Necrotizing fasciitis: review, recent concepts in etiopathogeny and diagnosis
Keywords:
FASCIITIS, NECROTIZING, ENVIRONMENTAL BIOMARKERS, SOFT TISSUE INFECTIONS, DIAGNOSISAbstract
Necrotizing fasciitis is part of the necrotizing infections of the soft tissues. It is a rare, but life-threatening condition, with different clinical manifestations and germs that progress in a similar way. In the musculoskeletal system this condition is mainly found in the limbs, its spreading is superficial and it causes local histic necrosis accompanied by severe systemic damage due to the release of bacterial toxins of Klebsiella, Clostridium, Escherichia coli, Staphylococcus aureus and Aeromonas hydrophila. However, group A Streptococcus is the commonest cause of the disease. The condition is presented with signs of pain and systemic toxicity, disproportionate to the findings of the cutaneous examination, what leads to suspect the presence of the disease. Even with an adequate treatment the condition has a high mortality. A bibliographic review article was carried out in order to bring concepts to date and highlight the recent progress in the study of necrotizing fasciitis. The following resources available in the Infomed network were used: PubMed, Hinari, The Cochrane Library and SciELO; MEDLINE and MedicLatina databases were accessed. Results of researches were compiled detailing the following contents: demography, comorbidities, epidemiology, classifications, etiology, mortality, diagnostic procedures, and biological and analytical risk indicators (LRINEC). There is controversy regarding the management, diagnostic procedures, results obtained with different procedures and there is no inter-observational uniformity. However, there is unanimous criterion concerning the special attention to be paid to clinical manifestations, advanced diagnosis and multidisciplinary care.
Downloads
References
Van Stigt SF, de Vries J, Bijker JB, Mollen RM, Hekma EJ, Lemson SM, et al. Review of 58 patients with necrotizing fasciitis in the Netherlands. World J Emerg Surg [revista en internet]. 2016 [citado 21 de septiembre 2017]; 11(1): 21. Disponible en: https://wjes.biomedcentral.com/articles/10.1186/s13017-016-0080-7.
Hernández GE; Mosquera BG; de la Rosa SV. Fasciitis necrotizante. Rev. Arch Med Camagüey [revista en internet]. 2015 [citado 21 de septiembre 2017]; 19(6). Disponible en: http://www.revistaamc.sld.cu/index. php/amc/article/view/3966.
Parra Caballero P, Pérez Esteban S, Patiño Ruiz M, Castaneda Sanz S, García Vadillo J. Actualización en fascitis necrotizante. Semin Fund Esp Reumatol [revista en internet]. 2012 [citado 21 de septiembre 2017]; 13(2): 41-48. Disponible en: https://www.sciencedirect.com/science/article/pii/S157735661100120 5.
Hakkarainen TW, Kopari NM, Pham TN, Evans HL. Necrotizing soft tissue infections: review and current concepts in treatment, systems of care, and outcomes. Curr Probl Surg [revista en internet]. 2014 [citado 21 de septiembre 2017]; 51(8): 344–362. Disponible en: http://www.currprobsurg.com/article/S0011-3840 (14)00104-X/abstract.
Goh T, Goh LG, Ang CH, Wong CH. Early diagnosis of necrotizing fasciitis. Br J Surg [revista en internet]. 2015 [citado 21 de septiembre 2017]; 101(1): e119–25. Disponible en: http://onlinelibrary.wiley.com/doi/ 10.1002/bjs.9371/full.
Hadeed GJ, Smith J, O'Keeffe T, Kulvatunyou N, Wynne JL, Joseph B, et al. Early surgical intervention and its impact on patients presenting with necrotizing soft tissue infections: A single academic center experience. J Emerg Trauma Shock. [revista en internet]. 2016 [citado 21 de septiembre 2017]; 9(1): 22–7. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766759/.
Jabbour G, El-Menyar A, Peralta R, Shaikh N, Abdelrahman H, Mudali IN, et al. Pattern and predictors of mortality in necrotizing fasciitis patients in a single tertiary hospital. World J Emerg Surg [revista en internet]. 2015 [citado 21 de septiembre 2017]; 11(1): 40. Disponible en: https://wjes.biomedcentral. com/articles/10.1186/s13017-016-0097-y.
Kiralj AI, Janjic Z, Nikolic J, Markov B, Marinkovic M. A 5-year retrospective analysis of necrotizing fasciitis – A single center experiences. Vojnosanit Pregl [revista en internet]. 2015 [citado 21 de septiembre 2017]; 72(3): 258–64. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663140/.
