Erysipelas and necrotizing fasciitis

Abstract

The clinical course of necrotizing fasciitis in 8 patients is compared with observations on 22 other patients with erysipelas. In necrotizing fasciitis the early erythematous areas turn into a dusky blue colour with later vesiculation and formation of bullae. An important finding is a non-pitting oedema extending outside the erythematous patches. The disease often progresses and involves further skin areas proximal to the initial ones. Gangrene tends to follow in multiple sites after the 1st week of illness. Group A streptococci in conjunction with widespread thrombosis and vascular necrosis of the involved skin are two major factors in the pathogenesis of the gangrene. Early debridement and excision of necrotic tissue in combination with large doses of penicillin and cloxacillin are confirmed as mandatory to remove toxaemia and inhibit further necrosis of the skin. In 3 of the 8 patients with necrotizing fasciitis the syndrome of disseminated intravascular coagulation complicated the course of the disease. A promising therapeutic result was seen in 2 further patients exhibiting alarming signs and symptoms of early necrotizing fasciitis; the combination of heparin, given intravenously in therapeutic doses guided by activated partial thromboplastin time studies, and of systemic antibiotics alleviated the symptoms, which vanished within 10 days of the start of treatment.

Necrotizing Fasciitis Due to Group A Streptococci: A Clinicopathological Study of Six Patients

“…Despite Meleney's observation, the type II form has been less frequently encountered in recent studies of necrotizing fasciitis (4)(5)(6). In addition, the form due to pure group A streptococci alone seems to be particularly rare, because of its frequent combination with S. aureus (7). However, beginning in the late 1980s, cases of invasive group A streptococcal infections, in which necrotizing fasciitis is the most common presentation (about 50%), have appeared in the United States and elsewhere (8)(9)(10)(11)(12).…”

Life Threatening Complication during Treatment of Erysipelas due to Undiagnosed Ischemia of the Calf

“…The rapidly developing necrosis and ulceration within two weeks before admission could be due to necrotizing fascitis when gangrene tends to follow in multiple sites. Infections with widespread thrombosis and vascular necrosis of involved skin are two major factors in pathogenesis of gangrene [3]. Early debridement can prevent the spread of necrosis what proved to be very effective in our case.…”

Necrotizing Fasciitis in Infancy: Report of Three Cases and Review of the Literature

“…The differential diagnosis includes erysipelas, cellulitis, clostridial myonecrosis, progressive bacterial gangrene (Meleney's ulcer), pyoderma gangrenosum, vasculitis, and purpura fulminans (21,22).…”