What is Necrotizing Fasciitis?
Necrotizing fasciitis (neck-roe-tie-zing fa-shee-eye-tis) is more commonly
known by the public as flesh-eating disease. The disease got this nickname as it
can spread through human tissue (flesh), destroying it at a rate of almost three
centimetres per hour. In some cases death can occur within 18 hours. When the
bacteria spread along the layers of tissue that surround muscle (called the
fascia), it is called necrotizing fasciitis.
What are the symptoms of the disease?
Symptoms include fever, feeling unwell, redness and severe pain at the site
of the infection. The original site of infection may be a minor wound or injury
such as a small cut or bruise. The infection can spread up the affected arm,
leg, or other body part very quickly.
An important clue to this disease is very severe pain that is out of
proportion to what you would expect from the type of wound or injury you may
have had. However, necrotizing fasciitis has also occurred when there has been
no known wound or injury.
What causes it?
Necrotizing fasciitis is caused by a number of different bacteria; one of
them is the Group A streptococcus. These bacteria also cause sore or strep
throat, scarlet fever, impetigo, and rheumatic fever. Researchers do not know
why the normally mild Group A streptococcus bacteria sometimes act in a
destructive way and cause necrotizing fasciitis. Many scientists believe the
bacteria makes proteins that destroy body tissue directly, as well as causing
the body's immune system to destroy its own tissue while fighting the bacteria.
How is it spread?
The Group A streptococcus is often found in the nose and throats of healthy
people. It is normally passed from person to person through close personal
contact with an infected person, such as through kissing, sharing forks or
spoons or cigarettes. Those at highest risk are:
persons living in the same household; people who share the same sleeping
arrangements; or people who have direct contact with the mouth or nose
secretions of the case.
How can it be prevented?
There is no vaccine to prevent Group A streptococcal infections. Antibiotics
are recommended for close contacts of cases of necrotizing fasciitis caused by
Group A streptococcus (for example, persons living in the same household). Since
this severe form of streptococcal infection can progress so rapidly, the best
approach is to seek medical attention as soon as tell-tale symptoms occur.
Remember - an important clue to this disease is very severe pain at the site of
infection.
It also makes good sense to always take good care of minor cuts, to reduce
the chance of infection getting into the tissues under the skin.
How is it treated?
Antibiotics are an important part of the treatment for these infections.
However, antibiotics on their own are not usually enough. This is because
necrotizing fasciitis cuts off the blood supply to body tissue, and the
antibiotics must be carried by blood to the infected site in order to work.
Surgery, combined with antibiotics is the usual treatment. However, researchers
are investigating other methods that can be used to supplement antibiotics and
surgery.
What are my chances of getting it?
Your chances of getting necrotizing fasciitis caused by Group A streptococus
are very low. In B.C., about 2 or 3 persons out of 1 million persons get it per
year. It is important to remember that even for those who have close, prolonged
contact with a person with necrotizing fasciitis, the chance of getting it is
very low.
Some people are known to have a higher risk of getting the disease. Illicit
injection drug use is the most imporant risk factor. Other risk factors include
skin wounds (burn, trauma, surgery), immunosuppresson due to disease (e.g.
HIV/AIDS), other chronic disease (e.g. chronic heart, lung or liver disease,
alcoholism), chicken pox, and recent close contact with a person who had
necrotizing fasciitis caused by Group A streptococcus.
