Necrotizing Fasciitis (cont.)
Charles Patrick Davis, MD, PhD
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
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.
In this Article
- Necrotizing fasciitis (flesh-eating disease) facts
- What is necrotizing fasciitis?
- Do different types of necrotizing fasciitis exist?
- What causes necrotizing fasciitis?
- What are necrotizing fasciitis symptoms and signs?
- How is necrotizing fasciitis diagnosed?
- What is the treatment for necrotizing fasciitis?
- How is necrotizing fasciitis prevented? Is necrotizing fasciitis contagious?
- Who is at risk to get necrotizing fasciitis?
- What is the prognosis (outcome) for patients with necrotizing fasciitis? What are complications of necrotizing fasciitis?
- What are some additional sources of information on necrotizing fasciitis?
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 who 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. For example, the recent necrotizing fasciitis infection of an otherwise healthy 24-year-old female occurred after a deep laceration was contaminated with Aeromonas bacteria. Although pregnant women 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 three to one), 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? What are complications of 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 are 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 multidrug-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.
The worst complication of this disease is rapid advancement that results in death. Other serious complications include tissue loss and organ damage to areas that have to be removed by surgery to limit the disease. Other complications include amputation, sepsis, kidney failure, and extensive scarring.
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