What is the definition of Necrotizing Fasciitis?
Necrotizing fasciitis is a serious infection of the skin, the tissue just beneath the skin (subcutaneous tissue), and the tissue that covers internal organs (fascia). Necrotizing fasciitis can be caused by several different types of bacteria, and the infection can arise suddenly and spread quickly. Early signs include flu-like symptoms and redness and pain around the infection site. A prompt diagnosis and treatment are essential. If the infection is not treated promptly, it can lead to multiple organ failure and death. Treatment typically includes intravenous (IV) antibiotics and surgery to remove infected and dead tissue.
What are the causes for Necrotizing Fasciitis?
Anyone can develop necrotizing fasciitis. The most common cause is group A Streptococcus. Other types of bacteria that can cause necrotizing fasciitis include Klebsiella, Clostridium, and Escherichia coli. Approximately one-half of necrotizing fasciitis cases caused by streptococcal bacteria occur in young and otherwise healthy individuals. Although necrotizing fasciitis most frequently develops after trauma that causes a break in the skin, it can also develop after minor trauma that occurs without a break in the skin. Necrotizing fasciitis can occur as a complication of surgery; it can also occur at the site of a relatively minor injury such as an insect bite or an injection. In addition, underlying illnesses that weaken the immune system may increase the risk of necrotizing fasciitis. Some studies suggest a possible relationship between the use of nonsteroidal anti-inflammatory medications (NSAIDs) during varicella infections and the development of necrotizing fasciitis.
What are the symptoms for Necrotizing Fasciitis?
Symptoms often begin within hours of an injury and typically include intense pain and tenderness over the affected area. The pain is often severe and may resemble that of a torn muscle. Early symptoms may be mistaken for the flu and can include fever, sore throat, stomach ache, nausea, diarrhea, chills, and general body aches. The patient may notice redness around the area that spreads quickly; the affected area can eventually become swollen, shiny, discolored, and hot to the touch. In addition, ulcers or blisters may develop. If the infection continues to spread, the patient may experience dehydration, high fever, fast heart rate, and low blood pressure. Pain may actually improve as tissues and the nerves are destroyed. As the infection spreads, vital organs may be affected and the patient may become confused or delirious. If not successfully treated, necrotizing fasciitis can lead to shock and eventual death.
What are the current treatments for Necrotizing Fasciitis?
Accurate and prompt diagnosis, treatment with intravenous (IV) antibiotics, and surgery to remove dead tissue are vital in treating necrotizing fasciitis. As the blood supply to the infected tissue becomes impaired, antibiotics often cannot penetrate the infected tissue. Therefore, surgery to remove the dead, damaged, or infected tissue is the primary treatment for necrotizing fasciitis. Early surgery may minimize tissue loss, eliminating the need for amputation of the infected body part. The choice of antibiotics will likely depend on the particular bacteria involved. In addition, supplemental oxygen, fluids, and medicines may be needed to raise the blood pressure. Hyperbaric oxygen therapy and IV immunoglobulin may also be considered, but their use in patients with necrotizing fasciitis is controversial.
What is the outlook (prognosis) for Necrotizing Fasciitis?
If diagnosed and treated early, most patients will survive necrotizing fasciitis. If tissue loss is significant, skin grafting may be necessary. In some patients, amputation of the affected area is required. Up to 25% of patients will die from necrotizing fasciitis, due to complications such as kidney failure, blood poisoning (septicemia), and organ failure. The particular type of bacteria, the health of the patient, the location of the infection, and the speed of treatment can all influence the outcome.