What is Necrotizing Fasciitis?

Necrotizing fasciitis, commonly known as flesh-eating disease, is a rare, but potentially lethal bacterial infection of the skin and underlying soft tissues. It is an infection with a rapid course of progression and a high mortality rate. Surgical removal of the infected tissue is often required and even with antibiotic treatment, amputation may still be necessary. Mortality rates range from 25% to 73% in the published scientific literature.

The symptoms of necrotizing fasciitis initially present as a small red bump on the skin that is more painful than a wound its size should be. The pain may not be localized to the site of infection. It is accompanied by severe flu-like symptoms including high fever, diarrhea, vomiting, dizziness, and lack of strength. Tissue death begins occurring within a few hours, with clear signs of inflammation if the infection is not localized deep within tissue. If the infection is allowed to progress untreated, within a matter of days, massive tissue death will occur. Continuing infection may manifest itself as white, blue, or purple skin discolorations accompanied by flakiness around the wound or as deep, black, oozing blisters. At this point the patient may go into toxic shock and become unconscious.

Necrotizing fasciitis may be caused by a number of different bacteria. Infections can involve one or multiple species of bacteria at the same site. Two of the species are commonly found in hospitals: Streptococcus pyogenes and methicillin-resistant Staphylococcus aureus (MRSA). The symptoms of are caused by toxins released by the infecting bacteria, which activate the immune system so potently that it wreaks mass destruction on the tissues around the toxin. As the toxin circulates through blood, the attacks follow.

The prescribed treatment for necrotizing fasciitis, once the infection has been diagnosed as such, is rapid and radical surgical removal of any infected tissue combined with broad-spectrum antibiotic treatment. Hyperbaric oxygen treatment, a procedure where the patient is placed in a chamber that delivers 100% oxygen to the infected tissues at high pressure, can be useful in patients who have been diagnosed with an infection caused by oxygen-avoiding bacteria. Although the treatments may seem aggressive, they actually reflect modern medicine’s inability to control this violent form of infection. Without treatment, death is inevitable.

Even when treatments are successful and the infection is fully removed, the patient will often leave the hospital with scars or deformities. Those who have had skin or tissue removed will require skin grafts and must take extra careful to prevent further infection while the new skin is growing. Amputees must undergo extensive physiotherapy and learn to perform their daily tasks without their lost limb.

Although necrotizing fasciitis is a terrible disease, it is relatively rare, with only about 600 diagnosed cases in the US in 1999. Its symptoms are similar to other, less serious diseases and as a result, necrotizing fasciitis is often misdiagnosed. Since time is of the essence in minimizing damage dealt to the patient, it is important for anyone presenting with the combined early symptoms of this disease to insist that it be ruled out first. Preventative measures include keeping the skin intact, practicing good hygiene, washing hands often with soap, and disinfecting any cuts or scrapes. Since many cases of this disease are linked to hospital visits, extra vigilance must be kept during and after a hospital visit.