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Necrotizing fasciitis is an infection that starts in the tissues just below the skin and spreads along the flat layers of tissue (known as fascia) that separate different layers of soft tissue, such as muscle and fat.

This dangerous infection is most common in the arms, legs, and abdominal wall and can be fatal.

The vast majority of victims affected by the disease already have compromised immune systems. If caught early, antibiotics can stop the disease before much damage is done. "It's a relatively rare disease, but at 10,000-15,000 cases a year, it's not unknown.

"One has to look at the mortality of this infection, and it's a relatively low 5-7 percent, although it's clearly tragic for the individual and the family.

Necrotizing fasciitis (flesh-eating disease) facts Necrotizing fasciitis refers to a rapidly spreading infection, usually located in fascial planes of connective tissue that results in tissue death (necrosis). Different types of bacterial infection can cause necrotizing fasciitis. The majority of cases begin with an existing infection, most frequently on an extremity or in a wound.

Necrotizing fasciitis is a serious condition that is often associated with sepsis and widespread organ failure. Treatment of an infection caused by flesh-eating bacteria involves antibiotics and surgical debridement of the wound areas as well as supportive measures such as insertion of a breathing tube, intravenous administration of fluids, and drugs to support the cardiovascular system.

Although necrotizing fasciitis may be caused by an infection with one or more than one bacterium, in most cases the term flesh-eating bacteria has been applied to describe infections caused by the bacterium known as Streptococcus pyogenes.

The term flesh-eating has been used because the bacterial infection produces toxins that destroy tissues such as muscles, skin, and fat. Streptococcus pyogenes is a member of the group A streptococci, a group of bacteria that are responsible for mild cases of sore throat (pharyngitis) and skin infections, as well as rare, severe illnesses such as toxic shock syndrome and necrotizing fasciitis.

Most infections with group A streptococci result in mild illness and may not even produce symptoms. The symptoms of necrotizing fasciitis include redness, swelling, and pain in the affected area. Blisters may be seen in the involved area of skin. Fever, nausea, vomiting, and other flulike symptoms are common.

Another characteristic of necrotizing fasciitis is that the symptoms develop very rapidly, usually within 24 hours after a wound in the skin has allowed the bacteria to invade the tissues beneath the skin.

The pain is described as being more severe than would be expected from the appearance of the wound.

Late symptoms can include death (gangrene) of affected areas with scaling, discoloration, or peeling of the skin.



Notes:


Currently, there are many names that have been used loosely to mean the same disease as necrotizing fasciitis: flesh-eating bacterial infection or flesh-eating disease; suppurative fasciitis; dermal, Meleney, hospital, or Fournier's gangrene; and necrotizing cellulitis.

Body regions frequently have the term necrotizing placed before them to describe the initial localization of necrotizing fasciitis (for example, necrotizing colitis, necrotizing arteriolitis), but they all refer to the same disease process in the tissue.

Important in understanding necrotizing fasciitis is the fact that whatever the infecting organism(s), once it reaches and grows in connective tissue, the spread of the infection can be so fast (investigators suggest some organisms can progress to involve about 3 centimeters of tissue per hour) that the infection becomes difficult to stop even with both antimicrobial drugs and surgery.


Mortality (death) rates have been reported as high as 75% for necrotizing fasciitis associated with Fournier's (testicular) gangrene. Patients with necrotizing fasciitis have an ongoing medical emergency that often leads to death or disability if it is not promptly and effectively treated.

- Many of the people who have developed nnecrotizing fasciitis have been in good health before developing the condition. People with chronic medical conditions (for example diabetes and cancer) or who have weakened immune systems are at an increased risk of developing necrotizing fasciitis.

- Recent wounds (including surgical incissions) and recent viral infections that cause a rash (such as chickenpox) also confer an increased risk.

- Hospitalization, usually with treatment in the intensive-care unit (ICU), is required. Surgery to remove infected fluids and tissue may be necessary, along with medications to treat shock and other potential complications