(A&E) (Peri-Op & Anaesthesia)

Overview

• Life-threatening subcutaneous soft tissue infection that requires a high index of suspicion for diagnosis
• Type I ⇒ polymicrobial infection caused by mixed aerobes and anaerobes. More common, often occurs post-surgery in diabetics
• Type II ⇒ monomicrobial infection caused by Streptococcus pyogenes
• Risk Factors → immunosuppresion (diabetes), IVDU, cutaneous trauma, surgery, varicella zoster infections
• Most commonly affected site is the perinuem ⇒ Fournier’s Gangrene
  • Risk Factor for this is use of an SGLT-2 inhibitor (-flozins) in type 2 diabetics. Inhibits SGLT-2 co-transporter in PCT, increasing urinary excretion of glucose (and reducing glucose , hence increases chance of developing a urinary and genital infection, including necrotising fasciitis.

Making Diagnosis

Clinical Features:

• Acute Onset
• Anaesthesia or Severe Pain over site of infection
• Oedema (Swelling) and Erythema
• Systemic signs of infection → fever, palpitations, tachycardia, tachypnoea, hypotension, lightheadedness, N&V
• Delirium and Crepitus (advanced cases)

<aside> 💡 Often presents as rapidly worsening cellulitis with pain out of keeping with physical features

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