DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20212828

Patterns and diagnostic criteria of necrotizing fasciitis

Muhammed Ihsan Muhammad, Mezzher Mohammad Alsaeed, Ali Abdulghalib Alhayek, Layla Hassan Alnosair, Aqeel Salman Al Alkhazal, Amar Mustafa Alhaji, Mohammed Abdullah Mersil, Amina Mohamed Hamid, Abdulaziz Hussain Alfoudari, Huda Ayedh AlGossadi, Aisha Jaber Asiri, Fatma Abdulla Al-Fodari

Abstract


Although the condition is not common, if the diagnosis of necrotizing fasciitis was established late, many life-threatening complications might develop as sepsis and septic shock, which might lead to multiorgan damage. In the present literature review, we aim to discuss the classification and clinical patterns of necrotizing fasciitis, in addition to the diagnostic criteria and modalities that were reported among studies in the literature to evaluate such cases. Two main types of necrotizing fascitis were reported in the literature, including the poly and monomicrobial types, however, the diagnostic criteria for each are usually similar. Establishing an early diagnosis is essential to achieve better management and reduce the potential development of complications and death. The clinical patterns are the cornerstone for establishing the diagnosis, however, laboratory investigations might also be used as valid approaches to confirm the diagnosis. Many laboratory models have been proposed to establish the diagnosis of necrotizing fasciitis with variable sensitivities and specificities, and the laboratory risk indicator for necrotizing fasciitis (LRINEC) remains the commonest most efficacious modality. A tissue biopsy can also be used within the clinical settings for indicating the infection, however, it should not hinder the intended surgical interventions. Studies also show that magnetic resonance imaging can adequately detect liquefactive necrosis and is reported with a higher sensitivity than computed tomography. Although the condition is not very common, it might lead to severe consequences, and therefore, early extensive treatment and interventional approaches are encouraged.

 


Keywords


Clinical, Infection, Necrotizing fasciitis, Diagnosis

Full Text:

PDF

References


Wong CH, Chang HC, Pasupathy S, Khin LW, Tan JL, Low CO. Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality. J bone and joint surgery Am vol. 2003;85(8):1454-60.

Sadasivan J, Maroju NK, Balasubramaniam A. Necrotizing fasciitis. Indian J Plast Surg. 2013;46(3):472-8.

Fournier JA. Jean-Alfred Fournier 1832-1914. Gangrène foudroyante de la verge (overwhelming gangrene). Sem Med 1883. Diseases of the colon and rectum. 1988;31(12):984-8.

MELeney FL. Hemolytic Streptococcus gangrene. Arch Surg. 1924;9(2):317-64.

Carter PS, Banwell PE. Necrotising fasciitis: a new management algorithm based on clinical classification. Int wound j. 2004;1(3):189-98.

Dufel S, Martino M. Simple cellulitis or a more serious infection? J family practice. 2006;55(5):396-400.

Bisno AL, Stevens DL. Streptococcal infections of skin and soft tissues. N Engl J Med. 1996;334(4):240-5.

Cherneski CL, Embil JM. Necrotizing fasciitis. Saudi med J . 2001;22(7):565-8.

Meltzer DL, Kabongo M. Necrotizing fasciitis: a diagnostic challenge. Am Fam Physician. 1997;56(1):145-149.

Holmström B, Grimsley EW. Necrotizing fasciitis and toxic shock-like syndrome caused by group B Streptococcus. Southern med j. 2000;93(11):1096-8.

El-Qushayri AE, Khalaf KM, Dahy A. Fournier's gangrene mortality: A 17-year systematic review and meta-analysis. Int J Infect Dis. 2020;92:218-25.

Ghozy S, Tran L, Naveed S. Association of breastfeeding status with risk of autism spectrum disorder: A systematic review, dose-response analysis and meta-analysis. Asian J Psychiatr. 2020;48:101916.

Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg. 2014;51(8):344-62.

Jabbour G, El-Menyar A, Peralta R. Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emergency Surg. 2016;11.

Shiroff AM, Herlitz GN, Gracias VH. Necrotizing soft tissue infections. J intensive care med. 2014;29(3):138-44.

Stevens DL, Bryant AE. Necrotizing Soft-Tissue Infections. N Engl J Med. 2017;377(23):2253-65.

Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Frontiers in surg. 2014;1:36.

Henry S, Davis K, Morrison J, Scalea T. Can necrotizing soft tissue infection be reliably diagnosed in the emergency department? Trauma Surgery Acute Care Open. 2018;3:e000157.

Kiat HJ, En Natalie YH, Fatimah L. Necrotizing Fasciitis: How Reliable are the Cutaneous Signs? J emergencies, trauma, and shock. 2017;10(4):205-10.

Fontes RA, Jr, Ogilvie CM, Miclau T. Necrotizing soft-tissue infections. J Am Academy Orthop Surgeons. 2000;8(3):151-8.

Stevens DL, Bisno AL, Chambers HF. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):e10-52.

Montravers P, Snauwaert A, Welsch C. Current guidelines and recommendations for the management of skin and soft tissue infections. Current opinion in infectious diseases. 2016;29(2):131-8.

Wang JM, Lim HK. Necrotizing fasciitis: eight-year experience and literature review. Brazilian j infect diseases. 2014;18(2):137-43.

Zundel S, Lemaréchal A, Kaiser P, Szavay P. Diagnosis and Treatment of Pediatric Necrotizing Fasciitis: A Systematic Review of the Literature. Eur j pediatric surg. 2017;27(2):127-37.

Thieu H, Bach Dat B, Nam NH. Antibiotic resistance of Helicobacter pylori infection in a children's hospital in Vietnam: prevalence and associated factors. Minerva medica. 2020;111(5):498-501.

Bystritsky R, Chambers H. Cellulitis and Soft Tissue Infections. Ann Intern Med. 2018;168(3):Itc17-32.

Wall DB, Klein SR, Black S, de Virgilio C. A simple model to help distinguish necrotizing fasciitis from nonnecrotizing soft tissue infection. J Am Coll Surg. 2000;191(3):227-31.

Simonart T. Group a beta-haemolytic streptococcal necrotising fasciitis: early diagnosis and clinical features. Dermatology (Basel, Switzerland). 2004;208(1):5-9.

Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. 2004;32(7):1535-41.

Wysoki MG, Santora TA, Shah RM, Friedman AC. Necrotizing fasciitis: CT characteristics. Radiology. 1997;203(3):859-63.

Young MH, Aronoff DM, Engleberg NC. Necrotizing fasciitis: pathogenesis and treatment. Expert review of anti-infective therapy. 2005;3(2):279-94.

Fugitt JB, Puckett ML, Quigley MM, Kerr SM. Necrotizing fasciitis. Radiographics : a review publication of the Radiological Society of North America, Inc. 2004;24(5):1472-6.

Anaya DA, Dellinger EP. Necrotizing soft-tissue infection: diagnosis and management. Clin Infect Dis. 2007;44(5):705-10.