Necrotizing Fasciitis: Causes, Risk factors, Symptoms and Treatment.

Necrotizing fasciitis is known as flesh-eating disease. It is a rapid, destructive, invasive, infective condition of the skin, subcutaneous tissue, and deep fascia of the body.

Necrotizing fasciitis is a medical emergency.

Necrotizing Fasciitis mainly affects the following areas of the body

1. Groin

2. Anterior abdominal wall

3. Lower extremities 

4. Genitals

INCIDENCE IN THE WORLD

Necrotizing Fasciitis affects about 0.4 in every 100,000 people per year in the United States. About 1,000 cases of necrotizing fasciitis occur per year in the United States, but the rates have been increasing day by day because of the low immune response of the body.

HISTORICAL BACKGROUND

It was first described by the Army surgeon Joseph Jones during the civil war.

TYPES OF NECROTIZING FASCIITIS

1. Type 1/ Polymicrobial Infection

It is the most common type of infection. Mainly bacterias are addressing into this category such as-

This type of infection is usually caused by various species of Gram-positive cocci, (Staphylococcus aureus, Streptococcus pyogenes, and enterococci), Gram-negative rods, (Escherichia coli, Pseudomonas aeruginosa), and anaerobes. (Bacteroides and Clostridium species.)

2. Type 2/ Streptococcus Infections

 About 30% cases of necrotizing fasciitis are associated with Group A Streptococcus pyogenes bacteria. These streptococcus manifest as toxic shock syndrome. 

3. Type 3 / Vibrio Vulnificus

These type of infections happens because of break down of skin through saltwater. Vibrio Vulnificus found in saltwater mainly.

4. Type 4 / Fungal Infections

Mucoraceous fungi lead to this type of infection. 

ETIOLOGY

1. Low socio-economic people mainly affected by necrotizing fasciitis because of there unawareness or careless attitude.

2. Immunosuppressant patients who suffer from chronic diabetic conditions or AIDS-like diseases.

3. Insect bite injuries

4. Cuts and burns.

5. NSAIDs uses in the varicella-zoster like infections.

6. Smoking. 

7. Tobacco chewing 

8. Alcoholism also increases the risk of necrotizing fasciitis.

All these above factors are quietly associated with the bacterial invasion and infection in the body. 

SYMPTOMS

1.Gross swelling of the affected area.

2. Pain

3. A necrotic patch of the skin

4. Subcutaneous induration 

5. Bullae

6. Erythema

7. Surgical emphysema 

8. The profuse and foul smell of the discharge

9. Irregular edge ulcers

DIAGNOSIS

The gold standard for diagnosis is a surgical exploration in a setting of high suspicion. When in doubt, a small incision can be made into the affected tissue, and if a finger easily separates the tissue along the fascial plane, the diagnosis is confirmed and an extensive debridement should be performed.

INVESTIGATION

Investigation for necrotizing fasciitis is important for proper diagnosis of the disease.

• Computer tomography
• Magnetic resonance imagining
• (LRINEC) Score- It is a scoring factor of 6 indicators of the infection. It is may disrupt the true image of the disease because if other infections are present in the body. If LRINEC score ≥ 6 have a higher rate of both death and amputation. This LRINEC scoring system was introduced by Wong and colleagues in 2004. It uses six laboratory values: C-reactive protein, total white blood cell count, haemoglobin, sodium, creatinine, and blood glucose. A score of 6 or more indicates that necrotizing fasciitis should be seriously considered.
•  The scoring criteria are:
  • CRP (mg/L) ≥150: 4 points
  • WBC count (×10³/mm³)
    • <15: 0 points
    • 15–25: 1 point
    • >25: 2 points
  • Hemoglobin (g/dl)
    • >13.5: 0 points
    • 11–13.5: 1 point
    • <11: 2 points
  • Sodium (mmol/l) <135: 2 points
  • Creatinine (umol/l) >141: 2 points
  • Glucose (mmol/l) >10: 1 point^[15][16]

However, the scoring system has not been validated. The values would be falsely positive if any other inflammatory conditions are present.

Prevention

Proper cleaning and management of the injuries.

TREATMENT

1. Surgical Debridement or Amputation of the affected part.

2.Broad-spectrum antibiotics Such as

Moxifloxacin (a fluoroquinolone) and amoxicillin-clavulanate (penicillin) and evaluated the appropriate duration of treatment (varying from 7 to 21 days).

3. Antifungal medications

4. Hyperbaric oxygen therapy.

COMPLICATIONS

1. Streptococcal toxic shock syndrome
2. Compartment syndrome
3. Myositis
4. Muscle necrosis.

Read more health-related articles to stay healthy and fit.