Necrotizing fasciitis (neck-roe-tie-zing fa-shee-eye-tis) is more commonly known as “flesh-eating disease”. It is a very severe bacterial infection that spreads quickly through the tissue, or flesh surrounding the muscles. In some cases death can occur within 18 hours. Necrotizing fasciitis kills about 1 in 4 people infected with it.
Necrotizing fasciitis may start from an infection in a minor cut or bruise. It may follow a chickenpox infection. Sometimes there is no obvious skin wound or injury.
What are the symptoms of the disease?
Most often, there is sudden onset of pain and swelling with redness at the site of a wound. Fever may also occur. The pain is commonly far greater than you would expect from that kind of wound or injury.
The pain can sometimes occur at a distance from the wound. It can spread quickly up the affected arm, leg, or other body part. This kind of infection can cause gangrene-the death of tissue in a part of the body.
What causes necrotizing fasciitis?
Necrotizing fasciitis is caused by a number of different bacteria. One of these is group A streptococcus. These bacteria are found on the skin or in the nose and throat of healthy people.
Many people carry these bacteria but don’t get sick; however, these bacteria can also cause strep throat, scarlet fever, skin infections, and rheumatic fever. It is not fully understood why group A streptococcus bacteria, on rare occasions, cause necrotizing fasciitis.
However, these bacteria make toxins that destroy body tissue directly, as well as causing the body’s immune system to destroy its own tissue while fighting the bacteria.
How is it spread?
Group A streptococcus bacteria are spread by contact with saliva or mucus from the mouth, nose or throat of an infected person. When an infected person coughs or sneezes, the bacteria spread through droplets in the air.
You can become infected when you breathe in these droplets or touch objects contaminated with them. The bacteria can also be spread through close personal contact such as kissing, or sharing drinking cups, forks, spoons or cigarettes.
Those at highest risk of getting it from an infected person are:
- Persons living in the same household;
- People who sleep in the same room; or
- People who have direct contact with the infected person’s mouth or nose secretions.
How can necrotizing fasciitis be prevented?
There is no vaccine to prevent group A streptococcal infections. Antibiotics are recommended for close contacts of cases of necrotizing fasciitis caused by group A streptococcus (for example, persons living in the same household).
Since this severe form of streptococcal infection can progress so rapidly, the best approach is to get medical attention as soon as symptoms occur.
Remember, an important clue to this disease is very severe pain at the site of a wound.
Always take good care of minor cuts to reduce the chance of the tissues under the skin getting infected. If you have a small cut or wound, wash it well in warm soapy water, and keep it clean and dry with a bandage.
How is it treated?
Antibiotics are an important part of the treatment for necrotizing fasciitis. However, antibiotics on their own are not usually enough. This is because necrotizing fasciitis cuts off the blood supply to body tissue, and the antibiotics must be carried by blood to the infected site in order to work.
Surgery, combined with antibiotics, is the usual treatment.
What are my chances of getting necrotizing fasciitis?
Your chances of getting necrotizing fasciitis caused by group A streptococcus are very low. In B.C., about 2 or 3 people out of 1 million get it every year. Even for those who have close, prolonged contact with a person with necrotizing fasciitis, the chance of getting it is very low.
Some people are known to have a higher risk of getting the disease. Injection drug use is the biggest risk factor.
Scientists do not know exactly why GAS causes only minor infections for some people, but poses a serious threat to others. However, some risk factors have been identified, including:
A weakened immune system, which could be caused by such factors as disease (HIV infection, AIDS), cancer treatments (radiation and chemotherapy), or by taking anti-rejection drugs following an organ or bone-marrow transplant;
Chronic diseases, including heart, lung or liver disease;
Recent close contact with someone who has flesh-eating disease that was caused by GAS; and
Chickenpox- it should be noted, however, that while flesh-eating disease is a complication of chickenpox in children, very few children with chickenpox will develop flesh-eating disease.
Keep in mind that flesh-eating disease is very rare. Your chance of getting it is low, even when these risk factors are present.
Other risk factors include:
- Skin wounds (burn, trauma, surgery);
- A weakened immune system due to disease or medical treatment;
- Chronic diseases such as heart, lung or liver disease, alcoholism or diabetes;
- Recent close contact with a person who had necrotizing fasciitis caused by group A streptococcus; or
Treatment for flesh-eating disease
Because flesh-eating disease progresses so rapidly, treatment usually involves surgery to remove the infected tissue and antibiotics to fight the infection. There is no vaccine to prevent flesh-eating disease.
Minimizing your risk
The following steps will help to minimize any risk that exists:
Seek immediate medical attention if you have the symptoms of flesh-eating disease.
If you have been in close contact with someone who has flesh-eating disease caused by GAS, consult your doctor.
It may be a good idea to take antibiotics as a precaution.
Take proper care of minor wounds and cuts. Wash the affected area in warm soapy water, and keep it clean and dry with a bandage.