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As the case of Aimee Copeland entered national consciousness this week, we've had occasion to learn about the horrors of necrotizing fasciitis, the body-ravaging infection that's often referred to as flesh-eating disease.

Copeland, a 24-year-old graduate student in Georgia, contracted the infection two weeks ago, when she fell from a zip line into a river of brackish water and gashed open her leg, providing a deep enough wound for bacteria in the water to enter and penetrate below her skin.

She now finds herself in a hospital bed, a respiratory tube down her throat, one leg amputated, and more amputations likely to come, including of her fingers and her remaining foot, the Atlanta Journal Constitution reports.

The harrowing experience of necrotizing fasciitis is incomprehensible to those who've not gone through it.

The exact prevalence rate is unknown, but it's rare enough, says William Schaffner, chair of preventable diseases at Vanderbilt, that it is not considered a "reportable" disease. Estimates vary state to state.

And, in part, it's the very rarity of the diagnosis-as well as its extreme and rapid progression-that leaves survivors bewildered long after the ordeal is over.

"I'm walking around and unless I take my shirt off and you see the scar, you have no idea that I've gone through this," says Sean Helgesen, who contracted necrotizing fasciitis four years ago. "Whereas there are people whose lives are compromised because of the disease and when you think about it, I got off pretty easy. That was tough to think about it."

Helgesen, now 43, was a physical education teacher at a high school in California. During a routine workout, he pulled a muscle on the right side of his torso. The muscle soreness soon escalated into a storm of extreme symptoms-crippling pain, flu-like weakness, unquenchable thirst. In a few days he was unable to lift his right arm. At last, he agreed to go to the emergency room, where, he says, doctors told him his organs were in the process of shutting down.

"They told my wife that I had a 20 to 25 percent chance of making it," he said.

It was his great fortune, Helgesen said, to encounter Dr. Lawrence McArthy, who was familiar with necrotizing fasciitis and rushed Helgesen into surgery within two hours of his checking into the hospital. When he emerged, he had a massive amount of flesh missing from the right side of his torso, a swath cut from his armpit down to his hip.

The treatment for necrotizing fasciitis almost inevitably involves immediate, aggressive surgery because the infection is caused by bacteria that have penetrated deeply below the skin, and into the spaces surrounding the body's muscles. Surgeons must open up the muscle fascia-a procedure called debridement-and use a scalpel to scrape out all the infected tissue. Typically, they also will cut out some of the surrounding viable tissue to be sure they've completely removed the infection.

Helgesen got lucky. Although the operation was aggressive, he needed only one. Many patients, like Aimee Copeland, must endure multiple operations, and even amputations.

Helgesen's infection, as it turned out, was caused by streptococcus, the same bacterium that causes strep throat. Helgesen's doctors checked him for any external cuts or scrapes, trying to figure out how the strep had gotten so deeply into his body. They concluded, he said, that the strep already was present in his system, and when he pulled his muscle exercising, the strep evidently attacked the weakened spot.

It's not always clear what's causing the infection, however.

"One other perverse aspect of it is that you often don't find the bacteria," says Dr. Kent Sepkowitz, an infectious-disease specialist at Sloan-Kettering hospital in New York, and a Daily Beast contributor. "The bacterial load is modest, but the amount of junk that they're producing is substantial. The bitter irony in this is that people who do poorly often have negative cultures for the bacteria at the end. It's just that the enzymes and the cultures that are chewing up the tissue are still present. So they've done their dirty work-we've killed the bacteria-but it's too late."

Today, almost exactly four years later, Helgesen is back at work, now the director of his school's athletic department. Of his experience with the "flesh-eating disease" he says, "It was hard physically but it was probably harder mentally."

He later elaborated via email.

"You kind of feel like you are a member in a very exclusive club (that no one really wants to be a member of). If you tell someone you had necrotizing fasciitis, the first thing they ask is "what is that?" When you say you had the flesh-eating bacteria, they look at you like you have two heads."

