Necrotizing fasciitis, more popularly known as “flesh-eating disease,” is a rare but potentially fatal condition. Each year, approximately 200,000 humans contract the disease worldwide. The Centers for Disease Control and Prevention (CDC), through the Active Bacterial Core surveillance (ABCs) system monitors the roughly 600 to 1,200 yearly U.S. incidences of necrotizing fasciitis caused by the specific bacteria group A strep—the same bacteria that causes strep throat.
Although necrotizing fasciitis is rare, do not take this crippling illness for granted. It is extremely important to seek immediate medical attention and prompt hospitalization if you or someone you know exhibits the peculiar symptoms associated with the disease.
Necrotizing Fasciitis Causes
Necrotizing fasciitis is not contagious. Instead, it is caused by a group of known, as well as lesser known bacteria, that most often infect the skin before aggressively spreading to surrounding fasciae, destroying muscle tissue, nerve cells, connective tissue, fat cells, and blood vessels. Bacteria suspected to cause necrotizing fasciitis include:
- Group A Streptococcus (group A strep), Streptococcus pyogenes and enterococci
- Escherichia coli
- Pseudomanas aeruginosa
- Staphylococcus aureus
- Bacteroides and Clostridium species
- Aeromona hydrophila
- Acinetobacter calcoaceticus
- Haemophilus influenzae
- Vibrio vulnificus
Vital organs may also become damaged during bacteria proliferation. Systemic inflammatory response syndrome (SIRS), or inflammation that affects the entire body, may occur if necrotizing fasciitis is left untreated.
Infectious bacteria can enter the body through an open wound, burn, or through the gastrointestinal tract. However, some people have developed necrotizing fasciitis from unknown causes. Certain necrotizing fasciitis cases in Asia were linked to “consumption of raw or undercooked seafood or injury by fish fins.” In these instances, “marine bacteria” (Vibrio spp., Aeromonas spp., and Shewanella spp.) were usually involved. Blunt-force trauma from an automobile accident is known to have triggered the illness. Other known triggers for sudden onset of necrotizing fasciitis include:
- Insect or animal bites
- Human bites (sources of infection can be from the offender’s mouth or from the victim’s skin)
- Catheter insertion
- Intravenous drug injection
- Insulin injection
- Fistula connecting internal organs to the skin
Once bacteria enter the body and spread rapidly, septic shock—more profuse infection resulting in organ failure and low blood pressure—may ensue. The fast-paced spread of infection has been attributed to polymicrobial infection from several bacterial strains or microbe types and their possible synergistic relationships. Sometimes, deadly bacteria produce poisonous toxins that kill tissue they infect. Speed of infection coupled with these debilitating effects increase the likelihood for loss of limb or death. Close to 25% of necrotizing fasciitis patients die from the disease, which is an astoundingly high and unsettling statistic.
Doctors refer to necrotizing fasciitis of the genital region as Fournier’s gangrene. In the World Journal of Emergency Surgery, researchers published a 2016 report that highlights site frequency of necrotizing fasciitis. Of the infected patients that were observed, 53% suffered infection of the lower limb/thigh, 25% experienced perineum infection (of the anus and the scrotum or vulva region), the abdominal/groin region showed a 11.5% rate of occurrence, and necrotizing fasciitis occurred less frequently in the neck/facial region at 6.3%. The report also emphasized that of the patients observed, the mortality rate was highest among sufferers with necrotizing fasciitis of the sacral region, which is located at the bottom of the spine.
Necrotizing fasciitis can occur anywhere on the body; however, among survivors and non-survivors the limbs, perineum, and genitals are the more common sites of infection. The disease affects adults older than 60 years of age more than other age groups, and cases are less frequent among children. Females with a body mass index over 30 or more have been more prone to infection; however, both sexes have been impacted comparably.
These other risk factors increase the likelihood of contracting necrotizing fasciitis or of resultant death:
- Diabetes mellitus
- Chronic alcohol disease
- Chronic smoking
- Perforated appendicitis
- Perforated diverticulitis
- Viral infections
- Compromised immune system
- Renal complications
- Cardiovascular disease (particularly, hypertension)
- Systemic lupus erythematosus
- Addison’s disease
High serum creatinine coupled with elevated blood urea is linked to higher mortality rates in necrotizing fasciitis patients. Diabetes mellitus is considered the most frequent co-morbidity in patients with any type of related necrosis. Forty to 60 percent of affected diabetic patients in a 2014 necrotizing fasciitis study contracted skin-eating bacteria. The study sites chronic renal failure as another predisposing factor for higher mortality in patients.
Necrotizing Fasciitis Symptoms
It is important to be suspicious and maintain a high degree of vigilance when bacterial infection for necrotizing fasciitis is possible. Its symptoms are sometimes indistinguishable from those of other far less pernicious afflictions. Patients may downplay the severity of their insidious condition, belittle the symptoms they experience, and fail to seek prompt medical attention.
