Materiały źródłowe

• #1 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

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

  Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. The infection typically travels along the fascial plane, which has a poor blood supply. The overlying tissues are initially unaffected, potentially delaying diagnosis and surgical intervention. The infectious process can rapidly spread, causing infection of the fascia and perifascial planes and secondary infection of the overlying and underlying skin, soft tissue, and muscle. […] 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. […] The infection rapidly transits the muscle fascia. After several days, the overlying skin, which initially appears unaffected, will transition to an erythematous, reddish-purple to bluish-gray hue. The skin’s texture will become indurated, swollen, shiny, and warm in temperature. At this stage, the skin is exquisitely tender to palpation and can also be painful and out of proportion to presenting symptoms. Skin breakdown will begin in 3 to 5 days and is accompanied by bullae and cutaneous gangrene. Pain is reduced in the affected area secondary to thrombosed small vessels and the destruction of the subcutaneous tissues’ superficial nerves. Advanced stages of the infection are characterized by systemic symptoms such as fever, tachycardia, and sepsis.

• #2 Necrotizing fasciitis – Wikipedia

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

  Symptoms include red or purple or black skin, swelling, severe pain, fever, and vomiting. […] Symptoms emerge very quickly, often within hours. […] Rapid progression to shock despite antibiotic therapy is another indication of necrotizing fasciitis. […] The initial skin changes are similar to cellulitis or abscess, so diagnosis in early stages may be difficult. […] Later signs more suggestive of necrotizing changes (but only present in less than half of cases) are: Bullae (blisters), Crepitus (palpable gas in tissues), Reduced or absent sensation over the skin of the affected area, Ecchymosis (bruising) that progresses to skin necrosis. […] The affected area may need to be debrided several times, usually once every 12-36 hours. […] Despite high-quality treatment, the risk of death remains between 25 and 35%.

• #3 Necrotising fasciitis

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

  Symptoms of necrotising fasciitis can develop quickly within hours or over a few days. […] At first you may have: intense pain or loss of feeling near to a cut or wound the pain may seem much worse than you would usually expect from a cut or wound, swelling of the skin around the affected area, flu-like symptoms, such as a high temperature, headache and tiredness. […] Later symptoms can include: being sick (vomiting) and diarrhoea, confusion, black, purple or grey blotches and blisters on the skin (these may be less obvious on black or brown skin). […] Necrotising fasciitis gets worse quickly and can be fatal. It must be treated in hospital as soon as possible.

• #4 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. […] Necrotizing fasciitis should be suspected in any patient with a rapidly progressing soft-tissue infection and any of the following: severe pain (disproportionate to the clinical findings) or anesthesia over the site of infection; edema and erythema (edema will typically extend beyond the erythema); systemic signs of infection. […] However, necrotizing fasciitis can be easily missed because the patient may present earlier in the disease process with nonspecific signs and symptoms.

• #5 Signs, symptoms and diagnosis of necrotizing fasciitis experienced by survivors and family: a qualitative Nordic multi-center study

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6114743/

  Most of the participants experienced treatment delay and contacted healthcare several times before receiving correct treatment. […] Other important findings included the description of three stages of early disease progression with increase in symptom intensity. Pain experienced in necrotizing soft tissue infections is particularly excruciating and unresponsive to pain medication. Other common symptoms were dyspnea, shivering, muscle weakness, gastrointestinal problems, anxiety, and fear. […] Typical signs and symptoms of NSTI are first of all pain, with other responses including localized edema, erythema, fever, hypotension, perspiration, skin necrosis and crepitus. […] The intensity of pain escalated and most of the patients became bedridden due to muscular weakness. […] The signs and symptoms of infection described by the patients are displayed in Table 3. Symptoms of disease were present even during the first stage whereas signs of illness were typically present in the second and third stages. […] Our study suggested that the level of pain experienced in NSTI is particularly excruciating and unresponsive to over-the-counter pain medications.

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

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

  Necrotising fasciitis is difficult to diagnose in its initial stages, as it mimics cellulitis. […] Important early clues are pain, tenderness and systemic illness out of proportion to the localised physical signs. […] Necrotising fasciitis typically develops over a few days but can progress much more rapidly in some cases – eg, with infection with Vibrio spp. and A. hydrophila where it may be fatal within 48 hours. The typical development of symptoms and signs is: […] Severe, constant pain, out of proportion to the physical signs, is a notable feature. […] Systemic illness – malaise, tachycardia fever and dehydration. One review suggests that patients often 'feel worse than they have ever felt and don’t know why’. […] The affected area develops tense oedema, extending beyond the margin of erythema.

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

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

  Skin becomes discoloured, progressing to grey necrosed skin which breaks down. […] Hypotension and septic shock develop. […] Patients become confused and apathetic. […] Fournier’s gangrene is a rapidly progressive form of infective necrotising fasciitis of the perineal, genital or perianal regions, leading to thrombosis of the small subcutaneous vessels and necrosis of the overlying skin.

