Invasive Infections

Thank goodness these are rare but I have included them here as they are very often fatal and again it is imperative not to miss them.

  • Necrotising fasciitis This occurs most commonly in elderly, debilitated and diabetic especially post-surgery. It may be streptococcal or due to mixed infection. The patient may not be toxic in the early stages but the most striking finding is of severe pain, often seeming to be out of proportion to what one sees on the skin surface. Tender erythematous skin evolves into a rapidly spreading area of black necrosis around the wound. Treatment is with immediate extensive surgical debridement, antibiotics and supportive care.

  • "Fournier's gangrene" is a version of the above that often starts in the scrotum/lower abdomen.