Necrotizing Fasciitis is a bacterial infection of the skin, commonly occurring when bacteria pass into the body through an open cut, scrape, burn wound or other puncture wound.
In 1977 necrotizing fasciitis was classified into four different categories based on the types of bacteria infecting the soft tissue.
Type I Infection
The most common type of fasciitis diagnosed is a type I infection. It accounts for roughly 70% to 80% of cases and consists of various kinds of bacteria. Most of these infections begin within the groin and abdominal areas.
Various species make up this type of infection, including streptococcus and anaerobes. Older people are most likely to acquire skin-eating bacteria of this type. They often have other comorbidities, including obesity or immunodeficiencies.
Type II Infection
Type II infections make up 20% to 30% of cases and chiefly involve a patient’s extremities. Streptococcus pyogenes bacteria are the main driving force of this flesh-eating virus. It may appear along with or together with staphylococcal infections. Both types of skin-eating bacteria can spread rapidly and lead to toxic shock syndrome.
Unlike type I infections, type II infections are more common in younger people. It is also exclusively developed through a traumatic injury of some kind.
Type III Infection
Type III infections are caused by bacteria commonly found in saltwater. It is rare and displays a similar necrotizing progression as type II necrotizing fasciitis. However, it lacks the same visible skin symptoms, resulting in its presence not being immediately apparent, particularly in the case of early-stage flesh-eating bacteria.
Type IV Infection
Few cases of type IV infection have been found among humans. Most healthcare professionals typically believe this group of infections is fungal. Due to how rare it is, little in-depth research has been conducted into diagnosing and treating a type IV infection.
Bacteria causing necrotizing fasciitis symptoms can enter the body in many ways. The primary entry points include:
- Puncture wounds
- Surgical wounds
- Insect bites
The bacteria that lead to necrotizing fasciitis gain entry into the body through the connective tissues just beneath the skin. Known as the superficial fascia, once the bacteria gain access to a certain area of the body, necrotizing fasciitis symptoms on the skin typically begin to appear.
Doctors have also seen situations where the primary infection cause is unknown. However, people with weakened immune systems are more likely to experience necrotizing fasciitis than others.
However, it’s important to remember that necrotizing fasciitis remains relatively rare, and there are also preventative steps you can take to reduce your overall risk.
Patients with Necrotizing Fasciitis may complain of swelling and muscle soreness at the site of the infectious process. In addition, the skin is generally warm to the touch and red or purple. Consequently, it may cause blisters, ulcers or blackening of the skin. Necrotizing Fasciitis is a medical emergency requiring urgent treatment as the bacteria quickly spreads through connective tissue and can lead to amputations or death within a narrow window of time. Aggressive surgical debridement, coupled with systemic antimicrobials and hyperbaric oxygen, is often required to prevent the infection from spreading.
People who live unhealthy lifestyles are much more likely to contract this disease. People who drink heavily, eat poor diets and smoke are at higher risk. Obesity, alcohol abuse, autoimmune disorders, heart disease and diabetes are among the conditions that can increase the chances of contracting this disease.
Anyone with a depressed immune system may be temporarily or permanently vulnerable to this disease. Appropriate management of traumatic conditions, including cancer and heart disease, can go a long way in mitigating the chances of being diagnosed with this disease.
The elderly are most vulnerable to type I infections, the most common form of this disease. Older adults are more likely to suffer from contributing comorbidities and have weaker immune systems.
Evaluating risk, particularly if undergoing major surgery, is essential for healthcare providers to reduce the risk of this bacteria developing beneath the skin.
Diagnosing necrotizing fasciitis as soon as possible is crucial to saving a patient’s life. Luckily, this is not a disease that will persist for months before visible symptoms. Many types of infection may take only two to three days to develop.
Early diagnosis is crucial, and patients must move quickly to consult their doctor if they experience any symptoms. It must be underlined that fasciitis qualifies as a genuine medical emergency. Patients should present themselves at their local hospital to receive an immediate test. Every hour counts in diagnosing the condition.
Upon presenting at a medical facility, a doctor will perform a full-body examination and review the symptoms. If a doctor suspects a patient may have flesh-eating bacteria symptoms, they will admit the patient to a hospital and perform immediate tests.
Healthcare personnel have several tests to choose from and may opt to perform more than one test to confirm the presence of the bacteria. Here are the most common tests run to diagnose necrotizing fasciitis:
- Blood Tests
The first test a doctor may opt to provide is a blood test. Simple blood tests can provide the first indications that someone is suffering from this condition.Patients with the condition will have elevated levels of white blood cells. When an infection enters the body, it mobilizes its defenses to fight back against the disease.Unfortunately, blood tests alone cannot diagnose the condition because any infection can lead to high levels of white blood cells. This is merely the first step in detecting infection in the body.
