Necrotizing Fasciitis

What is Necrotizing Fasciitis?

Necrotizing Fasciitis is commonly known as flesh-eating bacteria which is a rapidly progressing infection involving the deeper layer of the skin and the fascia or the subcutaneous connective tissue. The onset is sudden and severe requiring immediate medical intervention through high dosages of antibiotics introduced intravenously. It is a rare and severe disease that can be fatal to those afflicted with this disease. Death can occur within 18 hours from initial infection of the causative agent.


Fascia is a sheath of tissue that covers the muscles that is being attacked by certain bacteria causing necrosis. The necrosis spread widely through the fascia and the subcutaneous connective tissue and also destroys the skin. The onset of flesh-eating disease is often associated with sepsis and complete organ failure which put the patient at high risk for death. The most dangerous areas affected with high percentage for possible mortality are those that occur in the arms, legs and the abdominal wall.

Majority of Necrotizing Fasciitis primarily occur in the extremity or wound that resulted from an existing infection. The incidence is common to people aged 38 and above and pediatric onset rarely occurs while it is more common to women than in men. It mostly affects people with compromised immune system specially those suffering from diabetes, alcoholism and those with cancer.

Dr. Joseph Jones, a Confederate Army surgeon first described Necrotizing Fasciitis during the US Civil War although this condition was first termed by Dr. B. Wilson in 1952 without reference to specific causative agent or specific pathologic bacteria.

Symptoms

The onset of Necrotizing Fasciitis is sudden and rapidly progressing. The spread of infection is rapid while the disease is potentially life-threatening. The symptom of pain occurs right after an injury while pain will appease in 24 to 36 hours and recurring with worsening pain after it has appeased.

Early symptoms of necrotizing fasciitis begins within 24 hours post infection and the symptoms include:

  • Initial development of spot or small bump that is painful
  • Redness appears surrounding the affected area or the site of the wound
  • Pain is progressive or worsening
  • Fever
  • Diarrhea
  • General body weakness
  • Dizziness
  • Nausea

Developing symptoms occur within 3 to 4 days from initial infection and progress to its advancing stage. The symptoms include:

  • Swelling or inflammation of the affected site or part of the body
  • Purplish or bronze discoloration rapidly increasing in size in the affected area
  • Affected area may begin to develop with a large blister filled with fluid
  • Central portion of the blister is blackened with fluid oozing out
  • Wound rapidly increasing in size
  • Necrosis begins to develop characterized by flaky with bluish blemish appearance with black scabs

Life-threatening symptoms develop usually after 4 to 5 days from initial infection which requires immediate medical intervention. Symptoms of such should not be taken for granted while the symptoms include:

  • Skin disfigurement and permanent scarring resulting from rapid tissue damage while the infection is spreading from its original site to other parts of the muscle and subcutaneous connective tissue
  • Limbs may lose its function resulting from necrosis of subcutaneous skin tissue
  • Potential risk for sepsis that develops with fever and a heart rate above 90 beats per minute while respiratory rate is above 20 breaths per minute
  • Organ dysfunction will emerge
  • Mental confusion
  • Platelet count is decreasing
  • Urine output alarmingly decreasing
  • Difficulty in breathing
  • Septic shock may occur during the alarming stage of sepsis
  • Low blood pressure is tremendous
  • Loss of consciousness

Sepsis as a complication and during its severe stage or the onset of septic shock is the cause of death for most patient suffering from necrotizing fasciitis.

Causes

Aerobic, anaerobic bacteria and mixed flora are implicated for necrotizing fasciitis. Bacteria causing this disease enter the body through various means such as minor cuts, wound, abrasion and surgical incisions or surgical wound.

Necrotizing fasciitis is divided into three types according to the causative agent and the clinical findings.

Type 1 is saltwater necrotizing fasciitis which can be harbored through minor cuts infected with Vibrio contaminated saltwater. Candida is also considered in the causative agent in this type while infection from the bacteria is polymicrobial.

Type 2 is caused by Group A Streptococcus or staphylococcus which may infect an individual either as single bacterial genus or in combination with other bacteria

Type 3 is also known as type 3 gas gangrene initially caused by Clostridium bacteria. Necrotizing fasciitis of this type has clinical findings of gas in the affected area.

Other clinical findings through obtaining samples from necrotic tissues have revealed other bacteria causing the disease. E. coli, Klebsiella and Pseudomonas are among the bacteria found and considered to cause necrotizing fasciitis.

Report has also shown an infection from Aeromonas hydrophilia, gram-negative rod-shaped bacteria, which is rare and difficult to treat.

Treatment

Following confirmation of necrotizing fasciitis, immediate medical intervention is recommended to further inhibit the spread of bacterial infection and prevent potential damage from severity of the condition.

High dosages of antibiotics are initially given intravenously while prescribed antibiotics depend on the severity and the causative agent that infected the patient. Broad based antimicrobial therapy which can work to inhibit the gram-positive, gram-negative and anaerobes organisms are immediately given. Clindamycin is the initial drug of choice for treating the flesh-eating disease while combination of aminoglycoside and penicillin G is also a choice for the treatment.

Surgery is the immediate choice in treating necrotizing fasciitis through a procedure known as surgical debridement. This surgical procedure can be life-saving while minimizing the risk for tissue loss and while saving a limb. Extensive debridement beyond the area affected is required to inhibit damage from rapid progress of the disease. Antibiotic dressing is also prescribed and to change daily wherein Silver sulfadiazine or Silvadene is the most accepted antimicrobial cream owing to its broad based spectrum with its little medical complication in the wound.

Necrotizing Fasciitis Pictures

Picture collection of Necrotizing Fasciitis…

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