Necrotizing Fasciitis - Signs and Symptoms

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What are necrotizing fasciitis symptoms and signs?

The majority of infected individuals who develop necrotizing fasciitis begin with an existing infection (cellulitis, abscess, or wound), most frequently on an extremity or in a wound or surgical site. The initial infection can be from almost any cause (for example, cuts on the skin, puncture wounds, surgical incisions, or rarely, insect bites [spiders, biting flies]). Early symptoms may resemble those of cellulitis and include the following:

  • Instead of healing, the infected site (see above) can show erythema (redness) and swelling.
  • The site may be very sensitive to pain, and skin pain can occur even past the area of erythema.
  • The presence of pain is far in excess of what would be expected based upon physical findings.
  • Fever and chills
  • Fatigue

Progressive or later symptoms include the following:

  • Progressive skin changes such as skin ulceration and bullae (thin-walled fluid-filled blisters) formation
  • Skin discoloration
  • Necrotic scars (black scabs)
  • Gas formation in the tissues (that can produce a crackling sensation under the skin)
  • Fluid and/or pus 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 flesh-eating disease begins in deep facial planes.
  • Septic shock (bacteremia, low blood pressure, rapid breathing, mental status altered)

Necrotizing fasciitis 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 bacteria, 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 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 is either immunosuppressed or has 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 a single type of bacteria causes this infection, 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 dysfunction of the intestinal tissue.

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See what others are saying

Comment from: rockie, 45-54 Female (Patient) Published: October 01

I got necrotizing fasciitis (NF) from shaving and maybe contaminated money. I had 7 surgeries and was in the hospital for a month. I have minor nerve damage in my legs from the surgeries but I'm lucky to be alive. You can't see my scars unless I'm in a bathing suit. They had to cut almost 7 pounds of me to remove the bacteria.

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Comment from: jjenkins, 55-64 Male (Patient) Published: May 21

In October 2012 I got necrotizing fasciitis from cutting my neck shaving. It attacked my heart and lungs and I came very close to death. I had to have muscle and tissue removed from shoulder and neck. In September 2013 I was going in to surgery to have my hip replaced and at the last minute the doctor saw a small red bump on my hip and was concerned and stopped surgery. The next day my neck started to swell with a lot of pain. The infection from 2012 had got in to the bone in neck and had to be removed. I still have to have hip surgery.

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