The surreal shock of the diagnosis is something that Gerry Ryan, 47, a management consultant in London, can relate to. Just before Christmas last year, a Baker's cyst in Ryan's knee burst. Doctors sent him home with anti-inflammatories and instructions to elevate his leg. But the pain continued to worsen.

"I just couldn't move. I was hallucinating slightly. And it felt like someone had a blow torch-a naked flame-and was running it up and down my leg," Ryan says. "The pain was absolutely intense."

Doctors initially thought Ryan had a blood clot, but an infectious-disease doctor identified the true problem.

"I look back on it now, and it feels like it all happened in about 10 minutes," Ryan says. "You think you're lucid, you think you're thinking straight." Ryan was texting family members, reassuring him that although he was in the hospital, he was okay, not to worry.

Yet just before he was admitted for his first surgery, Ryan was told by a hospital staffer, he says, "Look I'm going to make this really simple for you. You're seriously ill. Your kidneys, your liver, your heart, are all under a lot of pressure. You have a 50 percent chance of coming out of this alive, and a good result would be that you don't lose your leg."

He stayed in the hospital for weeks, having surgeries every two days, as doctors scraped away more and more of the infected tissue inside his leg.

"You're on a roller coaster," Ryan said.

Ryan, just like Sean Helgesen, had no external scrapes or cuts-his was another case of necrotizing fasciitis caused internally by the actions of a latent strep A strain.

Though Ryan did not lose his leg, he was in hospital for weeks. He lost a great deal of weight and strength; when he left, it was on crutches, which he was told he would need for months. The most difficult part, however, for Ryan, was getting used to the skin graft that doctors covered his wound with. "It looks alien. It looks like it shouldn't be there," he said. "I couldn't touch it."

Now, back at work, Ryan is walking without crutches. He has reduced mobility in his left leg, but says it's "a small price to pay."

More dominant in his thought process has been the sentiment of disbelief.

"There was an element of, how did I survive this?" he says. "I said to one person, it feels so random, it's like walking down the street and a piano falling on your hand. It's just not going to happen. The chances of you getting it are so random that when you come through it, you just think, I can't begin to make sense of that."

Often, necrotizing fasciitis occurs in a person with a pre-existing health problem-such as diabetes or lupus-that has left his or her immune system compromised, and thus less able to stave off the initial bacterial infection.

"Bad things always happen to already sick people," as Sepkowitz puts it.

But in some cases, there are no pre-disposing factors: the patient is young and healthy-just terribly unlucky.

"This has always been an episodic, tragic, and rare event," says Sepkowitz. "It's not going to go away, but people shouldn't flip out."

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Necrotizing Fasciitis: Life After Flesh-Eating Bacteria

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As the case of Aimee Copeland entered national consciousness this week, we've had occasion to learn about the horrors of necrotizing fasciitis, the body-ravaging infection that's often referred to as flesh-eating disease.

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Under the Skin - Flesh Eating Bacteria Story

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(Source)

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Tissue biopsy, blood tests and CT scans can all be used as diagnostic tools. Tissue biopsy identifies the bacteria, blood tests will recognize heightened levels of white blood cells as a symptom of infection and CT scans find bubbles under the skin.(link)

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Antibiotics and surgery. IV antibiotics usually. It's not unusual to need multiple surgeries to remove decayed tissue.
(link)

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PubMed, this is a comprehensive explaining how terrifying this disease is, the mean length of hospital time was nearly 30 days!

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Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.

² Macquarie University Hospital, Sydney, Australia.

³ The University of Sydney, Sydney, Australia.

⁴ Chris O'Brien Lifehouse, Sydney, Australia.

⁵ Crown Princess Mary Cancer Centre, Westmead Hospital, Australia.

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.

² Macquarie University Hospital, Sydney, Australia.

³ The University of Sydney, Sydney, Australia.

⁴ Chris O'Brien Lifehouse, Sydney, Australia.

⁵ Crown Princess Mary Cancer Centre, Westmead Hospital, Australia.

Abstract

Background: Cervical necrotizing fasciitis is a progressive soft tissue infection with significant morbidity and mortality.

