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Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy

Necrotizing fasciitis is a serious bacterial infection that spreads rapidly and destroys the body's soft tissue. Commonly called a "flesh-eating infection" by the media, this rare disease can be caused by more than one type of bacteria. These include group A Streptococcus (group A strep), Klebsiella, Clostridium, E. coli, Staphylococcus aureus, and Aeromonas hydrophila, among others. Group A strep is considered the most common cause of necrotizing fasciitis.

Usually, infections from group A strep bacteria are generally mild or moderate and are easily treated. But sometimes toxins made by these bacteria destroy the tissue they infect, causing it to die. ("Necrotizing" means "causing the death of tissues.") Accurate diagnosis and prompt treatment with antibiotics through a vein and surgery are important.

Common sense and good wound care are the best ways to prevent a bacterial skin infection.

  • Keep draining or open wounds covered with clean, dry bandages until healed.
  • Don't delay first aid of even minor, non-infected wounds like blisters, scrapes or any break in the skin.
  • If you have an open wound or active infection, avoid common-use sites like whirlpools, hot tubs and swimming pools until infections are healed.
  • Wash hands often with soap and water or use an alcohol-based hand rub if washing is not possible.

Necrotizing Fasciitis Causes

Most cases occur randomly and are not linked to similar infections in others. The most common way of getting necrotizing fasciitis is when the bacteria enter the body through a break in the skin, like a cut, scrape, burn, insect bite, or puncture wound. Most people who get necrotizing fasciitis have other health problems that may lower their body's ability to fight infection. Some of these conditions include diabetes, kidney disease, cancer, or other chronic health conditions that weaken the body's immune system.

If you're healthy, have a strong immune system, and practice good hygiene and proper wound care, your chances of getting necrotizing fasciitis are extremely low.

In cases of necrotizing fasciitis, bacteria spread rapidly once they enter the body. They infect flat layers of a membrane known as the fascia, connective bands of tissue that surround muscles, nerves, fat, and blood vessels. The infection also damages the tissues next to the fascia.

Necrotizing Fasciitis Symptoms Can Often Be Confusing

The symptoms often start within hours after an injury and may seem like another illness or injury. Some people infected with necrotizing fasciitis may complain of pain or soreness, similar to that of a "pulled muscle." The skin may be warm with red or purplish areas of swelling that spread rapidly. There may be ulcers, blisters or black spots on the skin. Patients often describe their pain as severe and way out of proportion to how the painful area looks when examined by a doctor. Fever, chills, fatigue (tiredness) or vomiting may follow the initial wound or soreness. These confusing symptoms may delay a person from seeking medical attention quickly. If you think you may have these symptoms after a wound, see a doctor right away.

Prompt Treatment Needed for Necrotizing Fasciitis

Photo: Man's hand with intravenous tubeThe first line of defense against this disease is strong antibiotics given through a needle into a vein. But because the bacterial toxins can destroy soft tissue and reduce blood flow, antibiotics may not reach all of the infected and decaying areas. This is why the rapid surgical removal of dead tissue – in addition to antibiotics – may be critical to stopping the infection.

CDC Tracks Necrotizing Fasciitis due to the Most Common Cause

CDC tracks specific infections in the US, including necrotizing fasciitis caused by group A strep, with a special system called Active Bacterial Core surveillance (ABCs).

ABCs is an important part of CDC's Emerging Infections Programs network (EIP), a collaboration among CDC, state health departments, and universities. By sharing this kind of information in a timely way, public health professionals can stay connected and look for trends in rising cases. Each year in the US, there are about 650-800 cases of necrotizing fasciitis caused by group A strep; this is likely an underestimation as some cases are probably not reported. According to ABCs data, the number of annual infections does not appear to be rising.

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  • Page last reviewed: June 28, 2013
  • Page last updated: June 28, 2013
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