Assistant Professor of Emergency Medicine
Necrotizing fasciitis is a rare but serious bacterial infection that affects the fascia; which is tissue beneath the skin and surrounding muscles and organs. It’s sometimes called the “flesh-eating disease”, although the bacteria that causes it do not “eat” flesh, but release toxins that damage nearby tissue.
It can start from a relatively minor injury, such as a small cut, but gets worse very quickly and can be life-threatening if it’s not recognized and treated early on. I have seen lives lost because of this disease, as patients didn’t recognize it and present early for care.
Today I will discuss this deadly condition so that we can understand the importance of early detection and treatment.
WHAT ARE SYMPTOMS OF NECROTIZING FASCIITIS?
The symptoms of necrotizing fasciitis develop quickly over hours or days. They may not be obvious at first, and can be similar to less serious conditions, such as flu, gastroenteritis or cellulitis.
Early symptoms can include:
• a small but painful cut or scratch on the skin
• intense pain that’s out of proportion to any damage to the skin
• high grade fever and other flu-like symptoms
After a few hours to days, you may develop:
• swelling and redness in the painful area – the swelling will usually feel firm to the touch
• diarrhea and vomiting
• dark spots on the skin that turn into fluid-filled blisters
• If left untreated, the infection can spread quickly through the body and cause symptoms such as dizziness, weakness and confusion.
WHAT CAUSES NECROTIZING FASCIITIS?
Necrotizing fasciitis can be caused by several different types of bacteria. The bacteria live in the gut, throat and, in some people, on the skin, where they do not usually cause any serious problems. In rare cases, the bacteria can cause necrotizing fasciitis if they get into deep tissue, either through the bloodstream or an injury or wound, such as:
• cuts and scratches
• insect bites
• puncture wounds caused by injecting drugs
• surgical wounds.
The infection can also be spread from person to person, but this is very rare. Anyone can get necrotizing fasciitis, including young and otherwise healthy people, but it tends to affect older people, and those in poor general health.
WHAT SHOULD YOU DO IF YOU SUSPECT NECROTIZING FASCIITIS?
Necrotizing fasciitis is a medical emergency that requires immediate treatment. You should go to your nearest emergency department as soon as possible if you think you have it. Doctors may do blood tests and scans to find out what’s causing your symptoms. Often, a diagnosis of necrotizing fasciitis can usually only be confirmed by having an operation to examine the affected tissue.\
HOW IS NECROTIZING FASCIITIS TREATED?
Necrotizing fasciitis needs to be treated in hospital. The following are the main components of treating this deadly disease:
• surgery to remove infected tissue – this may be repeated several times to ensure all the infected tissue is removed. Amputation of affected limbs may be necessary sometimes.
• antibiotics – usually several different types are given directly into a vein
• supportive treatment – including treatment to control your blood pressure, fluid levels and organ functions
• patients with necrotizing fasciitis often need to be looked after in an intensive care unit and may need to stay in hospital for several weeks.
• while in hospital, they may be isolated from other patients to reduce the risk of spreading the infection.
CAN NECROTIZING FASCIITIS BE PREVENTED?
There’s no vaccine for necrotizing fasciitis, and it’s not always possible to prevent it. The following measures may help to reduce your risk:
• treat wounds quickly – after stopping any bleeding, clean wounds with running water and pat them dry with a clean towel
• keep wounds clean and dry – after a wound has been cleaned, cover it with a sterile dressing, such as a plaster, and change the dressing if it gets wet or dirty
• wash your hands regularly with soap and warm water – alcohol-based hand gels can also help, but washing with soap and water is generally best
• If you’re in close contact with someone who has necrotizing fasciitis, ask your doctor if you will need a course of antibiotics to reduce your risk of infection
WHAT IS THE OUTLOOK LIKE WITH NECROTIZING FASCIITIS?
Necrotizing fasciitis can progress very quickly and lead to serious problems, such as blood poisoning and organ failure. Even with treatment, it’s estimated that 1 or 2 in every 5 cases are fatal. People who survive the infection are sometimes left with long-term disability as a result of amputation or the removal of a lot of infected tissue.
Do take steps to decrease your risk of getting this deadly disease, and advise others, so that we may avoid loss of lives from it.
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