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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.

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Necrotizing means dying tissue and Fasciitis means inflammation of the fascia tissue under the skin. Fascia surrounds the muscles, nerves, blood vessels, and fat. An infection eats away at live tissue and destroys the body.

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Group A Streptococcus is thought to be the most common cause of necrotizing fasciitis. Group A strep most often enters the body through breaks in the skin like cuts, scrapes, burns, bug bites, and surgical incisions or wounds.

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A fever can occur with necrotizing fasciitis.

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Early signs of necrotizing fasciitis:
1. red swollen area of skin that spreads quickly
2. severe pain in and around the affected area
3. fever

Later symptoms:
1. ulcers, blisters, black spots on skin
2. puss or oozing from the skin
3. fatigue, nausea, dizziness

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Necrotizing fasciitis can be similar to other infections in the earlier stages, therefore tests are requires. A tissue sample (biopsy) is required as well as bloodwork for signs of infection. There may also be imaging of the area (MRI, CT, ultrasound).

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This article includes information on underlying illnesses in necrotizing fasciitis cases as well as other clinical features. This figure shows that 71% of adult cases in this study occurred in patients with at least 1 chronic underlying condition. Half of the cases in the children (4 of 8) occurred as a complication of varicella. This shows the impact an underlying condition can have on contracting necrotizing fasciitis. Anyone susceptible to soft tissue injuries or wounds may be more likely to contract necrotizing fasciitis.

Kaul, R., McGeer, A., Low, D. E., Green, K., Schwartz, B., & Simor, A. E. (1997). Population-based surveillance for Group A streptococcal necrotizing fasciitis: Clinical features, prognostic indicators, and microbiologic analysis of seventy-seven cases. The American Journal of Medicine, 103(1), 18–24. https://doi.org/10.1016/s0002-9343(97)00160-5

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Surgery is often needed, sometimes limb amputation.

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Prompt treatment is key!

Early surgery to remove dead tissue and IV antibiotics to fight the infection is usually the first line of defense. Some patients require multiple surgeries. To heal the wounds created in surgery from dead tissue removal patients require skilled wound care. This can involve special dressings, debridement, and negative pressure wound therapy.

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An example of negative pressure wound therapy in an OR.

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Once a patient has had surgery a surgeon may place (or have a wound Physical Therapist place) something called a Wound VAC. A wound VAC can only be used on a patient once all the dead tissue is removed and health tissue is exposed to regrow. A special foam is placed on the wound bed and covered with a clear adhesive drape. Then a hose is attached and a constant pressure vacuum seals the wound. This pulls all of the excess fluid from the wound and promoted tissue growth and healing. The settings on a Wound VAC can be changed depending on the patient's needs. This dressings are usually change every other day. This therapy has been proven to cut healing time nearly in half!

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The reason I chose to research necrotizing fasciitis is because I have seen it before during my time working at a hospital. I assist wound physical therapists with care sometimes, which includes placing wound VACs and other dressings. Majority of these patients had underlying conditions which prompted my interest in the article I chose for this Padlet.

The main difference between pressure injuries/wound compared to necrotizing fasciitis that I have seen are the size of the wound and the amount of time it takes to heal. If an infection is not found early enough a large amount of tissue must be cut out. Sometimes amputation may be necessary to save the patient's life. The wounds also differ by color initially. If a surgeon cannot remove all of the infected tissue the first time, the patient returns to the OR for surgery multiple times. Sometimes it is impossible to remove all of the dead tissue during the first surgery. After successful surgery the wound appears much more healthy.

After researching the cause of this infection and how it progresses I may be able to better assist the physical therapists with wound care.

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Clean bandage changes often promote healing.

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Clean all cuts, abrasions, and wounds with soap and water and cover with a dry sterile bandage. See a physician for more serious injuries or if you are unsure of how to care for a wound. Avoid hot tubs, pools, and natural bodies of water while a wound is healing. Take care of underlying medical conditions to the best of your ability to avoid wounds and injuries.

