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Flesh Eating Bacteria (Necrotizing fasciitis)

Necrotizing fasciitis is a term used to describe a disease condition or disorder that relates to the death and damage of tissues due to rapidly spreading infection which is generally located in the fascial areas of connective tissues. The disease occurs rarely, but can affect any part of the body. Most cases of the disease have been caused by group A beta-hemolytic streptococci, but recent studies indicate that many different types and species of bacteria can cause the disease, either on their own or in combination with the other types. On occasions, necrotizing fasciitis has been known to be caused by a fungal species.

The symptoms of necrotizing fasciitis were described by many people during the 1800s, but it was only in 1952, that the term was used to describe the condition. There are many names  in the current medical world, such as Fournier’s gangrene, dermal, etc. that loosely indicate necrotizing fasciitis.

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It is however important to understand that no matter what the infecting organisms are, once they reach and grow in the connective tissues, they can spread so rapidly that stopping the infection becomes very difficult even with the use of surgery and antimicrobial medications. Necrotizing fasciitis has a high mortality rate of up to 75 percent and most patients have ongoing medical emergencies that can result in disability or death if they are not effectively and promptly treated.

There are three types of necrotizing fasciitis which are listed below:

  • Type 1 is caused by two kinds of bacteria or may be caused by a single bacteria like Vibrio or by the Candida fungus
  • Type 2 is caused by Streptococcus spp
  • Type 3 is caused by Clostridium spp

Symptoms of necrotizing fasciitis

  • Most cases of necrotizing fasciitis begin with a pre-existing infection on a wound or in the areas adjacent to the wound. The wound may be caused due to any reason such as cuts, insect bites, etc., but instead of healing, the affected area may show swelling and redness
  • The infected area and the surrounding regions may be extremely sensitive to pain and this may be often accompanied by chills and fever. As the infection progresses, there may be progressive and rapid skin changes such as formation of fluid-filled blisters with thin walls, skin ulceration, black scabs, draining of fluid and formation of gas in the tissues.
  • In cases where necrotizing fasciitis starts within deep fascial planes, there is greater risk of the spread of infection to the bloodstream and all over the body, before any changes in the skin are diagnosed.
  • Type 1 tends to occur after surgery or trauma and may result in the formation of miniscule amounts of gas.
  • Type 2 tends to occurs after simple skin injuries such as abrasions, cuts, insect bites, etc. and affects the more shallow fascial planes with almost nil gas formation.
  • Type 3 tends to occur after the wounds or injuries get contaminated with dirt that has Clostridium spp. This results in the formation of gas and black scabs.
  • The symptoms of the different variations of necrotizing fasciitis are not definitive and usually tend to vary from one affected individual to another. Hence every individual case is handled differently by doctors.

Causes of necrotizing fasciitis

  • Necrotizing fasciitis is mostly caused by different types of bacteria. On rare occasions, other microorganisms such as fungi may cause the disease.
  • Most cases of necrotizing fasciitis are caused by Staphylococci and Group A Streptococci, on their own or in combination with other bacteria. In case, gas is found in the affected tissue, then one should also consider Clostridium spp.
  • Necrotizing fasciitis research has revealed that other non-anaerobic bacteria such as Klebsiella, E. coli, Pseudomonas and others are also infect the affected sites along with the anaerobic bacteria
  • It has been found that non-anaerobic organisms cause enough damage to the tissue areas that result in local regions of hypoxia.  Anaerobic organisms can then thrive in such areas and further expand the infection.  This causes polymicrobial infection which a single type of bacteria aids the growth an survival or another type of bacteria.
  • When individuals with liver function abnormalities consume seafood contaminated with Vibrio vulnificus or if their wounds get infected with seawater that contains the virus, then it can also cause necrotizing fasciitis.

Necrotizing fasciitis treatment

  • During preliminary diagnosis, the patient has to be hospitalized and intravenous administration of antibiotics should be immediately started. The choice of antibiotics is based on type of bacteria that is suspected of having caused the infection, but most doctors believe in the use of multiple antibiotics at one go to protect the patient from the affect of multiple types of bacteria.
  • Once the type of bacteria that has resulted in the infection has been isolated in a laboratory, then the doctor can choose the right antibiotics to treat the patient.
  • In case, the patient is suspected or diagnosed with necrotizing fasciitis, then a surgeon needs to be immediately contacted. The type of surgeon for treating the affected individual depends on the body part that is infected. It is essential to carry out early surgical intervention to reduce the chances of morbidity and mortality that arise due to necrotizing fasciitis.
  • Most patients of necrotizing fasciitis require to be admitted into ICU and should be aggressively and promptly treated for sepsis an organ failure. The patient may require treatment methods such as intravenous delivery of fluids, insertion of a breathing tube and medications to support the cardiovascular system.
  • Hyperbaric oxygen therapy, wherein the patient is placed in a chamber and oxygen is given to him/her under pressure may also be used to treat individuals affected by necrotizing fasciitis. This treatment is very helpful as oxygen promotes tissue recovery and also stops or inhibits the growth of anaerobic bacteria. This therapy is not a replacement for surgery or the administration of antibiotics. Studies have revealed that hyperbaric oxygen therapy further reduces morbidity and mortality in some patients by about ten to twenty percent when used in conjunction with surgery and antibiotics.
  • Necrotizing fasciitis pictures

     

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