Necrotizing fasciitis (NF), commonly known as flesh-eating disease or flesh-eating bacteria syndrome, is a rare infection of the deeper layers of skin and subcutaneous tissues, easily spreading across the fascial plane within the subcutaneous tissue.Necrotizing fasciitis is usually treated immediately with high doses of intravenous antibiotics.
Necrotizing fasciitis is a severe complication of group A streptococcal infection. The bacteria cause the destruction of skin and muscle by releasing toxins.
How are group A streptococci spread? These bacteria are spread by direct contact with nose and throat discharges of an infected individual or with infected skin lesions. The risk of spread is greatest when an individual is ill, such as when people have strep throat or an infected wound. Individuals who carry the bacteria but have no symptoms are much less contagious.
Few people who come in contact with a virulent strain of GAS will develop invasive GAS disease; most will have a routine throat or skin infection and some may have no symptoms whatsoever. Although healthy people can get invasive GAS disease, people with chronic illnesses like cancer, diabetes and kidney dialysis, and those who use medications such as steroids, are at higher risk. In addition, breaks in the skin, like cuts, surgical wounds or chickenpox, may provide an opportunity for the bacteria to enter the body.
Popularly known as the flesh-eating disease, necrotizing fasciitis is an uncommon condition, but it can lead to life-threatening illness and death, with mortality rates approaching 50 percent.
The single most important variable influencing mortality is time to surgical debridement. Thus, a high degree of clinical suspicion is necessary to avert potentially disastrous consequences.
Necrotizing fasciitis is often initially overlooked by doctors because it invades tissue deep inside the wound while the outer wound appears to be healing normally, Dr. William Schaffner of the Vanderbilt University Medical School said."This often is a very subtle infection initially," Schaffner said. "These bacteria lodge in the deeper layers of the wound. The organism is deep in the tissues and that's where it's causing its mischief."
Typical initial signs and symptoms include swelling, erythema [rash], exquisite pain, and tachycardia [rapid heartbeat] that rapidly progresses to tense edema [swelling] of the area surrounding compromised skin, pain out of proportion to lesions, skin discoloration, blisters/bullae and necrosis [tissue death], crepitus [crackling under the skin], and subcutaneous gas.
About 500 to 1,500 cases of necrotizing soft tissue infections (NSTIs) occur per year in the United States. Although NSTIs occur in all age groups, they are most likely to occur in patients older than 50 years with comorbid medical conditions such as diabetes, hypertension, peripheral vascular disease, alcoholism or cardiopulmonary disease.
Like many diseases that have been "discovered" in our modern medical era, necrotizing fasciitis was actually first described by Hippocrates in the 5th century BC. He discussed it as a complication of "erysipelas:"
"... the erysipelas would quickly spread widely in all directions. Flesh, sinews and bones fell axvay in large quantities Fever was sometimes present and sometimes absent ... There were many deaths. The course of the disease was the same to whatever part of the body it spread."
By the mid-19th century, hospital gangrene and phagedena were the preferred names. ... In England, from the 1780s through the 1850s, the disease was known as one of the most dread to befall those serving in the army and navy. Hospital gangrene was rare in civilian hospitals