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 is seen.
- First 1 or 2 days, the lesions develop with progressive colour changes from red to purple to blue and then becomes frankly gangrenous, first turning black, then greenish yellow.
- If the patient has survived, a line of demarcation between viable and necrotic tissue would become sharply defined from days 7 to 10.
- Sloughing of necrotic skin would reveal the underlying pus and extensive liquefaction necrosis of subcutaneous tissues, which will be significantly more extensive than would be suspected with the overlying area of necrotic skin.
- Metastatic abscesses and pulmonary distress may develop as well.
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.