Necrotizing Fasciitis Due to Group A ß-hemolytic Streptococci

Abstract

NECROTIZING fasciitis due to group A β-hemolytic streptococci, though rare, continues to present problems in diagnosis and management and continues to be associated with an alarmingly high mortality rate. The high mortality and morbidity are probably a result of failure to recognize pathognomonic features which allow early diagnosis.¹ One of the earliest reports of the disease, described as "hospital gangrene," came from the Civil War. The skin of affected parts was described as turning green, blue-gray, or black, and virtually melting away. The official records cite 2,642 cases, of which 1,142 (46%) proved fatal.² Before the widespread use of modern methods of bacterial identification, streptococcal necrotizing fasciitis was confused with other types of gangrene. According to White,³one of the first cases to be supported by bacteriologic studies was reported as "necrotizing erysipelas" by Pfanner in 1918 and was shown to be caused by β-hemolytic streptococci.