Necrotizing fasciitis refers to a relatively rare infection that spreads rapidly and is located in the fascial planes of the connective tissues that link the skin to the underlying muscle. In most cases the disease starts where there has been a wound to the skin that is exposed to infectious bacteria. The disease can occur in any part of the body and can spread extremely rapidly, as fast as 3 cm per hour; if it spreads into the blood stream it will cause sepsis, or a system-wide infection. Necrotizing fasciitis is considered a medical emergency and can cause death and disability if it is not treated rapidly.
Most cases of necrotizing fasciitis are caused by either Group A Streptococci or Staphylococci, either alone or with other bacteria. Sometimes necrotizing fasciitis is divided into sub-categories based on the number of bacteria causing the infection, but often the type of necrotizing fasciitis is identified simply by the names of the bacteria involved.
Symptoms of Necrotizing Fasciitis
Most cases of necrotizing fasciitis start with a relatively minor wound to the skin, such as a cut, puncture wound or insect bite, or where a surgical incision has been made. The first signs include swelling and redness at the site of the wound. Other symptoms include:
- sensitivity to pain, even beyond the area of redness and/or swelling
- fever and chills
- skin ulcers or blisters
- black scabs on the skin
- gas formation in the tissues of the body
- fluid draining from the site of the wound
Diagnosing Necrotizing Fasciitis
The first diagnosis of necrotizing fasciitis is often made based on the patient’s symptoms and his or her medical and exposure history. Other medical tests may be conducted to determine which strain of the disease the patient has and the extent of the infection, but in most cases treatment will begin prior to a definitive diagnosis because the disease can spread so rapidly.
Other tests that may be conducted to diagnose necrotizing fasciitis include:
- laboratory analysis of fluids or biopsied tissue
- X-rays, CT or MRI to help show gas in tissues and define the extent of the infection
- blood tests such as a white blood cell count (WBC) or blood urea pathogen (BUN)
Treatment for Necrotizing Fasciitis
Shriners Hospitals for Children® provides treatment for necrotizing fasciitis, and will involve surgeons, anesthesiologists and other specialists as needed to prevent further spread of the infection and save as much tissue as possible.
The first line of defense against necrotizing fasciitis is intravenous antibiotics based upon the bacteria suspected of causing the infection. This may include the use of multiple antibiotics at the same time to protect the patient from other bacteria such as methicillin-resistant Staphylococcus aureus (MRSA).
Other treatments include:
- debridement of the necrotic, or dying, tissue
- in cases where the patient has developed sepsis a breathing tube may be inserted, and IV fluids and drugs may be given to support the cardiovascular system
- hyperbaric oxygen therapy to inhibit or stop anaerobic bacterial growth and promote tissue recovery