Necrotizing Fasciitis - Diagnosis

8/21/00 (Del Rio)

Group: Monday Residents

RE: A 66 year old male with history of CLL, presenting with nausea, vomiting, shortness of breath, and bilateral crepitus. 

Question: What are strategies or techniques for rapid diagnosis of necrotizing fasciitis are available?

Link Directly to Fulltext Article at Science Direct

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Unique Identifier: 20199832

Authors: Wall DB. de Virgilio C. Black S. Klein SR.

Institution: Department of Surgery, Harbor-University of California Los Angeles Medical Center, Torrance 90509, USA.

Abstract: BACKGROUND: Optimal treatment of necrotizing fasciitis (NF) requires rapid diagnosis. The purpose of the study was to identify objective admission measurements that help differentiate NF from nonnecrotizing (non-NF) infection and, among NF patients, to identify admission factors that predict mortality. METHODS: Twenty-one NF cases were paired with matched non-NF controls. Statistical comparison of admission vital signs, laboratory values, and radiographic studies was performed. RESULTS: On multivariate analysis, admission white blood cell count (WBC) >14 x 10(9)/L, serum sodium <135 mmol/L, and blood urea nitrogen (BUN) >15 mg/dL separated NF from non-NF patients. Mortality for NF patients was predicted by admission WBC >30 x 10(9)/L. Mortality was also significantly increased for patients transferred from an outside institution prior to definitive therapy. CONCLUSIONS: Objective admission criteria (elevated WBC and BUN and decreased serum sodium) can assist in distinguishing NF from non-NF infections. The best objective predictor of mortality in NF patients is marked elevation of admission WBC.

  Link Directly to Fulltext Article at Publisher

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Unique Identifier: 98045810

Authors: Majeski J. Majeski E.

Abstract: BACKGROUND: Necrotizing fasciitis is a soft tissue gangrenous infection that is optimally treated by early diagnosis, radical surgical debridement of all involved necrotic tissue, broad spectrum antibiotics, and aggressive nutritional support. The early clinical diagnosis of an area of necrotizing fasciitis is difficult and frequently unreliable. We are reporting a series of cases in which an early, accurate diagnosis of necrotizing fasciitis was established by a frozen section tissue biopsy obtained at the bedside. METHODS: Over a 15-year period, a consecutive series of 43 patients had a bedside biopsy under local anesthesia with immediate frozen section evaluation. All patients were seen in the hospital or emergency room for treatment of an inflammatory process. RESULTS: These 43 patients had bedside biopsy and frozen section evaluation of an inflammatory process. Twelve patients were found to have necrotizing fasciitis. These patients were treated with immediate surgical debridement of all gross necrotic tissue, broad spectrum antibiotics, and adequate nutritional support. All of them survived. No cases of infectious gangrene occurred in the group of patients whose biopsy did not reveal necrotizing fasciitis. CONCLUSION: Frozen section tissue biopsy is a useful adjunct in establishing an early, accurate diagnosis of infectious gangrene.

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Unique Identifier: 97324728

Authors: Leong WC. Lipman J. Hon H. Brouckaert NT.

Institution: Department of Anaesthesia, Baragwanath Hospital, Johannesburg.

Abstract: OBJECTIVES: This article was written to highlight the difficulty in diagnosing necrotising fasciitis (NF) and in differentiating it from other severe soft-tissue infections, and to stress the need for early aggressive therapy in all severe soft-tissue infections. METHOD: Four cases of severe soft-tissue infection admitted to Baragwanath Hospital Intensive Care Unit between January 1993 and March 1996 are reported, presenting the relevant clinical features. RESULTS: The clinical diagnosis of NF when used alone was found to be unreliable and the diagnosis appeared to be made late in the course of the disease. Late diagnosis makes intensive care (largely supportive therapy) of limited value. CONCLUSION: Astute clinical awareness and prompt therapy for severe soft-tissue infections are needed to enable the early diagnosis of these syndromes and thus prevent their serious sequelae. This should include a thorough knowledge of these conditions and predisposing risk factors. For comparative purposes specific defining clinical criteria are required. Even with full intensive care support, severe soft-tissue infections are associated with a significant mortality rate.

Fulltext Available in MDConsult using Journal Search and the search term: 97117086

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Unique Identifier: 97117086

Authors: Chapnick EK. Abter EI.

Institution: Division of Infectious Diseases, Maimonides Medical Center, Brooklyn, NY 11219, USA.

Abstract: Necrotizing soft-tissue infections may be rapidly fatal because of toxin-induced circulatory collapse. Because of the often nonspecific clinical presentation, prompt diagnosis may be difficult but is imperative as prompt treatment can be lifesaving. This article discusses necrotizing fasciitis and clostridial myonecrosis, and highlights pathogenesis, clinical presentation, diagnosis, and treatment. [References: 102]