Materiały źródłowe

• #1 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is typically an acute process that occurs rapidly over several days. In approximately 80% of cases, it is a direct sequela of bacterial infection introduced through a break in the skins integrity. Gram-positive cocci, specifically strains of Staphylococcus aureus and Streptococci are responsible for most of these single-site source infections. Polymicrobial infections also occur because of a combination of gram-negative and anaerobic involvement. The majority of patients have diabetes and a history of alcoholism. Patients with liver cirrhosis are also prone to necrotizing fasciitis. […] Necrotizing fasciitis can occur post-surgery, invasive procedures, or even a minor procedure like phlebotomy. The causative bacteria are usually mixed but do produce gas. […] Necrotizing fasciitis is a serious life-threatening infection with mortality rates ranging from 20 to 80%. Poor prognosis has been linked to certain streptococcal strains, advanced age, uncontrolled diabetes, state of immunosuppression, and delayed surgery. Even people who survive have a prolonged recovery with significant functional deficits.

• #2 Necrotizing Fasciitis (Flesh-Eating Disease): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/23103-necrotizing-fasciitis

  Necrotizing fasciitis is a severe rapidly spreading bacterial infection that can cause death. […] The most common way to get necrotizing fasciitis is when bacteria invade your body through a cut in your skin, although it can happen if you have a trauma that doesn’t break the skin. […] While Group A strep bacteria are the most common cause of necrotizing fasciitis, you can also get it from many different types of bacteria, including bacteria that live in water.

• #3 Necrotising Fasciitis: Causes, Symptoms, and Treatment

  https://patient.info/doctor/necrotising-fasciitis-pro

  Necrotising fasciitis classification and aetiology […] Types of bacteria which may be involved in necrotising infections have been classified into: […] Type 1 – polymicrobial infection with aerobic and anaerobic bacteria: usually in patients with immunocompromise or chronic disease. […] Type 2 – Group A streptococcus (GAS): occurs in any age group and in otherwise healthy people; occasionally accompanied by staphylococcal infection. […] Type 3 – Gram-negative monomicrobial infection: This includes marine organisms such as Vibrio spp. and Aeromonas hydrophila, which can occur following seawater contamination of wounds, injuries involving fish fins or stings, and raw seafood consumption – particularly in patients with chronic liver disease. […] Type 4 – fungal infection: Zygomycetes after traumatic wounds or burns.

• #4 Necrotising Fasciitis: Causes, Symptoms, and Treatment

  https://patient.info/doctor/necrotising-fasciitis-pro

  Candidal infection in immunocompromised patients. […] Note that necrotising fasciitis can occur in previously healthy people with no underlying disease, particularly where Group A streptococci are involved. […] Risk factors for necrotising fasciitis: These include: Skin injury including insect bite, trauma and open wounds. […] Underlying conditions including alcohol abuse, intravenous drug abuse, chronic liver or renal disease, diabetes, malignancy, immunosuppression and possibly, tuberculosis. […] Necrotising fasciitis in children may follow varicella-zoster infection. […] NF carries a significant mortality rate, particularly if marine organisms are involved. […] Increased mortality is associated with delays in diagnosis, poor surgical technique and diabetes.

• #5 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Necrotising fasciitis is a very serious bacterial infection of the soft tissue and fascia. The bacteria multiply and release toxins and enzymes that result in thrombosis in the blood vessels. The result is the destruction of the soft tissues and fascia. […] The main types of necrotising fasciitis are: Type I (polymicrobial ie, more than one bacteria involved), Type II (due to haemolytic group A streptococcus, and/or staphylococci including methicillin-resistant strains/MRSA), Type III (gas gangrene eg, due to clostridium), Other: marine organisms (vibrio species, Aeromonas hydrophila, considered Type III in some reports) and fungal infections (candida and zygomycetes, type IV in some reports). […] Bacteria causing type 1 necrotising fasciitis include Staphylococcus aureus, Haemophilus, Vibrio and several other aerobic and anaerobic strains (Escherichia coli, Bacteroides fragilis). It is usually seen in older people or in patients affected by diabetes mellitus or other conditions.

• #6 Necrotizing fasciitis – Wikipedia

  https://en.wikipedia.org/wiki/Necrotizing_fasciitis

  Bacterial infection is by far the most common cause of necrotizing fasciitis. […] Despite being called a „flesh-eating disease”, bacteria do not eat human tissue. Rather, they release toxins that cause tissue death. Typically, the infection enters the body through a break in the skin such as a cut or burn. […] Risk factors include recent trauma or surgery and a weakened immune system due to diabetes or cancer, obesity, alcoholism, intravenous drug use, and peripheral artery disease. […] Necrotizing fasciitis is divided into four classes by the type of bacteria causing the infection. […] Type I infection: This is the most common type of infection, and accounts for 70 to 80% of cases. It is caused by a mixture of bacterial types, usually in abdominal or groin areas. […] Type II infection: This infection accounts for 20 to 30% of cases, mainly involving the extremities.

• #7 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Type II necrotising fasciitis has been sensationalised in the media and is commonly referred to as a flesh-eating disease. It affects all age groups. Healthy people are also prone to infection with this group. […] Type III necrotising fasciitis is caused by Clostridium perfringens or less commonly Clostridium septicum. It usually follows significant injury or surgery and results in gas under the skin: this makes a crackling sound called crepitus. People who inject black tar heroin subcutaneously can also be infected with clostridia and develop necrotising fasciitis. […] Necrotising fasciitis due to marine organisms is usually due to contamination of wounds by seawater, cuts by fish fins or stingers, or consumption of raw seafood. It occurs more commonly in patients with liver disorders. These infections can be very serious and can be fatal if not attended within 48 hours.

• #8 Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html

  Multiple species of bacteria can cause necrotizing fasciitis. This page focuses on type II necrotizing fasciitis, which is also known as […] It’s characterized by the isolation of Streptococcus pyogenes (group A strep bacteria) with or without other bacterial species. Staphylococcus aureus is the most common species found in co-infection cases. […] Some streptococcal strains may be more likely to cause necrotizing fasciitis. Commonly involved strains, such as those containing M protein types 1, 3, 12, and 28, typically produce pyrogenic exotoxin A1. […] Certain systemic or local immunocompromising conditions increase the risk of getting necrotizing fasciitis, including: […] Corticosteroid therapy has been shown to be a predisposing factor. […] While rare, when necrotizing fasciitis occurs it frequently happens after trauma or surgery. […] Amputations are a common complication of necrotizing fasciitis. […] In the most recent 5 years, the mortality rate of streptococcal necrotizing fasciitis has been around 13 to 18%. It increases with age of the person affected and the presence of streptococcal toxic shock syndrome.