• #7 Signs, symptoms and diagnosis of necrotizing fasciitis experienced by survivors and family: a qualitative Nordic multi-center study | BMC Infectious Diseases | Full Text

  https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-018-3355-7

  Most of the participants experienced treatment delay and contacted healthcare several times before receiving correct treatment. […] Other important findings included the description of three stages of early disease progression with increase in symptom intensity. Pain experienced in necrotizing soft tissue infections is particularly excruciating and unresponsive to pain medication. Other common symptoms were dyspnea, shivering, muscle weakness, gastrointestinal problems, anxiety, and fear. […] The narratives from patients and their family members provided a good picture of the disease manifestations. We present these in three stages of symptom severity that appear differently depending on the duration of disease onset. In the first stage the patients described flu-like symptoms that could last for a month during long inception. In the second stage, most patients and family started to feel that something was seriously wrong. The spectrum of symptoms included pain, malaise, shivering, fever and nausea. The intensity of pain escalated and most of the patients became bedridden due to muscular weakness. Patient and family became anxious as the disease felt life-threatening. The third stage included intensified pain, fear and anxiety with confusion, dizziness or fainting.

• #8 Necrotizing Fasciitis (Flesh-Eating Bacteria) Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/necrotizing-fasciitis-flesh-eating-bacteria/

  Necrotizing fasciitis is an infection caused by bacteria. It can destroy skin, fat, and the tissue covering the muscles within a very short time. […] The symptoms often start suddenly after an injury. You may need medical care right away if you have pain that gets better over 24 to 36 hours and then suddenly gets worse. The pain may be much worse than you would expect from the size of the wound or injury. You may also have: Skin that is red, swollen, and hot to the touch. A fever and chills. Nausea and vomiting. Diarrhea. […] The infection may spread rapidly. It quickly can become life-threatening. You may go into shock and have damage to skin, fat, and the tissue covering the muscles. (This damage is called gangrene.) Necrotizing fasciitis can lead to organ failure and death.

• #9 What is NF — Necrotizing Fasciitis Foundation

  https://www.necfasc.org/what-is-nf

  The symptoms often start suddenly after an injury. You may need medical care right away if you have pain that gets better over 24 to 36 hours and then suddenly gets worse. The pain may be much worse than you would expect from the size of the wound or injury. You may also have: […] The infection may spread rapidly. It quickly can become life-threatening. You may go into shock and have damage to the skin, fat, and the tissue covering the muscles. (This damage is called gangrene.) Necrotizing fasciitis can lead to organ failure and death.

• #10 Necrotising Fasciitis: Classification, Diagnosis, & Treatment

  https://www.theplasticsfella.com/necrotising-fasciitis/

  Necrotising fasciitis is a severe infection causing tissue death. Symptoms include severe pain and rapid tissue destruction, requiring immediate medical and surgical intervention to prevent high mortality. […] Initial symptoms are erythema, pain, blistering, and fever are non-specific. Late signs like crepitus and patchy necrosis. […] The symptoms and signs of necrotising fasciitis are non-specific, especially in the early stages of the disease, and given its rarity and high mortality a high index of suspicion is vital for prompt diagnosis. […] Symptoms: Pain out of proportion to clinical findings, Rapid clinical deterioration, Skin changes: blistering, swelling, redness, bluish discoloration. […] Local signs: Pain extending beyond the affected area of demarcated erythema, Skin changes: edema, erythema, hemorrhagic bullae, patchy necrosis (late), Subcutaneous: emphysema and crepitus, Discharge: foul-smelling, dishwater fluid appearance, Rapidly progressing. […] Systemic signs: Febrile: rigors, generalised malaise, and fatigue, Decreased mental capacity, Septic shock (hypotension, tachycardia), Multiorgan failure. […] Crepitus, skin anaesthesia, and necrosis are late signs and are pathognomonic for necrotising fasciitis.

• #11 Necrotizing fasciitis – EMCrit Project

  https://emcrit.org/ibcc/necfas/

  Pain is generally the most useful finding (although it’s only ~90% sensitive). […] Pain is often severe. […] Pain may extend beyond superficial erythema (unlike cellulitis). […] Absence of late skin findings should not dissuade you from pursuing a diagnosis of necrotizing fasciitis. […] Purple discoloration, or a bruised appearance. […] Blistering or bullae may occur. […] These may become hemorrhagic (yielding characteristic violaceous bullae an extremely worrisome finding). Hemorrhagic bullae are ~96% specific for necrotizing fasciitis. […] Patients may look fine initially, or they may appear quite toxic. […] Fever is present in only ~25-40% of patients on admission. […] Patients with Type II necrotizing fasciitis due to group A streptococcus often have early manifestations of toxic shock (e.g. nausea/vomiting, diarrhea, fever, myalgias). The constellation of these flu-like systemic features plus extremity pain should be suggestive of necrotizing fasciitis plus toxic shock.

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

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

  Early symptoms of this condition include signs and symptoms that resemble those of the flu: […] The progression of necrotizing fasciitis is very quick. Later signs and symptoms include: […] Its important to seek care quickly if you have developed signs and symptoms of necrotizing fasciitis as this infection spreads fast. […] Necrotizing fasciitis (flesh-eating disease) gets worse quickly, destroying your tissue and causing things like organ failure. Even with treatment, 1 out of 3 people dies from this disease. […] You may see symptoms of necrotizing fasciitis within 24 hours of getting scratched, bit, or cutting yourself. Necrotizing fasciitis gets worse quickly. Keep an eye out for areas that look swollen or red and that continue to get bigger.

