Necrotising fasciitis
| Headline | |
|---|---|
| Etiology | Rapidly spreading infectious along fascial planes. Pathogen: Type I: polymicrobial. Type II: Strep pyogenes, Staph aureus. In perineum/groin: Fournier's gangrene. |
| Epidemiology | Risk factors: relatively minor trauma/surgery or blunt trauma causing "seeding"; immunocompromise (including T2DM) Klebsiella - associated with travel to Taiwan (!) |
| Clinical presentation | - Commonly present after being unwell for a few days - fever, pain out of proportion to findings (↓ swelling/redness); anaesthesia over affected area over 24-48 hours - LATE: haemorrhagic blisters, bruising, necrosis - DO NOT rely on these to make diagnosis |
| Pathogenesis | - superantigen toxins - enzymes which digest the fascia |
| Diagnostic investigations | |
| Management | Resuscitation as with sepsis Debridement Probably Level 2-3 care Example of empirical abx: taz/meropenem/ceftriaxone + vanc/linezolid + clindamycin |
LRINEC score
- CRP >150 = +4
- WCC 15-25 +1; >25 +2
- Hb 110-135 +1; <110 +2
- Na <135 +2
- Crt >141 +2
- glucose >10 +1
Each item is individually predictive, but score = 6 unctions as a diagnostic test for necrotizing fasciitis with a sensitivity of 89.9% and a specificity of 96.9%.