Diagnosis of skin and soft tissue infections using near-infrared spectroscopy
Marina Oi1, Takaaki Maruhashi1, Kenichi Kumazawa2
1Department of Emergency and Critical Care Medicine Kitasato University School of Medicine Sagamihara Japan.
Aim:
Skin and soft tissue infections are classified into cellulitis and necrotizing fasciitis, which are difficult to distinguish. Necrotizing fasciitis has a poor prognosis and requires immediate intensive care. The diagnostic gold standard is to incise the lesion to determine whether necrosis has reached the fascia. We aimed to show that these infections can be differentiated using near-infrared spectroscopy.
Methods:
We describe two cases in an observational study about the utility of near-infrared spectroscopy. Case 1 involved a 77-year-old man with a chief complaint of pain, redness, and swelling in the right lower leg for 1 week. Computed tomography of his legs showed no gas formation. Case 2 involved an 82-year-old man. He visited another hospital because of pain, redness, and swelling in the right thigh. Based on the X-ray examination, necrotizing fasciitis was suspected, and he was transferred to our hospital.
Results:
In Case 1, the regional oxygen saturation value was lower on the lesion side (41%) than on the healthy side (55%). We confirmed the depth of invasion by incision, leading to a diagnosis of necrotizing fasciitis. In Case 2, the thigh's regional oxygen saturation was higher on the affected side (76%) than on the healthy side (61%). An incision was made for diagnosis, but the fascia was not necrotized. Thus, we diagnosed cellulitis and provided conservative treatment using antibiotics.
Conclusion:
Near-infrared spectroscopy can be utilized to measure tissue blood flow, and it could be useful as a non-invasive diagnostic tool for skin and soft tissue infections.
Insights
Near-infrared spectroscopy can differentiate skin infections like cellulitis from necrotizing fasciitis. This non-invasive tool measures tissue oxygen saturation, aiding in timely diagnosis and treatment.
Area of Science:
- Medical Diagnostics
- Biomedical Engineering
- Dermatology
Background:
- Skin and soft tissue infections (SSTIs) include cellulitis and necrotizing fasciitis, which present similar symptoms but have vastly different prognoses.
- Distinguishing between these conditions is challenging, as the gold standard diagnostic method involves surgical incision to assess fascial necrosis.
- Necrotizing fasciitis is a medical emergency requiring immediate intervention to prevent severe morbidity and mortality.
Purpose of the Study:
- To evaluate the utility of near-infrared spectroscopy (NIRS) as a non-invasive method for differentiating cellulitis from necrotizing fasciitis.
- To demonstrate the potential of NIRS in assessing tissue blood flow and oxygenation in SSTIs.
Main Methods:
- An observational study describing two cases of suspected severe skin and soft tissue infections.
- Near-infrared spectroscopy was used to measure regional oxygen saturation in the affected and healthy limbs.
- Diagnostic incision was performed to confirm the diagnosis in both cases.
Main Results:
- Case 1: Lower regional oxygen saturation (41%) on the affected leg indicated necrotizing fasciitis.
- Case 2: Higher regional oxygen saturation (76%) on the affected thigh suggested cellulitis, which was confirmed by incision.
- NIRS measurements correlated with the severity and type of infection.
Conclusions:
- Near-infrared spectroscopy is a promising non-invasive tool for assessing tissue blood flow and oxygenation in skin and soft tissue infections.
- NIRS may aid clinicians in distinguishing between cellulitis and necrotizing fasciitis, potentially improving diagnostic accuracy and speed.
- Further research is warranted to validate NIRS as a standard diagnostic aid for SSTIs.
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