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Nec. Fasc. is a rare yet incredibly dangerous bacterial infection. Symptons develop very quickly and the disease spreads at an alarming rate, making it an incredibly high acuity disease leading to hospital admission and surgery. It may also be reffered to as 'flesh eating disease' as the bacteria begin to attack the infected patients skin cells and in essence eat through their skin and tissues.

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Necrotising fasciitis is an infection resulting primarily from group A streptococcus bacteria (commonly referred to as group A strep bacteria). While nec. fasc. (as it is known to medics) is thought to be caused by a large variety of bacteria, Strep A group bacteria are widely regarded as the most common cause. Typically, these bacteria enter the body via open wounds from cuts, scrapes, burns, bites .etc. although they have been know to enter following blunt trauma. While the infection is rare, roughly 700-1200 cases have been seen in the US each year since 2010 (according to CDC) and this is probably an underestimate. Nec. Fasc. is rarely contagious.

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Group A Streptococcus

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This review paper discusses the optimal diagnosis modalities and provides conclusion suggesting that MRi, biochemical analysis and high clinical suspicion are pivatol to prompt recognition of Nec. Fasc. Biochemical indicators include 'elevated C-reactive protein, elevated white blood cell count, low hemoglobin, decreased sodium, and increased creatinine'. MRi was found to have the greatest specificity at 86% Vs. other imaging such as CT or plain radiography.

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Abstract

Importance: Necrotizing fasciitis is a relatively uncommon and potentially life-threatening soft tissue infection, with morbidity and mortality approaching 25% to 35%, even with optimal treatment. The challenge of diagnosis for necrotizing soft tissue infections (NSTIs) is their rarity, with the incidence of approximately 1000 cases annually in the United States. Given the rapid progression of disease and its similar presentation to more benign processes, early and definitive diagnosis is imperative.

Findings: Signs and symptoms of NSTIs in the early stages are virtually indistinguishable from those seen with abscesses and cellulitis, making definitive diagnosis difficult. The clinical presentation will depend on the pathogen and its virulence factors which ultimately determine the area and depth of invasion into tissue. There are multiple laboratory value scoring systems that have been developed to support the diagnosis of an NSTI. The scoring system with the highest positive (92%) and negative (96%) predictive value is the laboratory risk indicator for necrotizing fasciitis (LRINEC). The score is determined by 6 serologic markers: C-reactive protein (CRP), total white blood cell (WBC) count, hemoglobin, sodium, creatinine, and glucose. A score ≥ 6 is a relatively specific indicator of necrotizing fasciitis (specificity 83.8%), but a score <6 is not sensitive (59.2%) enough to rule out necrotizing fasciitis. In terms of imaging, computed tomography (CT) imaging, while more sensitive (80%) than plain radiography in detecting abnormalities, is just as nonspecific. Computed tomography imaging of NSTIs demonstrates fascial thickening (with potential fat stranding), edema, subcutaneous gas, and abscess formation. Magnetic resonance imaging (MRI) has demonstrated sensitivity of 100% and specificity of 86%, though MRI may not show early cases of fascial involvement of necrotizing fasciitis.

Conclusions and relevance: Necrotizing soft tissue infections are rapidly progressive and potentially fatal infections that require a high index of clinical suspicion to promptly diagnose and aggressive surgical debridement of affected tissue in order to ensure optimal outcomes.Prompt surgical and infectious disease consultation is necessary for the treatment and management of these patients. While imaging is useful for further characterization, it should not delay surgical consultation. Necrotizing soft tissue infection remains a clinical diagnosis, although plain radiography, CT imaging, and ultrasound can provide useful clues. In general, the management of these patients should include rapid diagnosis, using a combination of clinical suspicion, laboratory data (LRINEC score), and imaging (MRI being the recommended imaging modality), prompt infectious disease and surgical consultation, surgical debridement, and delayed reconstruction. Laboratory findings that can more strongly suggest a diagnosis of NSTI include elevated CRP, elevated WBC, low hemoglobin, decreased sodium, and increased creatinine. Imaging findings include fascial thickening (with potential fat stranding), edema, subcutaneous gas, and abscess formation. Broad-spectrum antibiotics should be started in all cases of suspected NSTI. Surgical debridement, however, remains the lynchpin for treatment of cervical necrotizing fasciitis.

