middleaged men predominated. The disease followed such diverse initiating causes as self-injection with heroin, boil, ischiorectal abscess, perforated occult colonic cancer and trivial abrasions. In a few cases there was no evidence of an initiating lesion. Necrotizing fasciitis affected the arms, legs, trunk and neck. Bacteriologic analysis showed that the disease is usually caused by gram-negative bacilli and hemolytic streptococci, alone or in combination. Morbidity and mortality rates in the present series were influenced by associated clinical conditions such as old age, diabetes mellitus, carcinoma and gram-negative bacteremia.

Adult↗

PubMed1977

Bacteriology of necrotizing fasciitis.

Sixteen patients with necrotizing fasciitis were observed under clinical and laboratory conditions for collection, preservation, and culture that permitted optimal retrieval of anaerobes. The clinical observations of necrosis of fascia, subcutaneous fat and skin with thrombosis of the microvasculature, and absence of myonecrosis were clearly apparent in these patients. Two clear-cut groups of culture and gram stain results were found, suggesting that the clinical entity of necrotizing fasciitis can occur after infection by different infecting organisms. The cultivation of Streptococcus pyogenes (group A), either alone or in combination with staphylococcus, in three patients conforms to the culture results found by Meleney [1] in his original description.

Bacteria↗

PubMed2006

Zygomycotic necrotizing fasciitis in immunocompetent patients: a series of 18 cases.

Necrotizing fasciitis is most often associated with bacterial infections. Zygomycosis is an uncommon infection causing necrotizing fasciitis. We report 18 such cases of zygomycotic necrotizing fasciitis, of these, 15 were immunocompetent. Of the eight cases cultured, five were positive for Apophysomyces elegans. A retrospective case review conducted at a tertiary referral center, from 1998 to 2004, 18 cases of fungal necrotizing fasciitis were diagnosed based on histomorphology of fungal organisms; and in few of the cases diagnosis was supported by mycologic culture reports. Of the total of 18 cases, culture report was available in eight cases, and out of which five of them grew A. elegans. Fifteen patients were immunocompetent. Clinical presentation, mycologic findings and histopathologic results were evaluated. A review of the literature pertaining to A. elegans infection was also done. Histopathologic examination showed broad, predominantly aseptate and occasional pauciseptate, thin-walled fungal hyphae with occasional angioinvasion. To the best of our knowledge, this is the first largest series of zygomycotic necrotizing fasciitis from India. Herein, we present data on 18 cases of necrotizing fasciitis assosiated with zygomycosis. Most of the cases in our series were immunocompetent. Nonsuppurative necrosis with presence of typical fungal profiles was important histologic feature. Zygomycosis must be considered in the differential diagnosis not only in immunocompromised patients but also in the absence of any underlying disorders.

Adult↗

PubMed2003

Necrotizing fasciitis secondary to chickenpox infection in children.

BACKGROUND: Necrotizing fasciitis is an uncommon but serious complication of chickenpox infection in young children. Because many of these infections affect the musculoskeletal tissues, orthopedic surgeons are often the first caregivers to be involved in diagnosis and treatment. Our objective was to review the diagnostic features of necrotizing fasciitis and analyze treatment methods to control and eradicate the musculoskeletal infection. DESIGN: A review. SETTING: The Children's Hospital of Eastern Ontario, Ottawa, a major Canadian pediatric trauma and referral centre. PATIENTS: Five children who presented with necrotizing fasciitis secondary to chickenpox infection. INTERVENTION: Surgical debridement of the involved area of necrotizing fasciitis and intravenous antibiotic treatment with clindamycin and penicillin. MAIN OUTCOME MEASURES: Complications outcome. RESULTS: The average age of the 5 children at presentation was 3.8 years (range from 2.9-5.8 yr). The necrotizing fasciitis involved the lower extremity in 5 children, the upper extremity in 3, and the abdomen, chest, neck and back in 1 child each. One child presented with involvement of all 4 extremities. In 4 children, culture specimens grew group A beta-hemolytic Streptococcus. They all survived and all limbs were salvaged, although secondary closure and skin grafting were required. At an average follow-up of 1 year, each child had fully recovered with no loss of muscle function. CONCLUSIONS: Necrotizing fasciitis should be suspected in any child with a history of varicella infection and an increasing complaint of pain and swelling in an extremity or other body area associated with increasing fever, erythema, lethargy and irritability. Emergent surgical debridement and intensive antibiotic therapy are essential to prevent muscle necrosis, major limb dysfunction and death.

Chickenpox↗

PubMed1999

[Necrotizing fasciitis: case reports and review of the literature]

Necrotizing fasciitis is a rare, rapidly progressing infection affecting the superficial fascia and the subcutaneous tissue, accompanied by severe systemic toxicity and multiorgan failure. It is caused by aerobic and anaerobic bacteria, occasionally in a synergistic polymicrobial combination (Type I Necrotizing Fasciitis); in other cases group A -haemolitic Streptoccoccus is the organism responsible for the infection (Type II Necrotizing Fasciitis). The infection often originates from small traumatic injuries or operative wounds and rapidly spreads especially in individuals with identifiable risk factors or immunocompromised patients. Sometimes necrotizing fasciitis occurs when no known portal of entry for bacteria is present. The increasing incidence of necrotizing fasciitis observed may reflect a resurgence of highly virulent mutant strains of group A beta-haemolitic Streptococcus. The pathogenesis, clinical features and treatment of the disease have been reviewed in the light of recent literature. We also report clinical data for four patients with necrotizing fasciitis. They show the importance of early diagnosis and rapid, aggressive and radical surgical intervention. High-dose broad-spectrum antibiotic therapy and intensive medical support are also required to avoid a fatal outcome.

Journal Article↗

PubMed1998

Fatal necrotizing fasciitis caused by a toothpick injury.

Necrotizing fasciitis is a severe life-threatening infection. The portal of entry is usually a site of disruption of the skin barrier. We report a case of fatal necrotizing fasciitis caused by an accidental toothpick injury--a unique injury mechanism not reported this far to cause necrotizing fasciitis. Although toothpick injuries are usually regarded as trivial, it should be kept in mind that they have the potential to cause such a lethal infection.

Abscess↗