• #13 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. […] Symptoms appear usually within 24 hours of a minor injury. Pain is often very severe at presentation and worsens over time. There may be flu-like symptoms, such as nausea, fever, diarrhoea, dizziness and general malaise. […] The affected area starts to swell and may show a purplish rash. Large dark marks form that turn into blisters filled with dark fluid. The wound starts to die and area becomes blackened (necrosis). Oedema is common. A fine crackling sensation under the skin (crepitus) is due to gas in the tissues. Severe pain continues until necrosis/gangrene destroys peripheral nerves when the pain subsides. The infection may not improve when antibiotics are given.

• #13 Necrotising fasciitis

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

  By about days 4-5, the patient is very ill with dangerously low blood pressure and high temperature. The infection has spread into the bloodstream and the body goes into toxic shock. The patient may have altered levels of consciousness. […] Prompt diagnosis and treatment are essential to reduce the risk of death and disfigurement from necrotising fasciitis. 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.

• #14 Necrotising fasciitis — symptoms, treatment | healthdirect

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

  The bacteria can cause a severe infection throughout your body (sepsis). It can also form blood clots in a vein or artery (thrombosis). This can cause symptoms such as: high temperature (fever) and chills; low temperature; fast heart rate; having very little or no urine output (weeing); feeling exhausted, confused or sleepy; flu-like symptoms such as nausea, diarrhoea, dizziness and a general feeling of being unwell.

• #14 Necrotising fasciitis — symptoms, treatment | healthdirect

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

  Necrotising fasciitis can affect many parts of your body. For example, your arms, buttocks, trunk, head or neck. The most common area of infection is the lower leg. Early symptoms can quickly become severe. […] Look out for early symptoms, such as: skin that first looks normal but then quickly turns red, purple, or blue; skin becomes swollen, shiny and warm; extreme tenderness and pain in or around the area of a wound. […] Treat worsening symptoms promptly: skin begins to break down; blisters and dead skin tissue become visible; pain may lessen as your small blood vessels get blocked and nerves are damaged. […] If you or someone else is having trouble breathing, or if you have symptoms of stroke, heart attack or other signs of thrombosis, call triple zero (000) and ask for an ambulance.

• #15 Necrotising fasciitis

  https://www2.hse.ie/conditions/necrotising-fasciitis/

  Symptoms can develop quickly within hours or over a few days. […] Early symptoms may include: pain that seems much worse than you would expect from a cut or wound, loss of feeling near a cut or wound, swollen skin around the cut or wound, flu-like symptoms, such as a high temperature of 38 degrees Celsius and above, headache and tiredness. […] Later symptoms can include: getting sick (vomiting), diarrhoea, confusion, black, purple or grey blotches and blisters on your skin (these may be less obvious on black or brown skin). […] You must get treatment in a hospital quickly. […] Necrotising fasciitis gets worse quickly and you can die from it.

• #16 Necrotizing Fasciitis: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/necrotizing-soft-tissue-infection

  There may be oozing from the infected area, or it may become discolored as it decays. Blisters, bumps, black dots, or other skin lesions might appear. In the early stages of the infection, the pain will be much worse than it looks. […] Other symptoms of necrotizing fasciitis include fatigue, weakness, fever with chills and sweating, nausea, vomiting, dizziness, and infrequent urination. […] The outlook depends entirely on the severity of the condition. Early diagnosis is crucial for this dangerous, life-threatening infection. The earlier the infection is diagnosed, the earlier it can be treated. […] Without prompt treatment, this infection can be fatal. Other conditions that you have in addition to the infection can also have an impact on the outlook.

• #16 Necrotizing Fasciitis: Causes, Symptoms, and Treatment

  https://www.healthline.com/health/necrotizing-soft-tissue-infection

  Necrotizing fasciitis is a type of soft tissue infection. It can destroy the tissue in your skin and muscles as well as subcutaneous tissue, which is the tissue beneath your skin. […] This bacterial skin infection is rare in healthy people, but its possible to get this infection from even a tiny cut, so its important to be aware of the symptoms if youre at risk. You should see your doctor immediately if you have symptoms or believe that you may have developed the infection. Because the condition can progress quickly, its vital to treat it as early as possible. […] The first symptoms of necrotizing fasciitis may not seem serious. Your skin may become warm and red, and you may feel as if youve pulled a muscle. You may even feel like you simply have the flu. […] You can also develop a painful, red bump, which is typically small. However, the red bump doesnt stay small. The pain will become worse, and the affected area will grow quickly.

• #17 Necrotizing Fasciitis — Causes and Treatment | Everyday Health

  https://www.everydayhealth.com/necrotizing-fasciitis/guide/

  Symptoms of necrotizing fasciitis usually start within hours of an injury. […] Early on, you may notice: A skin infection that extends from the original source rapidly, Discomfort near the injury, Worsening of the pain that seems unusual for the type of injury, Flu-like symptoms such as chills, vomiting, diarrhea, dehydration, general malaise, weakness, muscle pain, and fever, Swollen, red, or hot skin and tissue. […] As the condition worsens, symptoms may include: Worsening of early symptoms, Dehydration and reduced urination, Drop in blood pressure and rapid heartbeat, All-over body rash that looks like a sunburn, Ulcers, blisters, or black spots on skin, Toxic shock (a life-threatening reaction). […] If toxic shock occurs, the organs begin to shut down, and death may soon follow.

