{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T06:13:24Z","timestamp":1793340804023,"version":"4.5.0"},"reference-count":17,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2004,9,27]],"date-time":"2004-09-27T00:00:00Z","timestamp":1096243200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acad Dermatol Venereol"],"published-print":{"date-parts":[[2004,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:p><jats:bold>Background\u2002<\/jats:bold> Necrotizing fasciitis (NF) due to group A \u03b2\u2010haemolytic streptococci (GAS) is a rare but still life\u2010threatening soft\u2010tissue infection characterized by rapidly spreading necrosis of the muscle fascia and of the surrounding tissues. NF other than that due to GAS involves the participation of one or more anaerobes and\/or of non\u2010group A streptococci, <jats:italic>Staphylococcus aureus<\/jats:italic>, enteric organisms, and may be associated with a better outcome. Early diagnosis and treatment, consisting of surgical debridement along with appropriate antibiotic therapy, are required to reduce morbidity and mortality rates.<\/jats:p><jats:p><jats:bold>Objectives\u2002<\/jats:bold> The aim of the study was to analyse the clinical and laboratory findings of patients with GAS NF and with non\u2010GAS NF, and to identify which characteristics could help to diagnose NF in the early stages of infection.<\/jats:p><jats:p><jats:bold>Methods\u2002<\/jats:bold> We retrospectively analysed the clinical and laboratory findings of 43 cases of GAS and non\u2010GAS NF that occurred in Belgium (<jats:italic>n<\/jats:italic>\u00a0=\u00a032) and at Saga Medical School (Japan) (<jats:italic>n<\/jats:italic>\u00a0=\u00a011) between May 1984 and December 2001.<\/jats:p><jats:p><jats:bold>Results\u2002<\/jats:bold> GAS NF more frequently occurred in previously healthy individuals than NF due to other pathogens (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.05) but was associated with a poorer prognosis. Both for patients with GAS NF and with non\u2010GAS NF, the first clinical manifestations often suggested a diagnosis of erysipelas or cellulitis and rarely evoked the correct diagnosis (12% and 15% of the cases, respectively). However, we found that creatine phosphokinase (CPK) values were far higher in patients with GAS NF than in those with non\u2010GAS NF.<\/jats:p><jats:p><jats:bold>Conclusions\u2002<\/jats:bold> Our data suggest that GAS may exert particular tropism and\/or toxicity for muscle, responsible for early muscle necrosis. This indicates that elevated levels of CPK in a patient with erysipelas or cellulitis\u2010like symptoms should clearly prompt the clinician to exclude the diagnosis of GAS NF.<\/jats:p>","DOI":"10.1111\/j.1468-3083.2004.01108.x","type":"journal-article","created":{"date-parts":[[2004,10,11]],"date-time":"2004-10-11T15:40:55Z","timestamp":1097509255000},"page":"687-690","source":"Crossref","is-referenced-by-count":22,"title":["The importance of serum creatine phosphokinase level in the early diagnosis and microbiological evaluation of necrotizing fasciitis"],"prefix":"10.1111","volume":"18","author":[{"given":"T","family":"Simonart","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J","family":"Nakafusa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Y","family":"Narisawa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2004,9,27]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198406283102601"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(94)90629-7"},{"key":"e_1_2_6_4_2","first-page":"463","article-title":"Erysip\u00e8le et fasciite n\u00e9crosante: prise en charge","volume":"28","author":"Soci\u00e9t\u00e9 Fran\u00e7aise de Dermatologie.","year":"2001","journal-title":"Ann Dermatol V\u00e9n\u00e9r\u00e9ol"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.1983.tb03989.x"},{"key":"e_1_2_6_6_2","first-page":"97","article-title":"Dermo\u2010hypodermal bacterial infections. 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