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Necrotizing fasciitis (NF) is a rapidly progressive bacterial infection of the fascia with secondary necrosis of the subcutaneous tissue. In severe cases, the underlying muscle (i.e., myositis) may be affected.
Risk factors for NF include immunosuppression (e.g., transplant patients), HIV/AIDS, diabetes, etc.
There are three categories of NF:
- Type I (poly-microbial infections)
- Type II (Group A streptococcus; sometimes referred to as the “flesh-eating bacteria)
- Type III (Clostridial myonecrosis; known as gas gangrene)
In the early stage of disease, diagnosis may be difficult; the physical exam sometimes does not reflect the severity of disease. Labs may be non-specific, but CT or MRI is important to diagnose and define the extent of the disease when planning surgical debridement.
Treatment should be aggressive and started as soon as the disease is suspected; this includes:
- Aggressive fluid and/or vasopressor therapy
- Broad spectrum antibiotics covering for gram-positive, gram-negative, and anaerobic bacteria; clindamycin should be added initially as it suppresses certain bacterial toxin formation
- Emergent surgical consult for debridement
- Once the patient is stable, other treatments may include intravenous immunoglobulin and hyperbaric oxygen therapy
References
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