Necrotizing Fasciitis (cont.)
What are the symptoms of necrotizing fasciitis?
The majority of cases begin with an existing infection, most frequently on an extremity or in a wound. The initial infection can be from almost any cause
(for example, cuts on the skin, puncture wounds, surgical incisions, or insect bites). Instead of healing, the infected site can show erythema (redness) and swelling. The site may be very sensitive to pain, even past the area of erythema. At the same time, patients often experience fever and chills. Early symptoms resemble those of cellulitis, but progressive skin changes such as skin ulceration, bullae (thin-walled fluid-filled blisters) formation, necrotic eschars (black scabs), gas formation in the tissues, and fluid draining from the site can occur rapidly as the infection progresses. Some patients can become septic (meaning the infection has spread to the bloodstream and throughout the body) before the skin changes are recognized, especially when necrotizing fasciitis begins in deep facial planes. Type 1 often occurs after trauma or surgery and may form little or undetectable amounts of gas.
Type 2 usually occurs after more simple skin trauma (cuts, abrasions, and insect bites) and infects more superficial facial planes with almost no gas formation. Type 3 usually occurs after trauma or after wounds become contaminated with dirt that contains
Clostridium spp, which produce gas in tissues (gangrene) and necrotic eschars. However, symptoms for
types 1-3 are not definitive, and symptoms vary widely which is why some investigators prefer to define the individual patients' disease by the organism(s) isolated from the patient rather than assigning a
type label.
One set of patients that is being recognized with a more specific set of symptoms and health history are those infected with
Vibrio vulnificus. The organisms occur in the warmer waters in the U.S. (Gulf of Mexico and southern coastal states) and elsewhere in the world with similar water conditions. Either ingesting the organisms or getting
Vibrio vulnificus from contaminated seawater into skin abrasions or cuts can cause necrotizing fasciitis. The majority of those affected are either immunosuppressed or have chronic liver problems (for example, alcoholic liver disease, hepatitis, or cirrhosis). Bullae formation and rapid progression of the disease (within hours) on the extremities are hallmarks of
Vibrio vulnificus wound infections. Even though this infection is caused by a single type of bacteria, some investigators classify it as a variant of
type 1 necrotizing fasciitis.
Necrotizing enterocolitis (also termed NEC; necrosis of gastrointestinal tissue) occurs mainly in premature or sick infants and may be another variant of necrotizing fasciitis. Although investigators suggest that bacterial infection causes this disease, there is no definitive data to prove this and others attribute the disease to a permeable gut tissue. A few individuals think the necrotizing enterocolitis is due to a "leaky gut syndrome," but this concept is not widely accepted by the medical community.
Next: How is necrotizing fasciitis diagnosed? »
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