• #18 What is necrotising fasciitis aka 'flesh-eating disease’? | Queensland Health

  https://www.health.qld.gov.au/newsroom/features/what-is-necrotising-fasciitis-aka-flesh-eating-disease

  Necrotising fasciitis is a rare and very serious infection. It can spread rapidly in the body and lead to sepsis, shock, organ failure and death. […] Symptoms appear usually within 24 hours of a minor injury. […] A red, warm, or swollen area of skin that spreads quickly. […] Severe pain, including pain beyond the area of the skin that is red, warm, or swollen. […] There may be flu-like symptoms, such as nausea, fever, diarrhoea, dizziness and general malaise (feeling unwell). […] Seek medical help as soon as possible if you have these symptoms after an injury or surgery.

• #19 Necrotizing Fasciitis: Symptoms, Diagnosis, and Treatment

  https://www.verywellhealth.com/necrotizing-fasciitis-5115254

  The condition is rare, but it progresses very quickly and if left untreated it could become severe enough to cause death. Therefore, its vital to seek immediate medical treatment any time symptoms of necrotizing fasciitis are present, particularly after an injury or a surgical procedure. […] The infection spreads rapidly. Often, an infected area of the skin can spread as fast as an inch every hour. […] Early symptoms of the condition include: An area of the skin that is warm, Erythema (a reddened area of the skin), Pain (the pain often radiates [spreads] beyond the area of the skin that is reddened), Swelling, Fever. […] When necrotizing fasciitis progresses to the late or advanced symptoms, a very high fever is usually involved (over 104 degrees Fahrenheit) or hypothermia (low body temperature) may occur. Dehydration can occur with constant piercing pain, and the infected skin may appear shiny, swollen, or feel hard to the touch (induration) due to swelling.

• #19 Necrotizing Fasciitis: Symptoms, Diagnosis, and Treatment

  https://www.verywellhealth.com/necrotizing-fasciitis-5115254

  As the condition progresses, necrotizing fasciitis can cause severe symptoms, these may include: Black spots on the skin, Skin ulcers, A change in skin color (including red, bronze, or violet-colored skin), Oozing pus from the skin ulcer, The presence of large, fluid-filled blisters (a sign that the tissue may be necrotizing or dying), Dizziness, confusion, Fatigue and weakness, Diarrhea, Nausea, Low blood pressure, Rapid heart rate. […] When the pain suddenly ceasesafter which it has been severethis can be a very late sign that may indicate the nerves have begun to die in the area. […] If left untreated, necrotizing fasciitis can cause toxic shock syndrome, which causes the bodys vital organs to shut down. Without treatment, the outcome is death.

• #20 Necrotizing Fasciitis: Treatment and Recovery – Nursing CE Central

  https://nursingcecentral.com/lessons/necrotizing-fasciitis-treatment-and-recovery/

  Necrotizing Fasciitis is a soft tissue infection that causes necrosis to the muscle fascia and subcutaneous tissue. […] This condition rapidly progresses over 24-48 hours and can cause significant damage that could lead to organ failure. […] The clinical signs and symptoms of necrotizing fasciitis can present similarly to cellulitis initially. […] A characterizing symptom of necrotizing fasciitis is pain that is unproportioned to the symptoms that are experienced. […] In the later stages of the infection, usually 24-48 hours into the infection, the pain may subside as the tissue dies. […] As the infection progresses systemic signs and symptoms appear. […] Black necrotic lesions then form, and the patient may lose feeling in the area. […] At this stage, organ failure can ensue from toxic shock which can lead to death.

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

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

  Early symptoms include fever, severe pain, and an infection that spreads quickly. […] Necrotizing fasciitis spreads very quickly. […] Later symptoms can include: Changes in the color of the skin, Diarrhea or nausea, Dizziness, Fatigue (tiredness), Pus or oozing from the infected area, Ulcers, blisters, or black spots on the skin. […] Necrotizing fasciitis is a very serious illness that requires hospital care. Antibiotics and surgery are typically necessary. […] Since necrotizing fasciitis can spread rapidly, patients often must get surgery quickly. It’s not unusual for someone with necrotizing fasciitis to end up needing multiple surgeries.

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

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

  The early symptoms of an infection with flesh-eating bacteria usually appear within the first 24 hours of infection. Symptoms are similar to those of other conditions like the flu or a less serious skin infection. The early symptoms are also similar to common post-surgical complaints, such as: […] Symptoms often include a combination of the following: […] More advanced symptoms happen around the painful infection site within 3 to 4 days of infection. They include: […] Critical symptoms, which often happen within 4 to 5 days of infection, include:

• #23 Necrotizing Fasciitis Clinical Presentation: History, Physical Examination

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

  Other indicative findings include edema extending beyond the area of erythema, skin vesicles, and crepitus. […] The fascial planes and muscle groups cannot be detected by palpation. […] Physical findings may not be commensurate with the degree of patient discomfort. Early in the disease course, the patient may look deceptively well; unfortunately, this may interfere with early detection, which is key to a favorable outcome. Soon, however, the patient will usually begin to appear moderately to severely toxic. […] Typically, the infection begins with an area of erythema that quickly spreads over a course of hours to days. The redness quickly spreads, and its margins move out into normal skin without being raised or sharply demarcated. As the infection progresses, the skin near the site of insult develops a dusky or purplish discoloration. Multiple identical patches expand to produce a large area of gangrenous skin, as the erythema continues to spread.

