Necrotizing soft tissue infections: The role of the LRINEC score

ABSTRACTNecrotizing soft tissue infections (NSTI) can be rapidly progressive and polymicrobial in etiology. Establishing the element of necrotizing infection poses a clinical challenge. A 64-year-old diabetic patient presented to our hospital with a gangrenous patch on anterior abdominal wall, which progressed to an extensive necrotizing lesion within 1 week. Successive laboratory risk indicator for necrotizing softtissue infections (LRINEC) scores confirmed the necrotizing element. Cultures yielded Enterococci, Acinetobacter species and Apophysomyces elegans and the latter being considered as an emerging agent of Zygomycosis in immunocompromised hosts. Patient was managed with antibiotics, antifungal treatment and surgical debridement despite which he succumbed to the infection. NSTI’s require an early and aggressive management and LRINEC score can be applied to establish the element of necrotizing pathology. Isolation of multiple organisms becomes confusing to establish the etiological role. Apophysomyces elegans, which was isolated in our patient is being increasingly reported in cases of necrotizing infections and may be responsible for high morbidity and mortality. This scoring has been proposed as an adjunct tool to Microbiological diagnosis when NSTI’s need to be diagnosed early and managed promptly to decrease mortality and morbidity, which however may not come in handy in an immunocompromised host with polymicrobial aggressive infection.

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The Role of Streptococcal and Staphylococcal Exotoxins and Proteases in Human Necrotizing Soft Tissue Infections

Toxins ◽

10.3390/toxins11060332 ◽

2019 ◽

Vol 11 (6) ◽

pp. 332 ◽

Cited By ~ 5

Author(s):

Patience Shumba ◽

Srikanth Mairpady Shambat ◽

Nikolai Siemens

Keyword(s):

Soft Tissue ◽

Current Knowledge ◽

Special Focus ◽

Soft Tissue Infections ◽

Gram Positive Bacteria ◽

Necrotizing Soft Tissue Infections ◽

Group A ◽

Clinical Conditions ◽

Major Pathogens

Necrotizing soft tissue infections (NSTIs) are critical clinical conditions characterized by extensive necrosis of any layer of the soft tissue and systemic toxicity. Group A streptococci (GAS) and Staphylococcus aureus are two major pathogens associated with monomicrobial NSTIs. In the tissue environment, both Gram-positive bacteria secrete a variety of molecules, including pore-forming exotoxins, superantigens, and proteases with cytolytic and immunomodulatory functions. The present review summarizes the current knowledge about streptococcal and staphylococcal toxins in NSTIs with a special focus on their contribution to disease progression, tissue pathology, and immune evasion strategies.

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The Role of Computed Tomography in the Diagnosis of Necrotizing Soft Tissue Infections

World Journal of Surgery ◽

10.1007/s00268-017-4145-x ◽

2017 ◽

Vol 42 (1) ◽

pp. 82-87 ◽

Cited By ~ 8

Author(s):

Myriam Martinez ◽

Thomas Peponis ◽

Aglaia Hage ◽

Daniel D. Yeh ◽

Haytham M. A. Kaafarani ◽

...

Keyword(s):

Computed Tomography ◽

Soft Tissue ◽

Soft Tissue Infections ◽

Necrotizing Soft Tissue Infections

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Laboratory risk indicator for necrotizing fasciitis: an objective scoring system as a tool for early diagnosis of necrotizing fasciitis

International Surgery Journal ◽

10.18203/2349-2902.isj20215139 ◽

2021 ◽

Vol 9 (1) ◽

pp. 102

Author(s):

Syed Saad ◽

Panchami P. ◽

Gulamnabi .

Keyword(s):

High Risk ◽

Soft Tissue ◽

Necrotizing Fasciitis ◽

Scoring System ◽

Risk Group ◽

High Risk Group ◽

Intermediate Risk ◽

Soft Tissue Infections ◽

Necrotizing Soft Tissue Infections ◽

Lrinec Score

Background: Necrotizing soft tissue infections are often fatal, characterized by extensive necrosis of the subcutaneous tissues and fascia. The mortality of 30-40% reflects the inadequacy of early recognition of necrotizing soft tissue infections. This study emphasizes on the search for a tool that reliably and rapidly identifies patients with NF. An objective of current study was to validate the LRINEC score as a tool for early distinguishing of necrotizing fasciitis from other soft tissue infections.Methods: Prospective clinical study analysis of outcome of sixty of patients with soft tissue infections were evaluated based on LRINEC. Based on their LRINEC score, the patients were categorized as low, intermediate and high risk for the onset of necrotizing fasciitis.Results: A total of 60 patients with soft tissue infections were prospectively evaluated and categorized on the basis of LRINEC score 45 patients in low risk category, 7 in Intermediate risk and 8 patients in high risk group. In terms of outcome, all cases (including positive tissue diagnosis cases) in low risk and intermediate risk groups and 2 cases in high risk group were improved with surgical debridement/fasciotomy. The cutoff of LRINEC ≥6 has better sensitivity and specificity in identifying the risk of the patient.Conclusions: LRINEC scoring system has a better positive predictive value in identifying the onset and risk strategizing of necrotizing fasciitis.

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Pivotal Role of Preexisting Pathogen-Specific Antibodies in the Development of Necrotizing Soft-Tissue Infections

The Journal of Infectious Diseases ◽

10.1093/infdis/jiy110 ◽

2018 ◽

Vol 218 (1) ◽

pp. 44-52 ◽

Cited By ~ 5

Author(s):

Anshu Babbar ◽

Trond Bruun ◽

Ole Hyldegaard ◽

Michael Nekludov ◽

Per Arnell ◽

...

Keyword(s):

Soft Tissue ◽

Pivotal Role ◽

Soft Tissue Infections ◽

Specific Antibodies ◽

Necrotizing Soft Tissue Infections

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LRINEC: an economical diagnostic tool for prognosis in patients with necrotizing soft tissue infections in a tertiary care centre

International Surgery Journal ◽

10.18203/2349-2902.isj20192282 ◽

2019 ◽

Vol 6 (6) ◽

pp. 2007

Author(s):

Ballapalli Hari Prasad ◽

Minchala Chengalrayan Narendra ◽

Shaik Nurul Hameed

Keyword(s):

Soft Tissue ◽

Tertiary Care ◽

Lower Limbs ◽

Soft Tissue Infections ◽

Tertiary Care Centre ◽

Female Ratio ◽

Medical College ◽

Necrotizing Soft Tissue Infections ◽

Lrinec Score ◽

A Prospective Study

Background: The objective of the study was to evaluate the efficacy of LRINEC score in the management and prognosis of patients with soft tissue necrotizing infections.Methods: This is a prospective study conducted in Sri Padmavathi Medical College (W), Tirupati, Andhra Pradesh, India from May 2018 to January 2019. It included 50 patients who were diagnosed with severe soft tissue infection of lower limbs who needed surgical intervention. The effectiveness of LRINEC score was determined from the outcome.Results: Age group varied from 40 to 60 years. Out of 50 patients 40 were men and 10 were women. The male to female ratio was 4:1. All the patients were investigated at the time of admission in the emergency department using the LRINEC score. Hospital stay varied from 15-45 days.Conclusions: This study concludes that LRINEC score is an economical and accurate investigating tool in necrotizing soft tissue infections to determine the prognosis and outcomes.

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