Bakleh et al used a histologic staging system to evaluate patients with necrotizing fasciitis. the author are from the Mayo Clinic in Rochester, Minnesota.
Parameters:
(1) degree of neutrophilic infiltration
(2) number of bacteria in infected tissue (after a careful examination of a Gram stain)
Neutrophilic Infiltrate
Number of Bacteria
Stage
moderate to severe
none
I
moderate to severe
present
II
none to few
none
II
none to few
present
III
where:
• The absence of both neutrophils and bacteria is Stage II and not Stage 0. It is important therefore that the patient have clinical evidence of necrotizing fasciitis and the biopsy be taken from an area that is definitely involved. Otherwise normal tissue would be classified as Stage II.
• A few neutrophils must correspond to a mild neutrophilic infiltrate.
• It may be difficult to classify the presence of rare bacteria (almost all microscopic fields negative, no more than 1 organism per microscopic field). This may be a function of the diligence of the examiner.
• A patient with agranulocytosis would tend to have a higher stage because of the absence of circulating neutrophils.
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