Pellicer García V, Gutiérrez C. Fascitis necrotizante fulminante tras inyección intramuscular glútea. Revista Española de Cirugía Osteoarticular [revista en internet]. 2015 [citado 21 de septiembre 2017]; 49(259). Disponible en: http://www.cirugiaosteoarticular.org/adaptingsystem/intercambio/.../2354_Art116.
Gosselin R A, Bickler S W, Al-Iedan AA A. Tropical Diseases and Orthopedics: En Global Orthopedics. New York, NY: Springer; 2014.p. 57-67.
Mzabi A, Marrakchi W, Alaya Z, Ben F, Rezgui A, Bouajina E, Kechrid Ch. Cellulitis in aged persons: a neglected infection in the literature. Pan African Medical Journal [revista en internet]. 2017 [citado 21 de septiembre 2017]; 27(1): 160. Disponible en: http://www.panafrican-medjournal.com/content/article/27/ 160/full/.
Ferrer-Lozano Y, Oquendo-Vázquez P, Asin L, Morejón-Trofimova Y. Diagnóstico y tratamiento de la fascitis necrosante. Medisur [revista en internet]. 2014 [citado 21 de septiembre 2017]; 12(2). Disponible en: http://www.medisur.sld.cu/index.php/medisur/article/view/2504.
Cheng CCh. Tai ChH, Chan SCh, Chang ChH, Lai HSh. Necrotizing fasciitis in patients with diabetes mellitus: clinical characteristics and risk factors for mortality. BMC Infectious Diseases [revista en internet]. 2014 [citado 21 de septiembre 2017]; 15(1): 417. Disponible en: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC4604726.
Neeki M, Dong F, Au C, Toy J, Khoshab N, Lee C, et al. Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department. Western Journal of Emergency Medicine [revista en internet]. 2017 [citado 21 de septiembre 2017]; 18(4). Disponible en: http://escholarship.org/uc/uciem_westjem.
Al Shukry S, Ommen J. Necrotizing Fasciitis-Report of ten cases and review of recent literature. Journal of Medicine and Life [revista en internet]. 2013 [citado 21 de septiembre 2017]; 6(2): 189-94. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725447/.
Kiat HJ, En YH, Lateef N, Lateef. Necrotizing Fasciitis: How Reliable are the Cutaneous Signs? J Emerg Trauma Shock [revista en internet]. 2017 [citado 21 de septiembre 2017]; 10(4): 205–210. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5663140/.
Chao WN, Tsai CF, Chang HR, Chan KS, Su CH, Lee YT, et al. Impact of timing of surgery on outcome of Vibrio vulnificus-related necrotizing fasciitis. Am J Surg [revista en internet]. 2013 [citado 21 de septiembre 2017]; 206(1): 32–9. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23414632.
Misiakos EP, Bagias G, Patapis P, Sotiropoulos D, Kanavidis P, Machairas A. Current concepts in the management of necrotizing fasciitis. Front Surg [revista en internet]. 2014 [citado 21 de septiembre 2017]; 1(2014): 36. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/25593960.
Kaafarani HM, King DR. Necrotizing skin and soft tissue infections. Surg Clin North Am [revista en internet]. 2014 [citado 21 de septiembre 2017]; 94(1): 155–63. Disponible en: https://www.ncbi.nlm.nih. gov/pubmed/24267503.
Yip HW, Wong OF, Lee HM. 12-year experience with necrotizing fasciitis in an Intensive Care Unit of a local regional hospital. Hong Kong J Emerg Med [revista en internet]. 2017 [citado 21 de septiembre 2017]; 23(5): 257–65. Disponible en: http://journals.sagepub.com/doi/abs/10.1177/102490791602300501#arti cleCitationDownloadContainer.
Szabo G, Saha B. Alcohol’s effect on host defense. Alcohol Res [revista en internet]. 2015 [citado 21 de septiembre 2017]; 37(2): 159–70. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590613/.
Alberts B, Johnson A, Lewis J, et al. In: Molecular Biology of the Cell. 4th ed. New York: Garland Science; 2002.
Arif N, Yousfi S, Vinnard C. Deaths from Necrotizing Fasciitis in the United States, 2003–2013. Epidemiol Infect [revista en internet]. 2016 [citado 21 de septiembre 2017]; 144(6): 1338–134 Disponible en: https://www.ncbi.nlm.nih.gov/pub/26548496doi:10.1017/S0950268815002745.
Das DK, Baker MG, Venugopal K. Risk factors, microbiological findings and outcomes of necrotizing fasciitis in New Zealand: a retrospective chart review. BMC Infect Dis [revista en internet]. 2012 [citado 21 de septiembre 2017]; 12(1): 348. Disponible en https://bmcinfectdis.biomedcentral.com/./10./1471-2334-12-34.