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Rupert Kaul, MD, Division Director of Infection Diseases at University of Toronto

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Rupert Kaul, MD, Division Director of Infection Diseases at University of Toronto

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https://facdir.deptmedicine.utoronto.ca/Detail.aspx?id=1274

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Necrotizing Fasciitis - Flesh Eating Bacteria

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https://spauldingrehab.org/about/patient-stories/monica

https://www.cdc.gov/groupastrep/diseases-public/necrotizing-fasciitis.html

https://www.sciencedirect.com/science/article/pii/S0002934397001605?via%3Dihub

https://facdir.deptmedicine.utoronto.ca/Detail.aspx?id=1274

https://youtu.be/bh--RlpuJIE

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https://spauldingrehab.org/about/patient-stories/monica

A story about a mother who contracted necrotizing fasciitis and required nearly 35 surgeries. From contracting the illness to recovering and heading home took four months total.

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Monica Jorge's life in August 2007 could not have been better. She was engaged to a wonderful man, Tony, and they were about to celebrate the arrival of their second child. On their way to the hospital neither could have imagined how much their lives were about to change.

The birth of her daughter via C-section went smoothly, yet she developed a low-grade fever a few hours later followed by a persistent sharp pain in the abdomen. At first, she thought it was related to the C-section, but it quickly it became apparent this was much more. Shortly after giving birth, she was in critical condition and airlifted to Massachusetts General Hospital.

Doctors Mass General diagnosed Monica and the news was grim. She had contracted necrotizing fasciitis, commonly known as "flesh-eating bacteria". Drastic action had to be taken to save her.

Clinging to life, the new mother slipped into septic shock, meaning time was short. Surgeons acted quickly to stabilize her and isolate the infection. Her uterus, ovaries, gall bladder, and most of her colon were removed in those first few hours. Once stabilized, physicians realized the infection had taken another toll - all four of her limbs would have to be amputated. Monica would endure almost 35 separate surgeries.

Medical and surgical recovery had to be followed by months of rehabilitation. Monica had to learn how to function and be a mom again as a quadruple amputee. She chose Spaulding Rehabilitation Hospital to give her the strength and hope to overcome incredible odds.

Her clinical team developed an extensive plan, and Monica pushed them even harder. If therapy was scheduled for one hour she wanted two. It was September and she faced the possibility of five to six months of rehab. So, she made a simple request: "I want to be home with my family by Christmas."

Monica and her clinical team worked tirelessly. With her occupational therapist and "Ruben" the practice baby doll, Monica would use her new prosthetics to learn all types of mom duties - from changing diapers to buckling a car seat to folding clothes.

The Spaulding team helped her take those first steps. She even borrowed a therapist's sneakers. Everyone worked overtime to help Monica reach her goal.

Just four months from the day she almost lost her life, with the cheers from the entire 5th floor, Monica walked out of Spaulding Rehabilitation Hospital, arriving home in time for Christmas Eve dinner with her family. It was the best Christmas present she could ever give to her daughters - and herself; she was home.

Monica's inspirational story has reached thousands nationwide. It was first featured in a February 2008 Boston Globe Magazine series called "Saving Monica." The piece caught the attention of Oprah Winfrey. In September 2008, Monica and Tony were flown to Chicago, their story featured on an "Oprah" episode called, "Warrior Moms." She has appeared on Oprah several times and in 2011 was featured on the Nate Berkus Show, where they built a customized adaptive home for Monica, Tony and their family.

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Monica's Story - Necrotizing Fasciitis - Spaulding Rehab

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Monica Jorge's life in August 2007 could not have been better. She was engaged to a wonderful man, Tony, and they were about to celebrate the arrival of their second child. On their way to the hospital neither could have imagined how much their lives were about to change.

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Up to 1 of 3 people who get necrotizing fasciitis die from the infection. Many people have life long complications from the infection. Sepsis, shock, and organ failure can occur as a result from necrotizing fasciitis, which is why prognosis is unfavorable.