Necrotizing Fasciitis Fall '11
Flesh-eating Disease, Gangrene (5)
There are many bacteria that cause necrotizing fasciitis (NF). The main one would be group A streptococci. The other bacteria that causes flesh eating disease are Clostridium perfringens, Staphylococcus aureus, and other aerobic and anerobic bacteria (1). Researchers classify necrotizing fasciitis into three different categories: Type I, Type II, and Type III. Type I NF is caused by many bacteria infecting the body; it is also the most common type (3). Type II NF is caused by one bacteria infecting the body (3). This particular one is mostly caused after a toxic shock syndrome associated with the causative organism(3). Type III NF is still under debate but is caused by Vibrio vulnificus and the person is at risk of getting this type when there is a break in the skin and exposed to warm sea water (3).
To get necrotizing fasciitis, the bacteria enters the body through a cut, including a small paper cut (7). The bacteria is entered into the skin from someone sneezing or coughing and the particles land on the open area (7). The bacteria then causes an infection; if the infection is not caught in time, the bacteria releases exotoxins (8). These exotoxins initiate the production of cytokines; the cytokines start damaging the tissue and release fluids (8).
Necrotizing fasciitis has been known as gangrene in the past (5). NF was first described by Hippocrates in the fifth century BC (6). Some of the soldiers that fought in the Civil War would get NF since they lived for long periods of time in encampments (6). These encampments were not very sanitary and it was easy to spread disease with close quarters between the men and that the doctors did not have the benefits of modern medicinesd to fight the disease (6).
The usual symptoms are flulike: fever, nausea, chills, dizziness, and sweating (5). The main symptom to look out for is a small, reddish, painful bump on the skin (5). This may turn into a bronze or purple patch. Eventually this bump will turn black and start to ooze fluids (5). Necrotizing fasciitis is often misdiagnosed for other diseases with some of the same symptoms (2). This wrong diagnosis leaves patients with more complications (2). Depending on where the infection is and severity of the infection, the patient may need to get an amputation (2). If not taken care of immediately, the patient could die (5). Diabetics, alcoholics, intravenous drug users, and those that just had surgery have the highest risk of getting necrotizing fasciitis(6). The diabetics and the IV drug users especially have a high risk since they are injecting themselves with a needle. If the bacteria were to land on the needle, it would be easily transferred through the skin (6). The same would also happen to the patients that just had surgery (6).
6%-7% cases of invasive diseases are related to necrotizing fasciitis (4). Approximately 25% of NF cases, the patient dies(4).
Antibiotics are given to a patient to kill the gram-negative and gram-positive organisms that are possibly causing the infection. Some of the antibiotics given are penicillin, aminoglycoside, and clindamycin(6). Surgey is usually done first in order to remove the infected area, to keep it from spreading to other parts of the body(6). Hyperbaric oxygen therapy places the patient into a chamber of oxygen at a high atmospheric pressure(6). The hyperbaric chamber helps the killing of certain anaerobic organisms and to increase collagen formation (6).
Necrotizing fasciitis is often mistaken for cellulitis and erysiplelas(6).
1. Miller, Loren G., et al. "Necrotizing Fasciitis Caused By Community-Associated Methicillin-Resistant Staphylococcus aureus in Los Angeles." New England Journal of Medicine 352.14 (2005): 1445-1453. Retrieved October 21, 2011
2. Machado, Norman Oneil. "Necrotizing fasciitis: The importance of early diagnosis, prompt surgical debridement and adjuvant therapy." North American Journal of Medical Sciences 3.3 (2011): 107-118. Retrieved December 2, 2011
3. Sarani, Babak, et al. "Necrotizing Fasciitis: Current Concepts and Review of the Literature." Journal of the American College of Surgeons 208.2 (2009): 279-288. Retrieved October 21, 2011
4. Diseases, National Center for Immunization and Respiratory Diseases: Division of Bacterial. "Group A Streptococcal (GAS) Disease." 3 April 2008. Centers for Disease Control and Prevention. 2 December 2011 <http://www.cdc.gov/ncidod/dbmd/diseaseinfo/groupastreptococcal_t.htm>.
5. A.D.A.M. "PubMed Health." 17 December 2009. Necrotizing soft tissure infection. 21 October 2011 <http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002415/>.
6. Green, Ronald J., Donald C. Dafoe and Thomas A. Raffin. "Necrotizing Fasciitis." American College of Chest Physicians 110.1 (1996): 219-229. Retrieved December 1, 2011
7. National Necrotizing Fasciitis Foundation. "National Necrotizing Fasciitis Foundation." 6 December 2005. Quick Print NF Fact Sheet. 3 December 2011 <http://www.nnff.org/nnff_factsheet.htm>.
8. Fink, Anne and Gail DeLuca. "Necrotizing Fasciitis: Pathophysiology and Treatment." Dermatology Nursing 14.5 (2002): 324-327. Retrieved December 3, 2011