• #9 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  In type II necrotizing fasciitis, varicella infection and the use of nonsteroidal anti-inflammatory drugs may be predisposing factors. […] Type III necrotizing fasciitis is usually caused by Clostridium perfringens. When type III necrotizing fasciitis occurs spontaneously, C septicum is more likely to be the etiologic agent; these cases usually occur in association with colon cancer or leukemia. […] Unusual causes include injection anthrax. […] Rapidly progressive necrotizing fasciitis following a stonefish sting has been described.

• #10 Necrotizing fasciitis – Wikipedia

  https://en.wikipedia.org/wiki/Necrotizing_fasciitis

  Type III infection: Vibrio vulnificus is a bacterium found in saltwater. It occasionally causes NF after entering the body through a break in the skin. […] Type IV infection: This type of NF accounts for less than 1% of cases. It is mostly caused by the Candida albicans fungus. Risk factors include age and immunodeficiency.

• #11 Necrotising Fasciitis: Causes, Symptoms, and Treatment

  https://patient.info/doctor/necrotising-fasciitis-pro

  Necrotising fasciitis classification and aetiology […] Types of bacteria which may be involved in necrotising infections have been classified into: […] Type 1 – polymicrobial infection with aerobic and anaerobic bacteria: usually in patients with immunocompromise or chronic disease. […] Type 2 – Group A streptococcus (GAS): occurs in any age group and in otherwise healthy people; occasionally accompanied by staphylococcal infection. […] Type 3 – Gram-negative monomicrobial infection: This includes marine organisms such as Vibrio spp. and Aeromonas hydrophila, which can occur following seawater contamination of wounds, injuries involving fish fins or stings, and raw seafood consumption – particularly in patients with chronic liver disease. […] Type 4 – fungal infection: Zygomycetes after traumatic wounds or burns.

• #12 Necrotizing fasciitis – Wikipedia

  https://en.wikipedia.org/wiki/Necrotizing_fasciitis

  Type III infection: Vibrio vulnificus is a bacterium found in saltwater. It occasionally causes NF after entering the body through a break in the skin. […] Type IV infection: This type of NF accounts for less than 1% of cases. It is mostly caused by the Candida albicans fungus. Risk factors include age and immunodeficiency.

• #13 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Type II necrotising fasciitis has been sensationalised in the media and is commonly referred to as a flesh-eating disease. It affects all age groups. Healthy people are also prone to infection with this group. […] Type III necrotising fasciitis is caused by Clostridium perfringens or less commonly Clostridium septicum. It usually follows significant injury or surgery and results in gas under the skin: this makes a crackling sound called crepitus. People who inject black tar heroin subcutaneously can also be infected with clostridia and develop necrotising fasciitis. […] Necrotising fasciitis due to marine organisms is usually due to contamination of wounds by seawater, cuts by fish fins or stingers, or consumption of raw seafood. It occurs more commonly in patients with liver disorders. These infections can be very serious and can be fatal if not attended within 48 hours.

• #14 About Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/about/necrotizing-fasciitis.html

  Necrotizing fasciitis is a rare, but serious bacterial infection. […] It can develop very quickly into a life-threatening emergency. […] Experts believe group A Streptococcus (group A strep bacteria) are the most common cause. […] Bacteria that live in water, including Vibrio vulnificus, can also cause necrotizing fasciitis. […] Group A Streptococcus (group A strep bacteria) cause necrotizing fasciitis. […] Most cases of necrotizing fasciitis occur randomly. However, less serious group A strep infections can turn into necrotizing fasciitis and these bacteria are contagious.

• #15 Necrotizing Fasciitis (Flesh-Eating Bacteria): Causes, Symptoms, and Treatment

  https://www.webmd.com/skin-problems-and-treatments/necrotizing-fasciitis-flesh-eating-bacteria

  Necrotizing fasciitis is commonly caused by group A streptococcus (GAS) bacteria. That’s the same type of bacteria that causes strep throat. But, several types of bacteria, including Vibrio vulnificus (bacteria that live in water), staphylococcus, and others, have also been linked to the disease. […] Necrotizing fasciitis happens when these types of bacteria infect the superficial fascia, a layer of connective tissue below the skin. […] The bacteria that cause necrotizing fasciitis can enter the body through surgical wounds, puncture wounds or an injury that doesn’t break the skin, burns, minor cuts and scrapes, insect bites, and abrasions. […] In some cases, it is unknown how the infection began. Once it takes hold, the infection rapidly destroys muscle, skin, and fat tissue.

• #16 Necrotising fasciitis

  https://www.nhs.uk/conditions/necrotising-fasciitis/

  Necrotising fasciitis is an infection that can happen after getting a wound. It causes damage to the deep layers of your skin. […] The infection may get into the body through: cuts and scratches, burns and scalds, insect bites, surgery, injecting drugs. […] You may be more at risk from developing necrotising fasciitis if you have diabetes or a weakened immune system.

• #17 Necrotising fasciitis — symptoms, treatment | healthdirect

  https://www.healthdirect.gov.au/necrotising-fasciitis

  Necrotising fasciitis is caused by bacteria entering your body through a cut, burn or wound the bacteria can spread through skin contact. […] Necrotising fasciitis happens when bacteria enter the body through a break in the skin and infects the soft tissue. Group A streptococcus bacteria is one of the most common causes. […] Bacteria can enter your body through: cuts, grazes or tears in your skin, burns, surgical wounds, minor wounds like a prick from a rose thorn or insect bites, a bump or hit that does not break the skin, skin punctures from intravenous drug use (when a needle is used to inject drugs directly into the bloodstream). […] In open wounds, the bacteria grow fast and release toxins and enzymes that cause septic shock, making blood pressure drop and cause blood clots. […] You are more likely to get necrotising fasciitis if you: have a weakened immune system, have diabetes, kidney disease, liver disease, a heart or lung condition or cancer, use steroids, alcohol or drugs, are older, are living with obesity. […] It can also be a rare complication of chickenpox in young children.

• #18 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  Surgical procedures may cause local tissue injury and bacterial invasion, resulting in necrotizing fasciitis. These procedures include surgery for intraperitoneal infections and drainage of ischiorectal and perianal abscesses. Intramuscular injections and intravenous infusions may lead to necrotizing fasciitis. […] Minor insect bites may set the stage for necrotizing infections. Streptococci introduced into the wounds may be prominent initially, but the bacteriologic pattern changes with hypoxia-induced proliferation of anaerobes. […] Local ischemia and hypoxia can occur in patients with systemic illnesses (eg, diabetes). Host defenses can be compromised by underlying systemic diseases favoring the development of these infections. Illnesses such as diabetes or cancer have been described in over 90% of cases of progressive bacterial gangrene.

