Necrotizing fasciitis overview

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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

Necrotizing fasciitis or fasciitis necroticans, commonly known as “flesh-eating bacteria,” is a rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue. Many types of bacteria can cause necrotizing fasciitis (eg. Group A streptococcus, Vibrio vulnificus, Clostridium perfringens, Bacteroides fragilis), of which Group A streptococcus (also known as Streptococcus pyogenes) is the most common cause. It is severe inflammation of the muscle sheath that leads to necrosis of subcutaneous tissue and adjacent fascia.

Historical Perspective

Necrotizing fasciitis was first described by Hippocrates in the fifth century B.C. as the complication of erysipelas.[1][2]It was described as "hospital gangrene" by confederate army surgeon Joseph jones.[3][4]Meleney reported a series of 20 patients in 1924 as having hemolytic streptococcal gangrene, later called Meleney's gangrene.[5]Necrotizing fasciitis of perineum was described in 1883 by the French physician, Jean Alfred Fournier.[6]

Classification

Necrotizing fasciitis may be classified according to international classification of diseases-10 (ICD-10) into M72.6 Necrotizing fasciitis.[7]Based on microbiological findings, necrotizing fasciitis may be classified into four types (type I, type II, type III, type IV). Necrotizing fasciitis is further classified based on anatomic location and severity of symptoms.[8]

Pathophysiology

Causes

Differentiating Necrotizing fasciitis overview from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Natural History

Complications

Prognosis

Diagnosis

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

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Treatment

Medical Therapy

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References

  1. Descamps V, Aitken J, Lee MG (1994). "Hippocrates on necrotising fasciitis". Lancet. 344 (8921): 556. PMID 7914656.
  2. Hasham S, Matteucci P, Stanley PR, Hart NB (2005). "Necrotising fasciitis". BMJ. 330 (7495): 830–3. doi:10.1136/bmj.330.7495.830. PMC 556077. PMID 15817551.
  3. WILSON B (1952). "Necrotizing fasciitis". Am Surg. 18 (4): 416–31. PMID 14915014.
  4. Janevicius RV, Hann SE, Batt MD (1982). "Necrotizing fasciitis". Surg Gynecol Obstet. 154 (1): 97–102. PMID 7031943.
  5. Sadasivan J, Maroju NK, Balasubramaniam A (2013). "Necrotizing fasciitis". Indian J Plast Surg. 46 (3): 472–8. doi:10.4103/0970-0358.121978. PMC 3897089. PMID 24459334.
  6. Chennamsetty A, Khourdaji I, Burks F, Killinger KA (2015). "Corary diagnosis and management of Fournier's gangrene". Ther Adv Urol. 7 (4): 203–15. doi:10.1177/1756287215584740. PMC 4580094. PMID 26445600.
  7. ICD-10 version:2016. http://apps.who.int/classifications/icd10/browse/2016/en#/M72.6 2016 Accessed on August 25,2016
  8. Lancerotto L, Tocco I, Salmaso R, Vindigni V, Bassetto F (2012). "Necrotizing fasciitis: classification, diagnosis, and management". J Trauma Acute Care Surg. 72 (3): 560–6. doi:10.1097/TA.0b013e318232a6b3. PMID 22491537.