Necrotizing fasciitis is a life-threatening bacterial infection that affects deeper body tissues. Necrotizing means causing the death of tissues; fasciitis means inflammation of the fascia (the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels). Necrotizing fasciitis has another daunting name known as “flesh-eating disease”.
Images credit to: DermNetNZ via CC BY-NC-ND 3.0 NZ
Although necrotizing fasciitis is a bacterial infection, it is rarely transmitted from one person to the other. Most cases of necrotizing fasciitis occur randomly, with some people more likely to develop necrotizing fasciitis than the other. If you’re curious—
What are the symptoms of necrotizing fasciitis?
Early symptoms of necrotizing fasciitis can include:
- A red, warm, or swollen area of skin that spreads quickly
- Severe pain, including pain beyond the area of the skin that is red, warm, or swollen
- Fever
These early symptoms can be confusing and mistaken for other similar medical conditions, such as cellulitis. If you develop these symptoms after an injury or surgery, see a doctor right away. Your doctor would do careful diagnosis and determine appropriate treatment.
As necrotizing fasciitis progresses, severe signs and symptoms below can be observed:
- Ulcers, blisters, or black spots on the skin
- Changes in the color of the skin
- Pus or oozing from the infected area
- Dizziness
- Fatigue (tiredness)
- Diarrhea or nausea
- Persistent spread of bacterial infection despite antibiotic treatment
- Kidney failure
- Deterioration of other body systems (sepsis)
Besides the limbs, necrotising fasciitis lcan happen anywhere in the body. It can also happen in the genital area known as Fournier's gangrene (one of the commonest presentation in the hospital).
Images credit to: DermNetNZ via CC BY-NC-ND 3.0 NZ
What bacteria causes necrotizing fasciitis?
There are many types of bacteria that can cause necrotizing fasciitis. The condition can be categorized based on the type of bacteria causing it:
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Type I necrotizing fasciitis are mostly caused by aerobic and anaerobic bacteria, such as E. coli, Klebsiella, enterococci, Bacteroides and Clostridium. This type of necrotizing fasciitis is also known as polymicrobial necrotizing fasciitis, and it mostly affects people of older age and with underlying medical conditions.
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Type II necrotizing fasciitis are most commonly used by group A streptococcus (GAS). Also known as monomicrobial necrotizing fasciitis, it may occur in any age group and in individuals with no underlying medical conditions.
The bacteria most commonly enter the body through a break in the skin, including:
- Cuts and scrapes
- Burns
- Insect bites
- Puncture wounds (including those due to intravenous or IV drug use)
- Surgical wounds
However, people can also get necrotizing fasciitis after an injury that does not break the skin (blunt trauma).
Treatment of necrotizing fasciitis
Since necrotizing fasciitis is a serious bacterial infection, immediate medical attention is very important. Treatment of necrotizing fasciitis involves:
- Aggressive surgical debridement — Removal of damaged, infected and dead tissues caused by necrotizing fasciitis to improve wound healing. For severe necrotizing fasciitis, amputation may be required to prevent the further spread of infection.
- IV antibiotic therapy — Broad spectrum antibiotics (i.e. antibiotics that kill many types of bacteria at once) should be given intravenously to individuals with necrotizing fasciitis. Examples of IV antibiotics typically given to necrotizing fasciitis are ertapenem,piperacillin-tazobactam and clindamycin.
- Ensure the patient is getting enough hydration, as well as maintaining optimal heart rate and blood pressure.
Time is key!
Necrotizing fasciitis must be treated as soon as possible, ideally within 12 hours. The longer treatment gets delayed, the more likely to have irreparable consequences.
Complications of necrotizing fasciitis
Necrotizing fasciitis can lead to sepsis, shock, and organ failure. It can also result in life-long complications from amputation or severe scarring due to surgically removing infected tissue.
Necrotizing fasciitis has a high death rate. Even with treatment, up to 1 in 3 people with necrotizing fasciitis die from the infection. Some people with GAS necrotizing fasciitis also develop streptococcal toxic shock syndrome, which causes the body to go into shock, extremely low blood pressure and eventually organ failure.
Who is more likely to develop necrotizing fasciitis?
While anyone can get necrotizing fasciitis, most people who get this infection have underlying medical conditions that impair their immunity. People with the following conditions should be extra careful about necrotizing fasciitis:
- Diabetes
- Kidney disease
- Scarring (cirrhosis) of the liver
- Cancer
- Use of a type of diabetic medication sodium-glucose cotransporter 2 inhibitors (e.g. empagliflozin, canagliflozin, dapagliflozin), although the risk is rare. Do not stop taking your diabetic medication without discussing it with your doctor first.
- Some data suggests that use of nonsteroidal anti-inflammatory drugs (NSAIDs) may also be associated with development of necrotizing fasciitis. Although the evidence on this is conflicting, use of medications that reduce inflammation such as NSAIDs may mask early symptoms of necrotizing fasciitis, which can delay diagnosis and treatment. If you have persistent skin infection despite taking medication, do not continue self-treatment and see a doctor instead.
To prevent necrotizing fasciitis, it’s important that you always keep good hand hygiene. Good wound care is also key to prevent necrotizing fasciitis, especially if you have other medical conditions such as diabetes that would make you more vulnerable to skin and soft tissue infections. Make sure you clean all minor cuts and injuries with soap and water, see a doctor for deeper or puncture wounds and care for fungal skin infections such as Athlete's foot properly. If you develop any symptoms that we mentioned above, seek medical attention immediately.
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Cover image credit: https://www.orthobullets.com/trauma/1007/necrotizing-fasciitis
