Necrotizing Fasciitis (cont.)
Who is at risk to get necrotizing fasciitis?
Theoretically, anyone with an infection has a small risk of getting necrotizing fasciitis; the risk begins to increase if the infection occurs in immunosuppressed individuals (for
example, diabetics, elderly, infants, those with liver disease, or those taking immunosuppressive drugs such as chemotherapy for cancer). Visible infections (skin, hair follicles, fingernails, visible trauma sites) are more likely to be noticed and treated than some deep infections. Patients that have any deep infections (muscle, bone, joint, gastrointestinal) are at somewhat higher risk for the disease because the initial infection and subsequent spread is usually not as noticeable as more visible infections. Although pregnant patients rarely develop the disease, the risk increases in the postpartum period, especially if the mother has diabetes and has procedures such as cesarean delivery (C-section) or episiotomy. Necrotizing enterocolitis occurs mainly in premature or sick infants and may be another variant of necrotizing fasciitis, but there is still controversy about the cause of this disease.
Necrotizing fasciitis has interesting demographics; more males than females are affected (about 3 to 1), and
Vibrio vulnificus infections seem limited to coastal areas with warm water where the organisms are found associated with seafood and contaminated water.
What is the prognosis (outcome) for patients with necrotizing fasciitis?
Untreated necrotizing fasciitis has a poor prognosis; death or severe morbidity
(for example, limb loss) is the frequent outcome. Data on the number of cases per year are estimated between 500-1,000 per year in the U.S.
Data in most other countries is incomplete, and some investigators think the actual U.S. case numbers may be much higher. Even with appropriate treatment, the mortality (death) rate can be as high as 25%. Infection with MRSA and other multi-drug resistant organisms tends to have higher morbidity and mortality rates. Combined mortality and morbidity (for example, limb loss, scar formation, renal failure, and sepsis) for all cases of necrotizing fasciitis has been reported as 70%-80%. Cases of Fournier's gangrene have reported as high as 75% mortality rates, while cases of
Vibrio vulnificus-associated necrotizing fasciitis have about a 50% mortality rate. Fortunately,
Vibrio vulnificus infection is relatively uncommon, but the incidence seems to be increasing. The U.S. Centers for Disease Control and Prevention (CDC), in 2007, made
Vibrio vulnificus infection a reportable disease so the statistics on the incidence (frequency of occurrence) should be more easily obtained in the future.
What are some additional sources of information on necrotizing fasciitis?
http://emedicine.medscape.com/article/1054438-overview
http://www.cdc.gov/nczved/dfbmd/disease_listing/vibriov_gi.html
http://www.medicinenet.com/gangrene/page5.htm
http://www.emedicinehealth.com/mrsa_infection/article_em.htm
http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-acidophilus.html
http://www.nlm.nih.gov/MEDLINEPLUS/ency/article/001148.htm
http://www.cdc.gov/ncidod/dbmd/diseaseinfo/Groupastreptococcal_g.htm
- 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 wound.
- Necrotizing fasciitis is a serious condition that is often associated with sepsis and widespread organ failure.
- Treatment 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.
Last Editorial Review: 5/13/2009
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