Patterns and diagnostic criteria of necrotizing fasciitis

Abstract

Although the condition is not common, if the diagnosis of necrotizing fasciitis was established late, many life-threatening complications might develop as sepsis and septic shock, which might lead to multiorgan damage. In the present literature review, we aim to discuss the classification and clinical patterns of necrotizing fasciitis, in addition to the diagnostic criteria and modalities that were reported among studies in the literature to evaluate such cases. Two main types of necrotizing fascitis were reported in the literature, including the poly and monomicrobial types, however, the diagnostic criteria for each are usually similar. Establishing an early diagnosis is essential to achieve better management and reduce the potential development of complications and death. The clinical patterns are the cornerstone for establishing the diagnosis, however, laboratory investigations might also be used as valid approaches to confirm the diagnosis. Many laboratory models have been proposed to establish the diagnosis of necrotizing fasciitis with variable sensitivities and specificities, and the laboratory risk indicator for necrotizing fasciitis (LRINEC) remains the commonest most efficacious modality. A tissue biopsy can also be used within the clinical settings for indicating the infection, however, it should not hinder the intended surgical interventions. Studies also show that magnetic resonance imaging can adequately detect liquefactive necrosis and is reported with a higher sensitivity than computed tomography. Although the condition is not very common, it might lead to severe consequences, and therefore, early extensive treatment and interventional approaches are encouraged.