1. Necrotizing fasciitis
Rapidly spreading destructive disease of the fascia.
Deep-seated infection of the subcutaneous tissue that progressively destroys fascia and fat but may spare the skin and muscle
Usually attributable to Group A Streptococci
Other etiologies: Mixed aerobe and anaerobe (Clostridium perfringens, Peptostreptococcus, Burkholderia and Bacteroides spp.)
Risk factors: Surgeries, Diabetes, Peripheral vascular disease
Harrison's Principles of Internal Medicine, 17th ed.

2. Necrotizing fasciitis
61-year-old Chinese man with a history of psoriasis and alcoholic liver cirrhosis sought treatment for left ankle swelling, erythema, and tenderness
could not recall any antecedent trauma to the affected limb
Febrile
Progression to formation of blisters, extensive subcutaneous tissue and fascial necrosis, loss of resistance of the normally adherent superficial fascia to blunt dissection, and foul-smelling “dishwater” pus

3. Necrotizing fasciitis
Culture: Burkholderia pseudomallei. (Endemic to Southeast Asia, Taiwan, China, Central and South America, and northern Australia)
sporadic infections occur throughout the world
Yi-Shi Wang, Chin-Ho Wong, and Asok Kurup. Cutaneous Melioidosis and Necrotizing Fasciitis Caused by Burkholderia pseudomallei. 2003

4. Necrotizing fasciitis
(Group A Streptococci) A. Definite case 1. Necrosis of soft tissues with involvement of the fascia PLUS 2. Serious systemic disease, including one or more of the following: a) Death b) Shock (systolic blood pressure <90 mm of Hg). c) Disseminated intravascular coagulopathy

5. Necrotizing fasciitis
d) Failure of organ systems
a. respiratory failure
b. liver failure
c. renal failure
3. Isolation of group A Streptococcus from a normally sterile body site

6. Necrotizing fasciitis
B. Suspected case and serologic confirmation of group A streptococcal infection by a 4-fold rise against: a) streptolysin O b) DNase B and histologic confirmation: Gram-positive cocci in a necrotic soft tissue infection

7. Usual Clinical Course
24 hours of the initial lesion— mild erythema, swelling, heat
Next 24 to 48 hours-the erythema changed from red to purple and then to blue, and blisters and bullae, which contained clear yellow fluid
Days 4 and 5- the purple areas became gangrenous.
Day 7 to day 10- the line of demarcation became sharply defined, and the dead skin began to separate at the margins or breaks in the center, revealing an extensive necrosis of the subcutaneous tissue.

8. Necrotizing fasciitis
More severe cases: the process advanced
rapidly until several large areas of skin became
gangrenous, and the intoxication rendered the patient dull, unresponsive, mentally cloudy, or even delirious.
Streptococcal Toxic-Shock Syndrome:Spectrum of Disease, Pathogenesis, and New
Concepts in Treatment
Dennis L. Stevens, Ph.D., M.D.
Emerging infectious Diseases Vol.1 No.3 July-Sept 1995