Necrotizing fasciitis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
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Overview
Natural History
- If left untreated, the acute inflammatory changes spread quickly, accompanied by high fever and extreme weakness.
- The overlying skin becomes smooth, tense and shiny. Diffuse erythema without distinct borders would be present.
- First 1 or 2 days, the lesions develop progressive colour changes from red to blue
Complications
Type 2 NF and streptococcal toxic shock syndrome
- Most of Type 2 NF cases are associated with STSS which increases the mortality of streptococcal NF alone from <40% to 67% with up to half of patients needing amputation.
- The superantigens cause massive activation of t-cell, cytokine release, tissue damage and toxic shock-like syndrome
Prognosis
This disease is one of the fastest-spreading infections known, as it spreads easily across the fascial plane within the subcutaneous tissue. For this reason, it is popularly called the “flesh-eating disease,” and, although rare, it became well-known to the public in the 1990s. Even with today's modern medicine, the prognosis can be bleak, with a mortality rate of approximately 25% and severe disfigurement common in survivors.