Lightning Learning: Necrotising Fasciitis
Suspect with “any soft tissue infection unresponsive to treatment with rapid deterioration.” This rare condition requires a high index of suspicion as it has devastating consequences...
Risk factors include: immunosuppression, diabetes, malnutrition, alcoholism, IV drug misuse
Trigger factors include: trauma, surgery, chickenpox (varicella), any local skin damage, omphalitis (in babies)
Important clues: it can take up to a week from the trigger to early signs (see below), after which progression is rapid
Clinical features are progressive… mortality doubles after 24 hours of presentation!
Stage 1: erythema, swelling, warmth, TENDERNESS beyond area of affected skin
Stage 2: blisters, bullae formation, serous fluid, fluctuance and induration of the skin
Stage 3: numb, crepitus, bleeding, discolouration, necrosis progressing to gangrene
The Top Bacterial Cause? Polymicrobial
Others? Group A haemolytic streptococci, Strep pyogenes, enterococci, E. Coli, Pseudomonas aeruginosa, Clostridium sp. & more.
FBC, CRP, U&Es, LFTs, Clotting and blood cultures
XR/USS imaging may help
CALL THE SURGEONS for urgent consult +/- surgical debridement (definitive treatment)
IV Antibiotics Broad beta-lactam or Carbapenem + clindamycin + vancomycin, NB: check local policy
Treat shock and deranged electrolytes as necessary