Methods: A case review of cervical necrotizing fasciitis managed at our institution (2007-2017) and a systematic review of PubMed, MEDLINE, and EMBASE databases using the algorithm "(cervical OR neck) AND necrotizing fasciitis."

Results: There were 1235 cases from 207 articles which were included in our clinical review. Mean age for cervical necrotizing fasciitis was 49.1 years (64.23% men). Etiology was odontogenic (47.04%), pharyngolaryngeal (28.34%), or tonsillar/peritonsillar (6.07%). There were 2 ± 0.98 organisms identified per patient; streptococci (61.22%), staphylococci (18.09%), and prevotella (10.87%). There were 2.5 ± 3.22 surgical debridements undertaken. Descending necrotizing mediastinitis occurred in 31.56% of patients. Mean length of stay in the hospital was 29.28 days and overall mortality was 13.36%.

Conclusion: Physicians and surgeons must be vigilant of the diagnosis of cervical necrotizing fasciitis as early clinical findings may be subtle and prompt identification to facilitate aggressive intervention is required to preclude catastrophic local and systemic morbidity and mortality.

Keywords: cervical necrotizing fasciitis; head and neck; mortality; necrotizing fasciitis; sequelae.

Complications of peritonsillar abscess.

Klug TE, Greve T, Hentze M. Klug TE, et al. Ann Clin Microbiol Antimicrob. 2020 Jul 30;19(1):32. doi: 10.1186/s12941-020-00375-x. Ann Clin Microbiol Antimicrob. 2020. PMID: 32731900 Free PMC article. Review.

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national center for biotechnology information

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Cervical necrotizing fasciitis: Systematic review and analysis of 1235 reported cases from the literature - PubMed

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1 Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia. 2 Macquarie University Hospital, Sydney, Australia. 3 The University of Sydney, Sydney, Australia. 4 Chris O'Brien Lifehouse, Sydney, Australia. 5 Crown Princess Mary Cancer Centre, Westmead Hospital, Australia. 1 Department of Otolaryngology, Head and Neck Surgery, Westmead Hospital, Sydney, Australia.

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1. A spreading red, warm, swollen area of skin.

2. Ulcers or black spots on skin.

3. Pus or oozing from the infected area. (link)

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Images of Vibrio Vulnificus and group A Strep

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Images of Vibrio Vulnificus and group A Strep

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Many different bacteria can cause Necrotizing Fasciitis, but this is a SEM image of Aeromonas hydrophila SSU

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Necrotizing Fasciitis or more commonly called the "flesh eating bacteria" is a condition when a bacteria, usually Strep-causing, infects your body and the toxins it releases decays your tissues.
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Centers for Disease Control and Prevention

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Necrotizing fasciitis (NECK-re-tie-zing FASH-e-i-tis) is a rare bacterial infection that spreads quickly in the body and can cause death.

Accurate diagnosis, rapid antibiotic treatment, and prompt surgery are important to stopping this infection.

See a doctor right away if your skin becomes red, warm, swollen, or very painful soon after an injury or surgery.

Group A strep thought to be most common cause

There are many types of bacteria that can cause the "flesh-eating disease" called necrotizing fasciitis. Public health experts believe group A Streptococcus (group A strep) are the most common cause of necrotizing fasciitis. This web page only focuses on necrotizing fasciitis caused by group A strep bacteria.

Bacteria that live in water, including Vibrio vulnificus, can also cause necrotizing fasciitis. Learn about Vibrio wound infections.

How you get necrotizing fasciitis

The bacteria most commonly enter the body through a break in the skin. Different breaks in the skin can include:

Cuts and scrapes

Burns

Insect bites

Puncture wounds (including those due to intravenous [IV] drug use)

Surgical wounds

However, people can also get necrotizing fasciitis after blunt trauma (an injury that does not break the skin).

Necrotizing fasciitis is rarely contagious

Most cases of necrotizing fasciitis occur randomly. It is very rare for someone with necrotizing fasciitis to spread the infection to other people. For this reason, doctors usually do not give preventive antibiotics to close contacts of someone with necrotizing fasciitis.

