Necrotizing soft tissue infections

Background

• Abbreviation: NSTI
• Includes necrotizing forms of cellulitis, myositis, and fasciitis

General types

• Type 1: polymicrobial infection
• Type 2: group A strep
  • May occur in healthy individuals
  • May occur via hematogenous spread from throat to site of blunt trauma

NSTI Types

• Necrotizing fasciitis
• Necrotizing myositis
• Necrotizing cellulitis

Differential Diagnosis

Skin and Soft Tissue Infection

• Cellulitis
  • Hand cellulitis
  • Facial cellulitis
  • Orbital cellulitis
• Erysipelas
• Lymphangitis
• Folliculitis
• Hidradenitis suppurativa
• Skin abscess
  • Anorectal abscess
  • Bartholin gland abscess
  • Pilonidal abscess
  • Scrotal abscess
• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
  • Fournier's gangrene
• Mycobacterium marinum

Look-A-Likes

• Sporotrichosis
• Osteomyelitis
• Deep venous thrombosis
• Pyomyositis
• Purple glove syndrome
• Tuberculosis (tuberculous inflammation of the skin)

Necrotizing rashes

• Necrotizing soft tissue infections
  • Necrotizing fasciitis
  • Necrotizing myositis
  • Necrotizing cellulitis
• Purpura fulminans
• Drug rash
• Levamisole toxicity
• Heparin-induced skin necrosis
• Warfarin-induced skin necrosis

Evaluation and Management

See specific type:

NSTI Types

• Necrotizing fasciitis
• Necrotizing myositis
• Necrotizing cellulitis

External Links

• MDCalc - LRINEC Score