• #19 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Fungal necrotising fasciitis complicates traumatic wounds in immunocompromised people. […] Necrotising fasciitis may occur in anyone, with almost half of all known cases of streptococcal necrotising fasciitis occurring in young and previously healthy individuals. The disease may occur if the right set of conditions is present, these include: An opening in the skin that allows bacteria to enter the body. This may occur following minor injury (eg, small cut, graze, pinprick, injection), or a large wound due to trauma or surgery (eg, laparoscopy, sclerotherapy, endoscopic gastrostomy, thoracostomy, Caesarean section, hysterectomy). Sometimes no point of entry can be found. […] Particularly invasive strains of bacteria eg, streptococci that evade the immune system and produce a toxin called cysteine protease SpeB, which dissolves tissue.

• #20 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Risks for necrotising fasciitis include: Aspirin and non-steroidal anti-inflammatory drugs, Advanced age, Diabetes mellitus, Immune suppression, Obesity, Drug abuse, Severe chronic illness, Malignancy. […] The infection starts in the superficial fascia. Enzymes and proteins released by the responsible micro-organisms cause necrosis of fascial layers. […] Streptococci produce: M proteins, which initiate an inflammatory response with the release of numerous cytokines (IL-1, IL-6, TNF), Exotoxins, which destroy neutrophils allowing bacterial growth and destroying tissues. […] Aerobic and anaerobic bacteria produce hydrogen, nitrogen, and hydrogen sulfide gases that destroy hyaluronic acid enabling the spread of infection. […] If diagnosed and treated early, most patients will survive necrotising fasciitis with minimal scarring. If there is significant tissue loss, later skin grafting will be necessary and in some patients amputation of limbs is required to prevent death. […] Up to 25% of patients will die from necrotising fasciitis, due to complications such as renal failure and septicaemia (blood poisoning) and multiorgan failure.

• #21 Necrotizing fasciitis pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Necrotizing_fasciitis_pathophysiology

  The pathogenesis of necrotizing fasciitis is the result of bacterial and host factors. […] The exact pathogenesis of type 1 necrotizing fasciitis is not fully understood but polymicrobial species work synergistically to enhance the spread of infection. Group A streptococcus is the most common causative agent of type 2 necrotizing fasciitis. […] Recurrent necrotizing fasciitis is caused by MRSA. […] The pathogenesis of type 2 NF is the result of the following process: Inhibition of phagocytosis of bacteria by hyaluronic acid capsule and M protein. […] The massive release of cytokines result in systemic inflammatory response syndrome resulting in shock, organ failure, depression of myocardial function and immune suppression. […] Recurrent NF is seen in following conditions: Methicillin resistant staphylococcus aureus (MRSA).

• #22 Necrotizing Fasciitis (Flesh-Eating Disease): Causes, Contagious, Symptoms & Treatment

  https://www.emedicinehealth.com/necrotizing_fasciitis/article_em.htm

  After the bacterial pathogen gains entry, the infection can spread from the subcutaneous tissues to involve deeper fascial planes. […] Various bacterial enzymes and toxins lead to vascular occlusion, resulting in tissue hypoxia (decreased oxygen) and ultimately tissue necrosis (death). […] Individuals with underlying medical problems and a weakened immune system are also at increased risk of developing necrotizing fasciitis. […] For classification purposes, necrotizing fasciitis has been subdivided into four distinct groupings, primarily based on the microbiology of the underlying infection; type 1 NF is caused by multiple bacterial species (polymicrobial), type 2 NF is caused by a single bacterial species (monomicrobial), which is typically Streptococcus pyogenes; type 3 NF (gas gangrene) is caused by Clostridium spp., and type 4 NF is caused by fungal infections, mainly Candida spp. and Zygomycetes. […] Infection caused by Vibrio spp. (frequently Vibrio vulnificus) is a variant form often occurring in individuals with liver disease, typically after ingesting seafood or exposing skin wounds to seawater contaminated by this organism.

• #23 Necrotizing fasciitis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8681631/

  Necrotizing fasciitis is an uncommon soft-tissue infection, usually caused by toxin-producing, virulent bacteria, which is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. […] The disease occurs more frequently in diabetics, alcoholics, immunosuppressed patients, i.v. drug users, and patients with peripheral vascular disease, although it also occurs in young, previously healthy individuals. […] Introduction of the pathogen into the subcutaneous space occurs via disruption of the overlying skin or by hematogenous spread from a distant site of infection. […] Polymicrobial necrotizing fasciitis is usually caused by enteric pathogens, whereas monomicrobial necrotizing fasciitis is usually due to skin flora. […] Tissue damage and systemic toxicity are believed to result from the release of endogenous cytokines and bacterial toxins. […] Mortality rates are as high as 76%. […] Delays in diagnosis and/or treatment correlate with poor outcome, with the cause of death being overwhelming sepsis syndrome and/or multiple organ system failure.

• #24 Flesh-eating necrotising fasciitis: What causes it and how is it treated? – ABC News

  https://www.abc.net.au/news/2017-11-17/necrotising-fasciitis-flesh-eating-bacteria-causes-and-treatment/9162062

  Necrotising fasciitis is caused by bacteria that gain access to the body, usually by damage to the skin, the first line of protection. […] Quite a few different types of bacteria can cause the disease. However, when they cause infection elsewhere, many are only associated with mild disease. […] These include group A streptococci, a common cause of tonsillitis, and Clostridium perfringens, a cause of food poisoning. […] Contrary to many news reports, it is not caused by viruses there is no flesh-eating virus. […] Some strains of bacteria produce toxins that can enable them to spread readily through tissue. […] Group A streptococci, for instance, produce a toxin called cysteine protease SpeB, which may allow the bacteria to dissolve tissue and evade the immune system. […] Group A streptococci also produce a range of other toxins but their role and function are not well understood.

• #25 Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html

  Multiple species of bacteria can cause necrotizing fasciitis. This page focuses on type II necrotizing fasciitis, which is also known as […] It’s characterized by the isolation of Streptococcus pyogenes (group A strep bacteria) with or without other bacterial species. Staphylococcus aureus is the most common species found in co-infection cases. […] Some streptococcal strains may be more likely to cause necrotizing fasciitis. Commonly involved strains, such as those containing M protein types 1, 3, 12, and 28, typically produce pyrogenic exotoxin A1. […] Certain systemic or local immunocompromising conditions increase the risk of getting necrotizing fasciitis, including: […] Corticosteroid therapy has been shown to be a predisposing factor. […] While rare, when necrotizing fasciitis occurs it frequently happens after trauma or surgery. […] Amputations are a common complication of necrotizing fasciitis. […] In the most recent 5 years, the mortality rate of streptococcal necrotizing fasciitis has been around 13 to 18%. It increases with age of the person affected and the presence of streptococcal toxic shock syndrome.

