Blood coagulation and fibrinolytic systems in patients with erysipelas and necrotizing fasciitis.

Necrotizing fasciitis (NF) is a skin infection caused by a group A streptococci, resulting in an erythematous lesion with cyanosis and vesicles or bullae leading to gangrene. The condition is prostrating and often accompanied with cerebral confusion. A table of diagnostic scores is given to differentiate initial symptoms and signs of NF from erysipelas (E). Assays of blood coagulation and fibrinolysis together with routine laboratory examinations were made in 12 patients with NF on admission to the hospital and they were compared with similar analyses of 5 patients with E. The NF and E patients showed increased levels of fibrinogen, factor V and factor VIII as well as positive ethanol gelation test, which hypercoagulability as did also decrease antithrombin III and increased levels of fibrinopeptide A. Slightly increased levels of fibrinogen degradation products were also noted. The Hageman factor was low in E compared to NF. In both conditions fibrin formation seems to be enhanced, most probably more extensively in NF. General signs of secondary fibrinolysis were less conspicuous. It is possible that the Hageman factor is activated to modulate the inflammatory response differently in E than in NE.