Significant increase in necrotizing fasciitis in the post-COVID era: a systematic review
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20260318Keywords:
Necrotizing fasciitis, Post-COVID era, Soft tissue infection, Immune dysregulationAbstract
Necrotizing fasciitis (NF) is a rapidly progressive, life-threatening soft tissue infection associated with high morbidity and mortality. The COVID-19 pandemic has significantly altered healthcare delivery and patient health profiles, potentially influencing the incidence and clinical characteristics of NF. To systematically review and analyze the reported literature on necrotizing fasciitis in the post-COVID era, with a focus on incidence, risk factors, clinical presentation, outcomes, and possible links with COVID-19 infection or its sequelae. A systematic review was conducted in accordance with the PRISMA guidelines. Major databases (PubMed, Scopus, Web of Science, and Google Scholar) were searched for studies published between January 2020 and July 2025 that reported cases or series of necrotizing fasciitis in the post-COVID period. Data regarding demographics, comorbidities, COVID-19 status, clinical features, management, and outcomes were extracted and analyzed. The review identified a notable increase in reported cases of necrotizing fasciitis in the post-COVID era, particularly among patients with a history of COVID-19 infection, diabetes mellitus, obesity, or immunosuppression. Delayed hospital presentations, atypical clinical manifestations, and higher rates of severe complications were frequently observed. Mortality remained significant despite aggressive surgical and medical management, with some studies attributing poorer outcomes to post-COVID immune dysregulation and healthcare system delays. Necrotizing fasciitis appears to have increased in frequency and severity in the post-COVID era, with COVID-19–related comorbidities and immune alterations serving as potential contributing factors. Early recognition, timely surgical intervention, and heightened clinical suspicion in post-COVID patients are crucial to improving outcomes. Further large-scale studies are needed to clarify the causal relationship and guide preventive strategies.
Metrics
References
Nguyen QD, Diab J, Khaicy D, Diab V, Hopkins Z, Foong LH, et al. Necrotising fasciitis during the COVID-19 pandemic: an Australian hospital network experience. World J Surg. 2023;47(7):1619-30. DOI: https://doi.org/10.1007/s00268-023-07040-2
Costa Senior O da, Van de Casteele E, Van Hemelen G, Nadjmi N, Vercruysse H Jr. Facing a new reality: significant increase in necrotizing fasciitis in the post-COVID era? J Stomatol Oral Maxillofac Surg. 2024;126(5):102145. DOI: https://doi.org/10.1016/j.jormas.2024.102145
Al Zadjali F, Hua N, Tohmé A, Alsaffar H, Johnson Obaseki S. Necrotizing fasciitis of the head and neck in the era of COVID-19: a single institution experience. IJID Reg. 2024;12:100413. DOI: https://doi.org/10.1016/j.ijregi.2024.100413
Breidung D, Billner M, Megas IF, Edo AM, Reichert B, Malsagova AT, et al. Increase in streptococcal necrotizing fasciitis during and after the coronavirus disease 2019 pandemic. Surg Infect (Larchmt). 2024;25:169-74. DOI: https://doi.org/10.1089/sur.2023.233
Epprecht G, Weller D, Hofmaenner DA, Andrianaki AM, Frey PM, Brugger SD, Zinkernagel AS. Impact of the COVID-19 pandemic on group A streptococcal necrotizing soft tissue infections: a retrospective cohort study. Open Forum Infect Dis. 2024;11(10):ofae572. DOI: https://doi.org/10.1093/ofid/ofae572
Subbaram K, Faiz R, Naher ZU, Manandhar PL, Ali S, Tazerji SS, Duarte PM. Post-COVID-19 pandemic surge of fatal streptococcal type 2 necrotizing fasciitis and toxic shock syndrome cases: review of articles. J Microbiol Infect Dis. 2025;15(1):1-4. DOI: https://doi.org/10.5455/JMID.2025.v15.i1.1
Santana LADM, Santos GA, Brasileiro BF, Gopalsamy RG, Borges LP, Trento CL. Comment on “Facing a new reality: Significant increase in necrotizing fasciitis in the post-COVID era?”. J Stomatol Oral Maxillofac Surg. 2024;126(5S):102163. DOI: https://doi.org/10.1016/j.jormas.2024.102163
Cobo-Vázquez E, Aguilera-Alonso D, Carrasco-Colom J, Calvo C, Saavedra-Lozano J. Increasing incidence and severity of invasive group A streptococcal disease in Spanish children in 2019–2022. Lancet Reg Health Eur. 2023;27:100597. DOI: https://doi.org/10.1016/j.lanepe.2023.100597
Arens Taga A, Lauria G. COVID-19 and the peripheral nervous system: a 2-year review from the pandemic to the vaccine era. J Peripher Nerv Syst. 2022;27(1):4-30.
van Kempen EB, Pries AM, Buddingh EP, Puiman PJ, van Veen M. Group A streptococcal disease in sudden unexpected death in youth in the pre- and post-COVID-19 era. Pediatr Infect Dis J. 2025;44(5):e156-60. DOI: https://doi.org/10.1097/INF.0000000000004775
Khan M, Furrukh N, Naveed F. The next pandemic? Streptococcal toxic shock syndrome on the rise. Disaster Med Public Health Prep. 2025;19:e53. DOI: https://doi.org/10.1017/dmp.2025.44
Taga A, Lauria G; JPND COVID-19 Working Group. COVID-19 and the peripheral nervous system: a 2-year review from the pandemic to the vaccine era. J Peripher Nerv Syst. 2022;27(1):4-30. DOI: https://doi.org/10.1111/jns.12482
Eijkenboom A, Friederichs J, Hackl S, Hungerer S, et al. A rise in severe necrotizing fasciitis—another consequence of the COVID-19 pandemic? Infection. 2025;53:2169-77. DOI: https://doi.org/10.1007/s15010-025-02564-2
Mania A, Mazur-Melewska K, Witczak C, Cwalińska A, Małecki P, Meissner A, et al. Invasive group A streptococcal infections as a consequence of coexisting or previous viral infection in the post-COVID-19 pandemic period. J Infect Public Health. 2025;18(1):102622. DOI: https://doi.org/10.1016/j.jiph.2024.102622
Salim O-A, Hillier-Smith R, Ardolino A. Necrotising fasciitis, invasive group A Streptococcus infection: a case series of eight patients requiring surgical debridement in one trauma unit within nine months. J Surg Case Rep. 2024;2024(7):rjad708. DOI: https://doi.org/10.1093/jscr/rjad708
Downloads
Published
How to Cite
Issue
Section
