Editing Necrotizing fasciitis (section)

==Signs and symptoms==
Symptoms emerge very quickly, often within hours.<ref name=":5">{{Cite web |title=UpToDate |url=https://www.uptodate.com/contents/necrotizing-soft-tissue-infections?search=necrotizing%20fasciitis%20antibiotics&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H24 |access-date=2024-12-09 |website=www.uptodate.com}}</ref> Manifestations include:

* Redness and swelling
* Induration (hardening of the skin and soft tissue)
* Excessive pain
* Systemic symptoms, including high fever > 102&nbsp;°F, fatigue, muscle pains<ref name=":5" />
* Large amounts of smelly pus and discharge, especially at a surgical site<ref name="CDC2016" />

The initial skin changes are similar to [[cellulitis]] or [[abscess]], so diagnosis in early stages may be difficult. The redness and swelling usually blend into surrounding normal tissues. The overlying skin may appear shiny and tense as well.<ref name="Trent 2002">{{cite journal |last1=Trent |first1=Jennifer T. |last2=Kirsner |first2=Robert S. |year=2002 |title=Necrotizing fasciitis |journal=Wounds |volume=14 |issue=8 |pages=284–292 |url=http://www.woundsresearch.com/article/945 }}</ref>

Later signs more suggestive of necrotizing changes (but only present in less than half of cases) are:

* [[Bulla (dermatology)|Bullae]] (blisters)
* Crepitus (palpable gas in tissues)
* Reduced or absent sensation over the skin of the affected area<ref name="Hak2014" /> 
* [[Ecchymosis]] (bruising) that progresses to skin [[necrosis]].<ref name="Hak2014" /> This is because the skin changes color from red to purple and black due to [[thrombosis|clotting]] blood vessels<ref name="Trent 2002" />

Rapid progression to [[shock (circulatory)|shock]] despite antibiotic therapy is another indication of necrotizing fasciitis. However, those who are immunocompromised may not show typical symptoms. This includes but is not limited to patients with:

* Cancer or malignancy
* [[Corticosteroid]] use
* Current [[Radiation therapy|radiotherapy]] or [[chemotherapy]]
* [[HIV/AIDS]]
* History of [[Organ transplantation|organ]] or [[Hematopoietic stem cell transplantation|bone marrow]] transplant

Immunocompromised persons are twice as likely to die from necrotizing infections compared to the greater population, so higher suspicion should be maintained in this group.<ref name="Hak2014" />

<gallery>File:Very early symptom of NF.jpg|The first symptom of NF. The center is clearly getting darker red (purple).
File:Early symptoms of NF.jpg|Early symptoms of necrotizing fasciitis. The darker red center is going black.
File:Necrotizing fasciitis caused by Vibrio Vulnificus.png|Necrotizing fasciitis type III caused by ''[[Vibrio vulnificus]]''.
</gallery>