Necrotizing fasciitis
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| ICD-10 | M72.6 | |
|---|---|---|
| ICD-9 | 728.86 | |
| MedlinePlus | 001443 | |
| eMedicine | emerg/332 derm/743 | |
| MeSH | C01.252.410.890.350 | |
Necrotizing fasciitis or fasciitis necroticans, commonly known as "flesh-eating bacteria", is a rare infection of the deeper layers of skin and subcutaneous tissues (fascia). Many types of bacteria can cause necrotizing fasciitis (eg. Group A streptococcus, Vibrio vulnificus, Clostridium perfringens, Bacteroides fragilis), of which Group A streptococcus is the most common cause.
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[edit] Symptoms
The infection often starts with pharyngitis (sore throat), but occasionally begins locally, at a site of trauma, which may be severe (such as the result of surgery), minor, or even non-apparent. The affected skin is classically, at first, very painful without any visible change. With progression of the disease, tissues become red, hot and swollen, often within hours. Skin color may progress to violet and blisters may form, with subsequent necrosis (death) of subcutaneous tissues. Patients with necrotizing fasciitis typically have a fever and appear very ill. More severe cases progress within hours, and the death rate is high, about 25%.
[edit] Pathophysiology
"Flesh-eating bacteria" is a misnomer, as the bacteria do not actually eat the tissue. They cause the destruction of skin and muscle by releasing toxins (virulence factors). Streptococcal pyogenic exotoxins and other virulence factors. S. pyogenes produces an exotoxin known as a superantigen, this toxin is capable of activating T-cells non-specifically. This causes the over-production of cytokines that over-stimulate macrophages. The macrophages cause the actual tissue damage by releasing oxygen radicals.
[edit] Treatment
The diagnosis is confirmed by either blood cultures or aspiration of pus from tissue. Early medical treatment is crucial. Initial treatment often includes intravenous antibiotics such aspenicillin, vancomycin and clindamycin. If necrotizing fasciitis is suspected, surgical exploration is always necessary, often resulting in aggressive debridement (removal of infected tissue). Amputation of the affected organ(s) may be necessary. Surgical procedures include extensive debridement as soon as possible, secondary closure. The mortality of this disease has not been altered by antimicrobials. Only early recognition and surgical treatment will improve the prognosis.
[edit] Prognosis
This disease is one of the fastest-spreading infections known as it spreads easily across the fascial plane within the subcutaneous tissue. For this reason, it is popularly called the "flesh-eating disease" and although rare, it became well-known to the public in the 1990s. Even with top-notch care today, the prognosis can be bleak, with a mortality rate of around 25 percent and severe disfigurement common in survivors. Mortality is nearly 100 percent if not properly treated.
[edit] Other bacterial strains
In February 2004, a rarer but even more serious form of the disease has been observed in increasing frequency, with several cases found specifically in California. In these cases, the bacterium causing it was a strain of Staphylococcus aureus (i.e. Staphylococcus, not Streptococcus as stated above) which is resistant against methicillin, the antibiotic usually used for treatment. (See Methicillin-resistant Staphylococcus aureus for details.)
[edit] Well-known victims
- Lucien Bouchard, former Quebec premier, who became infected in 1994 while leader of the federal official opposition Bloc Québécois party. He lost a leg to the illness.
- Eric Allin Cornell, winner of the 2001 Nobel Prize in Physics, who lost his left arm and shoulder to the disease in 2004.
- Melvin Franklin, bass singer for The Temptations. Though Franklin's condition was diagnosed early enough to prevent complete amputation of his arm, he died from other health complications soon afterward in 1995.
- Barbara Miller-Roy, the mother of former NHL goalie Patrick Roy,was believed to have gotten the infection from cuts she received while on a fishing trip. She had her arm amputated due to the disease in January 2006.
- Devin Adair, a 21-year-old student athlete on the University of Tulsa Golden Hurricane football team, died of the disease on April 28, 2006 after a week in the hospital.<ref>Tulsa tight end died from 'flesh-eating' bacteria The Associated Press, ESPN.com, 2 June 2006. Retrieved 8 October 2006. </ref>
- Lana Coc-Kroft, a New Zealand television celebrity, was infected after she stepped on a coral reef in Fiji in 2005.
- Matt Annis, grandson of legendary professional wrestler Stu Hart, died because of the disease in 1996 at the age of 13.
- Jim Henson, the man famous for creating the Muppets, was killed by severe Streptococcus "A" bacteria in 1990 at the age of 53
- Jan Peter Balkenende, Prime Minister of the Netherlands since 1998, was infected in 2004. He was in the hospital for several weeks, but fully recovered.
[edit] See also
[edit] References
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[edit] External links
- Hoax: Bananas imported from Costa Rica cause necrotizing fasciitis (refutation or information available from: CDC and FDA, CDC, Snopes.com, CIAC HoaxBusters)
- National Necrotizing Fasciitis Foundation official website
- Flesh-Eating Bacteriade:Nekrotisierende Fasziitis