• #23 Necrotizing Fasciitis Clinical Presentation: History, Physical Examination

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

  Usually, the most important signs are tissue necrosis, putrid discharge, bullae, severe pain, gas production, rapid burrowing through fascial planes, and lack of classic tissue inflammatory signs. […] Local crepitation can occur in more than one half of patients. This is an infrequent finding, specific but not sensitive, particularly in cases of nonclostridial necrotizing fasciitis. […] Fournier gangrene in males begins with local tenderness, itching, edema, and erythema of the scrotal skin. This progresses to necrosis of the scrotal fascia. The scrotum enlarges to several times its normal diameter. If the process continues beyond the penile-scrotal region to the abdomen or the upper legs, the normal picture of necrotizing fasciitis can be seen. […] In males, the scrotal subcutaneous layer is so thin that most patients present after the skin is already exhibiting signs of necrosis. In 2-7 days, the skin becomes necrotic, and a characteristic black spot can be seen. Early on, this infection may resemble acute orchitis, epididymitis, torsion, or even a strangulated hernia. […] In women, Fournier gangrene acts more like necrotizing fasciitis because of the thicker subcutaneous layers involving the labia majora and the perineum.

• #23 Necrotizing Fasciitis Clinical Presentation: History, Physical Examination

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

  Diagnosis of necrotizing fasciitis can be difficult and requires a high degree of suspicion. In many cases of necrotizing fasciitis, antecedent trauma or surgery can be identified. Surprisingly, the initial lesion is often trivial, such as an insect bite, minor abrasion, boil, or injection site. Idiopathic cases are not uncommon, however. […] The hallmark symptom of necrotizing fasciitis is intense pain and tenderness over the involved skin and underlying muscle. The intensity of the pain often causes suspicion of a torn or ruptured muscle. This severe pain is frequently present before the patient develops fever, malaise, and myalgias. […] In some cases, the symptoms may begin at a site distant from the initial traumatic insult. Pain may be out of proportion to physical findings. Over the next several hours to days, the local pain progresses to anesthesia.

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

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

  Necrotizing fasciitis is a rapidly progressive infection that destroys deep soft tissues. Diagnosing necrotizing fasciitis can be difficult due to non-specific early symptoms. It usually begins with pain in the affected area accompanied by erythema, heat, swelling, and tenderness. The patient’s pain is usually out of proportion to the signs of the local skin infection. Within 24 to 48 hours, overlying skin may turn dusky, cutaneous ischemia develops, bullae form and fill with straw-colored fluid, and bullae progressively turn dark due to hemorrhagic fluid. Swelling progresses to brawny edema and then to dark-red induration. Affected tissues progressively darken from red to purple to blue to black. As gangrene sets in, skin becomes anesthetized as superficial nerves die. Indications of advanced disease include anesthesia, bullae, crepitus, ecchymosis, and necrosis. The lesions become sharply demarcated. As skin sloughs, a necrotic eschar forms, resembling a third-degree burn. In the extremities, infection may progress to compartment syndrome, requiring emergent fasciotomy.

• #25 Necrotizing Myositis / Fasciitis – Myositis Association Australia

  https://myositis.org.au/myositis/necrotising-myositis/

  Necrotizing Myositis/Fasciitis signs and symptoms: Pain or soreness, similar to that of a pulled muscle […] Flu-like symptoms, such as nausea, fever, diarrhea, dizziness and general illness […] A fine, crackling sensation under the skin (crepitus) […] Swelling and tenderness […] Redness and warmth […] Intense thirst […] Fatigue […] Weakness […] Rash […] Blisters filled with dark, foul-smelling fluid […] Skin discoloration, peeling and flakiness. […] Early signs of Necrotizing Myositis/Fasciitis are easily missed and are often confused for a minor, superficial infection. […] Overtime, as the infection rapidly spreads, pain and illness will worsen and become very severe. By about 4-5 days, the individual is very ill with a severe drop in blood pressure and high temperature. […] Critical symptoms: Altered levels of consciousness, Unconsciousness, Dangerously low blood pressure, High temperature, Toxic shock.

• #26 How Quickly Does Necrotising Fasciitis Spread?

  https://www.necrotisingfasciitis.co.uk/medical-negligence-solicitors/how-quickly-does-necrotising-fasciitis-spread/

  As the infection settles in, the chronic pain will continue as more and more tissue becomes necrotic. The skin at the site of infection will become red and hot to touch. Flu-like symptoms will also appear, indicating that the bodys immune system is attempting to eliminate the infection. This will happen as soon as the tissue has begun to break down. […] The tissue will continue to break down, becoming increasingly dark in colour. Eventually an open wound will develop. This wound will grow in size as the bacteria multiply and spread. The bacteria reproduce at a rapid rate, so the area of infected tissue will expand incredibly quickly. It is different in every case, but it is possible that a patient will have a large open wound within 48 hours of the onset of symptoms. […] If the infection is not treated at this stage, the bacteria will have spread so far that they have reached the lymph nodes and/or bloodstream. This will result in sepsis, a life-threatening condition that causes inflammation and clotting across the body. The heart will not be able to work properly and a patients blood pressure will become dangerously low. This is called septic shock.

• #26 How Quickly Does Necrotising Fasciitis Spread?

  https://www.necrotisingfasciitis.co.uk/medical-negligence-solicitors/how-quickly-does-necrotising-fasciitis-spread/

  Sepsis and septic shock will compromise function in the bodys organs. Within hours this will lead to organ failure and possibly death. […] Necrotising fasciitis therefore spreads extremely quickly. It is not possible to put an exact time frame on each phase as every patient is different. However, it is safe to say that if left untreated, a patients condition will become critical within a matter of days (if not before).

