Necrotising Fasciitis: Aetiology, Clinical Features, and Diagnosis

This research essay provides a comprehensive overview of Necrotising fasciitis, a rare but serious bacterial infection. It delves into the disease's definition, epidemiology, and aetiology, exploring the causative agents and risk factors associated with its development. The essay also details the clinical f...Read More

Running head: HEALTHCARE ASSIGNMENT
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Name of the Student:
Name of the University:
Author Note:

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Introduction:
This paper intends to present a research essay on a dermatological issue
known as Necrotising fasciitis.
Description:
Necrotising fasciitis can be defined as a rare condition that is characterized by
bacterial infection. Although, the disease condition is rare but the impact is of a
serious magnitude. The bacterial infection manifests itself and characteristically
affects the tissue under the skin and facia, which is referred to the skin muscle that
surrounds the external organs (Bailey et al., 2014). The disease is commonly
referred to as the ‘flesh eating disease’. It should be noted in this context that the
causative agent responsible for the disease is not carnivore with respect to
nutritional status, but releases toxins that corrodes the skin and damages the
adjacent tissues (Swain et al., 2013). It should be noted in this context that
Necrotising fasciitis has been studied to progress from a minor injury which includes
a cut or a minor injury. However, the injury gets worse and is worsened by the
bacterial infection. Studies suggest that an early identification of the symptoms can
help in the prevention of the infection to an adverse stage.
Epidemiology:
Research studies indicate that Necrotising fasciitis can be fatal and identify it
as an aggressive skin and soft tissue disorder (Swain et al., 2013). The disorder has
been studied to affect the muscle fascia as well as the subcutaneous tissues.
Necrotising fasciitis has been studied to have an epidemiological prevalence of 0.4 in
every 100,000 people across the United States of America (Swain et al., 2013). Also,
research studies indicate that in certain regions of the world, the disorder manifests
in one out of every 100,000 individuals (Bailey et al., 2014). In addition to this,
statistical figures state that the incidence rate of Necrotising fasciitis is approximately
3.5 cases per 100,000 individuals in Australia (Bailey et al., 2014). The case fatality
percentage has been estimated to be 24%. Also, studies report that between the
years 2000 to 2012, a total of 84 cases of Necrotising fasciitis were reported within
the Northern Territory (Bailey et al., 2014). On an average, patients who were in
between 48-50 years of age were more susceptible to acquire the infection (Mehta et
al., 2013). The most common sites of infection were reported to be the lower limbs,

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upper limbs and tors, head and neck region as well as the region around the scrotum
or the perineum. Studies further reported that despite making use of the antimicrobial
therapy and prompt surgical intervention, a total of 25% patient mortality rate was
reported and 10% of the patients had to undergo amputation (Mehta et al., 2013).
Also, more than half of the affected patients were indigenous in origin and were
unaware of the fatal nature of the infection (Bailey et al., 2014).
Aetiology:
Necrotising fasciitis is caused by different bacterial agents. The causative
agent responsible for the infection is found inside the gut, throat as well as the skin
of people and normally do not cause any problem. However, the causative agent can
potentially come in direct contact with the body tissues through either cuts and
scratches, punctured wounds, surgical sites or infection bites. The infection typically
manifests itself when the bacteria normally present in the skin invades the body
tissues. Research studies suggest that the infection is communicable and can
transfer from one individual to another, but evidence backing the same is rare
(Mehta et al., 2013). The probability of acquiring the disease increases in people
living in unhygienic environment. Research studies also suggest that most commonly
the disease manifests itself in people who have a compromised or suppressed
immune system (Mehta et al., 2013; Goh et al., 2014). Individuals who suffer from
one or more of the physical health conditions such as immunosuppression, Diabetes,
Alcohol/Drug abuse, chronic illnesses or malignancies are at a high risk of
developing the infection (Goh et al., 2014). In addition to this, it is also important to
note here that the condition can occur anywhere in the body but is more common in
the genital region. The main cause of the infection ifs trauma which could be
triggered by an insect bite or an injection. The condition is complicated with the
formation of an abscess or ulcer at the infection site and the infection spreads
through the blood stream. The infection is generally characterized into Type I, Type
II, Type III or Type IV infections (Goh et al., 2014).
While discussing the clinical features of the Necrotising fasciitis health
condition, the outlook of the condition should be mentioned (Misiakos et al., 2014).
As per Glass et al. (2015), the outlook of the disease is completely dependent on the
severity of the health condition and early diagnosis could increase the recovery rate

