NECROTIZING FASCIITIS

NECROTIZING FASCIITIS

Necrotizing fasciitis is also known as the flesh-eating disease which is a type of skin infection that results in the progressive necrosis of skin tissue. The disease spreads rapidly along the fascia, destroying skin, muscle, and tissue in its path. It is the fastest spreading infection known. If not treated early, the condition can be life-threatening.

Necrotizing fasciitis is an inflammatory disease that chiefly arises from bacterial origins. More than 55% of all cases involve multiple bacteria entering the skin. Typical suspects include Group A Streptococcus and Methicillin-resistant Staphylococcus aureus (MRSA).

Typically, the infection enters the body through an area of trauma — wounds, cuts, or even insect bites. Immunocompromised individuals are at higher risk of developing the condition. More than 70% of necrotizing fasciitis cases involve individuals with comorbidities such as diabetes mellitus, obesity, and chronic system diseases.

TYPES

Cases of necrotizing fasciitis can be classified based on the types of bacteria infecting the fascia. 

  • Type I infection: Accounting for 70-80% of all cases, Type I is the most common infection type. In Type I necrotizing fasciitis, multiple bacteria are responsible for the symptoms. Suspect bacteria include (but are not limited to) the following: Staphylococcus aureus, Haemophilus, Vibrio, Escherichia coli, Pseudomonas aeruginosa, and Clostridium. Type I mostly affects older adults with pre-existing medical conditions such as diabetes and obesity. 
  • Type II infection: About 20-30% of all cases are of Type II. Mainly involving the extremities, type II necrotizing fasciitis affects all age groups. Even healthy, genetically normal individuals are at risk of developing the infection. Streptococcus pyogenes is the causative agent for a type II infection, but other staphylococcal infection can come into play. 
  • Type III infection: It is caused by Vibrio vulnificus, a species of Vibrio found in saltwater and brackish water. The bacterium enters through a break in the skin. 
  • Type IV infection: Unlike the other types, the type IV infection is of fungal origin. Because of its fungal nature, type IV is said to be extremely rare.

 

SYMPTOMS

In its earliest stages, necrotizing fasciitis causes the skin to become swollen. A painful, red bump may soon appear at the infection site, accompanied by flu-like symptoms (i.e., frailty, fatigue, chills, nausea). 

Redness and swelling will quickly progress, leading to an increase in pain and size. Blisters, skin lesions, and bullae might appear. These symptoms should occur before skin necrosis. 

In the later stages, the skin undergoes necrosis. The skin turns purple or black due to the clotting of blood vessels. The infected individual will experience reduced or absent sensation at the site of infection due to nerve damage.

DIAGNOSIS

Early diagnosis of necrotizing fasciitis is difficult as it tends to mimic the common symptoms of an abscess. Those who already have the infection might haphazardly delay treatment because the symptoms do not look serious.

Diagnosis involves testing the infection site for bacteria. The attending physician might also require X-rays, a CT scan, or an MRI to determine if the infection has damaged any underlying nerves or organs.

 

TREATMENT

Treatment involves intravenous antibiotic medication and surgery. Patients diagnosed with the infection are given a combination of antibiotics. Tissue decay may prevent antibiotics from reaching certain areas. As a result, surgery to remove the infected tissue is strongly recommended. Delaying surgery increases the risk of death. 

If left untreated, necrotizing fasciitis can lead to mortality. While treatment methods continue to improve, those diagnosed’ mortality rate remains above the 25% benchmark.

Despite its high mortality rate, the disease is quite rare. It is estimated that only 0.40 adult cases (0.80 for children) occur per 100,000 people annually. 

Most cases occur by chance. There is no definite way to prevent infection. Good handwashing and proper wound care, however, drastically reduces the risks of a necrotizing fasciitis infection.

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