What is Necrotizing Fasciitis?
Necrotizing fasciitis (NF), popularly referred to as the “flesh eating bacteria” or “flesh eating disease”, is a serious infection caused by a bacteria such as group A Streptococcus (strep), Staphylococcus aureus, Klebsiella, Clostridium, Escherichia coli, and others. The bacteria usually enters the body at the site of a trauma or skin opening, and sometimes there is no obvious wound or injury. Once the bacteria is in the body, it rapidly progresses, affecting the fascia (flat connective tissue covering fat, muscles and tendons), and surrounding tissues. Many NF patients are also systemically toxic (septic shock), which may lead to organ failure and death. Early diagnosis and treatment, including surgical removal of dead tissue and broad spectrum IV antibiotics, is critical in stopping the infection. Delays in treatment, including misdiagnosis, increase mortality and amputation rates.
Individuals with various underlying medical conditions are at an increased risk to get NF, such as diabetes, cancer, alcoholism, renal failure, liver disease or an otherwise weakened immune system. However, many cases occur in an otherwise previously healthy person, especially when group A Streptococcus is involved.
- In the area of a wound, incision, bug bite, scratch or other trauma, having general soreness, like the feeling of a “pulled muscle”
- Localized area that is warm, red, swelling and painful out of proportion to the visual appearance (this may mimic cellulitis (a superficial skin infection), as NF infects deep skin tissue not visible)
- Flu-like symptoms such as fever, chills, dizziness, vomiting, malaise
- The area may become grey or black in appearance and become rigid with edema
- Development of clear blisters or wound drainage
- Intense thirst, dehydration and cessation of urination
- Septic shock brings high fever, low blood pressure, rapid heartbeats, shallow breaths
- Confusion, delirium, death
- Broad spectrum IV antibiotics such as Vancomycin or Clindamycin
- Aggressive surgical debridement of necrotic tissue (repeated surgeries are often necessary and amputations may be necessary)
- Hyperbaric Oxygen
- IV immune globulin
- Intubation (breathing tube)
- Medically induced sedation
- For wound closure, sutures, skin grafts and/or a wound vacuum
Early diagnosis of necrotizing fasciitis, T. Goh1, L. G. Goh2, C. H. Ang3 and C. H. Wong