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.
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?
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.
MRSA (methicillin resistant Staphylococcus aureus) bacteria causes skin infections with the following signs and symptoms: cellulitis, abscesses, carbuncles, impetigo, styes, and boils. Normal skin tissue doesn't usually allow MRSA infection to develop. Individuals with depressed immune systems and people with cuts, abrasions, or chronic skin disease are more susceptible to MRSA infection.
Cellulitis is an acute spreading bacterial infection below the surface of the skin characterized by redness, warmth, inflammation, and pain. The most common cause of cellulitis is the bacteria Staph (Staphylococcus aureus).
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Sepsis (blood poisoning) is a potentially deadly infection with signs and symptoms that include elevated heart rate, low or high temperature, rapid breathing and/or a white blood cell count that is too high or too low and has more than 10% band cells. Most cases of sepsis are caused by bacterial infections, and some cases are caused by fungal infections. Treatment requires hospitalization, IV antibiotics, and therapy to treat any organ dysfunction.
Cuts, scrapes, and puncture wounds are common, and most people will experience one of these in their lifetime. Evaluating the injury, and thoroughly cleaning the injury is important. Some injuries should be evaluated by a doctor, and a tetanus shot may be necessary. Treatment will depend upon the severity of the injury.
Gangrene may result when blood flow to a tissue is lost or not adequate to keep the tissue alive. There are two types of gangrene: wet and dry. All cases of wet gangrene are infected by bacteria. Most cases of dry gangrene are not infected. If wet gangrene goes untreated, the patient may die of sepsis and die within hours or days. Dry gangrene usually doesn't cause the patient to die. Symptoms of dry gangrene include numbness, discoloration, and mummification of the affected tissue. Wet gangrene symptoms include swelling, pain, pus, bad smell, and black appearance of the affected tissue. Treatment depends upon the type of gangrene and how much tissue is compromised by the gangrene.
Group A streptococcal infections are caused by group A streptococcus, a bacteria that causes a variety of health problems, including strep throat, impetigo, cellulitis, erysipelas, and scarlet fever. There are more than 10 million group A strep infections each year.
Cellulite is caused by fat deposits that distort connective tissues under the skin, resulting in a dimpled appearance of the skin. Gender, skin thickness, heredity, and the amount and distribution of body fat all influence the presence and visibility of cellulite.
Bug bites and stings have been known to transmit insect-borne illnesses such as West Nile virus, Rocky Mountain spotted fever, and Lyme disease. Though most reactions to insect bites and stings are mild, some reactions may be life-threatening. Preventing bug bites and stings with insect repellant, wearing the proper protective attire, and not wearing heavily scented perfumes when in grassy, wooded, and brushy areas is key.
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