Early diagnosis of post-varicella necrotising fasciitis: A medical and surgical emergency

Abstract

Necrotising fasciitis (NF) is an extremely rare complication of a rather common paediatric viral exanthem varicella. Delayed diagnosis and treatment can lead to significant morbidity and mortality. Laboratory risk indicator of NF score aids in early clinical diagnosis in suspected cases of post-varicella NF thus enabling timely intervention. Surgery delayed for more than 24 hours, is an independent risk factor for death. Surgical debridement with good antibiotic coverage is the definitive treatment for NF.

Varicella Zoster Viral Infection Complicating into Necrotizing Fasciitis: A Case Report

“…3 The central nervous system and soft tissue infections are the most frequent complications of chickenpox infection. 1,2,4 In a recent study, 1.3% of chickenpox infections were complicated into necrotizing fasciitis (NF). 5 NF is a rapidly progressing infection of the fascial layer with delayed skin, subcutaneous, and muscle involvement with systemic toxicity.…”

“…Early diagnosis is key for better management of NF. 1,3 The most important finding in the patient's history is pain, which will be much more intense than the local dermatological manifestations. The tissue biopsy is the gold standard for the diagnosis of NF.…”

“…Chickenpox is usually a milder disease but can lead to serious neurological and respiratory complications and soft tissue infection. 1 Less than 1% of children and 1.3% of adult patients with chicken pox will be complicated into necrotizing fasciitis. 2 Necrotizing fasciitis (NF) is a rare but potentially fatal skin and soft tissue infection and a surgical and medical emergency.…”

Streptococcus pyogenes Endocarditis Associated With Varicella—Case Report and Review of the Literature

“…However, various serious and potentially lethal complications (e.g., bacterial skin and soft-tissue infections, pneumonia, encephalitis, cerebral vasculopathy, myocarditis) do occur occasionally and may lead to hospitalization or death (1). Bacterial superinfection of the skin is reported in up to 45% of hospitalized varicella cases (2, 3). In Europe annual incidence rates for varicella vary from 300 to 1291 per 100,000 population (4).…”

Post-varicella necrotising fasciitis

“…[ 1 ] Xavier et al . mentioned that ‘NF should be suspected in post-varicella cellulitis, not responding to adequate antibiotic therapy'[ 1 ] and also concluded that ‘Laboratory Risk Indicator for Necrotising Fasciitis score aids in early diagnosis, where imaging studies are pending'. [ 1 ] Indeed, the varicella is not an uncommon viral infection.…”