• #26 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is typically an acute process that occurs rapidly over several days. In approximately 80% of cases, it is a direct sequela of bacterial infection introduced through a break in the skins integrity. Gram-positive cocci, specifically strains of Staphylococcus aureus and Streptococci are responsible for most of these single-site source infections. Polymicrobial infections also occur because of a combination of gram-negative and anaerobic involvement. The majority of patients have diabetes and a history of alcoholism. Patients with liver cirrhosis are also prone to necrotizing fasciitis. […] Necrotizing fasciitis can occur post-surgery, invasive procedures, or even a minor procedure like phlebotomy. The causative bacteria are usually mixed but do produce gas. […] Necrotizing fasciitis is a serious life-threatening infection with mortality rates ranging from 20 to 80%. Poor prognosis has been linked to certain streptococcal strains, advanced age, uncontrolled diabetes, state of immunosuppression, and delayed surgery. Even people who survive have a prolonged recovery with significant functional deficits.

• #27 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  Of patients with necrotizing fasciitis, 20-40% are diabetic. As many as 80% of Fournier gangrene cases occur in people with diabetes. In some series, as many as 35% of patients were alcoholics. However, approximately one half of the cases of streptococcal necrotizing fasciitis occur in young and previously healthy people. […] A study by Hung et al suggested that liver cirrhosis is an independent risk factor for necrotizing fasciitis. […] Group A beta-hemolytic streptococci have historically been noted as a cause of necrotizing fasciitis, but Haemophilus aphrophilus and S aureus are also associated with the condition, and some patients have mixed infections involving multiple species of bacteria, including mycobacteria, as well as fungi. […] In type I necrotizing fasciitis, anaerobic and facultative bacteria work synergistically to cause what may initially be mistaken for a simple wound cellulitis. A variant of type I necrotizing fasciitis is saltwater necrotizing fasciitis in which an apparently minor skin wound is contaminated with saltwater containing a Vibrio species.

• #28 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  Of patients with necrotizing fasciitis, 20-40% are diabetic. As many as 80% of Fournier gangrene cases occur in people with diabetes. In some series, as many as 35% of patients were alcoholics. However, approximately one half of the cases of streptococcal necrotizing fasciitis occur in young and previously healthy people. […] A study by Hung et al suggested that liver cirrhosis is an independent risk factor for necrotizing fasciitis. […] Group A beta-hemolytic streptococci have historically been noted as a cause of necrotizing fasciitis, but Haemophilus aphrophilus and S aureus are also associated with the condition, and some patients have mixed infections involving multiple species of bacteria, including mycobacteria, as well as fungi. […] In type I necrotizing fasciitis, anaerobic and facultative bacteria work synergistically to cause what may initially be mistaken for a simple wound cellulitis. A variant of type I necrotizing fasciitis is saltwater necrotizing fasciitis in which an apparently minor skin wound is contaminated with saltwater containing a Vibrio species.

• #29 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/784690-overview

  Of patients with necrotizing fasciitis, 20-40% are diabetic. […] A study by Hung et al suggested that liver cirrhosis is an independent risk factor for necrotizing fasciitis. […] Group A beta-hemolytic streptococci have historically been noted as a cause of necrotizing fasciitis, but Haemophilus aphrophilus and S aureus are also associated with the condition, and some patients have mixed infections involving multiple species of bacteria, including mycobacteria, as well as fungi. […] In type I necrotizing fasciitis, anaerobic and facultative bacteria work synergistically to cause what may initially be mistaken for a simple wound cellulitis. […] In type II necrotizing fasciitis, varicella infection and the use of nonsteroidal anti-inflammatory drugs may be predisposing factors. […] Type III necrotizing fasciitis is usually caused by Clostridium perfringens. […] Unusual causes include injection anthrax. […] Rapidly progressive necrotizing fasciitis following a stonefish sting has been described.

• #30 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  Of patients with necrotizing fasciitis, 20-40% are diabetic. As many as 80% of Fournier gangrene cases occur in people with diabetes. In some series, as many as 35% of patients were alcoholics. However, approximately one half of the cases of streptococcal necrotizing fasciitis occur in young and previously healthy people. […] A study by Hung et al suggested that liver cirrhosis is an independent risk factor for necrotizing fasciitis. […] Group A beta-hemolytic streptococci have historically been noted as a cause of necrotizing fasciitis, but Haemophilus aphrophilus and S aureus are also associated with the condition, and some patients have mixed infections involving multiple species of bacteria, including mycobacteria, as well as fungi. […] In type I necrotizing fasciitis, anaerobic and facultative bacteria work synergistically to cause what may initially be mistaken for a simple wound cellulitis. A variant of type I necrotizing fasciitis is saltwater necrotizing fasciitis in which an apparently minor skin wound is contaminated with saltwater containing a Vibrio species.

• #31 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/784690-overview

  Of patients with necrotizing fasciitis, 20-40% are diabetic. […] A study by Hung et al suggested that liver cirrhosis is an independent risk factor for necrotizing fasciitis. […] Group A beta-hemolytic streptococci have historically been noted as a cause of necrotizing fasciitis, but Haemophilus aphrophilus and S aureus are also associated with the condition, and some patients have mixed infections involving multiple species of bacteria, including mycobacteria, as well as fungi. […] In type I necrotizing fasciitis, anaerobic and facultative bacteria work synergistically to cause what may initially be mistaken for a simple wound cellulitis. […] In type II necrotizing fasciitis, varicella infection and the use of nonsteroidal anti-inflammatory drugs may be predisposing factors. […] Type III necrotizing fasciitis is usually caused by Clostridium perfringens. […] Unusual causes include injection anthrax. […] Rapidly progressive necrotizing fasciitis following a stonefish sting has been described.

• #32 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Risks for necrotising fasciitis include: Aspirin and non-steroidal anti-inflammatory drugs, Advanced age, Diabetes mellitus, Immune suppression, Obesity, Drug abuse, Severe chronic illness, Malignancy. […] The infection starts in the superficial fascia. Enzymes and proteins released by the responsible micro-organisms cause necrosis of fascial layers. […] Streptococci produce: M proteins, which initiate an inflammatory response with the release of numerous cytokines (IL-1, IL-6, TNF), Exotoxins, which destroy neutrophils allowing bacterial growth and destroying tissues. […] Aerobic and anaerobic bacteria produce hydrogen, nitrogen, and hydrogen sulfide gases that destroy hyaluronic acid enabling the spread of infection. […] If diagnosed and treated early, most patients will survive necrotising fasciitis with minimal scarring. If there is significant tissue loss, later skin grafting will be necessary and in some patients amputation of limbs is required to prevent death. […] Up to 25% of patients will die from necrotising fasciitis, due to complications such as renal failure and septicaemia (blood poisoning) and multiorgan failure.

