Necrotizing Fasciitis - Signs and Symptoms

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What are necrotizing fasciitis symptoms and signs?

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 and may tingle. 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 scars (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 flesh-eating disease 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 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 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 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: 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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