Flesh Eating Bacteria

AKA: Necrotizing Fasciitis

The truth about flesh eating bacteria is that it is fairly rare. The misunderstanding surrounding it is that it does not eat the flesh, only rapidly kills it.

Cause

Flesh eating bacteria is also called necrotizing fasciitis. It is a bacterial infection of soft tissues and fascia (muscle sheath), but can also affect deep tissue of the muscle and bone. Group A Strep is the version referred to as flesh eating bacteria. It is the bacteria that causes common strep throat. Some strains of this Strep are far more powerful. Under certain conditions, it can cause necrotizing fasciitis.

One of the fastest spreading forms of necrotizing fasciitis comes as a result of Group A Strep infection. It can kill within days. But Strep is not the only bacteria of concern. The bacterial cause can be of a single type or come in a mixed form. The mixed form is slightly slower moving and is composed of several different types of bacteria.

Methicillin resistant Staph (MRSA) is on the increase and is another form of bacteria which can cause necrotizing fasciitis. These cases are complicated by the limited range of effective antibiotics available for treatment. With a greater presence of community-acquired MRSA, health care professionals must consider it as a source when faced with new cases of necrotizing fasciitis and use appropriate antibiotics to counter the infection.

Symptoms

Following infection, toxins and bacterial enzymes destroy body tissue. The bacteria can effectively hide from the immune system as it causes damage.

The symptoms reported are most frequently flu-like, with fever and nausea, vomiting, diarrhea, fatigue, and weakness prevalent. Necrotizing fasciitis has been shown to mimic other illnesses, so misdiagnosis happens often. The infection can also be confused with normal post-operative pain and inflammation.

Individuals should watch for discomfort in the area where an injury has occurred. Watch for pain out of proportion to the injury or pain which grows quickly. Swelling and redness may arise, even though the wound itself may not appear infected. Boil or blister-like sores may appear on the skin. As it progresses, the infection can cause dehydration, infrequent urination, a severe drop in blood pressure, and a fast heartbeat. In some cases, a rash appears over the entire body.

In advanced cases, there may be pronounced swelling of the limb, dark blisters or rash on the skin, black fluid present under the skin, and blue or white areas where the tissue begins to die around the wound. Patients may become confused and experience severe pain. The infection can spread through the bloodstream and trigger a systemic inflammatory response. Toxic shock can occur, involving major organ shutdown.

Serious ramifications

Shock from the illness can cause dangerous, life threatening effects- renal, respiratory, and heart failure, with every bodily system in danger. The progression can happen alarmingly fast, happening in a matter of hours. The infection can cause death, sometimes within days and in a significant percentage of cases.

Treatment

The illness requires hospitalization, IV antibiotics, treatment for ongoing complications, and medicines to counter symptoms as they appear. Timely medical intervention is needed. As the tissue dies, it must be surgically removed through debridement.

Antibiotics are started as soon as an infection is suspected. Surgical removal of the infected tissue is required to help stop the spread. When caught early, the removal of tissue can be minimized to flesh, fat, and subcutaneous tissue in a more limited area. In advanced cases, patients can lose limbs. Multiple amputations may be necessary to stop the progress of the infection.

Recovery

Wounds are typically left open during treatment to keep ongoing watch on the progress of the infection and tissue damage. The wounds are closed once the infection has been eradicated. With treatment, the infection will not reoccur.

Healing can involve reconstructive surgery and multiple skin grafts to cover the lost tissue. Physical therapy and psychological recovery follow. Therapy may be more extensive in cases where multiple regions of the body were affected or extremities were lost.

Who is most at risk

Groups at increased risk for infection include people who are ill, addicts, the elderly, diabetics, and those who are obese or who are experiencing malnutrition. Those who have open wounds, are undergoing surgery, or giving birth are at greater risk. However, the infection needs no predisposing condition, no suppression of the immune system. It can strike persons of any age, across the health spectrum.

Transmission

Everyday objects are not thought to be points of infection and infected persons are unlikely to be contagious. There must be direct contact with a carrier of the bacteria for transmission to occur. People can infect themselves if they carry the bacteria.

Infection can occur in otherwise healthy individuals following a minor cut, scrape or bruise. People should be aware that any injury, break in the skin, or major procedure (such as surgery) which causes abnormal pain or a number of suspect symptoms should be checked.

People can protect themselves by acting as quickly as possible on their own behalf. If necrotizing fasciitis is suspected or the symptoms are present, demand that it be checked as a possible cause. Patients should be aware that the infection may be uncommon to their doctor and to ER staff. Because of this and due to the confusing symptoms, misdiagnosis is very common.

Prevention

Although "spontaneous" cases have occurred where no wound could be identified, preserving the integrity of unbroken skin is considered the best preventative measure. There are many asymptomatic carriers of Strep A, so cleanliness and basic hygiene practices are recommended- wash hands, cover coughs and sneezes. Avoid contact with people who have sore throats. Use antibiotic ointment and sterile bandages on every wound.

If a person has been exposed to Strep (even through other people), they should do everything possible to prevent contaminating others. A person does not need to have symptoms present in order to infect others.

Additional Resources

http://www.nnff.org/

National Necrotizing Fasciitis website

http://www.cdc.gov/ncidod/dbmd/diseaseinfo/Groupastreptococcal_g.htm

Department of Health and Human Services

Centers for Disease Control and Prevention

Group A Streptococcal (GAS) Disease

http://www.medpagetoday.com/MeetingCoverage/IDSA/4278

By Michael Smith, Senior Staff Writer, MedPage Today

Published October 12, 2006

IDSA: MRSA Linked To Necrotizing Fasciitis