坏死性筋膜炎

应无系统性毒性或降到最低。[5]Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

全血细胞计数和血清生化检查无明显异常。

片状分布的浅表水疱，，伴有结硬皮和红斑，有或无大疱。 可能是无症状的或伴随瘙痒。

通过感染组织的培养鉴别金黄色葡萄球菌或化脓性链球菌。[5]Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

亮红色、有压痛的红斑，边界清晰。[5]Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

通过感染组织的培养鉴别化脓性链球菌或其它链球菌。[5]Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

未累及皮肤或软组织。 受累区域上方肿胀，但可能无疼痛。 很少出现系统性体征/毒性症状。

超声检查或 CT/MRI，以识别肌肉局部受累伴肿胀。

MRI 也能够鉴别水肿。

进展迅速的梭菌属感染。通常继发于伴随有受累区域血供中断的严重穿透伤或挤压伤之后。可能临床上难以鉴别。[5]Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

感染组织的培养可鉴别梭菌属。[5]Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014 Jul 15;59(2):e10-52.https://academic.oup.com/cid/article/59/2/e10/2895845

有静脉内用药或接触动物或动物制品（例如兽皮、皮毛）的既往史。暴露后 2 至 5 天出现无痛、有瘙痒的丘疹。24 至 36 小时后，病损变为水疱，进展为坏死性黑痂，并伴有病灶周围严重水肿。常见局部淋巴结肿大。

囊泡液/血液革兰染色和培养：短链革兰氏阳性菌（炭疽杆菌）；5% 的羊血琼脂上生成扁平的非溶血性黏液状菌落。

皮肤病变的钻取活检：真皮和表皮的坏死、水肿和轻度炎症浸润；大量的杆菌状片段（抗生素治疗前）；炭疽杆菌（抗生素用药后）。