Platelet-Lymphocyte Ratio and Neutrophil-Lymphocyte Ratio: Updates in Prognosticating Fournier Gangrene in the Emergency Department

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Authors: Alessandra Della Porta, EMT-B, MSIIIUniversity of Miami School of Medicine

Kasha Bornstein, Msc Pharm, EMT-P, MSIV
AAEM/RSA Modern Resident Blog Copy Editor
University of Miami School of Medicine

Bottom Line Up Front:
Fournier gangrene (FG) is a necrotizing soft tissue infection (NSTI) associated with high mortality rates, particularly when it is not suspected early, or interventions are initiated late in the course. Diagnosis is clinical and challenged by overlap with more superficial skin infections (i.e. cellulitis) and the need for thorough examination of the genital region. Imaging and laboratory analysis are not able to consistently rule out FG. While risk calculators exist, they are also limited in their utility for ruling out severity of illness. This brief article discusses use of the monocyte-lymphocyte ratio, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio; recently innovated, simple, and effective biomarkers for prognosticating NSTIs. 

Necrotizing Fasciitis: A Dermatologic Emergency

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Author: Lauren Van Woy, OMS III
Western University of Health Sciences, College of Osteopathic Medicine of the Pacific

Introduction
Necrotizing fasciitis is a rare but potentially fatal dermatologic infection that emergency physicians must be able to promptly recognize and treat. Misdiagnosis of necrotizing fasciitis is common, with 41% to 96% of cases falsely identified as a less serious soft tissue infection (such as cellulitis or an abscess).[1] Failure to treat necrotizing fasciitis can lead to sepsis, organ failure, and death.[2] Therefore, it is imperative to have a low threshold for diagnosis.