Necrotizing fasciitis
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. It is a severe disease of sudden onset that spreads rapidly. Symptoms usually include red or purple skin in the affected area, severe pain, fever, and vomiting. The most commonly affected areas are the limbs and perineum.
| Necrotizing fasciitis | |
|---|---|
| Other names | Flesh-eating bacteria, flesh-eating bacteria syndrome, necrotizing soft tissue infection (NSTI), fasciitis necroticans |
| Person with necrotizing fasciitis. The left leg shows extensive redness and tissue death. | |
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| Specialty | Infectious disease |
| Symptoms | Severe pain, fever, purple colored skin in the affected area |
| Usual onset | Sudden, spreads rapidly |
| Causes | Multiple types of bacteria, occasional fungus |
| Risk factors | Poor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, peripheral artery disease |
| Diagnostic method | Based on symptoms, medical imaging |
| Differential diagnosis | Cellulitis, pyomyositis, gas gangrene |
| Prevention | Wound care, handwashing |
| Treatment | Surgery to remove the infected tissue, intravenous antibiotics |
| Prognosis | ~30% mortality |
| Frequency | 0.7 per 100,000 per year |
Typically, the infection enters the body through a break in the skin such as a cut or burn. Risk factors include poor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, and peripheral artery disease. It does not typically spread between people. The disease is classified into four types, depending on the infecting organism. Between 55 and 80% of cases involve more than one type of bacteria. Methicillin-resistant Staphylococcus aureus (MRSA) is involved in up to a third of cases. Medical imaging is often helpful to confirm the diagnosis.
Necrotizing fasciitis may be prevented with proper wound care and handwashing. It is usually treated with surgery to remove the infected tissue, and intravenous antibiotics. Often, a combination of antibiotics is used, such as penicillin G, clindamycin, IV vancomycin, and gentamicin. Delays in surgery are associated with a much higher risk of death. Despite high-quality treatment, the risk of death is between 25 and 35%.
Necrotizing fasciitis occurs in about 0.4 people per 100,000 per year in the U.S., and about 1 per 100,000 in Western Europe. Both sexes are affected equally. It becomes more common among older people and is rare in children. It has been described at least since the time of Hippocrates. The term "necrotizing fasciitis" first came into use in 1952.