Necrotizing Fasciitis: A Review

Abstract

Necrotizing fasciitis is a rapidly spreading, bacterial, soft-tissue infection reported in both humans and dogs. A review of the pathophysiology, clinical findings, diagnosis, and treatment of necrotizing fasciitis is presented, with the goal of familiarizing veterinarians with this uncommon but potentially fatal condition. A case report highlighting the fulminant course of this disease is also included.

Necrotizing fasciitis caused by Serratia marcescens after tooth extraction in a Doberman Pinscher: a case report

“…These signs were shown by the patient in the initial stages, however, fever, which is reported consistently (Jenkins et al, 2001;Naidoo et al, 2005;Worth et al, 2005), was not evident, so the initial differential diagnoses included cellulitis, lymphoedema and injection reaction, not fasciitis. Amoxicillin-clavulanic acid was chosen to provide initial broad spectrum, low toxicity antibacterial cover; allergy to it being considered unlikely.…”

“…Initial clinical findings of NF are reported to include localised erythaema, oedema and pain at the affected site (Naidoo et al, 2005). These signs were shown by the patient in the initial stages, however, fever, which is reported consistently (Jenkins et al, 2001;Naidoo et al, 2005;Worth et al, 2005), was not evident, so the initial differential diagnoses included cellulitis, lymphoedema and injection reaction, not fasciitis.…”

“…A minor skin injury is the usual portal of entry, signs of infection appearing a few days later (Naidoo et al, 2005). In man NF has occurred following injections (Rieger et al, 2007), trauma (Liu et al, 2005), surgery (Piper and West, 1995) and pyelonephritis (Paya et al, 1998).…”

“…The diagnosis is based on the clinical signs, which include localised erythema, oedema and pain of the affected area (Naidoo et al, 2005), surgical findings, histopathology results and positive culture of a recognised etiological agent (Liu et al, 2005).…”

“…Polymicrobial synergistic infection is identified in up to 54% of patients, with streptococci and enterobacteriaceae being most common co-isolates (Wong et al, 2003). Only a few reports of NF exist in the veterinary literature (Prescott et al, 1997;DeWinter et al, 1999;Naidoo et al, 2005;Worth et al, 2005), mostly caused by Streptococcus canis (Prescott et al, 1997;DeWinter et al, 1999), with one report of NF associated with Escherichia coli (Worth et al, 2005). Concurrent signs of systemic illness, shock and multiorgan failure are well recognised in severe streptococcal infections, and streptococcal toxic shock syndrome (STSS) sometimes accompanies streptococcal NF (Naidoo et al, 2005).…”