• #33 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Risks for necrotising fasciitis include: Aspirin and non-steroidal anti-inflammatory drugs, Advanced age, Diabetes mellitus, Immune suppression, Obesity, Drug abuse, Severe chronic illness, Malignancy. […] The infection starts in the superficial fascia. Enzymes and proteins released by the responsible micro-organisms cause necrosis of fascial layers. […] Streptococci produce: M proteins, which initiate an inflammatory response with the release of numerous cytokines (IL-1, IL-6, TNF), Exotoxins, which destroy neutrophils allowing bacterial growth and destroying tissues. […] Aerobic and anaerobic bacteria produce hydrogen, nitrogen, and hydrogen sulfide gases that destroy hyaluronic acid enabling the spread of infection. […] If diagnosed and treated early, most patients will survive necrotising fasciitis with minimal scarring. If there is significant tissue loss, later skin grafting will be necessary and in some patients amputation of limbs is required to prevent death. […] Up to 25% of patients will die from necrotising fasciitis, due to complications such as renal failure and septicaemia (blood poisoning) and multiorgan failure.

• #34 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Risks for necrotising fasciitis include: Aspirin and non-steroidal anti-inflammatory drugs, Advanced age, Diabetes mellitus, Immune suppression, Obesity, Drug abuse, Severe chronic illness, Malignancy. […] The infection starts in the superficial fascia. Enzymes and proteins released by the responsible micro-organisms cause necrosis of fascial layers. […] Streptococci produce: M proteins, which initiate an inflammatory response with the release of numerous cytokines (IL-1, IL-6, TNF), Exotoxins, which destroy neutrophils allowing bacterial growth and destroying tissues. […] Aerobic and anaerobic bacteria produce hydrogen, nitrogen, and hydrogen sulfide gases that destroy hyaluronic acid enabling the spread of infection. […] If diagnosed and treated early, most patients will survive necrotising fasciitis with minimal scarring. If there is significant tissue loss, later skin grafting will be necessary and in some patients amputation of limbs is required to prevent death. […] Up to 25% of patients will die from necrotising fasciitis, due to complications such as renal failure and septicaemia (blood poisoning) and multiorgan failure.

• #35 Necrotizing fasciitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/necrotizing-fasciitis-1?lang=us

  Necrotizing fasciitis (rare plural: necrotizing fasciitides) refers to a rapidly progressive and often fatal aggressive necrotizing soft tissue infection primarily involving fascial planes and spreading hematogenously. […] Necrotizing fasciitis is relatively rare, although its prevalence is rising. Over the past few years there has been an increase in vibriosis due to warming coastal and estuarine waters off East Coast USA, Gulf of Mexico and Australia. […] The most common risk factor is diabetes mellitus, especially in combination with peripheral arterial disease. Other predisposing factors include immunocompromise due to HIV infection, cancer, liver disease, alcohol use, or organ transplant. […] Deep soft tissue infections can also occur in otherwise healthy individuals following surgery, penetrating trauma, minor wounds such as tattoos, piercings, insect bites or abrasions, or even blunt trauma with no clear portal of entry.

• #36 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  Of patients with necrotizing fasciitis, 20-40% are diabetic. As many as 80% of Fournier gangrene cases occur in people with diabetes. In some series, as many as 35% of patients were alcoholics. However, approximately one half of the cases of streptococcal necrotizing fasciitis occur in young and previously healthy people. […] A study by Hung et al suggested that liver cirrhosis is an independent risk factor for necrotizing fasciitis. […] Group A beta-hemolytic streptococci have historically been noted as a cause of necrotizing fasciitis, but Haemophilus aphrophilus and S aureus are also associated with the condition, and some patients have mixed infections involving multiple species of bacteria, including mycobacteria, as well as fungi. […] In type I necrotizing fasciitis, anaerobic and facultative bacteria work synergistically to cause what may initially be mistaken for a simple wound cellulitis. A variant of type I necrotizing fasciitis is saltwater necrotizing fasciitis in which an apparently minor skin wound is contaminated with saltwater containing a Vibrio species.

• #37 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Type II necrotising fasciitis has been sensationalised in the media and is commonly referred to as a flesh-eating disease. It affects all age groups. Healthy people are also prone to infection with this group. […] Type III necrotising fasciitis is caused by Clostridium perfringens or less commonly Clostridium septicum. It usually follows significant injury or surgery and results in gas under the skin: this makes a crackling sound called crepitus. People who inject black tar heroin subcutaneously can also be infected with clostridia and develop necrotising fasciitis. […] Necrotising fasciitis due to marine organisms is usually due to contamination of wounds by seawater, cuts by fish fins or stingers, or consumption of raw seafood. It occurs more commonly in patients with liver disorders. These infections can be very serious and can be fatal if not attended within 48 hours.

• #38 Necrotizing Fasciitis (Flesh-Eating Disease): Causes, Contagious, Symptoms & Treatment

  https://www.emedicinehealth.com/necrotizing_fasciitis/article_em.htm

  Necrotizing fasciitis is caused by bacteria in the vast majority of cases, though fungi can also rarely lead to this condition as well. Most cases of necrotizing fasciitis are caused by group A beta-hemolytic streptococci (Streptococcus pyogenes), though many different bacteria may be involved, either in isolation or along with other bacterial pathogens. […] In recent years, there has been a surge in cases of necrotizing fasciitis caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA), often occurring in intravenous drug abusers. Most cases of necrotizing fasciitis are polymicrobial and involve both aerobic and anaerobic bacteria. […] In many cases of necrotizing fasciitis, there is a history of prior trauma, such as a cut, scrape, insect bite, burn, or needle puncture wound.

• #39 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Risks for necrotising fasciitis include: Aspirin and non-steroidal anti-inflammatory drugs, Advanced age, Diabetes mellitus, Immune suppression, Obesity, Drug abuse, Severe chronic illness, Malignancy. […] The infection starts in the superficial fascia. Enzymes and proteins released by the responsible micro-organisms cause necrosis of fascial layers. […] Streptococci produce: M proteins, which initiate an inflammatory response with the release of numerous cytokines (IL-1, IL-6, TNF), Exotoxins, which destroy neutrophils allowing bacterial growth and destroying tissues. […] Aerobic and anaerobic bacteria produce hydrogen, nitrogen, and hydrogen sulfide gases that destroy hyaluronic acid enabling the spread of infection. […] If diagnosed and treated early, most patients will survive necrotising fasciitis with minimal scarring. If there is significant tissue loss, later skin grafting will be necessary and in some patients amputation of limbs is required to prevent death. […] Up to 25% of patients will die from necrotising fasciitis, due to complications such as renal failure and septicaemia (blood poisoning) and multiorgan failure.

