Necrotizing fasciitis history and symptoms

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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

During early stages, the symptoms of necrotizing fasciitis are non specific and the diagnosis requires high degree of suspicion. The disease is often indistinguishable from cellulitis or abscess early in its evolution.

History

Specific areas of focus when obtaining a history from the patient include history of:

• Minor trauma
• Insect and human bites (soft tissue injury penetrating lesions)
• Recent surgery
• Injection sites
• Illicit intravenous drug use
• Previous MRSA colonization or clindamycin-resistant streptococcal infection
• Skin infection and ulcers
• Foreign travel (resistant or unusual organisms)
• Trauma involving soil contamination (fungal culture)
• Raw sea food ingestion
• Wound exposure to sea water
• Tonsillitis
• Close contacts with impetigo or soar throat
• NSAID's use
• Vaginitis
• Immunosupression
• Diabetes mellitus
• Peripheral vascular disease
• Alcoholism
• Carcinoma
• Smoking
• Varicella infection
• Burns

Symptoms

• Symptoms of necrotizing fasciitis include:

• Based on severity of symptoms, necrotizing fasciitis is classified into:

• Hyperacute (within 24 h of the inciting event):
  • Vibrio species are the notable causative agents
  • Extremely fulminant course with considerable involvement of surrounding tissue
  • Severe septicemia
  • Multiorgan failure
• Sub-acute (indolent):
  • Areas of soft tissue infections with minimal pain and discomfort
  • Progress over weeks to months

The infection begins locally, at a site of trauma, which may be severe (such as the result of surgery), minor, or even non-apparent. The affected skin is classically, at first, very painful without any grossly visible change. With progression of the disease, tissue becomes swollen, often within hours. Diarrhea and vomiting are common symptoms as well. Inflammation does not show signs right away if the bacteria is deep within the tissue. If it is not deep, signs of inflammation such as redness and swollen or hot skin show very quickly. Skin color may progress to violet and blisters may form, with subsequent necrosis (death) of the subcutaneous tissues. Patients with necrotizing fasciitis typically have a fever and appear very ill. More severe cases progress within hours, and the mortality rate is high, about 30%. Even with medical assistance, antibiotics take a great deal of time to react to the bacteria, allowing the infection to progress to a more serious state.