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: Yamuna Kondapally, M.B.B.S[2]

Overview

If left untreated, the acute inflammatory changes spread quickly, accompanied by high fever and extreme weakness leading to necrosis of soft tissue. Common complications of necrotizing fasciitis include limb loss, sepsis, toxic shock syndrome, disseminated intravascular coagulation (DIC). Depending on the extent of the necrotizing fasciitis at the time of diagnosis, the prognosis may vary. The prognostic factors associated with necrotizing fasciitis include diabetes mellitus, acute renal failure, admission serum creatinine >2mg/dl and admission white blood cells >30,000 cells mm3.

Natural History

  • If left untreated, the acute inflammatory changes spread quickly, accompanied by high fever,extreme weakness and may progress to death.[1]
  • 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 color 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 liquefactive 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

Common complications of necrotizing fasciitis include:[2]

Type 2 NF and Streptococcal Toxic Shock Syndrome

Prognosis

Depending on the extent of the necrotizing fasciitis at the time of diagnosis, the prognosis may vary.[3]

  • The prognostic factors associated with necrotizing fasciitis include:
Types Prognosis
Type 1 Better prognosis, more indolent, easier to recognize clinically
Type 2 Aggressive, easily missed, very variable
Type 3 Seafood ingestion or wound contamination with seawater
Type 4 Aggressive with rapid extension especially if immunocompromised

References

  1. Morgan MS (2010). "Diagnosis and management of necrotising fasciitis: a multiparametric approach". J Hosp Infect. 75 (4): 249–57. doi:10.1016/j.jhin.2010.01.028. PMID 20542593.
  2. Necrotizing soft tissue infection https://medlineplus.gov/ency/article/001443.htm (2016) Accessed on september 6, 2016
  3. Khamnuan P, Chongruksut W, Jearwattanakanok K, Patumanond J, Yodluangfun S, Tantraworasin A (2015). "Necrotizing fasciitis: risk factors of mortality". Risk Manag Healthc Policy. 8: 1–7. doi:10.2147/RMHP.S77691. PMC 4337692. PMID 25733938.

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