Necrotizing fasciitis in children in eastern Ontario: a case-control study

Area of Science:

• Pediatric Infectious Diseases
• Dermatology
• Critical Care Medicine

Background:

• Necrotizing fasciitis (NF) is a severe soft-tissue infection requiring prompt treatment for improved survival.
• Distinguishing NF from less severe infections like cellulitis is challenging due to overlapping symptoms.
• Early identification of pediatric NF cases is critical for timely intervention.

Purpose of the Study:

• To investigate potential increases in pediatric necrotizing fasciitis cases over time.
• To identify clinical and laboratory features differentiating NF from cellulitis in children.
• To improve diagnostic accuracy for pediatric soft-tissue infections.

Main Methods:

• Retrospective chart review of pediatric patients with necrotizing fasciitis (NF) and cellulitis at a tertiary care hospital.
• Definition of NF confirmed by surgical or pathological examination.
• Comparison of clinical manifestations and laboratory findings between NF and cellulitis cases.

Main Results:

• Eight cases of pediatric necrotizing fasciitis were identified between 1983 and 1999, with a notable increase in later years.
• Children with NF were significantly more likely to present with a generalized erythematous rash (OR 11.0) and toxic appearance (OR 23.0) compared to cellulitis.
• NF patients exhibited higher fever, increased respiratory rate, and lower platelet counts upon presentation than cellulitis patients.

Conclusions:

• Generalized erythematous rash, toxic appearance, fever, and low platelet count are key indicators for distinguishing pediatric necrotizing fasciitis from cellulitis.
• These findings aid in the early recognition and diagnosis of NF in children.
• Prompt identification facilitates timely treatment and potentially improves patient outcomes.