Necrotizing fasciitis is term which refers to a disorder that causes the damage and death of tissues. It is the result of rapid spread of infection which is usually located in the fascial regions of connective tissues. It is a rare disease, but can affect any part of the body. Almost all cases of the condition are caused group A beta-hemolytic streptococci. However, as knowledge about the disease has progressed, researchers have come to identify various other types of bacteria that can lead to the disease either in combination with other kinds of bacteria or on their own. Certain types of fungus are also known to cause the disease in certain cases.
In the 1800s, people were aware about the symptoms of necrotizing fasciitis, but it was not until 1952, that the term was used to describe the condition. As of now, the medical world uses several terms such as dermal, Fournier’s gangrene, etc. to loosely describe necrotizing fasciitis
Irrespective of the organisms that infect the tissues, it is important to note that once they affect and grow in the connective tissues they spread so rapidly, that treating the spread of infection becomes very difficult, even with modern treatment methods such antimicrobial drugs or surgery. Around 75 percent of the individuals affected by necrotizing fasciitis eventually die. Also, most patients have perennial medical emergencies that either result in fatality or disability, in case of delayed treatment.
Necrotizing fasciitis are of three types:
- Type 1 results from two kinds of bacterial infection or may be caused by a single bacterial infection like Vibrio or by the Candida fungus
- Type 2 results from Streptococcus spp infection
- Type 3 results from by Clostridium spp infection
Necrotizing fasciitis symptoms
- Necrotizing fasciitis generally tends to commence on a wound or an infection that already exists or in the areas that adjoin the wound. Such wounds may result from cuts, insect bites, etc, and they may swell up and have increased redness, instead of healing.
- The affected area and the adjacent regions may be hyper sensitive to pain. There may also be fever and chills. The spread of the infection may result in progressive and rapid changes in skin such as skin ulceration, the development of thin-walled fluid-filled blisters and the subsequent oozing of the fluids, formation of gas within the tissues and black scabs.
- Necrotizing fasciitis that involves infection of the deep fascial planes leads to greater vulnerability to its spread to the blood and other organs of the body, before any visible skin changes can be detected.
- Type 1 generally occurs after surgery or injury and may result in the development of some gas.
- Type 2 generally occurs after simple skin trauma such as abrasions, cuts, insect bites, etc. and affects the superficial fascial planes with nil gas formation.
- Type 3 generally occurs due to contamination of wounds with dirt that has Clostridium spp. This causes gas and black scabs formation.
Different variations of necrotizing fasciitis elicit different types of symptoms that vary from one affected patient to another. Hence, doctors tend to treat every individual as per the individual diagnosis of necrotizing fasciitis
Causes of necrotizing fasciitis
- Most cases of necrotizing fasciitis are caused by different types of bacteria. On rare occasions, a few fungal species may also cause the disease.
- Necrotizing fasciitis is primary caused by the Staphylococci and Group A Streptococci bacteria, either on their own or in combination with other types of bacteria. Detection of gas in the infected tissue may point to infection by Clostridium spp
- Even though anaerobic bacteria generally tends to cause the infection, research has indicated that Klebsiella, E. coli, Pseudomonas and other such non-anaerobic bacteria may also result in necrotizing fasciitis infections.
- The initial damage to the wound sites is caused by the non-anaerobic organisms that result in local regions of hypoxia. This facilitates the growth and expansion of anaerobic organisms in such body areas. Such an infection in necrotizing fasciitis is known as polymicrobial infection wherein a single type of bacteria abets the survival and growth of another kind of bacteria.
- Infection of wounds by seawater that contains the Vibrio vulnificus virus as well as consumption of virus contaminated seafood by individuals with weakened liver functionalities can also lead to the development of necrotizing fasciitis
Treatment for necrotizing fasciitis
- Initial treatment of necrotizing fasciitis involves hospitalization and intravenous injection of multiple antibiotics. This is done to prevent the adverse affects of multiple types of bacteria on the patient, till the exact kind of bacteria causing is condition is determined.
- Isolation and detection of the type of bacteria leads to the administration of the right kind of antibiotics.
- If the patient is detected to be affected by necrotizing fasciitis, then immediate surgical intervention is required to prevent the risk towards morbidity and mortality. The affected body part determines the type of surgeon needed to conduct the surgery.
- Patients of necrotizing fasciitis are almost always admitted into ICU to prevent sepsis and organ failure. Treatment in ICU involves intravenous delivery of fluids, insertion of a breathing tube and drugs to support the cardiovascular system.
Necrotizing fasciitis pictures
The picture right below is of Mrs. Karunawathi, a victim of flesh eating bacteria of necrotizing fasciitis. She is from India.