Keywords: ENT; cellulitis; flesh-eating bacteria; head and neck imaging; infectious disease; necrotizing fasciitis.

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national center for biotechnology information

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Cervical Necrotizing Fasciitis, Diagnosis and Treatment of a Rare Life-Threatening Infection - PubMed

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Necrotizing soft tissue infections are rapidly progressive and potentially fatal infections that require a high index of clinical suspicion to promptly diagnose and aggressive surgical debridement of affected tissue in order to ensure optimal outcomes.Prompt surgical and infectious disease consultat ...

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Early symptoms include:

~Fever/high temperature

~Severe pain

~Red, warm, swollen skin

~Rapidly migrating area of affected tissue

Later symptoms include:

~Ulcers and blisters

~Pus or secretions from the affected skin segments

~Fatigue

~Dizziness

~Nausea/vomitting

~Diarrhea

~Skin tissue changing colour

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A nec. Fasc. case needs to be handled urgently as the spread of the disease is rapid and devastating. This is why when patients are admitted with symptons of fever or infection, Nec. Fasc. is one of the first things doctors will rule out. If a case of Nec. Fasc. is identified, then antibiotics and surgery and typically required. Surgery for Nec. Fasc. patients involves recessing the dead or infected tissues and often leaves patients with severe wounds that require lengthy ICU and hospital stays to heal. It is not uncommon for a patient to need multiple surgeries to hold the infection back whilst the antibiotics attack the disease.

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This case review presents the use of vaccum assited closure as a treatment option post surgery for Nec. Fasc. debridement patients. VAC involves using a vaccum around the wound to reduce pressure and aid faster recovery. The review called for further investigation to explore wether VAC can be used to have more positive results for future patients with Nec. Fasc.

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national center for biotechnology information

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Vacuum-Assisted Closure Therapy: A Lifesaver in a Case of Neck Necrotizing Fasciitis - PubMed

# data[].attributes.attachment_link.description
Necrotizing fasciitis (NF) is a severe and rare soft tissue infection with a high potential for mortality, particularly in cases related to odontogenic infections in immunocompromised patients. The conventional treatment for NF includes broad-spectrum antibiotics and aggressive surgical debridement. ...

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Flesh Eating Bacteria (Necrotizing fasciitis)

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Dr Jessica Pelletier is a DO currently practicing at Washington university school of medicine in St. Louis. Pelletier collaborated as a Co-author in an article discussing the challenges of diagnosing Nec. Fasc. She has interests in medical education, in particular, the high-acuity applications of different teaching techniques and strategies. Pelletier attended Virginia Tech Carilion school of medicine and is currently in her second year of her medical education fellowship in St.Louis.

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CDC Information page

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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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'Necritizing Fasciitis:All you need to know', Multiple Co-Authors. CDC, Web. November 17 2022.

Fedder AM, Hvas AM, Wang M, Petersen KK, Ebdrup L, Christensen P, Helmig RB. [Necrotizing fasciitis]. Ugeskr Laeger. 2022 Sep 19;184(38):V11210825. Danish. PMID: 36178178.

Ba-Shammakh SA, Alrayes BM, Abu-Obead HM, Ba-Shammakh MA, Al-Mohd FM, Ramzoun EH, Abu-Nowar L. Vacuum-Assisted Closure Therapy: A Lifesaver in a Case of Neck Necrotizing Fasciitis. Cureus. 2023 Aug 28;15(8):e44291. doi: 10.7759/cureus.44291. PMID: 37779734; PMCID: PMC10535721.

Chen LL, Fasolka B, Treacy C. Necrotizing fasciitis: A comprehensive review. Nursing. 2020 Sep;50(9):34-40. doi: 10.1097/01.NURSE.0000694752.85118.62. PMID: 32826674; PMCID: PMC8828282.

'Current Fellows'. No accredited author. Washington university school of medicine in St.Louis, Web. Accessed 18th November 2023.