Symptoms Associated With Necrotizing Fasciitis

Symptoms and Signs progression (in order of occurrence)

Pain and Unexplained fever
Brawny edema and tenderness
Dark red induration
Bullae filled with blue or purple fluid
Skin friable, bluish, maroon, or black
Extensive thrombosis of dermal blood vessels
Extension to deep fascia leads to brown-gray appearance
Rapid spread along fascial planes, veins and lymph
Toxicity, shock, and multi-organ failure

Signs: Distribution

Extremities (53%)
Perineum or buttocks (20%)
Trunk (18%)
Head and neck (9%)

Risk factors

Age over 50 years
Corticosteroid use
Peripheral Vascular Disease
Diabetes Mellitus
Burn Injury
Intravenous Drug Abuse
Recent surgery
Colon Cancer
Hemorrhoids or Anal Fissure
Urethral tear

Group A Streptococcus (Streptococcus Pyogenes)

Begins deep at non-penetrating minor trauma
Contusion seeded by transient bacteremia
Gas production only if mixed infection
Severe toxicity, renal Impairment may precede shock
Myositis in 20-40% cases
Creatine Phosphokinase (CPK) is markedly elevated
Mortality: 20-50% despite Penicillin
Mixed aerobic and Anaerobic Bacteria
Break in Gastrointestinal or Genitourinary mucosa
Fournier’s Gangrene
Comorbid conditions associated with mixed infection
Diabetes Mellitus
Peripheral Vascular Disease
Staphylococcus aureus
Clostridium perfringens
Hyperbaric Oxygen treatment may help in Gas Gangrene

Diagnosis: Findings Suggestive of Necrotizing Fasciitis

Fever (Temperature over 100.4 F)
Soft tissue erythema, edema and severe pain
Vessicles, Bullae or Necrosis
White Blood Cell count over 16,300 per mm3
Hemoglobin less than 10 mg/dl
Platelet Count <150,000 per mm3

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