• #27 Pitfalls in Diagnosing Necrotizing Fasciitis | PSNet

  https://psnet.ahrq.gov/web-mm/pitfalls-diagnosing-necrotizing-fasciitis

  A high index of suspicion for NF is needed when SSTIs are encountered. […] In NF, early diagnosis and adequate debridement within 24 hours is the most important factor impacting survival. […] Symptoms may develop over a period of hours to several days. Patients presenting at an advanced stage may show signs of sepsis and systemic shock. […] Necrotizing fasciitis is a peculiar condition in which the skin manifestations apparent to the patient or health care provider lag behind the disease progression under the skin. […] In the initial stage of NF, the signs are nondescript and it may mimic a typical cellulitis. […] As the infective process progresses, the skin becomes increasingly tense and erythematous with indistinct margins. […] The local pain is replaced by numbness, which occurs from compression or infarction of the nerves.

• #28 Necrotizing Fasciitis | Types | Risk | Symptoms | Diagnosis | Treatment

  https://www.icliniq.com/articles/infectious-diseases/necrotizing-fasciitis

  Symptoms of necrotizing fasciitis usually appear after 24 hours of the entry of bacteria into the body. If the bacteria entered the body through a surgical wound, the patient would develop the following symptoms: Severe pain in the surgical site. Swelling or inflammation. Fever. Nausea. […] The other signs and symptoms include: Severe pain after a minor injury, such as a cut, abrasion, or opening. The area around the wound looks red and feels warm. Other flu-like symptoms include nausea, fever, chills, dizziness, diarrhea, malaise, and body pain. Dehydration results in intense thirst. […] Signs and symptoms that can develop at the site of infection within three to four days include: Purplish-blue skin rash with swelling. Violet marks that become blisters and are filled with foul-smelling fluid. Black scabs (necrotic scabs). Crackling sensation under the skin due to gas formation. Foul-smelling fluid drains from the wound. Gangrene – the tissues die and become discolored, peel, and flaky. […] If left untreated, necrotizing fasciitis can lead to a drastic drop in blood pressure, toxic shock, loss of consciousness, and death.

• #29 Necrotizing Fasciitis | Sepsis Alliance

  https://www.sepsis.org/sepsisand/necrotizing-fasciitis/

  The symptoms of necrotizing fasciitis are much like any type of infection, but they appear more rapidly and are more intense: […] The bacteria eat away at muscles, skin and underlying body tissues. Doctors must act fast to stop the infection before it spreads and before sepsis develops. […] If the infection is not treated quickly enough or properly, the result is often death.

• #30 What are the long-term effects of necrotising fasciitis?

  https://www.glynns.co.uk/necrotising-fasciitis/what-are-the-long-term-effects-of-necrotising-fasciitis.php

  Necrotising fasciitis is a fast-acting infection that affects and destroys the soft, deep tissue of the body, releasing toxins which destroy tissue and spreading until stopped by surgery. […] If the infection gets into the blood, it is likely to lead to blood-poisoning, a drop in blood pressure and multiple organ failure. […] Research has suggested that, even when patients survive, the experience of necrotising fasciitis can reduce their life expectancy. These patients seem to be left with an increased susceptibility to infections such as pneumonia, urinary tract infections and sepsis. […] Vital to surviving necrotising fasciitis and reducing the severity of long-term effects is the prompt diagnosis and treatment of the condition. The presence of red flag symptoms, such as fever, intense pain, diarrhoea and vomiting, especially in combination with the presence of a cut to the skin, whether through surgery, a wound, a cut or a bite should alert medical practitioners to the possibility of developing necrotising fasciitis and action should be taken immediately.

• #31 Necrotizing Soft-Tissue Infection – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/necrotizing-soft-tissue-infection

  Necrotizing soft-tissue infection is typically caused by a mixture of aerobic and anaerobic organisms that cause necrosis of subcutaneous tissue, usually including the fascia. Affected tissues become erythematous, warm, and swollen, resembling severe cellulitis, and pain develops out of proportion to clinical findings. Patients are acutely ill. The primary symptom of NSTI is intense pain. In patients with normal sensation, pain out of proportion to clinical findings may be an early clue. However, in areas denervated by peripheral neuropathy, pain may be minimal or absent. Affected tissue is warm, erythematous, and swollen and rapidly becomes discolored. Bullae, crepitus (resulting from soft-tissue gas), and gangrene may develop. Subcutaneous tissues (including adjacent fascia) necrose, with widespread undermining of surrounding tissue. Muscles may be spared initially but can be involved as the disorder progresses. Patients are acutely ill, with high fever, tachycardia, altered mental status ranging from confusion to obtundation, and hypotension. Patients may be bacteremic or septic and may require aggressive hemodynamic support.

• #31 Necrotizing Soft-Tissue Infection – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/bacterial-skin-infections/necrotizing-soft-tissue-infection

  Diagnosis of NSTI, made by history and examination, is supported by leukocytosis, elevated C-reactive protein, soft-tissue gas on x-ray, positive blood cultures, and deteriorating metabolic and hemodynamic status. […] Evidence of bullae, ecchymosis, fluctuance, crepitus, and systemic spread of infection requires immediate surgical exploration and debridement. The most common error is insufficient surgical intervention; repeat operation every 1 to 2 days, with further incision and debridement as needed, should be carried out routinely. […] All-cause mortality rate in treated patients is about 20 to 30%. Old age, underlying medical problems, delayed diagnosis and therapy, and insufficient surgical debridement worsen prognosis.

