Necrotizing Fasciitis
A young patient sustained a 1 ½ cm cut to the leg and was taken to the emergency room three days following the injury. The patient exhibited signs of pain, redness, erythema, high temperature, and low blood pressure. A culture was obtained to determine the species of bacteria present within the wound. The gram stain showed gram-positive cocci in chains (Group A streptococci). Necrotizing fasciitis, commonly known as flesh-eating disease, is a limb and life threatening soft tissue infection. Early diagnosis and adequate treatment is important to save the limb or the life. Necrotizing fasciitis usually occurs after a minor trauma and may be associated with chronic disease and illness. This condition usually occurs in alcoholics, diabetics, insect bites, or post-surgery infections. The mortality rate is 33%. It is underdiagnosed because it resembles low grade cellulitis. Surgical debridement should be urgent as a delay in surgery of more than 24 hours is associated with increased mortality. Pain and tenderness beyond apparent margin of infection is diagnostic and found in 98% of cases. Group A strep and other polymicrobial infections involve the fascia and the toxins spread.
Diagnosis includes erythemia 100% of the time. Bullae formation occurs in less than 50%, crepitus 14% and skin necrosis 14% of the time. Tachycardia occurs in 75% of cases and fever in 50%. Low blood pressure occurs in about 18% of cases. Early diagnosis is important. An aggressive and extensive debridement of the affected area will be necessary. A biopsy will need to be obtained from the periphery. Treatment consists of debridement, which should be repeated on an almost daily basis, antibiotics, and hyperbaric oxygen. There is a high incidence of extremity amputation if fascia is penetrated by infection.