Kalaivani V, Hiremath BV. Necrotizing soft tissue infection risk factors for mortality. J Clin Diagn Res [revista en internet]. 2013 [citado 21 de septiembre 2017]; 7(8): 1662–5. Disponible en: https://www.ncbi. nlm.nih.gov/pmc/articles/PMC3782925/.
Swain RA, Hatcher JC, Azadian BS, Soni N, De Souza B. A five-year review of necrotizing fasciitis in a tertiary referral unit. Ann R Coll Surg Engl [revista en internet]. 2013 [citado 21 de septiembre 2017]; 95(1): 57–60. Disponible en: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964641/.
Yong-Cheng Vivian, Chia-Rong Hsieh, Cheng-Li Lin, Yu-Chiao Wang, Wei-Kung Chen. Alcohol use disorder increases the risk of necrotizing fasciitis. A nationwide retrospective cohort study. Medicine [revista en internet]. 2017 [citado 21 de septiembre 2017]; 96(32): e7509. Disponible en: https://www.ncbi.nlm.nih. gov/pmc/articles/PMC5556201/.
Slade T, Chiu W, Glantz M, Kessler R, Lago L, Sampson N, et al. A cross-national examination of differences in classification of lifetime alcohol use disorder between DSM-IV and DSM-5: Findings from the World Mental Health Survey. Alcohol Clin Exp Res. [revista en internet]. 2016 [citado 21 de septiembre 2017]; 40(8): 1728–1736. Disponible en: https://connects.catalyst.harvard.edu/profiles/profile/1232822.
Psoinos CM, Flahive J M, Shaw J J, Li Y, Ng S C, Tseng J F, et al. Contemporary trends in necrotizing soft tissue infections in the United States. Surgery [revista en internet]. 2013 [citado 21 de septiembre 2017]; 153(6): 819–827. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23453328
Ali SS, Lateef F. Laboratory risk indicators for acute NF in the emergency department setting. J Acute Dis. [revista en internet]. 2016 [citado 21 de septiembre 2017]; 5(2): 114–6. Disponible en: https://www. sciencedirect.com/science/article/pii/S2221618916000068.
Alayed KA, Tan C, Daneman N. Red flags for necrotizing fasciitis: a case control study. Int J Infect Dis. [revista en internet]. 2015 [citado 21 de septiembre 2017]; 36(2015): 15-20. Disponible en: https://www. ncbi.nlm.nih.gov/pubmed/25975653.
Ponce G. Cruz, Rodríguez P, Torres A, Muñoz M. Choque séptico por fascitis necrotizante secundario infección por varicela; tratamiento y uso de hemoglobina en espray en terapia intensiva. Pediátricas [revista en internet]. 2017 [citado 21 de septiembre 2017]; 26(2): 64-70. Disponible en: http://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=74337.
Oud L, Watkins P. Contemporary trends of the epidemiology, clinical characteristics, and resource utilization of necrotizing fasciitis in Texas: a population-based cohort study. Critical Care Research and Practice [revista en internet]. 2015 [citado 21 de septiembre 2017]; 2015 Disponible en: https:/www. hindawi.com/journals/ccrp/2015/618067/.
El-Menyar A, Asim M, Mudali I, Mekkodathil A, Latifi R, Al-Thani H. The laboratory risk indicator for necrotizing fasciitis (LRINEC) scoring: the diagnostic and potential prognostic role. Scand J Trauma Resusc Emerg Med [revista en internet]. 2017 [citado 21 de septiembre 2017]; 25(1): 28. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28270166.
Bechar J, Sepehripour S, Hardwicke J, Filobbos G. Laboratory risk indicator for necrotizing fasciitis (LRINEC) score for the assessment of early necrotizing fasciitis: a systematic review of the literature. Ann R Coll Surg Engl [revista en internet]. 2017 [citado 21 de septiembre 2017]; 99(5): 341-346. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/28462647.
Neeki MM, Dong F, Au C, Toy J, Khoshab N, Lee C, et al. Evaluating the Laboratory Risk Indicator to Differentiate Cellulitis from Necrotizing Fasciitis in the Emergency Department. Western Journal of Emergency Medicine [revista en internet]. 2017 [citado 21 de septiembre 2017]; 18(4). Disponible en: http://escholarship.org/uc/uciem_westjem.
Wong CH, Khin LW, Heng KS, Tan KC, Low CO. The LRINEC (Laboratory Risk Indicator for Necrotizing Fasciitis) score: a tool for distinguishing necrotizing fasciitis from other soft tissue infections. Crit Care Med. [revista en internet]. 2004 [citado 21 de septiembre 2017]; 32(7): 1535–1541. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/15241098.
