Severe soft-tissue infections--a diagnostic challenge. The need for early recognition and aggressive therapy

This article was written to highlight the difficulty in diagnosing necrotising fasciitis (NF) and in differentiating it from other severe soft-tissue infections, and to stress the need for early aggressive therapy in all severe soft-tissue infections.

Four cases of severe soft-tissue infection admitted to Baragwanath Hospital Intensive Care Unit between January 1993 and March 1996 are reported, presenting the relevant clinical features.

The clinical diagnosis of NF when used alone was found to be unreliable and the diagnosis appeared to be made late in the course of the disease. Late diagnosis makes intensive care (largely supportive therapy) of limited value.

Astute clinical awareness and prompt therapy for severe soft-tissue infections are needed to enable the early diagnosis of these syndromes and thus prevent their serious sequelae. This should include a thorough knowledge of these conditions and predisposing risk factors. For comparative purposes specific defining clinical criteria are required. Even with full intensive care support, severe soft-tissue infections are associated with a significant mortality rate.