Necrotising Fasciitis

Necrotizing Fasciitis/Necrotising Fascitis (Common Mispellings)

Necrotising Fasciitis is also known as the 'Flesh Eating' bacteria or flesh eating bug. Necrotizing fasciitis is a condition where bacteria attacks soft tissue and a sheath of tissue covering the muscle (the fascia). This condition can occur after only a relatively minor penetrating injury which gives the opportunity for the bacteria to enter the body. A tiny scratch can be enough for the condition to develop and often patients cannot remember any type of trauma at all.

The normal conditions for necrotising fasciitis to occur are:-

a contusion abrasion cut or opening in the skin. However, it has been known for necrotising fasciitis to occur even when there is no apparent injury.
coming into contact with the bacteria through direct contact with a carrier or because the patient has the bacteria already present.

Once the bacteria has entered the body it quickly reproduces and destroys the soft tissue and fascia which then dies. It is essential that the dead (gangrenous) tissue is surgically removed to save life. Necrotising fasciitis results in often unbearable pain, very low blood pressure, confusion, fever and severe dehydration.

Necrotising fasciitis is rare and is difficult to diagnose. This is unfortunate because a failure to diagnose and treat swiftly will result in death.

Eventually, the bacteria will cause the body's organs to go into systemic shock. This can result in respiratory failure, heart failure, low blood pressure and renal failure. Basically, every system of the body can fail.

Necrotising fasciitis must be treated in a hospital with antibiotic intravenous therapy and aggressive removal of the affected tissue (known as debridement). For those patients who do survive there is usually some removal of the skin required which often requires skin grafting by a plastic surgeon. Amputation is sometimes needed to remove affected limbs.

A prompt diagnosis and early treatment are absolutely essential if the patient is to survive.

The Various Symptoms Of Necrotising Fasciitis

Necrotizing Fasciitis (NF) is a rare soft tissue infection. If it is left untreated it is almost always fatal.

What are the symptoms? These often include:-

Early Symptoms (usually within 24 hours)

Usually a minor trauma or other skin opening has occurred (the wound does not necessarily appear infected)
Some pain in the general area of the injury is present. Not necessarily at the site of the injury but in the same region or limb of the body
The pain is usually disproportionate to the injury and may start as something akin to a muscle pull, but becomes more and more painful
Flu like symptoms begin to occur such as diarrhoea, nausea, fever, confusion, dizziness, weakness and general malaise
Dehydration
The biggest symptom is all of these symptoms combined. In general you will probably feel worse than you've ever felt and not understand why

Advanced Symptoms (usually within 3-4 days)

The limb, or area of body experiencing pain, begins to swell and may show a purplish rash
The limb may begin to have large, dark marks that will become blisters filled with blackish fluid
The wound may actually begin to appear necrotic with a bluish, white or dark mottled, flaky appearance

Critical Symptoms (usually within 4-5 days)

Blood pressure will drop severely
The body begins to go into septic shock from the toxins the bacteria are giving off
Unconsciousness will occur as the body becomes too weak to fight off the infection

Many cases of Necrotizing Fasciitis are misdiagnosed because at the beginning symptoms look like a minor affliction. It is often the case that until a patient is so ill that they are at the critical stage that the medical profession does not consider Necrotizing Fasciitis. There is more chance of the condition being diagnosed in an accident and emergency department rather than at a GP surgery or a walk-in or out-of-hours service. However, even in accident and emergency departments, patients are diagnosed with other conditions, for example constipation if the affected area is in the buttock, meaning that the patient is left untreated with death being the eventual outcome.

Prevention

This is a list of recommendations to prevent the disease:-

good hand washing can prevent the spread of the infection
patients with sore throats should be seen by a doctor
patients with a strep throat should stay home until 24 hours after their last antibiotic dose
keeping the skin intact is an important factor in preventing necrotising fasciitis
wounds should be cleaned and monitored for signs of infection (redness, swelling, drainage, pain)
patients with an infected wound and fever should seek medical care

Treatment

The treatment is a combination of surgical debridement, antibiotics and optimal oxygen. Early diagnosis is of critical importance to prevent radical surgery or death.

An accident and emergency department will normally transfer a patient to a surgical team based on a high index of suspicion of necrotising fasciitis. Aggressive surgical debridement (removal of infected tissue) is always necessary to keep it from spreading. Diagnosis is made by visual examination of the tissues and by tissue samples sent for microscopic evaluation. If there is a high index of suspicion of necrotising fasciitis antibiotics should be started immediately. Initial treatment will include a combination of intravenous antibiotics including penicillin, vancomycin and clindamycin. Cultures are then taken to decide an overall appropriate antibiotic coverage and the initial intravenous antibiotics then may be changed.

As with other conditions characterised by tissue destruction, hyperbaric oxygen treatment can be a valuable therapy and can assist in reducing mortality and the rate of infection. However, it is not always widely available. Amputation of affected organs may therefore be necessary and repeat surgical procedures are usually needed to remove additional necrotic tissue. This often leaves a large open wound which will require skin grafting. Most patients will be monitored in an intensive care unit after surgery.

Need Advice About Necrotising Fasciitis?

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