- Tissue Biopsy
A tissue biopsy may be required in more complex scenarios, such as when infected by a rare form of bacteria. Tissue biopsies take the form of exploratory surgery. Surgeons will remove a small amount of tissue and submit it to the hospital for analysis.Because results from biopsies can take some time to be returned from the lab, the patient will always receive medicine to treat the infection. This course of action buys more time for the patient to fight off the disease while deciding if surgery is required to treat the condition.Because it is an invasive analysis, doctors will generally only opt for an exploratory tissue biopsy if a case is challenging to diagnose.
- CT Scan
CT scans are also helpful in diagnosing necrotizing fasciitis because the results can show a doctor where pus and other fluids have collected inside the body. A telltale sign of the condition is when bubbles or gas appear under the skin.
Note that someone suspected to have this condition will also need to have their household tested in the process. The disease is infectious, and it is not uncommon for entire households to have been infected after someone has been confirmed to have the condition.
Complications can occur when treating this condition, and these complications can lead to permanent disability or even death.
People who experience complications are most likely those who were delayed in being diagnosed or those who have more aggressive infections. Naturally, age and comorbidities also determine how likely someone might experience complications during treatment.
The most common complications include:
- Toxic shock syndrome
- Amputation of the arm/leg
- Organ failure
- Severe, visible scarring
Thankfully, treatments have improved as the medical community has learned more about this condition. The survival rates for flesh-eating bacteria are much higher than they used to be. Additional research and state-of-the-art case management approaches have dramatically increased the likelihood of survival.
The course of treatment will depend on the stage the disease has reached, when treatment is started and the type of infection. Doctors and surgeons will also collaborate to determine how invasive the procedure must be.
Surgery was typically the primary course of treatment in years past, but other therapies have been developed to reduce the invasiveness of treatment plans.
Surgery is typically only required if significant amounts of dead or damaged tissue are present. Tissue must be removed to prevent the further spread of infection. Unfortunately, entering the OR may also mean being left with permanent scarring and increases the risk of adverse health outcomes.
Temporary and permanent skin substitutes have become a standard part of wound treatment protocols. These products—often constructed of intact human skin, animal skin, or a combination of biological and manufactured materials—are designed to advance wound healing, either using inherent healing properties or added biologically active substances. Additionally, this process involves consulting with a plastic surgeon to ensure quality outcomes and, if necessary, establishing a clear path to successful long-term reconstruction.
Other treatments include:
- Intravenous antibiotic therapy – These treatments support the immune system in halting and fighting off the bacteria spreading through the body.
- Blood pressure – Raising the blood pressure can, once again, support the flow of white blood cells and the other body’s defenses in attacking infected areas.
- Amputation – Severe cases where the patient’s life is at risk may require amputation. As traumatic as this is, amputation could be the only way to stop a significant infection from spreading to the organs.
- Hyperbaric Oxygen Therapy – While used less often, sometimes an infection may need hyperbaric oxygen therapy to preserve healthy tissues and stop the spread.
- Blood transfusions – When blood flow to the afflicted areas becomes impaired, a direct blood transfusion may be required to replenish the body’s supply.
- Intravenous immunoglobulin – Deciding on intravenous immunoglobulin is designed to support the body and its ability to fight off infection when it cannot do it by itself.
Because necrotizing fasciitis is classified as a medical emergency, patients are usually kept in hospital until the infection has been largely eliminated. Many patients only have days to receive prompt treatment before the risk of complications spikes.
Patients are constantly monitored for signs of sepsis and toxic shock syndrome. Moreover, a medical team is on hand to provide emergency treatment if complications occur.
Early diagnosis is critical to the effectiveness of treatments. Approximately one in three people with the infection will die from it. This number rises to six in ten if the patient is also diagnosed with toxic shock syndrome.
Immediate treatment, however, can shift the odds in a patient’s favor and increase the likelihood of survival while also avoiding the most invasive treatment options.
In recent years, wound care has shifted to focus on the healing benefits of wounds in moist conditions. This method has been in place for decades at burn centers. Additionally, One of the essential tools in a moist healing environment is effective dressings. Bacteria can pass through 64 layers of moist gauze. As a result, the ideal dressing should remove excess seepage, allow high humidity and gaseous exchange, protect against secondary infection, and cause no trauma upon removal. One of the top dressings used today is silver-infused. Moreover, these dressings are effective against a broad range of germs.