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| Necrotizing fasciitis | |
|---|---|
| Other names | Flesh-eating bacteria, flesh-eating bacteria syndrome,[1] necrotizing soft tissue infection (NSTI),[2] fasciitis necroticans |
 | |
| Person with necrotizing fasciitis. The left leg shows extensive redness and tissue death. | |
| Pronunciation | |
| Specialty | Infectious disease |
| Symptoms | Severe pain, fever, purple colored skin in the affected area[3] |
| Usual onset | Sudden, spreads rapidly[3] |
| Causes | Multiple types of bacteria,[4] occasional fungus[5] |
| Risk factors | Poor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, peripheral artery disease[2][3] |
| Diagnostic method | Based on symptoms, medical imaging[4] |
| Differential diagnosis | Cellulitis, pyomyositis, gas gangrene[6] |
| Prevention | Wound care, handwashing[3] |
| Treatment | Surgery to remove the infected tissue, intravenous antibiotics[2][3] |
| Prognosis | ~30% mortality[2] |
| Frequency | 0.7 per 100,000 per year[4] |
Necrotizing fasciitis (NF), also known as flesh-eating disease, is a bacterial infection that results in the death of parts of the body's soft tissue.[3] It is a severe disease of sudden onset that spreads rapidly.[3] Symptoms usually include red or purple skin in the affected area, severe pain, fever, and vomiting.[3] The most commonly affected areas are the limbs and perineum.[2]
Typically, the infection enters the body through a break in the skin such as a cut or burn.[3] Risk factors include poor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, and peripheral artery disease.[2][3] It does not typically spread between people.[3] The disease is classified into four types, depending on the infecting organism.[4] Between 55 and 80% of cases involve more than one type of bacteria.[4] Methicillin-resistant Staphylococcus aureus (MRSA) is involved in up to a third of cases.[4] Medical imaging is often helpful to confirm the diagnosis.[4]
Necrotizing fasciitis may be prevented with proper wound care and handwashing.[3] It is usually treated with surgery to remove the infected tissue, and intravenous antibiotics.[2][3] Often, a combination of antibiotics is used, such as penicillin G, clindamycin, IV vancomycin, and gentamicin.[2] Delays in surgery are associated with a much higher risk of death.[4] Despite high-quality treatment, the risk of death is between 25 and 35%.[2]
Necrotizing fasciitis occurs in about 4 people per million per year in the U.S., and about 1 per 100,000 in Western Europe.[4] Both sexes are affected equally.[2] It becomes more common among older people and is rare in children.[4] It has been described at least since the time of Hippocrates.[2] The term "necrotizing fasciitis" first came into use in 1952.[4][7]
- ^ Rakel, David; Rakel, Robert E. (2015). Textbook of Family Medicine. Elsevier Health Sciences. p. 193. ISBN 9780323313087. Archived from the original on 2017-09-08.
- ^ a b c d e f g h i j k Hakkarainen, Timo W.; Kopari, Nicole M.; Pham, Tam N.; Evans, Heather L. (2014). "Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes". Current Problems in Surgery. 51 (8): 344–362. doi:10.1067/j.cpsurg.2014.06.001. PMC 4199388. PMID 25069713.
- ^ a b c d e f g h i j k l m "Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy". CDC. June 15, 2016. Archived from the original on 9 August 2016. Retrieved 13 August 2016.
- ^ a b c d e f g h i j k Paz Maya, S; Dualde Beltrán, D; Lemercier, P; Leiva-Salinas, C (May 2014). "Necrotizing fasciitis: an urgent diagnosis". Skeletal Radiology. 43 (5): 577–589. doi:10.1007/s00256-013-1813-2. PMID 24469151. S2CID 9705500.
- ^ Ralston, Stuart H.; Penman, Ian D.; Strachan, Mark W. J.; Hobson, Richard (2018). Davidson's Principles and Practice of Medicine E-Book. Elsevier Health Sciences. p. 227. ISBN 9780702070266.
- ^ Ferri, Fred F. (2013). Ferri's Clinical Advisor 2014 E-Book: 5 Books in 1. Elsevier Health Sciences. p. 767. ISBN 978-0323084314.
- ^ Wilson, B (1952). "Necrotizing fasciitis". The American Surgeon. 18 (4): 416–431. PMID 14915014.