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of the disease condition. The microscopic image of the disease is known as the
histological images through which, different lesions are seen as different image.
Such as gas gangrenes are observed as big hollow around the tissues, whereas,
infected tissues were observed as gas inclusions in between the muscle fibers.
Hence, the microscopic feature of the disease was found to be necrotic debris are
visualized as pink materials and the hollows are termed as fat lobules in between the
septae (Rajak et al., 2016). Biochemically, while undergoing this chronic health
condition, patient is observed with increased creatinine kinase levels, increased
inflammation of the markers and the increase in the C- reactive proteins, due to
which the clinical feature of the observed in the patient’s body. However, no such
clinical laboratory results are able to assess the high C- reactive proteins in the
patient’s body due to which this aspect of disease is not possible to be assessed
(Mehta et al., 2013). While discussing the growth of Necrotising fasciitis in the
human body, the fast spread of this condition in the human body should be
mentioned. The primary reason of its fast spreading is the association of this health
condition with muscle tissues. This spread from one tissue to another is very fast that
within seconds, the disease condition is spread from one cell to another (Glass et al.,
2015). The primary growth of this disease is from the nose or throat tissue of the
patient which causes the spread of this disease. Spread of this condition from one
person to another is caused by infected house hold, infected circle of people, and
due to the contact of noose or mouth secretion of affected individual (Misiakos et al.,
2014).
Clinical features:
There are several healthcare conditions, with which, Necrotising fasciitis
condition is confused by the healthcare physicians. These disease conditions are
acute eprididymitis, orchitis, toxic shock syndrome, testicular torsion due to
emergency medication, and emergence of gas gangrenes (Taylor, 2018). Acute
Epididymitis is the condition in which the epididymis is affected with swelling, pain
and inflammation and hence, due to similar occurrence and outline of the disorder,
Acute Epididymitis is differential diagnosis of Necrotising fasciitis. Further, orchitis is
also a virulent health complication, in which the muscle of patient, with subcutaneous
and superficial muscle, becomes affected and hence, leads to severe complication
like Necrotising fasciitis (Black, Brindle & Honaker, 2016). Hence, this condition is

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also termed as a differential diagnosis for Necrotising fasciitis and majority of the
healthcare professionals conduct both the diagnostic procedure so that the
occurrence among these two could be identified. Besides these two, gangrene,
testicular torsion and other health condition also showed similar complication, due to
which these are termed as the differential diagnosis for the patient (Black, Brindle &
Honaker, 2016).
Conclusion:
Upon concluding this research essay, the Necrotising fasciitis disease
definition, its epidemiology, scientific aetiology, evidences and theories associated to
it, differential diagnosis process and the clinical features including the microscopic
view, the growth feature and biochemistry associated with the process was provided.

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References:
Bailey, T., Mileva, M., &Zardawi, I. (2014). 4. Necrotising fasciitis in the northern
territory of australia. Pathology, 46, S107-S108.
Black, J. M., Brindle, C. T., & Honaker, J. S. (2016). Differential diagnosis of
suspected deep tissue injury. International wound journal, 13(4), 531-539.
Glass, G. E., Sheil, F., Ruston, J. C., & Butler, P. E. M. (2015). Necrotising soft
tissue infection in a UK metropolitan population. The Annals of The Royal
College of Surgeons of England, 97(1), 46-51.
Goh, T., Goh, L. G., Ang, C. H., & Wong, C. H. (2014). Early diagnosis of necrotizing
fasciitis. British Journal of Surgery, 101(1), e119-e125.
Mehta, R., Kumar, A., Crock, C., &McNab, A. (2013). Medical management of
periorbital necrotising fasciitis. Orbit, 32(4), 253-255.
Misiakos, E. P., Bagias, G., Patapis, P., Sotiropoulos, D., Kanavidis, P., &
Machairas, A. (2014). Current concepts in the management of necrotizing
fasciitis. Frontiers in surgery, 1, 36.
Rajak, S. N., Figueira, E. C., Haridas, A. S., Satchi, K., Uddin, J. M., McNab, A. A., ...
& Selva, D. (2016). Periocular necrotising fasciitis: a multicentre case
series. British Journal of Ophthalmology, 100(11), 1517-1520.
Swain, R. A., Hatcher, J. C., Azadian, B. S., Soni, N., & De Souza, B. (2013). A five-
year review of necrotising fasciitis in a tertiary referral unit. The Annals of The
Royal College of Surgeons of England, 95(1), 57-60.
Taylor, L. A. (2018). Necrotizing fasciitis. In Inpatient Dermatology (pp. 111-114).
Springer, Cham.