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Necrotizing fasciitis

Last reviewed: 30 Oct 2023
Last updated: 05 Aug 2020

Summary

Definition

History and exam

Key diagnostic factors

  • history of traumatic or nontraumatic cutaneous lesion
  • anesthesia or severe pain over site of cellulitis
  • fever
  • palpitations, tachycardia, tachypnea, hypotension, and lightheadedness
  • nausea and vomiting
  • delirium
  • crepitus
  • vesicles or bullae
  • gray discoloration of skin
  • edema or induration
  • location of lesion
More key diagnostic factors

Risk factors

  • inpatient contact with index case
  • Varicella zoster infection
  • cutaneous injury, surgery, trauma
  • nontraumatic skin lesions
  • intravenous drug use
  • chronic illness
  • immunosuppression
  • nonsteroidal anti-inflammatory drugs (NSAIDs)
More risk factors

Diagnostic investigations

1st investigations to order

  • complete blood count and differential
  • serum electrolytes
  • serum BUN and creatinine
  • serum CRP
  • serum creatine kinase (CK)
  • serum lactate
  • blood and tissue cultures
  • Gram stain
  • arterial blood gas
  • radiography, CT/MRI, ultrasound
  • surgical exploration
More 1st investigations to order

Treatment algorithm

INITIAL

organism unknown

ACUTE

type I necrotizing fasciitis (polymicrobial)

type II necrotizing fasciitis due to group A streptococcus

type II necrotizing fasciitis due to Staphylococcus aureus

type II necrotizing fasciitis due to Vibrio vulnificus

type II necrotizing fasciitis due to Aeromonas hydrophila

type II necrotizing fasciitis due to mucorales

ONGOING

persistent cosmetic and functional defects after debridement

Contributors

Authors

Kevin L. Steiner, MD, PhD, DTM&H

Fellow

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Disclosures

KLS declares that he has no competing interests.

William A. Petri, Jr, MD, PhD, FACP
William A. Petri, Jr

Wade Hampton Frost Professor of Epidemiology

Professor of Medicine

Microbiology and Pathology

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Disclosures

WAP declares that he has no competing interests.

Peer reviewers

Chris Huston, MD

Assistant Professor of Medicine

Division of Infectious Diseases

University of Vermont

Burlington

VT

Disclosures

CH declares that he has no competing interests.

Shiranee Sriskandan, MA, MBBChir, FRCP, PhD

Professor of Infectious Diseases and Hon. Consultant

Section of Infectious Diseases

Imperial College London

London

UK

Disclosures

SS declares that she has no competing interests.

  • Necrotizing fasciitis images
  • Differentials

    • Cellulitis
    • Impetigo
    • Erysipelas
    More Differentials
  • Guidelines

    • 2018 WSES/SIS-E Consensus Conference: recommendations for the management of skin and soft-tissue infections
    • Practice guidelines for the diagnosis and management of skin and soft-tissue infections
    More Guidelines
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