Necrotizing Fasciitis

Description: E-Medicine 2005 Necrotizing Fasciitis Author: Robert A Schwartz, MD, MPH, Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School Coauthor(s): Rajendra Kapila, MD, Associate Professor, Department of Medicine, UMDNJ, New Jersey Medical School Necrotizing fasciitis (NF) is an insidiously advancing soft tissue infection characterized by widespread fascial necrosis. A number of bacteria in isolation or as a polymicrobial infection can cause NF. The organisms most closely linked to NF are group A beta-hemolytic streptococci, though these bacteria may cause only a minority of the cases. Most cases are caused by other bacteria or different streptococcal serotypes. NF was first described in 1848. In 1920, Meleney identified 20 patients in China in whom hemolytic streptococcus was the sole organism. Wilson coined the term necrotizing fasciitis in 1952 and found no specific pathologic bacteria related to the disease. A few distinct NF syndromes should be recognized. The 3 most important are type I, or polymicrobial; type II, or group A streptococcal; and type III gas gangrene, or clostridial myonecrosis. A variant of NF type I is saltwater NF, in which an apparently minor skin wound is contaminated with saltwater containing a Vibrio species. NF may occur as a complication of a variety of surgical procedures, including cardiac catheterization (Federman, 2004). Familiarity with NF may facilitate earlier diagnosis and initiation of appropriate therapy.