Necrotizing Fasciitis

How do you say It?
The pronunciation is neck-row-tize-ing fash-e-i-tis, it means decaying skin

What Is It?
It is a bacterial infection caused most commonly by Strep A bacteria, which is the same bacteria that causes common Strep throat. Usually easily killed by antibiotics, sometimes a very strong variety of Strep occurs. This is the one that causes the life threatening cases. (It can also be caused by other bacteria, or a mixture of bacteria.) The bacteria destroys soft tissue at the subcutaneous level, and often is coupled with toxic shock syndrome, both are deadly alone, together they are even more so.(If muscle is destroyed, it is necrotizing myositis.)

How do you get it?
Most often the bacteria enters the body through an opening in the skin, very often a very minor opening, even as small as a paper cut, a staple puncture, or a pin prick. It can also enter through weakened skin, like a bruise, blister, or abrasion. It can also happen following a major trauma or surgery, and in rare cases there appears to be no identifiable point of entry.

Where does the bacteria come from?
It is most commonly transferred by respiratory droplets or direct contact with secretions of someone carrying Strep A. For instance, a person carrying a Strep A bacteria might not even show symptoms or become ill at all. They cough or sneeze, another person picks up the bacteria on their hands or directly at the point of a wound and the infection occurs. The NF patient is not likely to be contagious, and inanimate objects are unlikely to be points of transmission.

How can it be prevented?
It can't necessarily be prevented, but you can lessen your chances with some basic hygienic practices. Buy anti-bacterial soap and use it! From the offensive standpoint, cover your mouth when you cough or sneeze, throw away tissues, wash hands frequently. You could be the carrier and not know it. Fifteen to thirty per cent of the population carries Strep A at any given time usually with no symptoms. From a defensive standpoint: wash hands frequently, avoid contact with persons showing sore throat symptoms. Clean and care for even the smallest traumas, using an antibiotic ointment and sterile covering with frequent changes.

What are the symptoms?
The symptoms are varied, but often include:

EARLY SYMPTOMS (usually within 24 hours): 1. Usually a minor trauma or other skin opening has occurred (the wound does not necessarily appear infected); 2. Some pain in the general area of the injury is present. Not necessarily at the site of the injury but in the same region or limb of the body; 3. The pain is usually disproportionate to the injury and may start as something akin to a muscle pull, but becomes more and more painful; 4. Flu like symptoms begin to occur, such as diarrhea, nausea, fever, confusion, dizziness, weakness, and general malaise; 5. Intense thirst occurs as the body becomes dehydrated; 6. The biggest symptom is all of these symptoms combined. In general you will probably feel worse than you've ever felt and not understand why. ADVANCED SYMPTOMS(usually within 3-4 days): 7. The limb, or area of body experiencing pain begins to swell, and may show a purplish rash, 8. The limb may begin to have large, dark marks, that will become blisters filled with blackish fluid; 9. The wound may actually begin to appear necrotic with a bluish, white, or dark, mottled, flaky appearance.

CRITICAL SYMPTOMS(usually within 4-5 days): 10. Blood pressure will drop severely; 11. the body begins to go into toxic shock from the toxins the bacteria are giving off; 12. Unconsciousness will occur as the body becomes too weak to fight off this infection.

When should I seek medical attention?
Any time all of the early symptoms are present, go to a doctor at once, and insist that this be ruled out. The vast majority of cases are misdiagnosed. People have been told they fell when they didn't, they have had casts put on for bones not broken, they have been given Tylenol for flu and been told to come back the next day; they have been told they have an ingrown toenail, they've been told they have arthritis; they've been accused of burning themselves...many of these people have gone back to the hospital two days later and died. Insist that this be ruled out if you have all of the early symptoms. Seventy-five percent of the cases are misdiagnosed. Insist that an infectious disease doctor hear your symptoms and evaluate.

Why are so many cases misdiagnosed?
Because the beginning symptoms look like so many other things. None of the symptoms are exclusive to this, and until the patient is so ill that they are critical many health care workers don't consider NF. Although it is on the increase, it is rare, so many emergency rooms may never have seen a case before.

How rare is it?
There are varying statistics. A 1996 CDC report estimates from 500 to 1500 cases per year of necrotizing fasciitis of which 20% die. In 1998 the NNFF estimates the figure to be higher (based on cases reported to us measured against the general population with access to the Internet, which is how all of the cases we get are reported)

How is it treated?
It must be treated in the hospital through antibiotic IV therapy and aggressive debridement (removal) of affected tissue. Other treatments will take place depending upon the level of toxicity or organ failure being experienced by the patient. Medications to raise blood pressure, blood, and anti-globulins are also used. A hyperbaric oxygen chamber is sometimes used in certain cases.

What's the likely outcome?
Anywhere from minimal scars to death and everywhere in between. For those lucky enough to survive most often at least some removal of skin is required. Often this requires skin grafting. Also amputation is sometimes needed to remove the affected limb. Legs, hands, fingers, toes, arms, have all been sacrificed to save the life of NF patients.

What can decrease the risk of death and disfigurement?
Two words: prompt diagnosis!

What's being done to help promote prompt diagnosis?
The NNFF's mission is to educate for public awareness, recognition of symptoms and preventive measures; to offer resources; advocate research; and to offer support for those affected by necrotizing fasciitis. We hope that through projects in which we couple with medical professionals, public service campaigns, and media exposure, we can lessen the occurrence of the severe consequences of NF.