Necrotizing Fasciitis

Key Points
Soft tissue bacterial infection which causes tissue death
Caused usually by multiple bacteria, the most deadly of which is streptococcus pyogenes
Begins as a small, red, painful spot or bump, which quickly worsens

Flesh-eating disease, also known as flesh-eating bacteria or necrotizing faciitis, is a potentially deadly bacterial infection of the soft-tissue and fascia, the sheath of tissue which covers muscle. It is a rare infection, but very severe. It initially consists of a small, red, painful spot or bump. The infection develops rapidly, growing in size and becoming bronze or purple colored, and very painful. Shortly, the tissue at the center of the lesion may necrose, turning black, and the skin of the affected area may ooze fluid. Lesions grow extremely fast, and affected persons may see noticeable growth in under an hour. If left unchecked, the lesions may cause extensive tissue death, in some cases down to the bone. The infection can be accompanied by fever, chills, nausea, dizziness, and weakness. Over time, affected persons may go into shock. Without treatment, death may occur quickly.

Flesh-eating disease is caused by a bacterial infection. While there are many bacteria which may be responsible, the worst and most dangerous form of the condition is due to infection with the streptococcus pyogenes. Contrary to popular belief, it is not the bacteria itself which causes tissue death, but toxins which are released during its growth process, which can cause circulation issues within the affected tissue, degrade materials in the tissue causing quicker growth of bacteria, and may even cause tissue death directly. Any gender, age and ethnic group is susceptible to infection.

Differential Diagnosis (Other conditions with similar appearance)
Cellulitis
Acute Hemorrhagic Edema of Infancy
Pyoderma gangrenosum
Erythema induratum (Nodular Vasculitis)

Panniculitis

Venous leg ulcer/ stasis dermatitis

Diagnosis
Key Points
Diagnosis based on skin and tissue appearance
Imaging tests may be useful in determining the extent of tissue damage and infection
Other tests, including blood and fluid tests, may be performed to determine the causal organism(s)

Flesh-eating disease is often diagnosed based on the appearance of the affected skin and tissue. Blood and other tests can confirm the presence of a causal organism, and may be useful in determining the course of treatment. Imaging tests may be performed to determine the extent of tissue damage and infection.

Treatment
Condition is dangerous and should be treated by health care professionals immediately
Goal of treatment is to control and, if possible, eliminate the infection
In severe cases where infection cannot be controlled, amputation of the affected limb may be necessary
Primary treatment consists of administration of broad-spectrum Antibiotics, in conjunction with surgical excision of dead tissue

Flesh-eating disease is a very serious and very potentially life-threatening condition, and must be treated by health care professionals immediately upon diagnosis. The primary treatment consists of intravenous broad-spectrum Antibiotics, in conjunction with the surgical excision of dead tissue and drainage of the affected areas. In persons where the infection of a limb does not respond to treatment, amputation may be necessary. In some persons, the causal organism may be oxygen-avoiding, in which case health care professionals may order hyperbaric oxygen therapy, in which the affected person is exposed to oxygen at high pressure to assist in killing the organism. In all cases of the condition, the death rate is very high in spite of very aggressive treatment.

In cases where the infection is eliminated, skin-grafting and other cosmetic surgical procedures may be performed to reduce scarring and deformity, which can be extensive.