Facing a new reality: Significant increase in necrotizing fasciitis in the post-COVID era?

Background: Necrotizing fasciitis (NF) is a rare, rapidly progressing soft tissue infection characterized by the widespread necrosis of fascial planes and surrounding tissues.

Material and methods: We discuss four consecutive necrotizing fasciitis cases of the head and neck region, that accrued in a time window of 6 months. Patient demographics, clinical features, laboratory analyses, imaging findings, surgical interventions, and outcome were collected, assessed and discussed. These findings were checked against recent epidemiological data of invasive Group A Streptococcus (iGAS) in Europe.

Results: Four patients (two males and two females) aged between 31 and 65 years were included. The most common presenting symptom was severe pain and facial swelling (100 %), followed by fever (50 %) and erythema (50 %). All patients underwent emergency surgical debridement, and broad-spectrum antimicrobial therapy was initiated promptly. Streptococcus pyogenes was isolated in every patient. Three patients required multiple debridement procedures, and one case necessitated extensive neck resection due to the involvement of deeper structures. Overall, two patients recovered with no to minor residual deficits, one patient experienced persistent trismus and one patient passed away due to septic shock and multiorgan failure.

Conclusion: Prevalence of iGAS infections have increased in European countries, therefore increased vigilance is recommended so that a quick diagnosis can be established and appropriate treatment can be administered to avoid serious morbidity and mortality.