• #32 Necrotizing Fasciitis vs. Cellulitis: the signs and symptoms of skin and soft tissue infection | Burn and Reconstructive Centers of America

  https://burncenters.com/community/necrotizing-fasciitis-vs-cellulitis-the-signs-and-symptoms-of-skin-and-soft-tissue-infection/

  Early diagnosis is essential in limiting the damaging effects of this infection, but when it comes to diagnosing necrotizing fasciitis, it can be difficult, mainly if it develops as a secondary infection. […] Due to the rapidity at which necrotizing fasciitis spreads and the high mortality rate, treatment should be rendered as early in the infection process as possible. The treatment plans for necrotizing fasciitis are more aggressive than cellulitis and much more invasive. […] Necrotizing fasciitis is considered a medical emergency for the acute detrimental effects and the severe and common complications that contribute to this infections fatality. Even with treatment, necrotizing fasciitis can lead to the development of sepsis (generalized whole body infection), septic shock, organ failure and toxic shock syndrome. Other necrotizing fasciitis complications include severe scarring and amputation from removing dead or infected tissue.

• #33 Necrotizing fasciitis | EBSCO Research Starters

  https://www.ebsco.com/research-starters/consumer-health/necrotizing-fasciitis

  The skin at this point appears to be eaten away. […] The possibility exists that the underlying muscle adjacent to the fascia will become infected. […] In necrotizing fasciitis, the extremities and the area around the genitals and anus (perineum) are most commonly and extensively involved. […] The only lifesaving treatment available is extensive surgical debridement to remove the necrotic (dead) tissue and slow the spread of the bacteria. […] Because the infection spreads so rapidly, death often results even with heroic surgical and drug therapy unless the condition is diagnosed and treated early.

• #34 Necrotizing fasciitis (flesh-eating disease): Symptoms, causes, and m

  https://www.medicalnewstoday.com/articles/7884

  If the infection continues, the person may experience dehydration, a rapid heart rate, low blood pressure. […] The pain may, over time, become less as the bacteria destroy the tissues and nerves. If the infection affects vital organs, the person may experience confusion or feel delirious. […] Without effective treatment, the condition can lead to shock, and it can be fatal.

• #35 Necrotizing Fasciitis (Flesh-Eating Disease) | HealthLink BC

  https://www.healthlinkbc.ca/healthlinkbc-files/necrotizing-fasciitis-flesh-eating-disease

  Most often there is sudden onset of pain and swelling with redness at the site of a wound. Fever may also occur. The pain is often far greater than you would expect from the wound or injury. The pain can sometimes occur at a distance from the wound. It can spread quickly up the affected arm, leg or other body part. […] Remember, an important clue to this disease is very severe pain at the site of a wound.

• #36 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

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

  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.

• #36 Necrotizing Fasciitis – StatPearls – NCBI Bookshelf

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

  Necrotizing fasciitis is a subset of aggressive skin and soft tissue infections that cause muscle fascia and subcutaneous tissue necrosis. The infection typically travels along the fascial plane, which has a poor blood supply. The overlying tissues are initially unaffected, potentially delaying diagnosis and surgical intervention. The infectious process can rapidly spread, causing infection of the fascia and perifascial planes and secondary infection of the overlying and underlying skin, soft tissue, and muscle. […] 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. […] The infection rapidly transits the muscle fascia. After several days, the overlying skin, which initially appears unaffected, will transition to an erythematous, reddish-purple to bluish-gray hue. The skin’s texture will become indurated, swollen, shiny, and warm in temperature. At this stage, the skin is exquisitely tender to palpation and can also be painful and out of proportion to presenting symptoms. Skin breakdown will begin in 3 to 5 days and is accompanied by bullae and cutaneous gangrene. Pain is reduced in the affected area secondary to thrombosed small vessels and the destruction of the subcutaneous tissues’ superficial nerves. Advanced stages of the infection are characterized by systemic symptoms such as fever, tachycardia, and sepsis.

• #37 Necrotizing Fasciitis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/necrotizing-fasciitis-diagnosis/

  Necrotizing fasciitis is a rare but life/limb threatening disease and is a true surgical emergency. […] The hallmark is pain out of proportion to findings. The clinician should have a high level of suspicion and low threshold for surgical consultation in cases of severe pain, swelling, and fever. Furthermore, the physician should have a high index of suspicion for patients who present with severe pain in an anatomic area, with no other cause; necrotizing fasciitis may have severe pain as the ONLY symptom early on in the presentation. […] Early necrotizing fasciitis may present with no marks/lesions on the skin, and non-specific symptoms. […] Necrotizing fasciitis may follow minor trauma to the skin or varicella skin infection. A high index of suspicion is essential. Blood tests (elevated WBC, C-Reactive Protein, or CK) are non-specific. Typical labs drawn are CBC, eclectrolytes, BUN, CR (GFR), C Reactive Protein, INR, LFTs and an ECG. […] Presence of bullae or gas in tissue is a late finding with the latter usually only seen in Type III necrotizing fasciitis.

