Fasciitis
Fasciitis is an inflammatory condition affecting the fibrous connective tissues known as fascia, often caused by bacterial infections. This condition can arise from various skin injuries that allow bacteria to penetrate and spread along the fascia beneath the skin. Risk factors for developing fasciitis include diabetes, liver or kidney diseases, vascular issues, advanced age, and compromised immune systems, as well as exposure to certain organisms through water, animal contact, or drug use.
Common symptoms of fasciitis include localized warmth, redness, swelling, tenderness, and pain, alongside systemic signs such as fever and low blood pressure. Diagnosis typically relies on clinical evaluation and may involve imaging techniques like ultrasound or CT scans to assess the infection's depth and severity. Treatment generally involves intravenous antibiotic therapy targeted at specific bacterial strains, particularly for uncomplicated cases. Preventive measures are crucial, emphasizing the importance of protecting the skin and addressing minor infections promptly to avoid complications. Understanding fasciitis is vital for recognizing potential health risks and seeking timely medical intervention.
Fasciitis
- ANATOMY OR SYSTEM AFFECTED: Skin, tissue
- ALSO KNOWN AS: Uncomplicated or non-necrotizing infective fasciitis
Definition
Fasciitis is the inflammation of fibrous connective tissues of the body (fascia) associated with bacterial infection.
Causes
Skin and soft tissue infections (SSTIs), including fasciitis, can potentially develop from any damage to the skin that allows bacterial entry. Such damage includes cuts (accidental and surgical), scratches, bites, penetration of the skin by objects (such as needles), wounds (such as ulcers or chickenpox sores), and burns. Fasciitis develops when an infection, such as cellulitis, reaches deep enough in the tissue layers under the skin to spread along the underlying fascia.
Risk Factors
Persons with diabetes mellitus, liver or kidney disease, or vascular problems, or who are critically ill, of advanced age, or have reduced immune function are at an increased risk for developing SSTIs. Exposure to organisms through contact with water or animals or as the result of bite wounds or injectable-drug abuse can also increase the risk for SSTI development.
Symptoms
SSTI symptoms include damage associated with the route by which the infecting organisms entered the skin and the inflammation caused by the body’s response to the presence of the organisms and toxins they may release. Local symptoms include warmth, redness, swelling, tenderness and pain, and possibly dysfunction of the affected tissues. Persons may also present with general symptoms of infection, including fever, low blood pressure, and a rapid heart rate. In severe cases, persons may exhibit altered mental status.
Screening and Diagnosis
The symptoms and the appearance of the affected tissues are the primary basis for diagnosis. Further assessment may include culturing samples collected through tissue swabs, needle aspirations, or blood samples. High white blood cell counts and low serum sodium concentrations are more commonly associated with necrotizing forms of fasciitis. X-ray, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) may be used to assess the depth and extent of the infection.
For the evaluation of fasciitis, differentiation of uncomplicated from necrotizing forms is essential to determine how aggressively to treat the infection. Ultrasound is useful for detecting the degree of fascia involvement, and a CT and an MRI may be used to detect signs of necrosis in the deep tissues.
Treatment and Therapy
Once it has been determined that a case of fasciitis is uncomplicated and non-necrotizing, doctors will order antibiotic therapy (usually intravenous) as the primary course of treatment. Empiric treatment should be directed against staphylococcal and streptococcal species, with coverage against additional organisms, and follow treatment algorithms based on the location of infection and route of organism entry.
Prevention and Outcomes
To prevent the development of fasciitis, one should avoid damage to skin and should treat minor SSTIs to prevent the progression of disease to involvement of the fascia.
Bibliography
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May, A. K. “Skin and Soft Tissue Infections.” Surgical Clinics of North America 89 (2009): 403.
"Plantar Fasciitis." MedlinePlus, 17 June 2024, medlineplus.gov/ency/article/007021.htm. Accessed 3 Feb. 2025.
Vincent, Ki, and Coleman Rotstein. “Bacterial Skin and Soft Tissue Infections in Adults: A Review of Their Epidemiology, Pathogenesis, Diagnosis, Treatment, and Site of Care.” Canadian Journal of Infectious Diseases and Medical Microbiology 19 (2008): 173-184.
Wall, Derek, et al. “A Simple Model to Help Distinguish Necrotizing Fasciitis from Nonnecrotizing Soft Tissue Infection.” Journal of the American College of Surgeons 191 (2000): 227-231.