Causes and risk factors
This is a serious mixed infection caused due to hemolytic streptococci, staphylococci, peptostreptococci, E. coli, klebsiella, clostridium, and associated with excessive collagenase production, leading to dissolution of connective tissue. The infection involves the epifascial tissues of an operative wound, laceration, abrasion, or puncture. It may be immediately fulminant or may remain dormant for six or more days before beginning to spread rapidly. Risk factors include weakened immune system such as in case of diabetes, kidney disease, HIV, etc. Bacteria can spread rapidly once they enter the body. They invade fascia, connective tissue, fat, blood vessels, and nerves. Tissues adjacent to fascia are also affected.
Clinical presentation
The symptoms begin some hours post injury. Patient complains of soreness of muscles similar to that of a pulled muscle. The skin may appear warm and purple in color. There is swelling, ulcer, or blister on the skin. Surrounding skin becomes edematous, red, and inflamed. Ecchymosis is seen. Accompanied symptoms include fever with chills, malaise, and fatigue. Vomiting may be followed.
Investigation
Medical history by the patient and clinical examination by the doctor helps in diagnosis. CBC is recommended. Serum chemistry studies are done. Arterial blood gases are estimated. Urinalysis is done. Blood and tissue culture is obtained. CT scan and MRI will help in early diagnosis of the disease.
Treatment
Treatment involves administration of intravenous antibiotics. The bacteria may damage the tissue, hence surgical removal of the affected tissue is also required in some cases to stop further spread of infection.
Other Modes of treatment
The other modes of treatment can also be effective in treating necrotizing fasciitis. Homoeopathy is a science which deals with individualization and considers a person in a holistic way. This science can be helpful in combating the symptoms. Similarly, the Ayurvedic system of medicine which uses herbal medicines and synthetic derivates is also found to be effective in treating necrotizing fasciitis.
