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Fulminant group A streptococcal necrotizing fasciitis: clinical and pathologic findings in 7 patients
Patrick R Dahl1, Charles Perniciaro, Kristina A Holmkvist
1Department of Dermatology, Mayo Clinic, Rochester, USA.
Background:
Necrotizing fasciitis is a rapidly progressive soft tissue infection with high morbidity and mortality rates. Examination of deep incisional biopsy specimens can provide prompt diagnosis and improve survival. We describe 7 patients with necrotizing fasciitis caused by group A Streptococcus species.
Objective:
Our purpose was to describe the unique dermatopathology and clinical features in 7 patients with necrotizing fasciitis caused by group A Streptococcus.
Methods:
We conducted a retrospective review.
Results:
The average age of the patients was 47 years. Fasciitis occurred on an extremity in all cases. All 5 patients with streptococcal toxic shock syndrome died of their disease. The histopathologic findings from early fascial disease revealed superficial epidermal necrosis, edema, and hemorrhage with few inflammatory cells, whereas clinically advanced, necrotic skin lesions revealed diffuse necrosis, thrombosis, neutrophilia, and numerous gram-positive diplococci.
Conclusions:
Patients with clinical features of necrotizing fasciitis should have a deep incisional biopsy specimen obtained from the central area of ecchymotic, necrotic plaques to confirm the diagnosis. Immediate surgical intervention is necessary to reduce the morbidity and mortality rates associated with necrotizing fasciitis.
Insights
Group A Streptococcus can cause severe necrotizing fasciitis. Prompt diagnosis via deep incisional biopsy and surgical intervention are crucial for improving survival rates in patients with this aggressive infection.
Area of Science:
- Infectious Diseases
- Dermatopathology
- Surgical Pathology
Background:
- Necrotizing fasciitis is a severe soft tissue infection with high mortality.
- Early diagnosis through deep incisional biopsy can improve patient outcomes.
- This study focuses on 7 cases of necrotizing fasciitis caused by Group A Streptococcus.
Purpose of the Study:
- To detail the distinct dermatopathology and clinical presentations of necrotizing fasciitis caused by Group A Streptococcus.
- To highlight the diagnostic value of biopsy in Group A Streptococcus-induced necrotizing fasciitis.
Main Methods:
- A retrospective review of 7 patients diagnosed with necrotizing fasciitis caused by Group A Streptococcus was conducted.
Main Results:
- The average patient age was 47 years, with all cases occurring on an extremity.
- Histopathology showed superficial epidermal necrosis and edema in early stages, progressing to diffuse necrosis and thrombosis in advanced lesions.
- All 5 patients who developed streptococcal toxic shock syndrome (STSS) succumbed to the disease.
Conclusions:
- Deep incisional biopsy of necrotic plaques is essential for diagnosing necrotizing fasciitis.
- Prompt surgical intervention is critical to mitigate the high morbidity and mortality associated with this condition.