Signs, Symptoms, and Diagnosis of Necrotizing Fasciitis
- Fever, swelling, and excessive pain
- Skin changes similar to cellulitis or abscess
- Hardening of the skin and soft tissue
- Formation of bullae and bleeding into the skin
- Presence of gas in tissues and reduced sensation over the skin
- Necrotizing fasciitis producing gas in soft tissues as seen on CT scan
- Necrotizing fasciitis as seen on ultrasound
- Micrograph of necrotizing fasciitis showing necrosis of connective tissue
- Early diagnosis is difficult as it often resembles a simple skin infection
- Laboratory and imaging modalities can raise suspicion but not rule out the disease
- Plain radiography may show subcutaneous emphysema
- CT scan and MRI are more sensitive modalities than plain radiography
- CT scan may show fascial thickening, edema, subcutaneous gas, and abscess formation
- MRI can detect fluid collection with deep fascia involvement
- Ultrasonography can show superficial abscess formation but is not sensitive enough for diagnosis
- White blood cell count and serum sodium level can detect necrotizing soft tissue infection
- The laboratory risk indicator for necrotizing fasciitis (LRINEC) score is commonly used
- LRINEC score uses six laboratory values to determine likelihood of necrotizing fasciitis
- A score of 6 or more indicates serious consideration of necrotizing fasciitis
- Scoring system values should be interpreted with caution and validated
Causes and Risk Factors of Necrotizing Fasciitis
- Trauma, such as intravenous drug injection or animal bites
- Skin infections, like abscess or ulcers
- Spreading of infection through blood
- Fournier gangrene in the perineum and genitals
- Immunocompromised individuals may not show typical symptoms
- Immunocompromised conditions like diabetes, cancer, or HIV/AIDS
- Alcoholism, drug abuse, smoking
- Malignancies and chronic systemic diseases
- Trauma or surgery in the perineum and genitals
- Poor wound care and handwashing
Bacteria Associated with Necrotizing Fasciitis
- Types of soft-tissue necrotizing infection divided into four classes
- Type I infection caused by a mixture of bacterial types
- Gram-positive cocci like Staphylococcus aureus and Streptococcus pyogenes
- Gram-negative rods like Escherichia coli and Pseudomonas aeruginosa
- Anaerobes like Bacteroides and Clostridium species
Treatment and Management of Necrotizing Fasciitis
- Surgery to remove infected tissue
- Intravenous antibiotics, often a combination
- Delays in surgery associated with higher risk of death
- Risk of death between 25 and 35%
- Necrotizing fasciitis occurs in about 0.4 people per 100,000 per year in the U.S. and about 1 per 100,000 in Western Europe.
- Good wound care and handwashing can partly prevent necrotizing fasciitis
Prognosis, Complications, and Epidemiology of Necrotizing Fasciitis
- Necrotizing fasciitis affects approximately 0.4 in every 100,000 people per year in the United States.
- About 1,000 cases of necrotizing fasciitis occur per year in the United States.
- Rates of necrotizing fasciitis have been increasing, potentially due to increased awareness and reporting, bacterial virulence, or antibiotic resistance.
- In some areas of the world, the prevalence of necrotizing fasciitis is as high as one in every 100,000 people.
- Higher rates of necrotizing fasciitis are observed in individuals with obesity, diabetes, immunocompromised states, alcoholism, or peripheral artery disease. However, it can also occur in healthy adults.
- Hippocrates described necrotizing soft tissue infection in the fifth century BCE.
- The term 'necrotizing fasciitis' was first coined by Wilson in 1952.
- Various names have been used to describe necrotizing soft tissue infections throughout history.
- Hospital gangrene became a commonly used term.
- Fournier gangrene, a necrotizing infection of the perineum and scrotum, was described by Dr Jean-Alfred Fournier in 1883.
- Necrotizing fasciitis has gained media attention with sensationalistic headlines.
- Notable individuals, including politicians, musicians, and authors, have been affected by necrotizing fasciitis.
- Lucien Bouchard, former premier of Québec, lost a leg to the disease.
- Ken Kendrick, former agent and partial owner of the San Diego Padres and Arizona Diamondbacks, contracted the disease but fully recovered.
- Edgar Savisaar, an Estonian politician, had his leg amputated due to necrotizing fasciitis.
- Lucien Bouchard, future premier of Québec, lost a leg to the illness.
- A cluster of cases occurred in Gloucestershire, England, resulting in deaths and media coverage.
- Don Rickles, American comedian, contracted the disease in his left leg and underwent multiple surgeries.
- Eric Allin Cornell, Nobel Prize-winning physicist, lost his left arm and shoulder to the disease.
- Georgie Henley, British actress, contracted the disease while studying at Cambridge University and nearly died.
- Necrotizing fasciitis has a high mortality rate, ranging from 20% to 40%.
- Early diagnosis and prompt surgical intervention are associated with better outcomes.
Necrotizing fasciitis (NF), also known as flesh-eating disease, is a bacterial infection that results in the death of parts of the body's soft tissue. It is a severe disease of sudden onset that spreads rapidly. Symptoms usually include red or purple skin in the affected area, severe pain, fever, and vomiting. The most commonly affected areas are the limbs and perineum.
| Necrotizing fasciitis | |
|---|---|
| Other names | Flesh-eating bacteria, flesh-eating bacteria syndrome, necrotizing soft tissue infection (NSTI), fasciitis necroticans |
 | |
| Person with necrotizing fasciitis. The left leg shows extensive redness and tissue death. | |
| Pronunciation | |
| Specialty | Infectious disease |
| Symptoms | Severe pain, fever, purple colored skin in the affected area |
| Usual onset | Sudden, spreads rapidly |
| Causes | Multiple types of bacteria, occasional fungus |
| Risk factors | Poor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, peripheral artery disease |
| Diagnostic method | Based on symptoms, medical imaging |
| Differential diagnosis | Cellulitis, pyomyositis, gas gangrene |
| Prevention | Wound care, handwashing |
| Treatment | Surgery to remove the infected tissue, intravenous antibiotics |
| Prognosis | ~30% mortality |
| Frequency | 0.7 per 100,000 per year |
Typically, the infection enters the body through a break in the skin such as a cut or burn. Risk factors include poor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, and peripheral artery disease. It does not typically spread between people. The disease is classified into four types, depending on the infecting organism. Between 55 and 80% of cases involve more than one type of bacteria. Methicillin-resistant Staphylococcus aureus (MRSA) is involved in up to a third of cases. Medical imaging is often helpful to confirm the diagnosis.
Necrotizing fasciitis may be prevented with proper wound care and handwashing. It is usually treated with surgery to remove the infected tissue, and intravenous antibiotics. Often, a combination of antibiotics is used, such as penicillin G, clindamycin, IV vancomycin, and gentamicin. Delays in surgery are associated with a much higher risk of death. Despite high-quality treatment, the risk of death is between 25 and 35%.
Necrotizing fasciitis occurs in about 0.4 people per 100,000 per year in the U.S., and about 1 per 100,000 in Western Europe. Both sexes are affected equally. It becomes more common among older people and is rare in children. It has been described at least since the time of Hippocrates. The term "necrotizing fasciitis" first came into use in 1952.
necrotizing fasciitis (uncountable)
