Necrotizing fasciitis

Necrotizing fasciitis
Other namesFlesh-eating bacteria, flesh-eating bacteria syndrome,[1] necrotizing soft tissue infection (NSTI),[2] fasciitis necroticans
Person with necrotizing fasciitis. The left leg shows extensive redness and tissue death.
Pronunciation
  • /ˈnɛkrəˌtaɪzɪŋ ˌfæʃiˈaɪtɪs/ or /ˌfæs-/
SpecialtyInfectious disease
SymptomsSevere pain, fever, purple colored skin in the affected area[3]
Usual onsetSudden, spreads rapidly[3]
CausesMultiple types of bacteria,[4] occasional fungus[5]
Risk factorsPoor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, peripheral artery disease[2][3]
Diagnostic methodBased on symptoms, medical imaging[4]
Differential diagnosisCellulitis, pyomyositis, gas gangrene, toxic shock syndrome or toxic shock-like syndrome, pyoderma gangrenosum, deep vein thrombosis, Mucormycosis, brown recluse spider bite[6]
PreventionWound care, handwashing[3]
TreatmentSurgery to remove the infected tissue, intravenous antibiotics[2][3]
Prognosis~30% mortality with treatment,[2] ~100% mortality without treatment
Frequency0.7 per 100,000 per year[4]

Necrotizing fasciitis (NF), also known as flesh-eating disease, is an infection that kills the body's soft tissue.[3] It is a serious disease that begins and spreads quickly.[3] Symptoms include red or purple or black skin, swelling, severe pain, fever, and vomiting.[3] The most commonly affected areas are the limbs and perineum.[2]

Bacterial infection is by far the most common cause of necrotizing fasciitis. Despite being called a "flesh-eating disease", bacteria do not eat human tissue. Rather, they release toxins that cause tissue death. Typically, the infection enters the body through a break in the skin such as a cut or burn.[3] Risk factors include recent trauma or surgery and a weakened immune system due to diabetes or cancer, obesity, alcoholism, intravenous drug use, and peripheral artery disease.[3][2] It does not usually spread between people.[3] The disease is classified into four types, depending on the infecting organisms.[4] Medical imaging is often helpful to confirm the diagnosis.[4]

Necrotizing fasciitis is treated with surgery to remove the infected tissue, and antibiotics.[2][3] It is considered a surgical emergency. Delays in surgery are associated with a much higher risk of death.[4] Despite high-quality treatment, the risk of death remains between 25 and 35%.[2]

  1. ^ Rakel, David; Rakel, Robert E. (2015). Textbook of Family Medicine. Elsevier Health Sciences. p. 193. ISBN 9780323313087. Archived from the original on 2017-09-08.
  2. ^ a b c d e f g h Hakkarainen, Timo W.; Kopari, Nicole M.; Pham, Tam N.; Evans, Heather L. (2014). "Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes". Current Problems in Surgery. 51 (8): 344–362. doi:10.1067/j.cpsurg.2014.06.001. PMC 4199388. PMID 25069713.
  3. ^ a b c d e f g h i j k l "Necrotizing Fasciitis". NORD. September 8, 2023. Retrieved December 3, 2024.
  4. ^ a b c d e f Paz Maya, S; Dualde Beltrán, D; Lemercier, P; Leiva-Salinas, C (May 2014). "Necrotizing fasciitis: an urgent diagnosis". Skeletal Radiology. 43 (5): 577–589. doi:10.1007/s00256-013-1813-2. PMID 24469151. S2CID 9705500.
  5. ^ Ralston, Stuart H.; Penman, Ian D.; Strachan, Mark W. J.; Hobson, Richard (2018). Davidson's Principles and Practice of Medicine E-Book. Elsevier Health Sciences. p. 227. ISBN 9780702070266.
  6. ^ Ferri, Fred F. (2013). Ferri's Clinical Advisor 2014 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 767. ISBN 978-0323084314.
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