Necrotizing fasciitis is an abnormal soft-tissue infection typically caused by toxin-producing, lethal bacteria, which is characterized by extensive fascial necrosis with corresponding sparing of underlying muscle as well as skin (Goldman, Schafer, and Cecil). This disease frequently targets diabetics, alcoholics, IV drug users, immunosuppressed patients, patients with peripheral vascular disease, and young, formerly healthy individuals. Necrotizing fasciitis is capable of occurring in any region of the body however it is commonly found in the abdominal wall, extremities, and perineum (Raffin, Green, and Dafoe 221). However, this pathogen is one of the most important bacterial pathogens in humans since it is the most frequent bacterial cause of pharyngitis as well as cutaneous and systematic infections.
Hippocrates was the first to describe necrotizing fasciitis, in the 5th century BC, as a complication of “erysipelas”. Later in the early 19th century, necrotizing fasciitis was known as the fatal ulcer, phagedena, phagedenic ulcer, hospital gangrene, putrid ulcer, and phagenda gangraenosa. The first English descriptions were bestowed by Leonard Gillespie, a British naval surgeon who witnessed this disease ensue those in the army and navy (Scheld, Armstrong, Hughes 105). In the past, the characteristic features of this disease were the rapidity with which it progressed, demolishing subcutaneous tissue in a flash, the asperity of the pain, and invading formerly young individuals undermined by illness or injury. The United States gained their first
description of this disease in 1871 by Joseph Jones, a Confederate Army surgeon (Raffin, Green, and Dafoe 220). In 1883, Fehleisen isolated chain-forming organisms in pure culture from erysipelas lesions and determined that these organisms could induce humans with the disease.
Progress toward a reasonable classification of streptococci dates back to Schotmuller in 1903. Schotmuller proposed descriptions of the blood agar technique for discerning nonhemolytic streptococci from hemolytic streptococci (Goldman, Schafer, and Cecil ). Brown, in 1919, made a study of patterns of hemolysis and suggested the terms α-, β-, and γ-hemolysis. 1993 was a major turning point of human understanding of the epidemiology of streptococcal infections when Lancefield classified β-hemolytic streptococci into distinct serogroups (Mandell, Douglas, and Bennett).
In the early stages of necrotizing fasciitis the clinical findings can be indeterminate. As many as one third of patients are initially diagnosed with something other than necrotizing fasciitis. The only innuendo that might alert the clinician is a complaint of excruciating pain from a previous injury. Necrotizing fasciitis has been said to occur more often during the winter months and often the result of an infection due to varicella-zoster virus (Mandell, Douglas, and Bennett).
Streptococcal exotoxins, also known as superantigens, are central...