Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Necrotizing fasciitis refers to a rapidly spreading infection, usually located in fascial planes of connective tissue that results in tissue death (necrosis).
Different types of bacterial infection can cause necrotizing fasciitis.
The majority of cases begin with an existing infection, most frequently on an extremity or in a
Necrotizing fasciitis is a serious condition that is often associated with
sepsis and widespread organ failure.
Treatment of an infection caused by flesh-eating bacteria involves antibiotics and surgical debridement of the wound areas as well as supportive measures such as insertion of a breathing tube, intravenous administration of fluids, and drugs to support the cardiovascular system.
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). Fascial planes are bands of connective tissue that surround muscles, nerves, and blood vessels. Fascial planes can bind structures together as well as allow body structures to slide over each other effectively. 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.
Historically, several people first described this condition in the 1840s to 1870s, and Dr. B. Wilson first termed the condition necrotizing fasciitis in 1952. It is likely that the disease had 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 flesh-eating 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
to involve about 3 centimeters of tissue per hour) that the infection becomes difficult to stop
even 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.
Picture of necrotizing fasciitis (flesh-eating disease)
Medical Author: Melissa Conrad Stöppler, MD
Medical Editor: Jay W. Marks, MD, William C. Shiel Jr., MD, FACP, FACR
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 syndromeand necrotizing fasciitis. Most infections with group A streptococci result in
mild illness and may not even produce symptoms.