Necrotising Fasciitis - Failure To Treat The Flesh-Eating Disease
Necrotising fasciitis, the 'flesh-eating disease', has a high rate of morbidity. This is because it is a fast-moving infection that will quickly kill the patient if treatment is not given.
If there is a delay in treatment and this is the fault of medical practitioners, there may be grounds for a medical negligence compensation claim. If the patient did not survive, the claim can be made by the patient's family.
What is necrotising fasciitis/necrotizing fasciitis?
Necrotising fasciitis (also spelt necrotizing fasciitis) is regularly dubbed the 'flesh-eating disease'. It is a bacterial infection of the deep tissue which is particularly aggressive in nature. It can be caused by different types of bacteria, all commonly found in the UK.
For the infection to take hold the bacteria must get inside the body and into the body's deep tissues. Once in the deep tissue the bacteria start to multiply extremely quickly. The reproduction process causes a toxin to be released and this damages the surrounding tissue. The tissue will start to break down, disrupting the supply of blood and oxygen to the area.
The lack of blood and oxygen will cause the tissue to breakdown even more, resulting in gangrene. Gangrene is when the tissue dies because of a loss of blood supply. Within a short space of time there will be widespread tissue death – known medically as tissue 'necrosis'.
Symptoms of necrotising fasciitis
The process of the tissue breaking down and dying will be extremely painful for the patient. However, there will be no obvious cause for this pain. The skin around the site of infection will be red and hot to touch. As the infection progresses, the appearance of the skin will change, turning increasingly dark in colour. There may also be weeping blisters – called 'bullae' – on the surface of the skin. The patient will have symptoms of a fever, with a high temperature, sweatiness and generally feeling very poorly.
Who gets necrotising fasciitis?
Anyone can get necrotising fasciitis, although there must be some way for the bacteria to get inside the body. This means that almost all necrotising fasciitis patients can recall some sort of injury that enabled the bacteria to penetrate the skin. This can be an injury as small as a graze, or an injury as large as a surgical wound.
Along with a recent injury to the skin, there are other factors that increase the risk of necrotising fasciitis. Of particular note is immune-suppression, a problem often caused by medication – including chemotherapy or prescription drugs to treat rheumatoid arthritis. Such medication makes people much more vulnerable to infection.
Thus if a patient presents with the symptoms of necrotising fasciitis, and he/she is taking immune-suppressant drugs, and he/she has recently grazed their elbow (for example), alarm bells should start ringing in the minds of medical practitioners.
Observations to diagnose necrotising fasciitis
Someone with necrotising fasciitis will feel very unwell, prompting them to seek medical help, often heading straight to an A&E department. There are various physical indicators that are associated with necrotising fasciitis. The treating clinician should note that a patient has these physical indicators and use them to make an accurate diagnosis.
For example, a steady lowering of blood pressure is a sign of necrotising fasciitis. Taking a blood pressure reading is a basic test and should be part of other observations taken when a patient is admitted to hospital. These will help medical professionals determine the state of a patient's health. Observations should be performed repeatedly throughout the course of a patient's stay in hospital, as this will allow any improvement or deterioration in their condition to be noted.
Alongside a blood pressure reading, basic observations should include oxygen saturation, heart rate, respiratory rate, urine output, peripheral pulses, capillary refill time and temperature. The readings of a patient with necrotising fasciitis will usually be abnormal.
However, there are certain things that can affect the readings – for instance, a large dose of pain relieving medication can slow the heart rate down. These factors should be taken into consideration when assessing a patient's observations.
Tests to diagnose necrotising fasciitis
Other basic tests such should also be taken. Most notably, a blood sample should be taken and sent to the laboratory for culture analysis. A patient with necrotising fasciitis will have a low white cell count and a raised C-Reactive Protein (CRP). This combination points towards an infection.
An x-ray of the affected area can also prove useful as it will show areas of gas internally, a consequence of the bacteria releasing poisonous toxins inside the body.
Recognising necrotising fasciitis
The observations and tests should lead doctors towards a diagnosis of necrotising fasciitis. By way of review, the physical indicators that will signal necrotising fasciitis are:
- The patient's symptoms, particularly an intense pain with no obvious cause
- Abnormal observations, especially low blood pressure and high temperature
- Raised CRP and low white blood cell count
- Steady deterioration in the patient's condition
- Pockets of gas visible on an x-ray
All of these factors should be taken into account and a diagnosis of necrotising fasciitis suspected.
It is true that necrotising fasciitis is rare, and some may suggest that it is not reasonable to expect clinicians to have a thorough understanding of the condition. Nevertheless, this is not a valid point as necrotising fasciitis is deemed to be a “high profile condition”. This means that a competent middle ranking or emergency physician would be very aware of necrotising fasciitis, even though it is uncommon, as it is a condition that is extremely aggressive. It therefore requires immediate diagnosis and treatment.
Failure to diagnose necrotising fasciitis
Unfortunately there are times when medical practitioners fail to accurately consider a patient's history, symptoms and physical condition. This means that the patient is suspected of having a different condition altogether, and the necrotising fasciitis treatment that is needed so urgently is not provided.
This will be deemed negligent, as a competent practitioner should recognise that the physical signs point towards an infection, prompting them to address a possible diagnosis of necrotising fasciitis. A failure to achieve this diagnosis in a reasonable amount of time may lead to a successful medical negligence claim.
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