Necrotizing fasciitis: What to know

Necrotizing fasciitis is a serious but uncommon infection of the bacteria. It is also regarded as a disease that consumes flesh.

Necrotizing fasciitis occurs when bacteria enter a wound and cause skin inflammation, which can spread rapidly through the body’s deep tissues.

In the United States it is rare and affects only 0.4 in every 100,000 people.

In this article, we look closely at fasciitis necrotizing including its causes, symptoms, treatment, and recovery. We also explore how this infection can be avoided and treated.

What is it?

A person suffering from necrotizing fasciitis may develop a sore throat and other flu-like symptoms.

Necrotizing fasciitis is a bacterial infection which is rare but severe. It happens when bacteria break tissues deep within the body.

The term “necrotizing” means the infection causes body tissue to die, while “fasciitis” refers to the deep tissue inflammation. These include fascia, the tissues that surround the muscles, nerves and blood vessels.

Necrotizing fasciitis is a very serious condition and it is normal to have complications— which can include sepsis, shock, and organ failure. Even with treatment, the infection may cause as many as 1 in 3 people to die.

However, this infection may be avoided by an accurate, early diagnosis and rapid antibiotic treatment.

Causes

Many types of bacteria can cause fasciitis that is necrotizing. Group A Streptococcus is the most common, the same bacterium that causes strep throat.

Group A Streptococcus is also responsible for certain skin infections and some unusual, serious diseases, including syndrome of toxic shock.

Klebsiella, Clostridium, Escherichia coli and some water-based bacteria, such as Vibrio vulnificus, are other bacteria that can cause necrotizing fasciitis.

The bacteria may enter through breaks in the skin, resulting in:

  • cuts or scrapes
  • insect bites
  • surgical wounds
  • burns

In the United States, since 2010, group A Streptococcus has caused 700–1200 cases of necrotizing fasciitis annually.

People can get this infection on rare occasions, without causing an injury that damages the skin.

The person may become exposed to the bacteria by touching a carrier directly, or the bacteria may already be present on the body.

Symptoms

Infections with necrotizing fasciitis can grow unexpectedly and spread rapidly. Within hours of injury, the symptoms that start.

Early signs and symptoms of necrotizing fasciitis include:

  • flu-like symptoms, such as fever, sore throat, nausea, diarrhea, body aches, and chills
  • severe pain in the affected area that may resemble the pain of a torn muscle
  • redness around the infection site that spreads quickly
  • sometimes, ulcers or blisters

When the bacteria are deep within the tissue, early-stage signs of inflammation can not be evident. Pain that appears out of proportion to the redness is a warning sign of fasciitis being necrotized. Eventually the skin can get swollen, shiny, and hot to touch.

If the infection continues, the person may experience it

  • dehydration
  • a rapid heart rate
  • low blood pressure

Over time, the pain may become less as the bacteria kill the nerves and tissues. The person may experience confusion or feel delirious if the infection affects vital organs.

The condition can lead to shock without effective treatment and it can be fatal.

Risk factors

While anybody can get an infection with necrotizing fasciitis, some people are more likely to be affected than others.

An underlying state of health which weakens the immune system can increase the risk of infection.

Majority of those developing the infection have diabetes and a history of alcohol use disorder. Even people with cirrhosis in the liver are at greater risk.

This infection can be a rare complication of the varicella in young children.

Facial necrotizing fasciitis is extremely rare, but it can occur due to dental factors or problems with the tonsils or sinuses. Acne may also provide for infection.

Diagnosis and treatment

Doctors can often diagnose fasciitis by taking a sample of tissue and sending it to a laboratory for testing. They may also look at blood work and use image scans to inspect the damaged area, such as CT or MRI scans.

In early stages the infection can be hard to detect. When necrotizing fasciitis begins deep under the skin, the person may not be diagnosed with accuracy for a while.

If the doctor suspects necrotizing fasciitis they should immediately give the person antibiotic intravenous therapy. During treatment, the person should remain in the intensive care unit (ICU).

Necrotizing fasciitis is rapidly spreading and can result in extensive tissue death, so prompt treatment is crucial. Early detection minimizes the need for skin and soft tissue removal by surgery, and reduces the risk of toxic shock.

Emergency surgery can sometimes be required to remove infected tissue. This surgery could stop the spread of the infection. In advanced cases, the individual may need surgery to undergo limb amputation.

Recovery

The recovery process includes extended physical therapy and long-term psychological and emotional rehabilitation, until doctors are sure they have treated the infection.

The healthcare team will be helping with the wound care. People with large open wound may need surgery to graft skin or to repair it. For these individuals, hyperbaric oxygen treatment may be a beneficial supplementary therapy.

Some streptococcal strains have been related by experts to a poor outlook. Certain factors affecting a person’s perspective and recovery time include:

  • older age
  • uncontrolled diabetes
  • a suppressed immune system
  • delayed surgery

Prevention

The infection often happens after surgery or accident, in people with wounds. With proper wound care, people can avoid skin infections, which is necessary no matter how minor the wound.

Although necrotizing fasciitis is rare, people should see a doctor immediately after injury or surgery if they have early symptoms of wound infection. Including:

  • redness, warmth, or swelling in the skin that spreads quickly
  • severe pain
  • fever

Proper hygiene can help prevent skin infections. Good practices to adopt include:

  • cleaning all wounds that break the skin with soap and water
  • covering open wounds with clean, dry bandages after cleaning them
  • washing the hands often with soap and water, or using alcohol-based gel when washing is not possible
  • avoiding spending time in hot tubs, swimming pools, lakes, or rivers with an open wound or skin infection

In general, necrotizing fasciitis is not contagious. Most occurrences occur at random, and it is rare for someone else to notice it.

A system called Active Bacterial Core Surveillance is used by the Centers for Disease Control and Prevention (CDC) in the U.S. to detect cases of necrotizing fasciitis due to group A Streptococcus. The data indicate that the incidence doesn’t seem to increase.

Summary

Fasciitis necrotizing is a rare but dangerous bacterial infection with a high rate of fatality. This typically happens after a person undergoes surgery or accident to sustain a wound.

Early diagnosis and treatment make a person’s outlook greatly improved. So anyone with signs of necrotizing fasciitis should see a doctor immediately.

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