• #38 Initial skin necrosis presentation at emergency room was associated with fulminant clinical course and mortality in patients with Vibrio necrotizing fasciitis | Scientific Reports

  https://www.nature.com/articles/s41598-023-45854-1

  Necrotizing fasciitis (NF) is a life-threatening infection. Skin necrosis is an important skin sign of NF. […] Skin necrosis group had a significantly higher mortality rate than the non-skin necrosis group. […] All the patients in the skin necrosis group and 30 patients of non-skin necrosis group developed serous or hemorrhagic bullous lesions before operation (p=0.0003). […] Vibrio NF patients presenting skin necrosis at ER were significantly associated with fulminant clinical courses and higher mortality. […] The skin necrosis group had a significantly higher incidence of elevated APACHE score, postoperative intubation, ICU stay, shock, leukopenia, higher counts of banded leukocytes, elevated C-reactive protein (CRP), and lower serum albumin level. […] The purposes of this study was to investigate the initial skin conditions of Vibrio NF patients between ER to preoperative status, to compare the clinical and laboratory risk indicators of the skin necrosis group and non-skin necrosis group when they arrived at ER, and to evaluate whether initial cutaneous necrosis related to fulminant course and higher fatalities.

• #38 Initial skin necrosis presentation at emergency room was associated with fulminant clinical course and mortality in patients with Vibrio necrotizing fasciitis | Scientific Reports

  https://www.nature.com/articles/s41598-023-45854-1

  We found that the patients of skin necrosis group had a significantly higher incidence of WBC counts3500 cells/mm3 (normal ranges, 3500 to 11,000 cells/mm3), higher counts of banded leukocytes, elevated C-reactive protein (CRP), and lower serum albumin level than those patients in non-skin necrosis group. […] In conclusion, Vibrio NF patients presenting skin necrosis at ER were significantly associated with fulminant clinical courses and higher mortality.

• #39

  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. […] Necrotizing fasciitis is often initially misdiagnosed as a more benign soft-tissue infection. […] 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. […] Timely diagnosis, broad-spectrum antibiotic therapy, and aggressive surgical debridement of affected tissue are keys to the treatment of this serious, often life-threatening infection.

• #40 How someone gets flesh-eating bacteria, and other FAQs about necrotizing fasciitis | Ohio State Medical Center

  https://wexnermedical.osu.edu/our-stories/necrotizing-fasciitis-frequently-asked-questions

  Necrotizing fasciitis usually presents with tissue redness, swelling, severe pain or pain that’s out of proportion of physical exam findings, bruising, crepitus (abnormal popping or cracking sound in the joints and lungs) and fever. If you experience these symptoms, it’s important to seek emergency medical care as soon as possible. […] What makes necrotizing fasciitis so dangerous is that it progresses very rapidly (usually within hours) and can often trigger dangerous related conditions such as septic shock, multi-organ failure and loss of limbs, even when appropriate therapy and management is provided. Medical providers need to be acutely aware of patients who present with signs or symptoms that could point toward this life-threatening infection.

• #41 Necrotising fasciitis – Symptoms, diagnosis and treatment | BMJ Best Practice

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

  Necrotising fasciitis is a life-threatening subcutaneous soft-tissue infection that requires a high index of suspicion for diagnosis. […] Always suspect necrotising fasciitis in a patient with a rapidly progressing soft-tissue infection and any of the following: severe pain (disproportionate to the clinical findings) or anaesthesia over the site of infection; oedema and erythema (oedema will typically extend beyond the erythema); systemic signs of infection. However, necrotising fasciitis can be easily missed because the patient may present earlier in the disease process with non-specific signs and symptoms. […] If you suspect necrotising fasciitis, immediately refer the patient for urgent surgical debridement; do not wait for the results of investigations before referral. Necrotising fasciitis is a clinical diagnosis. However, investigations can support the diagnosis if this is unclear.

• #42 Symptoms Of Necrotising Fasciitis

  https://www.necrotisingfasciitis.co.uk/necrotising-fasciitis/symptoms/

  If treatment has not been provided within three to four days, critical symptoms will arise, including: Low blood pressure, Confusion, Septic shock, Unconsciousness. […] Two of the most telling signs are: An excruciating pain that does not tally with the level of trauma sustained (if an injury can even be detected); and Fever. […] Anyone who is displaying these symptoms of must go straight to hospital for assessment. All medical professionals should have an understanding of necrotising fasciitis, including a thorough knowledge of the symptoms involved. This should enable a quick diagnosis to be obtained, ensuring the infection is treated before it reaches the advanced stages.

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

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

  Necrotizing fasciitis is a term that describes a disease condition of rapidly spreading infection, usually located in the fascial planes of connective tissue that results in tissue necrosis (dead and/or damaged tissue). […] The symptoms and signs of necrotizing fasciitis vary with the extent and progression of the disease. […] Early in the course of the disease, patients with necrotizing fasciitis may initially appear deceptively well, and they may not demonstrate any superficial visible signs of an underlying infection. Some individuals may initially complain of pain or soreness, similar to that of a „pulled muscle.” However, as the infection rapidly spreads, the symptoms and signs of severe illness become apparent. […] Necrotizing fasciitis generally appears as an area of localized redness, warmth, swelling, and pain, often resembling a superficial skin infection (cellulitis). Many times, the pain and tenderness experienced by patients are out of proportion to the visible findings on the skin. Fever and chills may be present. Over the course of hours to days, the redness of the skin rapidly spreads and the skin may become dusky, purplish, or dark in color. Overlying blisters, necrotic eschars (black scabs), hardening of the skin (induration), skin breakdown, and wound drainage may develop.

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