Necrotizing soft tissue infections and necrotizing fasciitis: in childhood too!

Abstract

Necrotizing soft tissue infection in children with or without necrotizing fasciitis is a rare bacterial infection. Varicella and trauma represent the most frequent predisposing factors. These infections must be early diagnosed, before the occurrence of any complication, including extension necrosis of soft tissue and septic shock. Magnetic resonance imaging and computed tomography-scan are helpful to delimit necrosis extent in deeper tissues. However, indications should be discussed according to infection localisation and imaging timing should not delay appropriate care. Group A β-hemolytic streptococcus is the most common microorganism associated with these infections, although incidence of Staphylococcus aureus is increasing. Death occurs in 5–20% of patients. Good prognosis is related to early diagnosis, antibiotic treatment and surgery. This emergent multidisciplinary approach is sometimes difficult to manage in paediatrics because of the rarity of these infections.