Necrotizing Fasciitis – Introduction

Necrotizing fasciitis (NF) is a life-threatening soft tissue infection a condition, often referred to in the press as the ‘flesh-eating bug’ on account of the speed with which the infection spreads.  The condition was first described by Hippocrates around the fifth century, and the term “necrotizing fasciitis” was coined by Joseph Jones, a former Confederate Army surgeon, in 1871.(1) Some infecting organisms in NF have been reported to progress at about 3 centimeters per hour, meaning that the infection rapidly progresses beyond the capabilities of either antimicrobial drugs or surgery.(2,3) The rapid progressing can lead to significant morbidity and mortality. Indeed, mortality rates have been reported as high as 75% for necrotizing fasciitis associated with Fournier’s gangrene.(1)

Cause of Necrotizing Fasciitis

Necrotizing fasciitis is classically caused by group A beta-hemolytic streptococci (Streptococcus pyogenes), but most investigators now agree that many different bacterial genera and species, either alone or in combination can cause this disease. Occasionally, mycotic species cause necrotizing fasciitis.(1,3)

How Necrotizing Fasciitis Starts

The majority of cases of NF begin with an existing infection, usually on an extremity or in a wound. The initial infection can be from almost any cause; but instead of healing, the infected site exhibits excessive erythema, swelling, and pain.  At the same time, patients often experience fever and chills. Early symptoms resemble those of cellulitis, but progressive skin changes such as skin ulceration, bullae formation, necrotic eschars, gas formation in the tissues, and fluid draining from the site can occur rapidly as the infection progresses. Some patients can become septic before skin changes are recognized, especially when necrotizing fasciitis begins in deep facial planes.(3)

Necrotizing Fasciitis Statistics

The US Centers for Disease Control and Prevention (CDC) has estimated that around 500 to 1,000 cases of NF are diagnosed in the US every year.(1) The annual rate of NF has been reported as 0.40 cases per 100,000 population, with a recent exponential increase in this rate. Approximately 50% of patients have a history of skin in-jury, 25% have experienced blunt trauma, and 70% have one or more chronic illnesses. Half of cases occur in a single lower limb and one-third in a single upper limb.(1)

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Although cases of NF are mercifully relatively rare, it is important that wound care specialists learn to recognize this condition rapidly, differentiate it from other etiologies, and initiate appropriate management promptly.

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References

1. Shimizu T and Tokuda Y. Necrotizing fasciitis. Inter Med 2010; 49: 1051-1057
2. Cheung JPY, Fung B, Tang WM, Ip WY. A review of necrotising fasciitis in the extremities. Hong Kong Med J 2009; 15: 44-52
3. MedicineNet.com. Necrotizing fasciitis. Available from http://www.medicinenet.com/necrotizing_fasciitis/article.htm
4. Black JM, Black SB. Surgical wounds, tubes, and drains. In: Baranoski S, Ayello EA, eds. Wound Care Essentials: Practice Principles. 2nd Edition. Lippincott Williams & Wilkins, Ambler PA. 2008.