About Necrotizing Fasciitis

Necrotizing fasciitis, often referred to as "flesh eating bacteria," is a rare but fearsome infection. Faster spreading strains of the bacteria have been known to kill a human in days. Necrotizing fasciitis is most commonly caused by an invasive form of strep bacteria. Once the disease is contracted, bacteria begins destroying the fascia, a layer of tissue between the skin and muscle, and can spread as fast as 3 centimeters per hour.

Significance

• According to the Centers for Disease Control and Prevention, between 500 to 1,000 cases of necrotizing fasciitis are reported each year in the United States. Mortality rates of necrotizing fasciitis have been reported from 25 percent to 50 percent. Necrotizing fasciitis can be fatal within a week of contraction.

History

• Earliest descriptions of necrotizing fasciitis date to the 1840s. Dr. Joseph Jones, a Confederate health officer during the Civil War, reportedly documented 2,600 cases of the infection. Dr. B. Wilson coined the term "necrotizing fasciitis" in 1952. Famous victims include Lucien Bouchard, the former premier of Quebec, and Melvin Franklin of The Temptations.

Causes

• Necrotizing fasciitis is caused by a bacterial infection, commonly a combination of Group A streptococcus and other bacteria, that invades the body through a cut or abrasion. There are no special at-risk groups. The infection is based in the fascia, or soft connective tissue of the body. As they reproduce, the bacteria secrete toxins that cause necrosis in the fascia, making the skin gangrenous.

Symptoms

• Early symptoms include water retention in body tissue. The original wound or trauma will not heal. After one to two days, red discoloration (erythema) around the original infection site can be seen. Intense pain and crepitation, or crackling of tissue, are other early symptoms. As the infection progresses, the erythematic discoloration will advance and give way to painless skin ulcers. In advanced stages, septicemia or toxic shock can occur.

Treatment

• Early diagnosis is critical for survival. After diagnosis, patients should be immediately hospitalized and start a treatment of multiple intravenous antibiotics. Cultures derived from skin ulcers are used to identify specific bacteria. Patients should be kept in intensive care in case of toxic shock. In some cases, hyperbaric oxygen therapy, atmospheric oxygen administered to a patient in a high pressure chamber, can slow bacterial growth. As antibiotics only slow the progress of necrotizing fasciitis, amputation is often necessary.

Prognosis

• Necrotizing fasciitis can lead to limb loss and death. Mortality rates rise for multidrug-resistant bacterial infections. Mortality rates for the disease can be as high as 25 percent, . Again, early diagnosis is paramount to increase the chance of survival.

Prevention

• Proper hygiene practices are the best defense against bacterial infection leading to necrotizing fasciitis. Necrotizing fasciitis is often associated with surgery or drug use. Intravenous equipment and tools can carry bacteria that might lead to cases of necrotizing fasciitis. Improper surgical wound closure can also increase chances of infection. Although not necessarily contagious, infection leading to necrotizing fasciitis can be contracted from someone with the infection.