Medically, necrotizing fasciitis is not easily diagnosed. The disease is so rare that some doctors may be unfamiliar with its specific characteristics. Certain symptoms for necrotizing fasciitis are similar to those of other necrotizing soft tissue infections, while some symptoms are not typically associated with skin infections. A number of patients have expressed feeling a “pulled muscle” sensation at the infection site. Flu-like symptoms are also common in most cases of necrotizing fasciitis.
Necrotizing Fasciitis Treatment
Time is of the essence when treating necrotizing fasciitis. Most medical facilities in the United States are sufficiently equipped to triage and, therefore, address the infection’s extraordinarily aggressive nature with optimal treatment measures. MRI scans, x-rays, and other invasive imaging techniques, as well as tissue sampling and exploratory surgeries, aid in proper diagnosis. As there are a range of bacteria that can potentially cause necrotizing fasciitis, prompt lab work must be initiated once necrotizing fasciitis is suspected in order to classify the lethal microbe(s). Diagnosis of necrotizing fasciitis can be achieved faster when medical facilities use laboratory-scoring systems, such as Laboratory Risk Indicator for NECrotizing fasciitis score (LRINEC) score or the Fournier’s Gangrene Severity Index (FGSI) score.
The accessibility of a wide range of intravenous antibiotics is necessary to help counter one or more infectious bacteria as well as any aberrant strains. However, antibiotics may not be as effective if this treatment is initiated in the latter stages of infection when blood pressure decreases. Thusly, antibiotic treatment should begin as soon as infection is recognized. In addition to antibiotics, a vigorous treatment regimen for necrotizing fasciitis includes the following:
- Surgical debridement is the primary treatment for necrotizing fasciitis and involves cutting away infected soft tissue. Multiple surgeries may be necessary depending on bacterial prevalence. The earlier debridement is performed, the better a patient’s chances for healing and survival.
- Intravenous immunoglobulin has been shown to counter immunosuppressive toxins produced by staphylococcal and streptococcal bacteria.
- Negative Pressure Wound Therapy (NPWT) is beneficial for treating wounds that come in contact with polluted water. This therapeutic technique uses vacuum dressing to foster healing. The technology applies sub-atmospheric pressure to the local wound.
- Hyperbaric oxygen treatment can supplement other treatment measures to promote healing. Patients are placed in a high-pressure oxygen chamber in which oxygen is supplied at two or three times the atmospheric pressure. Pressurized oxygen treatment has been shown effective for bolstering immune system response.
The probability of death due to untreated necrotizing fasciitis is 100%. Delayed or deficient treatment for the illness increases the risk for amputations and severe impairment of one or more internal organs. Organ failure and septic shock are prime causes of death from necrotizing fasciitis.
Necrotizing Fasciitis Prevention
Keeping your immune system strong, adhering to good hygiene, and practicing diligent wound care as necessary are ways to help prevent bacterial infection. Support strong immune health by getting good rest, staying hydrated, and maintaining a proper diet. At the same time, minimize your consumption of or contact with food toxins, environmental pollutants, and emotional stressors. Antioxidants and polyunsaturated fats in fruit, grain, and vegetable whole foods, rather than canned or processed foods, offer the highest nutrient potential for a healthy disease-fighting immune system. Here is a list of natural antiviral and antibacterial suggestions to supplement a healthy diet and boost your immune system:
- Vitamins (C, D, E)
- Amino acids
- Oregano oil
- Olive leaf
- Colloidal silver
- Green tea
If infection does occur be highly suspicious, as microbes are invisible to the naked eye. Only by strict laboratory procedures can most bacteria be identified. Seeking medical attention for your infection as early as possible can help prevent irreversible and/or fatal necrotizing fasciitis complications.
Necrotizing Fasciitis Breakthroughs
Although rates of necrotizing fasciitis infection are low in the United States and abroad, researchers have rallied to address the disease’s host-hostile nature and its associated high mortality rate. Recently, Harvard Medical School researchers discovered that skin-eating bacteria actually hijacks a host’s pain receptors for their own benefit. The research team studied how Streptococcus pyogenes secretes a lethal toxin called streptolysin S (SLS) that distorts normal neuronic function and disrupts communication between the nervous and immune systems. The SLS data could help explain the excruciating pain necrotizing fasciitis sufferers experience. In the study, blocking the neuron’s signals enabled the immune system to fight bacteria. Establishing the cooperative link between the immune and nervous systems substantiates just how necessary this crucial relationship is for fighting infections.
Moreover, researchers in Singapore have recognized how the chemotherapeutic agent asparaginase (ASNASE) enzyme—which breaks down the amino acid asparagine—stops Group A Streptococcus progression in human blood and hinders microbe proliferation.