Necrotising fascitis

Question 1

Define nf

Answer 1

a life-threatening infection that spreads rapidly across fascial planes

Question 2

What is the aetiology and risk factors?

Answer 2

Usually polymicrobial involving streptococci, staphylococci, bacterioides and coliforms

risk factors;
inpatient contact  - patient to patient spread of group A streptococcus
Varicella zoster infection
cutaneous injury, surgery, trauma
non-traumatic skin lesions
IV drug use

weaker;
immunosuppression
NSAID

Question 3

Epidemiology?

Answer 3

rare

Question 4

When should we suspect nf?

Answer 4

Necrotising fasciitis should be suspected in any patient with

1. a soft-tissue infection accompanied by
2. prominent pain and/or anaesthesia over the infected area,
3. or signs and symptoms of systemic toxicity.

Question 5

Presenting symptoms of nf?

Answer 5

Anaesthesia or pain over site of cellulitis
Nausea
Vomiting
Tachycardia
Lightheaded
Palpitations
Fever

Question 6

Presenting signs of necrotising fasciitis?

Answer 6

Signs of systemic inflammatory response and sepsis
Tachycardia
Hypotension
Tachypnoea

uncommon;
oedema
grey discolouration
bullae
crepitus

Question 7

Investigations for nf?

Answer 7

It is a clinical diaignosis

Must refer straight away - do not await results first

Bloods;
FBC, U&Es, Inflam markers, cardiac enzymes,
Blood & Tissue cultures
Gram stain

Question 8

key sign of NF?

Mx of NF?

Answer 8

pain disproportionate to what would be expected in a superficial soft tissue infection is a surgical hallmark for consideration of necrotising fasciitis and requires prompt surgical referral and evaluation

1. –> refer the patient for urgent surgical debridement!
   1b. targeted antimicrobial/biotic