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The most common cause of necrotizing fasciitis is the Group A Streptococcus bacterium, most often Streptococcus pyogenes, a Gram-positive bacteria known for its aggressive tissue-destroying capabilities.

-Beta-hemolytic on blood agar

-Non-motile, non-spore forming

-Facultative anaerobe

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Necrotizing fasciitis is not typically contagious. It occurs when Strepococcus pyogenes enters through a break in the skin, such as:

Cuts or abrasions

Surgical wounds

Burns

Injection sites
-Transmission is direct, via contaminated skin surfaces, surgical instruments, or trauma.

Anything that destroys first line of defense

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Intense pain and swelling at the site of infection

Skin changes: redness → purplish → black necrosis (as seen above)

Fever, chills, fatigue

Rapidly spreading inflammation

Blistering, fluid oozing

Septic shock, multi-organ failure in advanced stages

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Streptococcal pyrogenic exotoxin B

A cysteine protease (pro-protein , ase-enzyme) that breaks down host tissues and molecules.

Degrades extracellular matrix proteins like fibronectin, which weakens cell structure

Helps spread bacteria rapidly through tissue

Triggers excessive immune response and cell death

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1. Clinical signs: rapidly spreading infection, disproportionate pain, visible skin deterioration

2. Tissue biopsy and bacterial culture: can confirm S. pyogenes presence

3. PCR: Detects toxin-producing genes like speB

4. Imaging (CT/MRI): Shows extent of tissue involvement and possible gas in soft tissues (severity)

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Class: Lincosamide antibiotic ( Ex: Clindamycin )

Targets: 50S ribosomal subunit

Action: Blocks protein synthesis by stopping peptide chain elongation

Key Benefit:

Works even on non-dividing bacteria

Reduces toxin production (like SpeA and SpeB)

Often paired with Penicillin G for better coverage

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Extensive scarring or disfigurement

Loss of limbs (amputation often required)

Chronic pain and phantom limb syndrome

Psychological trauma (PTSD, depression)

Organ dysfunction if sepsis was involved

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No approved vaccine currently available.

Vaccine research targeting M protein of Streptococcus pyogenes (GAS) is ongoing.

Preventative measures:

Immediate care of wounds and cuts

Good hygiene, especially after trauma or surgery

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USA:

~700 to 1,200 cases/year (CDC)

Mortality rate: 20–30%

Worldwide:

Varies by region—more common in tropical, low-resource settings

Underreporting common due to misdiagnosis

Locally:

Occasional outbreaks in hospitals, especially among surgical patients or after natural disasters

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-Known as the “flesh-eating disease”

-First described in 5th century BC by Hippocrates

"Father of Medicine"

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Wong, Chee Kheong, et al.
"Necrotizing fasciitis: clinical presentation, microbiology, and determinants of mortality." The Journal of Bone and Joint Surgery, vol. 85, no. 8, 2003, pp. 1454–1460.
doi:10.2106/00004623-200308000-00008.

Centers for Disease Control and Prevention (CDC).
"Necrotizing Fasciitis: All You Need to Know." CDC, 20 Jan. 2023,
https://www.cdc.gov/groupastrep/diseases-public/necrotizing-fasciitis.html.
Accessed 12 Apr. 2025.

Stevens, Dennis L., and Allen E. Bryant.
"Necrotizing Soft-Tissue Infections." The New England Journal of Medicine, vol. 377, no. 23, 2017, pp. 2253–2265.
doi:10.1056/NEJMra1600673.