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Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy

Necrotizing fasciitis (neck-ro-tie-zing Fas-e-i-tis) is a serious bacterial skin infection that spreads quickly and kills the body's soft tissue. (Necrotizing means "causing the death of tissues.") Accurate diagnosis, prompt treatment with antibiotics through a vein, and surgery are important to stopping this infection that can become life-threatening in a very short amount of time.

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, Escherichia 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 and are easily treated. But 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. Sometimes toxins made by these bacteria destroy the tissue they infect, causing it to die. When this happens, the infection is very serious and can result in loss of limbs or death.

Good Wound Care Is 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 using 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 Is Rarely Spread from Person to Person

Most cases of necrotizing fasciitis 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.

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. If you think you may have these symptoms after a wound, see a doctor right away.

Photo: Man's hand with intravenous tubePrompt Treatment Needed for Necrotizing Fasciitis

The 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 dying areas. This is why rapid surgical exploration and removal of dead tissue—in addition to antibiotics—is often critical to stopping the infection.

CDC Tracks Necrotizing Fasciitis due to the Most Common Cause

CDC tracks specific infections in the United States, 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 (EIP) network, a collaboration between 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 United States, there are about 650 to 850 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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