Necrotizing fasciitis

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at January 27, 2016
StartDiseasesNecrotizing fasciitis

Necrotizing fasciitis or NF is a rare but horrifying disease. Although also known as “'flesh-eating disease”' and “flesh-eating bacteria,” the bacteria that cause this life-threatening infection do not actually consume flesh but do release toxins that cause the destruction and death of skin tissue.

Contents

Definitions & Facts

Initially identified in 1952, necrotizing fasciitis occurs as a bacterial infection in deeper layers of skin and subcutaneous tissue. Occurrence of the condition is rare; an average of 650-850 cases of NF caused by group A streptococcus occur in the United States each year. However, one in every four patients who develop this illness will die from it. Adequate hygiene and wound care go far to prevent incidence of necrotizing fasciitis particularly for those with weakened immune systems.

Symptoms & Complaints

Patients who develop necrotizing fasciitis will not easily be aware of their condition. Symptoms involve the pain that comes from an open wound, cut, or scrape. Initially, the affected area may be uncomfortable or sore, swell, or develop discoloration. After the first 24 hours of infection, the severity of pain will increase rapidly and will be much worse than pain that would typically be expected for the type of injury or wound.

As the bacteria spreads after three or four days of infection, the patient may experience fever, chills, fatigue, vomiting, dehydration, lowered blood pressure, rapid heartbeat, and rash or blisters. The rash may be dark or purple, and it might include blisters filled with foul-smelling fluid. Days four or five of the infectious period may be met with the development of toxic shock, organ damage, and loss of consciousness. Without prompt treatment, necrotizing fasciitis can quickly lead to severe complications, amputation, and death.

Causes

Several bacteria cause NF, but group A streptococcus is the most common. Bacteria enters the body through an opening in the skin and attacks the fascia membrane, spreading through the connective tissues that surround muscle. The bacteria reproduces, attacks, and spreads very quickly, releasing toxins as it progresses. As the infection continues, the toxins cause tissue death and leads to septicemia, toxic shock, organ failure, and death.

The bacteria which cause the condition are relatively common, but certain lifestyle factors may play a role in incidence of the disease. These may include illnesses that inhibit the immune system, exposure to contaminated water, exposure in a hospital setting, consuming contaminated foods, and sharing needles when using intravenous drugs.

Diagnosis & Tests

Diagnosis and treatment during the early stages are crucial to survival because of how rapidly the disease progresses. Patients will describe pain that is unexpectedly severe and doctors will examine the physical appearance of the wound. Should the practitioner suspect that NF may be present, he or she will call for a round of tests. Blood tests or frozen tissue samples may confirm bacteria; an ultrasound will reveal any abscesses; and X-rays, CT scans and MRIs will indicate organ injury or spread of the disease.

Treatment & Therapy

Once a diagnosis of necrotizing fasciitis occurs, prompt, aggressive treatment is critical. Patients will generally experience treatment in the intensive care unit of the hospital. First, a plethora of antibiotics, both oral and intravenous, will begin to eliminate the bacterial infection. Generally, antibiotics will be unable to completely rid the body of infection, and surgery must follow. In recent years, some strains of antibiotic resistant bacteria have been seen in cases of necrotizing fasciitis.

Exploratory surgery identifies affected and dead tissue which must be removed. Several exploratory and removal surgeries will probably occur to ensure complete eradication of the infection. Amputation is often necessary to make survival possible. Following treatment, these multiple surgeries and excisions often create the need for skin graft surgeries to repair the areas damaged by the life-saving surgeries.

Oxygen treatment with a hyperbaric device is often used to attempt tissue preservation. Other treatments also occur to treat complications caused by the infection including medication to raise blood pressure, monitoring of cardiac symptoms, blood transfusions, and even induced coma.

Prevention & Prophylaxis

Because patients with chronic illnesses, recent illness, recent steroid use, or weakened immune systems for any other reason are at a higher risk for developing NF, wound care is particularly important for those patients. Fresh, dry bandages should be applied frequently to any open wound until it heals. Also, any wound should receive prompt first aid.

Anyone who has an open wound should avoid all activities that involve immersing the area in public or dirty waters, including whirlpools, lakes, etc. The simplest and most effective way to avoid necrotizing bacterial infection is hand washing.