Signs, Symptoms, and Diagnosis of Necrotizing Fasciitis
- Fever, swelling, and excessive pain
- Skin changes similar to cellulitis or abscess
- Hardening of the skin and soft tissue
- Formation of bullae and bleeding into the skin
- Presence of gas in tissues and reduced sensation over the skin
- Necrotizing fasciitis producing gas in soft tissues as seen on CT scan
- Necrotizing fasciitis as seen on ultrasound
- Micrograph of necrotizing fasciitis showing necrosis of connective tissue
- Early diagnosis is difficult as it often resembles a simple skin infection
- Laboratory and imaging modalities can raise suspicion but not rule out the disease
- Plain radiography may show subcutaneous emphysema
- CT scan and MRI are more sensitive modalities than plain radiography
- CT scan may show fascial thickening, edema, subcutaneous gas, and abscess formation
- MRI can detect fluid collection with deep fascia involvement
- Ultrasonography can show superficial abscess formation but is not sensitive enough for diagnosis
- White blood cell count and serum sodium level can detect necrotizing soft tissue infection
- The laboratory risk indicator for necrotizing fasciitis (LRINEC) score is commonly used
- LRINEC score uses six laboratory values to determine likelihood of necrotizing fasciitis
- A score of 6 or more indicates serious consideration of necrotizing fasciitis
- Scoring system values should be interpreted with caution and validated

Causes and Risk Factors of Necrotizing Fasciitis
- Trauma, such as intravenous drug injection or animal bites
- Skin infections, like abscess or ulcers
- Spreading of infection through blood
- Fournier gangrene in the perineum and genitals
- Immunocompromised individuals may not show typical symptoms
- Immunocompromised conditions like diabetes, cancer, or HIV/AIDS
- Alcoholism, drug abuse, smoking
- Malignancies and chronic systemic diseases
- Trauma or surgery in the perineum and genitals
- Poor wound care and handwashing

Bacteria Associated with Necrotizing Fasciitis
- Types of soft-tissue necrotizing infection divided into four classes
- Type I infection caused by a mixture of bacterial types
- Gram-positive cocci like Staphylococcus aureus and Streptococcus pyogenes
- Gram-negative rods like Escherichia coli and Pseudomonas aeruginosa
- Anaerobes like Bacteroides and Clostridium species

Treatment and Management of Necrotizing Fasciitis
- Surgery to remove infected tissue
- Intravenous antibiotics, often a combination
- Delays in surgery associated with higher risk of death
- Risk of death between 25 and 35%
- Necrotizing fasciitis occurs in about 0.4 people per 100,000 per year in the U.S. and about 1 per 100,000 in Western Europe.
- Good wound care and handwashing can partly prevent necrotizing fasciitis

Prognosis, Complications, and Epidemiology of Necrotizing Fasciitis
- Necrotizing fasciitis affects approximately 0.4 in every 100,000 people per year in the United States.
- About 1,000 cases of necrotizing fasciitis occur per year in the United States.
- Rates of necrotizing fasciitis have been increasing, potentially due to increased awareness and reporting, bacterial virulence, or antibiotic resistance.
- In some areas of the world, the prevalence of necrotizing fasciitis is as high as one in every 100,000 people.
- Higher rates of necrotizing fasciitis are observed in individuals with obesity, diabetes, immunocompromised states, alcoholism, or peripheral artery disease. However, it can also occur in healthy adults.
- Hippocrates described necrotizing soft tissue infection in the fifth century BCE.
- The term 'necrotizing fasciitis' was first coined by Wilson in 1952.
- Various names have been used to describe necrotizing soft tissue infections throughout history.
- Hospital gangrene became a commonly used term.
- Fournier gangrene, a necrotizing infection of the perineum and scrotum, was described by Dr Jean-Alfred Fournier in 1883.
- Necrotizing fasciitis has gained media attention with sensationalistic headlines.
- Notable individuals, including politicians, musicians, and authors, have been affected by necrotizing fasciitis.
- Lucien Bouchard, former premier of Québec, lost a leg to the disease.
- Ken Kendrick, former agent and partial owner of the San Diego Padres and Arizona Diamondbacks, contracted the disease but fully recovered.
- Edgar Savisaar, an Estonian politician, had his leg amputated due to necrotizing fasciitis.
- Lucien Bouchard, future premier of Québec, lost a leg to the illness.
- A cluster of cases occurred in Gloucestershire, England, resulting in deaths and media coverage.
- Don Rickles, American comedian, contracted the disease in his left leg and underwent multiple surgeries.
- Eric Allin Cornell, Nobel Prize-winning physicist, lost his left arm and shoulder to the disease.
- Georgie Henley, British actress, contracted the disease while studying at Cambridge University and nearly died.
- Necrotizing fasciitis has a high mortality rate, ranging from 20% to 40%.
- Early diagnosis and prompt surgical intervention are associated with better outcomes.