• #40 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Risks for necrotising fasciitis include: Aspirin and non-steroidal anti-inflammatory drugs, Advanced age, Diabetes mellitus, Immune suppression, Obesity, Drug abuse, Severe chronic illness, Malignancy. […] The infection starts in the superficial fascia. Enzymes and proteins released by the responsible micro-organisms cause necrosis of fascial layers. […] Streptococci produce: M proteins, which initiate an inflammatory response with the release of numerous cytokines (IL-1, IL-6, TNF), Exotoxins, which destroy neutrophils allowing bacterial growth and destroying tissues. […] Aerobic and anaerobic bacteria produce hydrogen, nitrogen, and hydrogen sulfide gases that destroy hyaluronic acid enabling the spread of infection. […] If diagnosed and treated early, most patients will survive necrotising fasciitis with minimal scarring. If there is significant tissue loss, later skin grafting will be necessary and in some patients amputation of limbs is required to prevent death. […] Up to 25% of patients will die from necrotising fasciitis, due to complications such as renal failure and septicaemia (blood poisoning) and multiorgan failure.

• #41 Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html

  Multiple species of bacteria can cause necrotizing fasciitis. This page focuses on type II necrotizing fasciitis, which is also known as […] It’s characterized by the isolation of Streptococcus pyogenes (group A strep bacteria) with or without other bacterial species. Staphylococcus aureus is the most common species found in co-infection cases. […] Some streptococcal strains may be more likely to cause necrotizing fasciitis. Commonly involved strains, such as those containing M protein types 1, 3, 12, and 28, typically produce pyrogenic exotoxin A1. […] Certain systemic or local immunocompromising conditions increase the risk of getting necrotizing fasciitis, including: […] Corticosteroid therapy has been shown to be a predisposing factor. […] While rare, when necrotizing fasciitis occurs it frequently happens after trauma or surgery. […] Amputations are a common complication of necrotizing fasciitis. […] In the most recent 5 years, the mortality rate of streptococcal necrotizing fasciitis has been around 13 to 18%. It increases with age of the person affected and the presence of streptococcal toxic shock syndrome.

• #42 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  In type II necrotizing fasciitis, varicella infection and the use of nonsteroidal anti-inflammatory drugs may be predisposing factors. […] Type III necrotizing fasciitis is usually caused by Clostridium perfringens. When type III necrotizing fasciitis occurs spontaneously, C septicum is more likely to be the etiologic agent; these cases usually occur in association with colon cancer or leukemia. […] Unusual causes include injection anthrax. […] Rapidly progressive necrotizing fasciitis following a stonefish sting has been described.

• #43 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/784690-overview

  Of patients with necrotizing fasciitis, 20-40% are diabetic. […] A study by Hung et al suggested that liver cirrhosis is an independent risk factor for necrotizing fasciitis. […] Group A beta-hemolytic streptococci have historically been noted as a cause of necrotizing fasciitis, but Haemophilus aphrophilus and S aureus are also associated with the condition, and some patients have mixed infections involving multiple species of bacteria, including mycobacteria, as well as fungi. […] In type I necrotizing fasciitis, anaerobic and facultative bacteria work synergistically to cause what may initially be mistaken for a simple wound cellulitis. […] In type II necrotizing fasciitis, varicella infection and the use of nonsteroidal anti-inflammatory drugs may be predisposing factors. […] Type III necrotizing fasciitis is usually caused by Clostridium perfringens. […] Unusual causes include injection anthrax. […] Rapidly progressive necrotizing fasciitis following a stonefish sting has been described.

• #44 Necrotising fasciitis — symptoms, treatment | healthdirect

  https://www.healthdirect.gov.au/necrotising-fasciitis

  Necrotising fasciitis is caused by bacteria entering your body through a cut, burn or wound the bacteria can spread through skin contact. […] Necrotising fasciitis happens when bacteria enter the body through a break in the skin and infects the soft tissue. Group A streptococcus bacteria is one of the most common causes. […] Bacteria can enter your body through: cuts, grazes or tears in your skin, burns, surgical wounds, minor wounds like a prick from a rose thorn or insect bites, a bump or hit that does not break the skin, skin punctures from intravenous drug use (when a needle is used to inject drugs directly into the bloodstream). […] In open wounds, the bacteria grow fast and release toxins and enzymes that cause septic shock, making blood pressure drop and cause blood clots. […] You are more likely to get necrotising fasciitis if you: have a weakened immune system, have diabetes, kidney disease, liver disease, a heart or lung condition or cancer, use steroids, alcohol or drugs, are older, are living with obesity. […] It can also be a rare complication of chickenpox in young children.

• #45 Necrotising Fasciitis: Causes, Symptoms, and Treatment

  https://patient.info/doctor/necrotising-fasciitis-pro

  Candidal infection in immunocompromised patients. […] Note that necrotising fasciitis can occur in previously healthy people with no underlying disease, particularly where Group A streptococci are involved. […] Risk factors for necrotising fasciitis: These include: Skin injury including insect bite, trauma and open wounds. […] Underlying conditions including alcohol abuse, intravenous drug abuse, chronic liver or renal disease, diabetes, malignancy, immunosuppression and possibly, tuberculosis. […] Necrotising fasciitis in children may follow varicella-zoster infection. […] NF carries a significant mortality rate, particularly if marine organisms are involved. […] Increased mortality is associated with delays in diagnosis, poor surgical technique and diabetes.

• #46 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is typically an acute process that occurs rapidly over several days. In approximately 80% of cases, it is a direct sequela of bacterial infection introduced through a break in the skins integrity. Gram-positive cocci, specifically strains of Staphylococcus aureus and Streptococci are responsible for most of these single-site source infections. Polymicrobial infections also occur because of a combination of gram-negative and anaerobic involvement. The majority of patients have diabetes and a history of alcoholism. Patients with liver cirrhosis are also prone to necrotizing fasciitis. […] Necrotizing fasciitis can occur post-surgery, invasive procedures, or even a minor procedure like phlebotomy. The causative bacteria are usually mixed but do produce gas. […] Necrotizing fasciitis is a serious life-threatening infection with mortality rates ranging from 20 to 80%. Poor prognosis has been linked to certain streptococcal strains, advanced age, uncontrolled diabetes, state of immunosuppression, and delayed surgery. Even people who survive have a prolonged recovery with significant functional deficits.

