Authors’ contributions DD drafted the manuscript. AY analyzed the patient’s clinical data and was major contributor in writing the manuscript, NA conceived and designed the study and and co-drafted the manuscript, AK analyzed the imaging studies. DV made substantial contributions to conception and design. All authors read and approved the final manuscript.”
“Background Necrotizing soft tissue VE-822 manufacturer infection (NSTI) is a rare but potentially fatal infection involving skin, subcutaneous tissue and muscle [1]. It is usually BMN 673 molecular weight accompanied by the systemic inflammatory

response syndrome (SIRS) and needs prolonged intensive care treatment [2]. Necrotizing fasciitis is characterized by widespread necrosis of the subcutaneous tissue and fasciae. However NF as a soft tissue infection “”per se”" typically does not cause myonecrosis, but does invade the deep fascia and muscle [3]. Its rapid and destructive clinical course is assumed to be caused by polymicrobial symbiosis and synergy [1, 2]. Monomicrobial infection is usually associated with immunocompromised patients (cancer, diabetes mellitus, vascular insufficiencies, organ transplantation or alcohol abusers) [4]. Many aerobic

and anaerobic pathogens may be involved, including Bacteroides, Clostridium, Peptostreptococcus, Enterobacteriaciae, Proteus, Pseudomonas, and Klebsiella, but group SN-38 A hemolytic streptococcus and Staphylococcus aureus, alone or in synergism, are the initiating infecting bacteria [5]. Typical sites of the infection are the extremities, (primarily the lower extremities), abdomen, and perineum [1]. In most NSTI cases anaerobic bacteria are present, usually in combination with aerobic gram-negative organisms. They proliferate in an environment of local tissue hypoxia. Because of lower oxidation-reduction potential, they produce gases such as hydrogen, nitrogen, hydrogen sulfide and methane, which accumulate GPX6 in soft tissue spaces because of reduced solubility in water [6]. Establishing the diagnosis of NF (as the most common type

of NSTI) can be challenging. Clinical findings may include swelling, pain, fever, erythema, induration, crepitations, sloughing off of the skin, or a blistering and purulent collection. The need for more rapid and scientific methods of NF diagnosis led to the development of a clinical scoring systems, like the LRINEC scoring system (The Laboratory Risk Indicator for Necrotizing Fasciitis) or the APACHE II scoring system (The Acute Physiology and Chronic Health Evaluation) [6, 7]. Unfortunately, still the hallmark NF symptoms are intense pain and tenderness over the involved skin and underlying muscle [6]. Because NF is a surgical emergency and a life-threatening condition, the patient must be admitted to an ICU, where start IC therapy and where immediate and aggressive surgical debridement must be performed [8].