Serious skin and soft tissue infections

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What is it about ?

Serious infections are infections that grow poorly quickly. It can be associated with extensive tissue damage and can be life threatening without treatment. There are 3 types: cellulitis, necrotizing fasciitis and gas gangrene.

  • The cellulite is an infection of the skin that extends into the subcutaneous tissue. The difference with theerysipelas, a less serious infection, is poorly defined. Cellulitis is caused by bacteria (usually streptococci or staphylococci). Sometimes it is caused by just one bacteria, but it can also be a combination of two or more species.
  • The necrotizing fasciitis is an infection that spreads quickly and also affects other soft tissues, such as subcutaneous tissue, connective tissue, fatty tissue (adipose tissue), muscles, tendons, nerves, and blood vessels. It is associated with the death of these tissues (necrosis). Toxic substances are released, making patients sick and feverish. The cause is contamination by the same bacteria as with cellulite. When they cause necrotizing fasciitis, they are commonly referred to as “carnivorous” bacteria.
  • The gas gangrene is a localized infection of the skin and dermis of a necrotic nature. The infection is caused by a specific bacteria, Clostridium.

What is its frequency?

Fortunately, these infections are very rare. Necrotizing fasciitis only develops in 4 in 100,000 people in the United States. No figures are available for our country because the number of cases is too low. These serious infections are more common in people with chronic conditions, such as diabetes, and among those who inject drugs.

How to recognize them?

Sometimes the infection starts with a small sore. Bacteria enter through the wound and proliferate under the skin. But often there is no lesion on the skin. At first, the symptoms are very localized.

The cellulite causes redness, heat of the skin, swelling and pain. It looks a bit like theerysipelas, but the edges of the infected area are not as well demarcated.

In case of necrotizing fasciitis, the same abnormalities appear, but blisters can also form and the pain is much more pronounced. The skin turns purplish red. The tissue under the skin dies and turns black.

Finally, in the case of gas gangrene, tissue dies quickly in and around the wound, within hours. The wound area turns black. The bacteria involved produce oxygen which accumulates in the tissue. By pressing lightly on the wound, it can be felt and sometimes heard cracking under the skin (like when walking in snow (crackles)).

Other symptoms appear quickly and can lead to shock very quickly: fever, diarrhea, rash and low blood pressure (hypotension).

How is the diagnosis made?

The doctor will think about this diagnosis based on the symptoms. He will possibly do a blood test to determine the white blood cells and inflammation. He will also take a sample of wound tissue to culture the offending bacteria in the laboratory.

What can your doctor do?

The doctor must make the diagnosis quickly so that treatment can be started as soon as possible.

The cellulite can be treated with antibiotics.

Treatment of necrotizing fasciitis is based on two pillars, carried out in the hospital: surgical disinfection of the wound, by removing all dead (necrotic) tissue, and the administration of high doses of antibiotics.

In case of gas gangrene, surgical disinfection of the wound remains the most important aspect to consider. Hyperbaric oxygen therapy may be required. For this treatment, the patient must be transferred to a place of hyperbaric treatment.

Want to know more?

Source

Foreign clinical practice guide ‘Serious skin and soft tissue infections’ (2000), updated on 26.05.2017 and adapted to the Belgian context on 06.03.2019 – ebpracticenet

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