{"id":409,"date":"2023-09-16T22:11:23","date_gmt":"2023-09-16T21:11:23","guid":{"rendered":"https:\/\/microregistrar.com\/?p=409"},"modified":"2023-09-16T22:11:23","modified_gmt":"2023-09-16T21:11:23","slug":"necrotising-fasciitis","status":"publish","type":"post","link":"https:\/\/microregistrar.com\/?p=409","title":{"rendered":"Necrotising fasciitis"},"content":{"rendered":"\n

Necrotising fasciitis (NF)<\/strong>:<\/p>\n\n\n\n

It is an infection of the subcutaneous tissue\/fat and fascia of the skin. It spreads rapidly along the fascial plane. Muscles are less commonly affected\/ affected later in the disease due to better blood supply.<\/p>\n\n\n\n

\"\"<\/figure>\n\n\n\n

Classification<\/h2>\n\n\n\n
Types<\/strong><\/td>Organism<\/strong><\/td>Note<\/strong><\/td><\/tr>
Type 1 \u2013 polymicrobial\/synergistic<\/td>Aerobic and anaerobic bacteria<\/td>Often derived from gut\/bowel<\/td><\/tr>
Type 2 \u2013 monomicrobial<\/td>Group A Streptococcus<\/em> (Strep pyogenes<\/em>), occasionally Staph aureus<\/em> (especially neonates);<\/td>Commonly skin or throat derived.<\/td><\/tr>
Type 3<\/td>Vibrio spp<\/em> mainly;
Other organism \u2013 Pasteurella multocida, Haemophilus influenzae<\/em> , Klebsiella<\/em> spp. and Aeromonas<\/em> spp.<\/td>		Common in Asia, associated with seafood\/seawater<\/td><\/tr>
Type 4<\/td>Fungal
(Candida<\/em> in immunocompromised or zygomycetes in immunocompetent patients)<\/td>		<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n

Type 1 is the commonest (up to 80% of cases).
Type 4 has the highest mortality.<\/p>\n\n\n\n

Some authorities classify <\/em>necrotising fasciitis as only two types \u2013
Type 1 \u2013 polymicrobial.
Type 2 \u2013 monomicrobial (NF caused by Vibrio, fungus etc., falls into this category).<\/em><\/p>\n\n\n\n

Mortality<\/h2>\n\n\n\n

Approx 20%. It is a surgical emergency<\/p>\n\n\n\n

Common sites<\/h2>\n\n\n\n

Perineum and lower extremities (commonest)<\/strong>
Surgical site,
Upper extremities,
Abdomen,
Mouth
Face<\/p>\n\n\n\n

Predisposing factors<\/h2>\n\n\n\n

Trauma \u2013 including surgery
Burns
Skin and soft tissue infection
Immunosuppression
Obesity\/malnutrition
Alcoholism
Peripheral vascular disease
Intravenous drug abuse and
Diabetes mellitus
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)<\/p>\n\n\n\n

Diabetes is the most common preexisting medical condition<\/strong>.
In children, it is usually associated with recent varicella-zoste<\/strong>r.<\/strong><\/p>\n\n\n\n

Presentation<\/h2>\n\n\n\n
    \n
  • Common signs\/symptoms are \u2013 swelling (75%), pain (72.9%), and erythema (66.3%) [Diab, BMJ 2020].<\/li>\n\n\n\n
  • The skin changes often do not reflect the extent of the damage.
    Pain could be out of proportion to skin changes.
    Anaesthesia over the infected area also could be present<\/strong>.<\/li>\n\n\n\n
  • One-fifth of patients have influenza-like symptoms characterised by fever and myalgia.<\/li>\n\n\n\n
  • Inflammatory markers (WCC, CRP) could be raised along with creatine kinase and creatinine.<\/li>\n\n\n\n
  • Patients may deteriorate rapidly, developing signs of sepsis. In later stages NFcould present with visible bruising, bullae and cutaneous necrosis.<\/li>\n<\/ul>\n\n\n\n

    Management<\/h2>\n\n\n\n
      \n
    • It is a surgical emergency \u2013 an immediate surgical referral.<\/li>\n\n\n\n
    • Debridement.<\/li>\n\n\n\n
    • Haemodynamic support.<\/li>\n\n\n\n
    • Critical care support.<\/li>\n\n\n\n
    • Broad-spectrum empirical antibiotic.<\/li>\n<\/ul>\n\n\n\n

      Antibiotics should cover both type 1 and type 2 pathogens.<\/strong><\/p>\n\n\n\n

        \n
      1. A broad-spectrum antibiotic with gram-negative and gram-positive cover \u2013
        Pip-tazobactam or a carbapenem (e.g. meropenem).<\/li>\n\n\n\n
      2. An antibiotic to inhibit group A Streptococcus toxin production \u2013
        Clindamycin or Linezolid<\/li>\n\n\n\n
      3. An antibiotic to cover MRSA (according to the local microbiology or presence of risk factors for MRSA) \u2013
        Vancomycin or daptomycin, or linezolid.<\/li>\n<\/ol>\n\n\n\n
          \n
        • Isolation of the patient until group A Streptococcus is excluded as a pathogen or, if isolated, managed accordingly.<\/li>\n\n\n\n
        • Infection control.<\/li>\n\n\n\n
        • If group A Streptococcus is isolated \u2013 inform public health.<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"

          Necrotising fasciitis (NF): It is an infection of the subcutaneous tissue\/fat and fascia of the skin. It spreads rapidly along […]<\/p>\n","protected":false},"author":1,"featured_media":411,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[107],"tags":[],"class_list":["post-409","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-infection"],"_links":{"self":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/409","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=409"}],"version-history":[{"count":1,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/409\/revisions"}],"predecessor-version":[{"id":410,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/posts\/409\/revisions\/410"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=\/wp\/v2\/media\/411"}],"wp:attachment":[{"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=409"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=409"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/microregistrar.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=409"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}