Necrotizing Fasciitis, (Flesh Eating Disease) A Simple Guide To The Condition, Diagnosis, Treatment And Related Conditions

This book describes the Necrotizing Fasciitis, Diagnosis and Treatment and Related Diseases
I had a Malay female patient who used to see me for minor coughs and cold.

She was 50 years old and was walking through a grass area bringing her grandson to school when she developed rashes on her right leg.

That very night she developed high fever so her children sent her to hospital.

In the hospital her rash on her right spread quickly and become ulcerating.

The doctors there had to do emergency surgery to remove the infected flesh in order to save her leg.

The tissues removed were sent for microscopic examination and culture.

The cause was necrotizing fasciliitis or flesh eating disease.

She was eventually discharged after 1 month after the wound healed leaving a long hole in her leg where the muscles were removed.

Her life was saved as a result of the emergency surgery but the deep hollow in her leg would always remind her of her ordeal.

That was 15 years ago and her grandson is already 22 years old and working.

She passed away from a heart attack 5 years ago.

It was a frightening experience for her and her grandson.

It was my first and last case of necrotizing fasciliitis seen by me in my 45 years of practice as a doctor.

Necrotizing Fasciitis is a rare medical disorder that is caused by a very severe type of bacterial infection.

It can injure the muscles, skin, and underlying tissue.

The word "necrotizing" indicates something that causes body tissue to die.

Necrotizing fasciitis (NF) is an infrequent but life-threatening infection.

It is described as a destructive infection affecting any layer of the deep soft tissue compartment (dermis, subcutaneous tissue, fascia or muscle)

1. Necrotizing fasciitis is difficult to diagnose in its early stages, as it imitates cellulitis.

2. Important early signs are:

a. Pain,

b. Tenderness and

c. Systemic illness out of proportion to the localized physical signs

3. Bullae and ecchymotic skin lesions also indicate the condition (not found with cellulitis).

4. A high index of suspicion is required.

5. Suspected cases should be referred immediately.

6. Prompt surgical debridement is important.

A high index of suspicion is required when a patient manifests with cutaneous infection causing swelling, pain and erythema, especially if the patient also has diabetes, malignancy, alcohol abuse, or chronic liver or kidney disease.

The presence of bullae or gas on plain X-ray can be diagnostic.

Early surgical exploration is advised when there is any uncertainty of the diagnosis.

During surgery, the diagnosis of NF is made on its macroscopic features, which are:

1. Grey necrotic tissue,

2. Lack of bleeding,

3. Thrombosed vessels,

4. 'Dishwater pus',

5. Lack of resistance to finger dissection

6. Non-contracting muscle

The following tests may help to identify necrotizing infection where the medical picture is uncertain.

1. Blood tests - may show leukocytosis, acidosis, altered coagulation profile, hypoalbuminaemia and abnormal renal function.

2. Bedside finger test:

This is carried out under local anesthesia.

TABLE OF CONTENT

Introduction

Chapter 1 Necrotizing Fasciitis

Chapter 2 Causes

Chapter 3 Symptoms

Chapter 4 Diagnosis

Chapter 5 Treatment

Chapter 6 Prognosis

Chapter 7 Cellulitis

Chapter 8 Abscess

Epilogue