Necrotizing fasciitis

Necrotizing fasciitis or fasciitis necroticans, commonly known as "flesh-eating bacteria", is a rare infection of the deeper layers of skin and subcutaneous tissues (fascia). Many types of bacteria can cause necrotizing fasciitis (eg. Group A streptococcus, Vibrio vulnificus, Clostridium perfringens, Bacteroides fragilis), of which Group A streptococcus is the most common cause.

Symptoms

The infection occasionally starts with pharyngitis (sore throat), but more often begins locally, at a site of trauma, which may be severe (such as the result of surgery), minor, or even non-apparent. The affected skin is very painful, red, hot and swollen. Skin color may progress to violet and blisters may form, with subsequent necrosis (death) of subcutaneous tissues. Patients with necrotizing fasciitis typically have a fever and appear very ill. More severe cases progress within hours, and the death rate is high, about 25%.

Pathophysiology

"Flesh-eating bacteria" is a misnomer, as the bacteria don't actually eat the tissue. They cause the destruction of skin and muscle by releasing toxins (virulence factors). Streptococcal pyogenic exotoxins and other virulence factors lead to the release of cytokines which cause the clinical symptoms.

Treatment

The diagnosis is confirmed by either blood cultures or aspiration of pus from tissue. Early medical treatment is crucial. Treatment often includes intravenous penicillin, vancomycin and clindamycin. If necrotizing fasciitis is suspected, surgical exploration is always necessary, often resulting in aggressive debridement (removal of infected tissue). Amputation of the affected organ(s) may be necessary.

Prognosis

This disease is one of the fastest-spreading infections known as it spreads easily across the fascial plane within the subcutaneous tissue. For this reason, it is popularly called the "flesh-eating disease" and although rare, it became well-known to the public in the 1990s. Even with top-notch care today, the prognosis can be bleak, with a mortality rate of around 20 percent and severe disfigurement common in survivors. Mortality is nearly 100 percent if not properly treated. Correct diagnosis and early treatment of this disease is therefore of extreme importance.

Other bacterial strains

In February 2004, a rarer but even more serious form of the disease has been observed in increasing frequency, with several cases found specifically in California. In these cases, the bacterium causing it was a strain of Staphylococcus aureus (i.e. Staphylococcus, not Streptococcus as stated above) which is resistant against methicillin, the antibiotic usually used for treatment. (See Methicillin-resistant Staphylococcus aureus for details.)

Well-known victims

Lucien Bouchard, former Quebec premier, who became infected in 1994 while leader of the federal official opposition Bloc Québécois party. He lost a leg to the illness.
Eric Allin Cornell, winner of the 2001 Nobel Prize in Physics, who lost his left arm and shoulder to the disease in 2004.
Melvin Franklin, bass singer for The Temptations. Though Franklin's condition was diagnosed early enough to prevent complete amputation of his arm, he died from other health complications soon afterward in 1995.
Barbara Miller-Roy, the mother of former NHL goalie Patrick Roy had her arm amputated due to the disease in January 2006.
Devin Adair a 21-year-old student athlete on the University of Tulsa Golden Hurricane football team, died of the disease on April 28, 2006 after a week in the hospital^*.
Jim Henson creator of The Muppets died of a connection of the disease in 1990.

In Pop Culture

A fictional virus with symptoms like necrotizing fasciitis was featured in the modern horror film Cabin Fever.
Necrotizing fasciitis is mentioned by Dick Harper in the Jim Carrey movie, "Fun with Dick and Jane (2005 film)," during the robbery of AmeriBank.
An episode of Crime Scene Investigation incorrectly described this "flesh-eating bacteria."

External links

Hoax: Bananas imported from Costa Rica cause necrotizing fasciitis (refutation or information available from: CDC and FDA, CDC, Snopes.com, CIAC HoaxBusters)
Necrotizing Fasciitis Facts and Information on Treatment
National Necrotizing Fasciitis Foundation official website

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