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Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z



Necrotising fasciitis

Learning objectives
Clinical features
Investigations
Management
Activity

Learning objectives

Clinical features

Necrotising fasciitis (NF) is infection of the subcutis and deep fascia. It is a surgical emergency, most often due to Streptococcus pyogenes producing pyrogenic exotoxins A, B and C (flesh-eating bacteria, Type 2 NF). It is less frequently polymicrobial (Type 1 NF) or due to Staphylococcus aureus, clostridia (gas gangrene, Type 3 NF) and other organisms.

Necrotising fasciitis Necrotising fasciitis Necrotising fasciitis
Necrotising fasciitis Necrotising fasciitis Necrotising fasciitis
Necrotising fasciitis

Investigations

The exudate should be gram stained. Rapid streptococcal diagnostic kit and polymerase chain reaction tests may be helpful for diagnosis. MRI or CT scans can be used to delineate the extent of NF.

Management

Management should include:

Intravenous immunoglobulins may be useful.

Some strains of Streptococci are more pathogenic due to certain extracellular products, toxins and superantigens. These may include cell surface molecules such as the M protein, opacity factor, the hyaluronic acid capsule, C5a peptidase and streptococcal inhibitor of complement (SIC), in addition to secreted proteins, pyrogenic and erythrogenic toxins, exotoxins, cysteine proteinase, streptolysins O and S, hyaluronidase, streptokinase and other enzymes.

Necrotising fasciitis aftere debriding
After debriding

Activity

Find out why non-steroidal anti-inflammatory drugs are contraindicated in the management of necrotising fasciitis.

 

Page 7 of 7. End of course. Back to: Bacterial skin infections contents.

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Author: Clin Assoc Prof Amanda Oakley

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