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Necrotizing Soft-Tissue Infections: Clinical Features and Diagnostic Aspects
Martin Bruun Madsen1, Per Arnell2, Ole Hyldegaard3
1Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. martin.bruun.madsen.01@regionh.dk.
Advances in Experimental Medicine and Biology
|October 20, 2020
Summary
Necrotizing soft-tissue infections (NSTI) are diverse and diagnosed via surgical exploration, often presenting with vague symptoms and severe pain. Clinical presentation and cause vary by body site, necessitating prompt surgical intervention.
Area of Science:
- Infectious Diseases
- Surgical Pathology
Background:
- Necrotizing soft-tissue infection (NSTI) is a severe condition with varied clinical presentations.
- Diagnosis relies on surgical findings, as clinical symptoms can be vague and laboratory values non-specific.
Purpose of the Study:
- To describe the heterogeneous nature of necrotizing soft-tissue infections.
- To highlight diagnostic challenges and site-specific variations in etiology.
Main Methods:
- Surgical exploration is the primary diagnostic method for NSTI.
- Clinical examination and assessment of local/systemic severity are crucial for diagnosis.
Main Results:
- NSTI diagnosis involves identifying subcutaneous or muscle necrosis, skin undermining, and vascular thrombosis during surgery.
- Extremity NSTIs are often monomicrobial (Group A Streptococcus), while anogenital NSTIs are typically polymicrobial.
- Patients may experience vague symptoms or severe pain; laboratory findings are non-distinct and resemble sepsis.
Conclusions:
- No definitive diagnostic criteria exist for NSTI; clinical suspicion is paramount.
- Prompt surgical intervention is essential and should not be delayed by imaging.
- Understanding site-specific microbiological differences is important for management.
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