Contributor: John M. Kissane and John D.Pfeifer
Necrotizing fasciitis (hospital gangrene, necrotizing erysipelas) is a severe infection of deep fascial tissues caused by Group A streptococci [Streptococcal infection] . Necrotizing fasciitis is the destructive soft tissue infection caused by "flesh eating streptococci" that have received so much attention in the tabloid press. The disorder practically always follows trauma, which may have been minor, trivial, or even overlooked. Early, the skin becomes bluish purple and sloughs revealing purulent inflammation that dissects along fascial planes (Fig. 2). Systemic toxicity and impaired consciousness are often conspicuous. Necrotizing fasciitis is most commonly caused by beta hemolytic Streptococcus of Lancefield Group A, less commonly Group C, but Staphylococci [stapylococcal infection], Clostridial species [clostridium infection], and anaerobic cocci can cause similar lesions, often as a mixed infection.