What is Necrotizing Fasciitis? What is Flesh-Eating Disease?

Editor's Choice
Main Category: Infectious Diseases / Bacteria / Viruses
Also Included In: Dermatology
Article Date: 06 Mar 2012 - 0:00 PST


Necrotizing fasciitis (NF), also known as flesh-eating disease, is a bacterial infection which can progress rapidly, causing severe disease. It is treated with very high doses of intravenous antibiotics. This rare and serious condition attacks the deeper layers of skin and subcutaneous tissues. It easily spreads across the fascial plane (tissue covering the muscle) within the subcutaneous tissue.

Muscle and fat tissue are affected as a consequence of infection. Necrotizing fasciitis is a severe complication of group A streptococcal infection. The bacteria cause the destruction of skin and muscle by releasing toxins. Additional complications can occur from necrotizing fasciitis, such as shock and organ failure.

The flesh-eating bacteria can appear where there is a wound or trauma. It begins at the site of a break in the skin (a surgical or non-surgical wound). In order for someone to contract necrotizing fasciitis, the bacteria must be introduced into the body. Group A Strep is the same bacterium that causes strep throat. This group of bacteria is responsible for mild cases of sore throat (pharyngitis), skin infections, as well as rare, severe illnesses such as toxic shock syndrome and necrotizing fasciitis. However, there are various strains of the bacteria, some of which are more powerful than others. With the right set of conditions, necrotizing fasciitis is a real risk and can cause severe damage.

According to Medilexicon's medical dictionary, Necrotizing Fasciitis is:

"A rare soft-tissue infection primarily involving the superficial fascia and resulting in extensive undermining of surrounding tissues; progress is often fulminant and may involve all soft-tissue components, including the skin; usually occurs postoperatively, after minor trauma, or after inadequate care of abscesses or cutaneous ulcers."

What are the signs and symptoms of Necrotizing Fasciitis?

Infection starts where the skin was cut, often referred to as the wound. The break in the skin might be from surgery, a small cut, a broken bone, a rash - the cut may range from severe to fairly minor. Sometimes you cannot even see the broken skin.

Signs and symptoms of necrotizing fasciitis may include:

• As the infection progresses, there is inflammation
• Blisters
• Confusion
• Dehydration
• Diarrhea
• Fever
• General feeling of being ill
• Hypotension (low blood pressure)
• Intense pain in the affected area
• Skin becomes warm (hot) and red
• Skin coloration changes, and becomes violet
• Subcutaneous tissues die (necrosis)
• Vomiting

In the early stages, signs of inflammation may not be apparent if the bacteria are deep within the tissue.

There is a high risk of death if the flesh eating disease is not treated.

What are the causes of Necrotizing Fasciitis?

The bacteria enter through the skin, via a cut, scrape, abrasion, contusion - referred to often as a wound. Sometimes there is no visible cut.

The patient has to come into contact with this particular invasive strain of bacteria. This can be through direct contact with a carrier, or because the bacteria is present on the person.

Below is a list of people who might be at a higher risk of developing necrotizing fasciitis. However, the disease may attack "healthy" individuals.

• Alcohol abusers
• Diabetics
• Drug abusers
• Elderly
• In rare occasion, children with chicken pox
• Individuals suffering from malnutrition
• Chronically ill patients
• Severely ill patients
• Those with weakened immune systems
• Patients with peripheral vascular disease
• Anybody who has experienced a recent injury that broke (cut) the skin, including surgery
• Obese people
• Women giving birth

What are the treatment options for Necrotizing Fasciitis?

The doctor evaluates the patient's signs and symptoms and will probably diagnose flesh eating disease by looking at the tissues. Samples are sent to the lab and analyzed under a microscope.

Surgery is often needed to remove infected tissue - the aim here is to stop the infection from spreading.

The patient should start on intravenous antibiotic therapy immediately if necrotizing fasciitis is diagnosed, or even suspected.

When detected during the early stages before toxic shock, the need to surgically remove skin and soft tissue can be kept to a minimum. In more advanced cases major limb amputation is necessary.

When physicians are confident that the infection has been stopped, the wounds are closed. Usually, a large open wound requires skin grafting. Because of massive wounds or tissue destruction, hyperbaric oxygen treatment can be a beneficial supplementary therapy. The recovery process involves extended physical therapy, and long-term psychological, emotional healing.

As necrotizing fasciitis can start deep under the skin, there may be no signs and symptoms for a while, and diagnosis occurs later, or diagnosis is inaccurate (misdiagnosis).

There is a serious risk that the patient's body organs go into systemic shock. Spread and growth of the disease in other areas of the body including the bloodstream can lead to an overwhelming bacterial infection and death. All body functions can shut down as a result of the severe infection and toxicity in the system. This may result in respiratory failure, heart failure, low blood pressure and renal failure.

Death from this condition is not uncommon. However, many successfully treated patients recover satisfactorily.

Patients will be placed in the ICU (intensive care unit). Flesh eating disease is a rapidly spreading infection which can cause a lot of tissue death and damage. Prompt treatment is vital.

How to prevent necrotizing fasciitis infection?

Since the infection mostly occurs in persons with wounds due to surgery or injury, appropriate precautions and care should be taken. Wounds should be kept thoroughly clean. Any signs of infection (redness, swelling, inflammation, hot skin, secretion) should require medical attention. The infection can be treated with antibiotics.

Good hygiene habits are important to help stop the spread of group A streptococcal infections. You should wash your hands with warm water and soap after sneezing, coughing, caring for somebody with a wound or strep throat, before preparing meals, and before you sit down to eat.

Doctors, nurses and other health care staff should respect strict sanitary measures (changing gloves between patients, thorough and frequent hand washing, and proper disposal of items contaminated by respiratory secretions or wound drainage).

Regular hand washing is the most important measure to reduce the risks of transmitting microorganisms from one person to another or from one site to another on the same patient. It is crucial to wash hands thoroughly and immediately between patient contacts and after contact with blood, body fluids and secretions.

Written by Christian Nordqvist
Original article date: 03 May 2004. Article updated: 6 March 2012.
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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