Necrotizing fasciitis is a catastrophic infection problem
that can lead to amputation or death. Necrotizing fasciitis will have a better
outcome if it is recognized early and treated successfully. It presents itself
as a cellulitis case and confused health care professionals.
Necrotizing fasciitis can spread rapidly and the condition
of the patient can deteriorate, even though the patient is in the hospital under
the care of physicians. By the time the physician figures it out, it may be too
late!
A small incision can be made over the involved area in the
clinic or the emergency room, with direct inspection of the fascia and the
muscles. This may differentiate between necrotizing fasciitis and cellulitis.
A culture is usually obtained to determine the species of
bacteria present within the wound. The gram stain may show gram-positive cocci
in chains or polymicrobial.
Necrotizing fasciitis, commonly known as flesh-eating
disease, is a limb and life threatening soft tissue infection. The bacteria
produces toxins and spreads rapidly. There is also an association between
hepatitis C and necrotizing fasciitis. Early diagnosis and adequate treatment
is important to save the limb or the life. It usually occurs after a minor
trauma and may be associated with chronic disease and illness. It is usually
found in alcoholics, diabetics, insect bites, or post-surgical infections.
The mortality rate is 33%. It is underdiagnosed because it
resembles low grade cellulitis. Surgical debridement should be performed
urgently. A delay in surgery of more than 24 hours is associated with an
increased mortality rate.
A diagnosis is made when the patient has pain and tenderness
beyond the apparent margin of infection, this is found in 98% of cases. Other diagnostic
symptoms include erythema, bullae formation, crepitus, skin necrosis,
tachycardia, fever, and low blood pressure (hypotension).
An early diagnosis is important and should include
aggressive and extensive debridement of the affected area. The physician should
obtain a biopsy from the periphery. Debridement should be repeated on an almost
daily basis. The patient will be prescribed antibiotics (according to the culture
results) and hyperbaric oxygen (good results for clostridial myonecrosis). There
is a high incidence of extremity amputation if the fascia is penetrated by the
infection.