• #47 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  Of patients with necrotizing fasciitis, 20-40% are diabetic. As many as 80% of Fournier gangrene cases occur in people with diabetes. In some series, as many as 35% of patients were alcoholics. However, approximately one half of the cases of streptococcal necrotizing fasciitis occur in young and previously healthy people. […] A study by Hung et al suggested that liver cirrhosis is an independent risk factor for necrotizing fasciitis. […] Group A beta-hemolytic streptococci have historically been noted as a cause of necrotizing fasciitis, but Haemophilus aphrophilus and S aureus are also associated with the condition, and some patients have mixed infections involving multiple species of bacteria, including mycobacteria, as well as fungi. […] In type I necrotizing fasciitis, anaerobic and facultative bacteria work synergistically to cause what may initially be mistaken for a simple wound cellulitis. A variant of type I necrotizing fasciitis is saltwater necrotizing fasciitis in which an apparently minor skin wound is contaminated with saltwater containing a Vibrio species.

• #48 Necrotising fasciitis

  https://dermnetnz.org/topics/necrotising-fasciitis

  Fungal necrotising fasciitis complicates traumatic wounds in immunocompromised people. […] Necrotising fasciitis may occur in anyone, with almost half of all known cases of streptococcal necrotising fasciitis occurring in young and previously healthy individuals. The disease may occur if the right set of conditions is present, these include: An opening in the skin that allows bacteria to enter the body. This may occur following minor injury (eg, small cut, graze, pinprick, injection), or a large wound due to trauma or surgery (eg, laparoscopy, sclerotherapy, endoscopic gastrostomy, thoracostomy, Caesarean section, hysterectomy). Sometimes no point of entry can be found. […] Particularly invasive strains of bacteria eg, streptococci that evade the immune system and produce a toxin called cysteine protease SpeB, which dissolves tissue.

• #49 Necrotizing fasciitis not always caused by bacteria but by a combination of tissue damage and a gene defect | HUS

  https://www.hus.fi/en/newsroom/necrotizing-fasciitis-not-always-caused-bacteria-combination-tissue-damage-and-gene-defect

  A new Finnish-led study suggests that necrotizing fasciitis, a life-threatening inflammation of connective tissue that leads to tissue necrosis, may be caused by a gene defect. […] Severe fasciitis has previously been thought to be caused by so-called carnivorous bacteria. Previously, the same Finnish researchers discovered a form of fasciitis that occurs as a result of a routine procedure or tissue damage combined with a gene defect in the patient’s genome. This is when the body overreacts to tissue damage and causes inflammation. Bacteria are often not found at all or the infection is of minor importance. […] Researchers have found an inflammation-activating defect in the NFKB1 gene in three Finnish and three foreign pediatric and adult patients with severe fasciitis. NFKB1 is one of the most important genes regulating the immune system.

• #50 Necrotizing fasciitis not always caused by bacteria but by a combination of tissue damage and a gene defect | HUS

  https://www.hus.fi/en/newsroom/necrotizing-fasciitis-not-always-caused-bacteria-combination-tissue-damage-and-gene-defect

  The study investigated the mechanism of how a gene defect causes an excessive and violent inflammatory response. In patients, mild injury, surgery or infection had triggered an uncontrolled inflammatory reaction leading to severe deep tissue inflammation. The immune cells of patients carrying the gene defect secreted large amounts of mediators greatly accelerating inflammation. […] „If these findings are confirmed, it will be important to investigate in the future whether targeting the mediators now found could help in the treatment of other necrotizing fasciitis.”

• #51 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/2051157-overview

  In type II necrotizing fasciitis, varicella infection and the use of nonsteroidal anti-inflammatory drugs may be predisposing factors. […] Type III necrotizing fasciitis is usually caused by Clostridium perfringens. When type III necrotizing fasciitis occurs spontaneously, C septicum is more likely to be the etiologic agent; these cases usually occur in association with colon cancer or leukemia. […] Unusual causes include injection anthrax. […] Rapidly progressive necrotizing fasciitis following a stonefish sting has been described.

• #52 Necrotizing Fasciitis: Practice Essentials, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/784690-overview

  Of patients with necrotizing fasciitis, 20-40% are diabetic. […] A study by Hung et al suggested that liver cirrhosis is an independent risk factor for necrotizing fasciitis. […] Group A beta-hemolytic streptococci have historically been noted as a cause of necrotizing fasciitis, but Haemophilus aphrophilus and S aureus are also associated with the condition, and some patients have mixed infections involving multiple species of bacteria, including mycobacteria, as well as fungi. […] In type I necrotizing fasciitis, anaerobic and facultative bacteria work synergistically to cause what may initially be mistaken for a simple wound cellulitis. […] In type II necrotizing fasciitis, varicella infection and the use of nonsteroidal anti-inflammatory drugs may be predisposing factors. […] Type III necrotizing fasciitis is usually caused by Clostridium perfringens. […] Unusual causes include injection anthrax. […] Rapidly progressive necrotizing fasciitis following a stonefish sting has been described.

• #53 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is typically an acute process that occurs rapidly over several days. In approximately 80% of cases, it is a direct sequela of bacterial infection introduced through a break in the skins integrity. Gram-positive cocci, specifically strains of Staphylococcus aureus and Streptococci are responsible for most of these single-site source infections. Polymicrobial infections also occur because of a combination of gram-negative and anaerobic involvement. The majority of patients have diabetes and a history of alcoholism. Patients with liver cirrhosis are also prone to necrotizing fasciitis. […] Necrotizing fasciitis can occur post-surgery, invasive procedures, or even a minor procedure like phlebotomy. The causative bacteria are usually mixed but do produce gas. […] Necrotizing fasciitis is a serious life-threatening infection with mortality rates ranging from 20 to 80%. Poor prognosis has been linked to certain streptococcal strains, advanced age, uncontrolled diabetes, state of immunosuppression, and delayed surgery. Even people who survive have a prolonged recovery with significant functional deficits.

