NECROTISING FASCITIS :Causative organism ,clinical features, diagnosis and treatment

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                      NECROTISING FASCITIS 

INTRODUCTION:

  • It is a spreading ,destructive ,invasive infection of skin and soft tissue including deep fascia with relative sparing of muscle
  • Common sites:
 Lower extremities

Genitalia

Groin

Lower abdomen 

  • Similar to melaneys gangrene







CAUSATIVE ORGANISM :

MONOMICROBIAL :

  • Group A BETA hemolytic streptococci
  • Type 2 necrotizing fasciitis 

POLYMICROBIAL :

  • Synergistic combination anaerobe +coliform /non-group A streptococci 
  • Type 1 necrotizing fasciitis 
  • No history of injury when it occurs in lower limbs







RISK FACTORS FOR TYPE 1 NECROTISING FASCITIS :

  • Diabetic mellitus
  • Malnutrition
  • Obesity
  • Corticosteroid
  • Immune deficiency 

CLINICAL FEATURES:

  • Affected area: sudden pain, gross swelling of the limbs
  • part:
  • swollen red, erythematous ,edematous skip lesion of necrosis ,ulceration

skin changes :

  • Bronze hue
  • Brawney induration
  • Blebs /crepitus
  • High degree fever ,jaundice ,renal failure

a)TYPE 2 SPECIFIC FEATURE:

  • Caused by streptococcus pyogens
  • Occur in young healthy people
  • Minor abrasion ,laceration -precipitating factors 
  • Severe multiorgan failure -systemic illness and streptococcal toxic shock syndrome 




DIAGNOSIS:

  • Bed side -full thickness biopsy reveals watery pus (dishwater liquid)




TREATMENT :

1)SUPPORTIVE:

  • Hospitalization 
  • Adequate hydration
  • Broad spectrum antibiotics(vancomycin and carbapenem)
  • Type 2 case : high dose penicillin and clindamycin which act as potent suppressor of bacterial toxin synthesis 


2)SURGICAL:

  • Wide excision 
  • Generous debridement -skin grafting ( few days or weeks later)





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