Necrotizing means causing the death of tissues. Fasciitis means inflammation of the fascia (the tissue under the skin that surrounds muscles, nerves, fat, and blood vessels).

Symptoms can often be confusing and develop quickly

The infection often spreads very quickly.

Early symptoms of necrotizing fasciitis can include:

A red, warm, or swollen area of skin that spreads quickly

Severe pain, including pain beyond the area of the skin that is red, warm, or swollen

Fever

See a doctor right away if you have these symptoms after an injury or surgery. Even though minor illnesses can cause symptoms like these, people should not delay getting medical care.

Later symptoms of necrotizing fasciitis can include:

Ulcers, blisters, or black spots on the skin

Changes in the color of the skin

Pus or oozing from the infected area

Dizziness

Fatigue (tiredness)

Diarrhea or nausea

Some people are at increased risk

While anyone can get necrotizing fasciitis, it is rare.

Other health factors

Most people who get this illness have other health problems that may lower their body's ability to fight infections. Some conditions that weaken the body's immune system include:

Diabetes

Kidney disease

Cirrhosis (scarring) of the liver

Cancer

Diagnosis can be difficult and acting fast is key

There are many infections that look similar to necrotizing fasciitis in the early stages, which can make diagnosis difficult. In addition to looking at the injury or infection, doctors can diagnose necrotizing fasciitis by:

Performing a biopsy (taking a tissue sample)

Looking at bloodwork for signs of infection and muscle damage

Looking at imaging (CT scan, MRI, ultrasound) of the damaged area

However, it is important to start treatment as soon as possible. Therefore, doctors may not wait for test results if they think a patient might have necrotizing fasciitis.

Prompt treatment is key

Necrotizing fasciitis is a very serious illness that requires care in a hospital. Antibiotics and surgery are typically the first lines of defense if a doctor suspects a patient has necrotizing fasciitis.

Doctors treat necrotizing fasciitis with IV antibiotics.

Antibiotics

To try to stop the infection, doctors give antibiotics through an IV, which allows medicine to flow into a vein.

Sometimes, however, antibiotics cannot reach all the infected areas because the bacteria have killed too much tissue and reduced blood flow. When this happens, doctors must surgically remove the dead tissue.

Surgery

Since necrotizing fasciitis can spread so rapidly, patients often must get surgery done very quickly. It is not unusual for someone with necrotizing fasciitis to end up needing multiple surgeries. In serious cases, the patient may need a blood transfusion.

Up to 1 in 5 people with necrotizing fasciitis die from the infection.

Serious complications are common

Necrotizing fasciitis can lead to

It can also result in life-long complications from loss of limbs or severe scarring due to surgically removing infected tissue.

Looking at data from the most recent five years:

Even with treatment, up to 1 in 5 people with necrotizing fasciitis died from the infection

Up to 1 in 3 people who got both necrotizing fasciitis and streptococcal toxic shock syndrome at the same time died from their infections

Prevent necrotizing fasciitis

There are no vaccines to prevent group A strep infections, but there are things you can do to help protect yourself and others.

To help prevent group A step infections, you should:

Wash your hands often

Clean and care for wounds

Clean and care for wounds

If you have an open wound or skin infection, avoid spending time in:

Hot tubs

Swimming pools

Natural bodies of water (e.g., lakes, rivers, oceans)

Care for fungal infections like athlete's foot to help prevent group A strep infections. Learn about athlete's foot (ringworm).

CDC tracks necrotizing fasciitis caused by group A strep bacteria

CDC tracks necrotizing fasciitis caused by group A strep bacteria with a special system called Active Bacterial Core surveillance (ABCs). Since 2010, approximately 700 to 1,150 cases occur each year in the United States. This is likely an underestimate. According to ABCs data, the number of annual group A strep necrotizing fasciitis infections reported to ABCs does not appear to be rising.

Related diseases

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Necrotizing fasciitis is a rare bacterial infection that spreads quickly and can cause death. Accurate diagnosis, rapid antibiotic treatment, and prompt surgery are important to stopping it.