Necrotizing fasciitis
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| ICD-10 | M72.6 | |
|---|---|---|
| ICD-9 | 728.86 | |
| MedlinePlus | 001443 | |
| eMedicine | emerg/332 derm/743 | |
| MeSH | C01.252.410.890.350 | |
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.
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[edit] Symptoms
The infection often starts with pharyngitis (sore throat), but occasionally 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 classically, at first, very painful without any grossly visible change. With progression of the disease, tissues becomes swollen, often within hours. 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 30%[1].
[edit] Pathophysiology
"Flesh-eating bacteria" is a misnomer, as the bacteria do not actually eat the tissue. They cause the destruction of skin and muscle by releasing toxins (virulence factors). These include streptococcal pyogenic exotoxins and other virulence factors. S. pyogenes produces an exotoxin known as a superantigen. This toxin is capable of activating T-cells non-specifically. This causes the over-production of cytokines that over-stimulate macrophages. The macrophages cause the actual tissue damage by releasing oxygen radicals.
[edit] Treatment
The diagnosis is confirmed by either blood cultures or aspiration of pus from tissue, but early medical treatment is crucial and often presumptive; thus, antibiotics should be started as soon as this condition is suspected. Initial treatment often includes a combination of intravenous antibiotics including penicillin, vancomycin and clindamycin. If necrotizing fasciitis is suspected, surgical exploration is always necessary, often resulting in aggressive debridement (removal of infected tissue). As in other maladies characterized by massive wounds or tissue destruction, hyperbaric oxygen treatment can be a valuable adjunctive therapy. Amputation of the affected organ(s) may be necessary. Surgical procedures include extensive debridement as soon as possible, secondary closure. The mortality of this disease has not been altered by antimicrobials. Only early recognition and surgical treatment will improve the prognosis.
[edit] 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 today's modern medicine, the prognosis can be bleak, with a mortality rate of around 25% and severe disfigurement common in survivors. Mortality is nearly 100% if not properly treated.
[edit] 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.)
[edit] Well-known victims
- David Walton, a leading economist in the UK and a member of the Bank of England’s Monetary Policy Committee which is responsible for setting interest rates, died of the disease within 24 hours of diagnosis on June 21, 2006.
- 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.
- Lana Coc-Kroft, a New Zealand television celebrity, was infected after she stepped on a coral reef in Fiji in 2005.
- Jan Peter Balkenende, Prime Minister of the Netherlands since 2002, was infected in 2004. He was in the hospital for several weeks, but fully recovered.
- Alan Coren, British writer and satirist, announced in his Christmas 2006 column for The Times that his long absence as a columnist has been due to contracting the disease whilst on holiday in France.
- Alexandru Marin, physicist, professor at MIT, Boston University and Harvard University. Major works include MUON detector at CERN.
[edit] See also
- Toxic shock syndrome
- Mucormycosis, a rare fungal infection which can present like necrotizing fasciitis
[edit] References
In season 2 of the T.V. show Scrubs, Dr. Elliott's patient died of Necrotizing fasciitis.
[edit] External links
- Hoax: Bananas imported from Costa Rica cause necrotizing fasciitis (refutation or information available from: CDC and FDA, CDC, Snopes.com, CIAC HoaxBusters)
- National Necrotizing Fasciitis Foundation official website
- Flesh-Eating Bacteria
