Necrotizing Fasciitis (flesh eating bacteria)

Necrotizing Fasciitis (flesh eating bacteria ) from an essay by Katrina Tram Duong, edited by S.N. Carson M.D.

Necrotizing fasciitis, known commonly known as "flesh eating bacteria [infection]", occurs in a wide range of people 1. It occurs in the elderly, middle aged and younger patients. It occurs in athletes and debilitated individuals. It can occur in drug abusers with self inflicted wounds and healthy individuals with incidental injuries. It may occur in those with metabolic disorders such as diabetes and those with suppressed immune systems. It may occur in those with no underlying disorders and no known particular injury. It occurs under ordinary circumstances such as a seemingly harmless cut or scrape and in wounds resulting from major trauma such as an auto accident.

There is no single way of contracting necrotizing fasciitis. One patient reported that he caught it while he was at the beach and may have scraped his skin. There are some cases that have been reported after bug or dog bites. We have also seen confirmed drug users who got the infection but declared they didn’t know how the bacteria could have entered their body. There have been numerous cases where injection of illicit drugs can produce infections that present with signs of a simple cutaneous abscess and yet unpredictably evolve into an extensive necrotizing soft tissue infection 1.

Fig1. This is a picture of a leg with full blown necrotizing fasciitis, just prior to surgery. Note the discoloration. The skin feels crepitant and the area is extremely tender. A larger picture with detail is available by clicking this thumbnail print.

Necrotizing fasciitis is a deep infection of the subcutaneous tissues that results in progressive destruction of fat and fascia. The progression is usually rapid and, as an example, this author has seen it spread throughout one leg in a little over one hour. Of course, this has an instant effect on the blood supply to these areas. Alternative names for necrotizing fasciitis are fasciitis-necrotizing; infection-necrotizing subcutaneous; subcutaneous infection-bacterial5. Untreated and unconstrained, it can destroy massive amounts of tissue and result in amputation and even death in a short period of time.

Fig. 2. Another leg as above presurgical for necrotizing fasciitis. When first seen two hours prior, the discoloration was only present at the ankle. A larger picture with detail is available by clicking this thumbnail print.

Necrotizing fasciitis is caused most commonly by Streptococcus pyogenes, group A streptococcus, which is the same bacteria that causes common strep throat 8.