Risk factors •
Clinical Features •
Diffuse Necrotizing Infection
Difficult to diagnose •
Extremely toxic •
Spread rapidly •
May lead to limb amputation •
@ Colistridial :
# Necrotizing cellulitis
@ Non-colistridial :
# NECROTIZING FASCIITIS
# Streptococcal gangrene
It is a progressive, rapidly spreading,
inflammatory infection located in the deep
fascia with 2ry necrosis of the
Immunocompression illnesses •
e.g.: DM, Cancer, alcoholism, vascular
insufficiency, organ transplant, HIV or
Trauma or foreign bodies in surgical wound. •
Idiopathic as scrotal or penile necrotizing •
It is a mixed microbial flora:
# microaerophilic streptococci.
# aerobic gram –ve
# anaerobes ( peptostreptococi –
Mortality & Morbidity
The overall morbidity & mortality is 70 –
Fournier’s gangrene has a reported mortality
as high as 75%
Sex: Male : Female 3:1
* the mean age is 38 to 44
* pediatric cases are rare but
reported from countries where
poor hygiene in.
*sudden onset of pain and swelling at
the site of trauma or recent surgery.
*in some cases, the symptoms may
begin at the site distant from the initial
*Fournier's gangrene begin with pain
and itching of the scrotal skin.
Clinical Features (cont.)
* pt. appears moderately to severely toxic (but sometimes
might looks well)
* typically, erythema that quickly spread over a course of hours
* the redness quickly spread & the margin of infection move
out into normal skin without being raised nor sharply demarcated.
*I.M. injections & I.V. infusions may lead to necrotizing fasciitis.
*minors insect bites may set the stage for necrotizing infections.
Lab: CBC, U&E, Glu, Creatinine, Blood &
tissue cultures, Urine analysis, &
# X-ray gas in the subcutaneous
?? D.D. of subcutaneous gas in a
# C.T. demonstrating necrosis with
asymmetric fascial thickening
& gas in the tissues.
Gram stain & wound culture
Biopsy is the best method to use to obtain
proper cultures for micro-organisms.
Emergency Department care
If streptococci are the identified major pathogens,
the D.O.C is Penicillin-G with clindamycin as an
To ensure adequate treatment, we have to cover
aerobic & anaerobic bacteria.
The anaerobic coverage can be provided by
Metronidazole or 3rd generation cephalosporin's.
Gentamicine combined with clindamycine or
chloramphenicol has been reported as a
Ampicilline may be added to the basic
regimen to treat enterococci if suspected
by gram stain.
Further In-Patient Care
Surgical debridment. •
Renal Failure. •
Septic Shock with cardiovascular collapse. •
Scarring with cosmetic deformity. •
Early in the course of the disease,
necrotizing fasciitis may appear quiet
Be wary of the patient with pain out of the
proportion to physical finding.