Necrotizing fasciitis secondary to group A streptococcus. Morbidity and mortality still high.
OBJECTIVE
To update physicians on Group A streptococcal necrotizing fasciitis, including current methods of diagnosis and treatment.


METHODS
Current literature (1990-1998) was searched via MEDLINE using the MeSH headings necrotizing fasciitis, toxic shock syndrome, and Streptococcus. Articles were selected based on clinical relevance and design. Most were case reports, case series, or population-based surveys. There were no randomized controlled trials.


RESULTS
The hallmark of clinical diagnosis of necrotizing fasciitis is pain out of proportion to physical findings. Suspicion of underlying soft tissue infection should prompt urgent surgical examination. Therapy consists of definitive excisional surgical debridement in conjunction with high-dose intravenous penicillin G and clindamicin. Risk factors for mortality include advanced age, underlying illness, hypotension, and bacteremia.


CONCLUSIONS
Necrotizing soft tissue infections due to Group A streptococcus might be increasing in frequency and aggression. Overall mortality remains high (20% to 34% in larger series). Clinical diagnosis requires a high level of suspicion and should prompt urgent surgical referral.
Division of Hematology, McGill University Health Centre, Montreal, Que.
H A
HA
Leitch
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Palepu
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CM
Fernandes
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D019115:Fasciitis, Necrotizing / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006801:Humans; D006931:Hyperbaric Oxygenation; D007116:Immunization, Passive; D009864:Ontario / Q000453:epidemiology; D012307:Risk Factors; D012772:Shock, Septic / Q000209:etiology
D000900:Anti-Bacterial Agents