Necrotizing Fasciitis Causes, Symptoms, Diagnosis, Treatment and Prevention by MedicineNet.com

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Necrotizing Fasciitis

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Medical Author: Charles Davis, MD, PhD
Medical Editor: Melissa Conrad Stöppler, MD

What Is a "Flesh-Eating" Bacterial Infection?

Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Jay W. Marks, MD, William C. Shiel Jr., MD, FACP, FACR

Discover the causes, symptoms and treatment of a flesh-eating bacterial infection (necrotizing fasciitis). Media reports have popularized the term "flesh-eating bacteria" to refer to a very rare but serious bacterial infection known as necrotizing fasciitis. Necrotizing fasciitis is an infection that starts in the tissues just below the skin and spreads along the flat layers of tissue (known as fascia) that separate different layers of soft tissue, such as muscle and fat. This dangerous infection is most common in the arms, legs, and abdominal wall and is fatal in 30%-40% of cases.

Although necrotizing fasciitis may be caused by an infection with one or more than one bacterium, in most cases the term flesh-eating bacteria has been applied to describe infections caused by the bacterium known as Streptococcus pyogenes. The term flesh-eating has been used because the bacterial infection produces toxins that destroy tissues such as muscles, skin, and fat. Streptococcus pyogenes is a member of the group A streptococci, a group of bacteria that are responsible for mild cases of sore throat (pharyngitis) and skin infections, as well as rare, severe illnesses such as toxic shock syndrome and necrotizing fasciitis. Most infections with group A streptococci result in mild illness and may not even produce symptoms.

Learn the symptoms of necrotizing fasciitis »

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What is necrotizing fasciitis?

Necrotizing fasciitis is a term that describes a disease condition of rapidly spreading infection, usually located in fascial planes of connective tissue that results in tissue necrosis (dead and damaged tissue). The disease occurs infrequently, but it can occur in almost any area of the body. Although many cases have been caused by group A beta-hemolytic streptococci (Streptococcus pyogenes), most investigators now agree that many different bacterial genera and species, either alone or together (polymicrobial) can cause this disease. Occasionally, mycotic (fungal) species cause necrotizing fasciitis.

This condition was described by several people in the 1840s to 1870s, and Dr. B. Wilson in 1952 first termed the condition necrotizing fasciitis. It is likely that the disease has been occurring for many centuries before it was first described in the 1800s. Currently, there are many names that have been used loosely to mean the same disease as necrotizing fasciitis: flesh-eating bacterial infection or disease; suppurative fasciitis; dermal, Meleney, hospital, or Fournier's gangrene; and necrotizing cellulitis. Body regions frequently have the term "necrotizing" placed before them to describe the initial localization of necrotizing fasciitis (for example, necrotizing colitis, necrotizing arteriolitis), but they all refer to the same disease process in the tissue. Important in understanding necrotizing fasciitis is the fact that whatever the infecting organism(s), once it reaches and grows in connective tissue, the spread of the infection can be so fast (investigators suggest some organisms can progress about 3 centimeters per hour) that the infection becomes difficult to stop with both antimicrobial drugs and surgery.

Mortality (death) rates have been reported as high as 75% for necrotizing fasciitis associated with Fournier's (testicular) gangrene. Patients with necrotizing fasciitis have an ongoing medical emergency that often leads to death or disability if it is not promptly and effectively treated.