• #54 Necrotizing fasciitis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/8681631/

  Necrotizing fasciitis is an uncommon soft-tissue infection, usually caused by toxin-producing, virulent bacteria, which is characterized by widespread fascial necrosis with relative sparing of skin and underlying muscle. […] The disease occurs more frequently in diabetics, alcoholics, immunosuppressed patients, i.v. drug users, and patients with peripheral vascular disease, although it also occurs in young, previously healthy individuals. […] Introduction of the pathogen into the subcutaneous space occurs via disruption of the overlying skin or by hematogenous spread from a distant site of infection. […] Polymicrobial necrotizing fasciitis is usually caused by enteric pathogens, whereas monomicrobial necrotizing fasciitis is usually due to skin flora. […] Tissue damage and systemic toxicity are believed to result from the release of endogenous cytokines and bacterial toxins. […] Mortality rates are as high as 76%. […] Delays in diagnosis and/or treatment correlate with poor outcome, with the cause of death being overwhelming sepsis syndrome and/or multiple organ system failure.

• #55 Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html

  Multiple species of bacteria can cause necrotizing fasciitis. This page focuses on type II necrotizing fasciitis, which is also known as […] It’s characterized by the isolation of Streptococcus pyogenes (group A strep bacteria) with or without other bacterial species. Staphylococcus aureus is the most common species found in co-infection cases. […] Some streptococcal strains may be more likely to cause necrotizing fasciitis. Commonly involved strains, such as those containing M protein types 1, 3, 12, and 28, typically produce pyrogenic exotoxin A1. […] Certain systemic or local immunocompromising conditions increase the risk of getting necrotizing fasciitis, including: […] Corticosteroid therapy has been shown to be a predisposing factor. […] While rare, when necrotizing fasciitis occurs it frequently happens after trauma or surgery. […] Amputations are a common complication of necrotizing fasciitis. […] In the most recent 5 years, the mortality rate of streptococcal necrotizing fasciitis has been around 13 to 18%. It increases with age of the person affected and the presence of streptococcal toxic shock syndrome.

• #56 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK430756/

  Necrotizing fasciitis is typically an acute process that occurs rapidly over several days. In approximately 80% of cases, it is a direct sequela of bacterial infection introduced through a break in the skins integrity. Gram-positive cocci, specifically strains of Staphylococcus aureus and Streptococci are responsible for most of these single-site source infections. Polymicrobial infections also occur because of a combination of gram-negative and anaerobic involvement. The majority of patients have diabetes and a history of alcoholism. Patients with liver cirrhosis are also prone to necrotizing fasciitis. […] Necrotizing fasciitis can occur post-surgery, invasive procedures, or even a minor procedure like phlebotomy. The causative bacteria are usually mixed but do produce gas. […] Necrotizing fasciitis is a serious life-threatening infection with mortality rates ranging from 20 to 80%. Poor prognosis has been linked to certain streptococcal strains, advanced age, uncontrolled diabetes, state of immunosuppression, and delayed surgery. Even people who survive have a prolonged recovery with significant functional deficits.

• #57 Clinical Guidance for Type II Necrotizing Fasciitis | Group A Strep | CDC

  https://www.cdc.gov/group-a-strep/hcp/clinical-guidance/necrotizing-fasciitis.html

  Multiple species of bacteria can cause necrotizing fasciitis. This page focuses on type II necrotizing fasciitis, which is also known as […] It’s characterized by the isolation of Streptococcus pyogenes (group A strep bacteria) with or without other bacterial species. Staphylococcus aureus is the most common species found in co-infection cases. […] Some streptococcal strains may be more likely to cause necrotizing fasciitis. Commonly involved strains, such as those containing M protein types 1, 3, 12, and 28, typically produce pyrogenic exotoxin A1. […] Certain systemic or local immunocompromising conditions increase the risk of getting necrotizing fasciitis, including: […] Corticosteroid therapy has been shown to be a predisposing factor. […] While rare, when necrotizing fasciitis occurs it frequently happens after trauma or surgery. […] Amputations are a common complication of necrotizing fasciitis. […] In the most recent 5 years, the mortality rate of streptococcal necrotizing fasciitis has been around 13 to 18%. It increases with age of the person affected and the presence of streptococcal toxic shock syndrome.

• #58 Necrotizing fasciitis – Symptoms, diagnosis and treatment | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/821

  Necrotizing fasciitis is a life-threatening subcutaneous soft-tissue infection that requires a high index of suspicion for diagnosis. […] Infection may be polymicrobial in etiology (type I) due to mixed anaerobic/facultative anaerobic organisms, or due to a single organism (type II), most commonly Streptococcus pyogenes, also called group A streptococcus. […] Type I necrotizing fasciitis is a polymicrobial infection with an anaerobe such as Bacteroides, Peptostreptococcus, or Clostridium and facultative anaerobes such as certain Enterobacterales or non-group A streptococcus. […] Type II necrotizing fasciitis is most commonly a monomicrobial infection with typically Streptococcus pyogenes (group A streptococci) or occasionally Staphylococcus aureus. […] Other infectious etiologies may rarely cause a monomicrobial necrotizing infection that may be associated with specific exposures or risk factors (e.g., freshwater exposure associated with Aeromonas hydrophila, saltwater exposure or consumption of raw oysters associated with Vibrio vulnificus, recent travel to [or living in] Taiwan, where Klebsiella pneumoniae is a common cause of monomicrobial infection).

• #59

  https://journals.lww.com/jaaos/fulltext/2009/03000/necrotizing_fasciitis.6.aspx

  Necrotizing fasciitis is a rare but life-threatening soft-tissue infection characterized by rapidly spreading inflammation and subsequent necrosis of the fascial planes and surrounding tissue. […] Infection typically follows trauma, although the inciting insult may be as minor as a scrape or an insect bite. […] Often caused by toxin-producing, virulent bacteria such as group A streptococcus and associated with severe systemic toxicity, necrotizing fasciitis is rapidly fatal unless diagnosed promptly and treated aggressively. […] The single most important variable influencing mortality is time to surgical debridement. […] Thus, a high degree of clinical suspicion is necessary to avert potentially disastrous consequences.

• #60 Necrotizing fasciitis not always caused by bacteria but by a combination of tissue damage and a gene defect | HUS

  https://www.hus.fi/en/newsroom/necrotizing-fasciitis-not-always-caused-bacteria-combination-tissue-damage-and-gene-defect

  A new Finnish-led study suggests that necrotizing fasciitis, a life-threatening inflammation of connective tissue that leads to tissue necrosis, may be caused by a gene defect. […] Severe fasciitis has previously been thought to be caused by so-called carnivorous bacteria. Previously, the same Finnish researchers discovered a form of fasciitis that occurs as a result of a routine procedure or tissue damage combined with a gene defect in the patient’s genome. This is when the body overreacts to tissue damage and causes inflammation. Bacteria are often not found at all or the infection is of minor importance. […] Researchers have found an inflammation-activating defect in the NFKB1 gene in three Finnish and three foreign pediatric and adult patients with severe fasciitis. NFKB1 is one of the most important genes regulating the immune system.

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