Burner E, Henderson SO, Burke G, Nakashioya J, Hoffman JR et al. Inadequate sensitivity of laboratory risk indicator to rule out necrotizing fasciitis in the emergency department. West J Emerg Med [revista en internet]. 2016 [citado 21 de septiembre 2017]; 17(3): 333-6. Disponible en: https://www.ncbi.nlm.nih.gov /m/pubmed/27330667.
Wilson MP, Schneir AB. A case of necrotizing fasciitis with a LRINEC score of zero: clinical suspicion should trump scoring systems. J Emerg Med [revista en internet]. 2013 [citado 21 de septiembre 2017]; 44(5): 928. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/23287745.
Jones AE, Fiechtl JF, Brown MD, Ballew JJ, Kline JA. Procalcitonin test in the diagnosis of bacteremia: a meta-analysis. Annals of emergency medicine [revista en internet]. 2007 [citado 21 de septiembre 2017]; 50(1): 34-41. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/17161501.
Markanday A. Acute Phase Reactants in Infections: Evidence-Based Review and a Guide for Clinicians. Open Forum Infect Dis [revista en internet]. 2015 [citado 21 de septiembre 2017]; 2(3). Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/26258155.
Al-Thani H, El-Menyar A, Shaikh N, Mudali IN, Mekkodathil A, et al. Risk stratification of necrotizing fasciitis based on the initial procalcitonin concentration: A single center observational study. Surg Infect [revista en internet]. 2015 [citado 21 de septiembre 2017]; 16(6): 806-812. Disponible en: https://www.ncbi.nlm. nih.gov/pubmed/26280767.
Monares Zepeda E, Rodríguez Guillén J, Valles Guerrero A, Galindo Martín C, Corrales Brenes E, Suárez Cruz A. Validación de la «escala evaluación de fallo orgánico secuencial» (SOFA) con modificación del componente cardiovascular en la Unidad de Terapia Intensiva del Hospital San Ángel Inn Universidad. Med Crit [revista en internet]. 2016 [citado 21 de septiembre 2017]; 30(5): 319-323. Disponible en: http://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=70589.
Rhodes A, Evans L, Alhazzani W, Mitchell. Guía internacional para el manejo de la sepsis y el choque séptico. Actualización de las recomendaciones para el manejo de la sepsis y choque séptico de la "Campaña para la Supervivencia de la Sepsis”. Care Med [revista en internet]. 2017 [citado 21 de septiembre 2017]; 45(3): 486–552. Disponible en: http://www.survivingsepsis.org/SurvivingSepsisCampaig nInternationalSpanish2018.
Andriolo BNG, Andriolo RB, Salomão R, Atallah ÁN. Effectiveness and safety of procalcitonin evaluation for reducing mortality in adults with sepsis, severe sepsis or septic shock. Cochrane Database of Systematic Reviews [revista en internet]. 2017 [citado 21 de septiembre 2017]; 1(2). Disponible en: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010959.pub2/full.
Hoshino T, Omura K, Kimura S, 1 Takahashi H, Kamei K, Ohkusu M. A case of disseminated cryptococcosis with necrotizing fasciitis in a non‐HIV patient Acute Med Surg [revista en internet]. 2017 [citado 21 de septiembre 2017]; 4(4): 454–457. Disponible en: https://www.ncbi.nlm.nih.gov/pubmed/29123908.
Chakradeo K, Paul Chia YY, Liu C, Mudge D, De Silva J. Disseminated cryptococcosis presenting initially as lower limb cellulitis in a renal transplant recipient - a case report. BMC Nephrol [revista en internet]. 2018 [citado 21 de septiembre 2017]; 19(1): 18. Disponible en: https://bmcnephrol.biomedcentral.com/articles.
Che JLY, Ravins M, Hanski E, Chan SL. Complete Genome sequence of Streptococcus pyogenes emm14 JS95, a necrotizing fasciitis strain isolated in Israel. Genome Announce [revista en internet]. 2017 [citado 21 de septiembre 2017]; 5(11). Disponible en: https://doi.org/10.1128/genomeA.00025-17.
Downloads
Published
How to Cite
Issue
Section
License
This journal provides free and immediate access to its content under the principle that making research freely available to the public supports a greater exchange of global knowledge. This means that the authors transfer the copyright to the journal, so that copies and distribution of the contents can be made by any means, as long as the authors' acknowledgment is maintained. These terms are a reflection that the journal assumes copyright under Creative Commons licenses, specifically under a Creative Commons Attribution 4.0 International license.
Registration and submission of articles to the journal is free. The processing, including review, editing and publication, is completely free of charge.