Necrotizing
Fasciitis (Flesh Eating Disease)Introduction Flesh
eating disease conjures up an immediate image from newspaper articles and
TV shows. In medical terms this is the same as necrotizing
fasciitis or necrotizing cellulitis. It is caused by the same bug,
Streptococcus pyogenes, which belongs into the group A Streptococcus type of bacteria
and is also the cause of cellulitis. The difference is that with cellulitis the
infection is on the surface of the skin. With flesh eating disease it is
in a deeper skin layer where the anatomy is softer. Once the bacteria
have broken through the protective skin layer they can spread very rapidly due
to protein digesting enzymes eating their way through the fascia, which is located
just below the subcutaneous tissue of the skin, and into the muscles and tendons.
Once the fascia is liquefied with these enzymes, the bacteria have ideal growing
conditions and multiply rapidly. It is extremely important to recognize that hours
count in terms of early detection and swift initiation of surgical and intravenous
antibiotic therapy. Signs and Symptoms There is
usually acute localized pain in the area where the infection is localized. The
overlying skin is swollen, red colored and hot. With further deterioration there
can be blistering and the color gets more of an angry looking, violet tinged appearance
to it. With touching there is sometimes a grating or crackling sensation that
can be felt (medically termed "crepitation"). There is a fever,
fast heart beat and the patient may have a change in the level of consciousness
from initial drousiness to confusion and finally coma. Blood pressure drops due
to loss of blood volume into the infected area. Here is a link to a site with
a picture
of flesh eating disease (use the back arrow in your left upper screen
to return to this page). Diagnosis and Prognosis Even
with the best intervention there is a mortality rate of 30%! It is important to
get tests done rapidly and then to start therapy right away. X-rays often show
gas formation from bacteria in the soft tissues. If it appears that there is pus
under pressure, it is important to have a surgeon open this area for adequate
drainage. Prior to that the physician might take a needle aspirate for Gram staining,
or a swab taken during surgery can be sent off for that. Routine blood tests are
taken for kidney and liver function tests as well as a coagulation screen to rule
out other diseases and to gage the severity of this condition. Treatment Intravenous fluid replacement
is given as large quantities of fluid have been lost into the infected region.
The surgeon will do a generous exploration and wide opening of pus pockets to
allow all of the infection to drain. In some centers where hyperbaric chamber
treatments are available less debridements are necessary and better survival has
been achieved. At times an arm or a leg has to be partially or totally amputated
just to save the person's life. This is an area of medicine, which is cruel and
gruesome! Nevertheless, great progress has been made in the last decade in treating
this life threatening condition. Apart from surgery, intravenous antibiotic treatment
is given, which usually consists of gentamycin, clindamycin (often in combination)
or cefoxitine alone. Later the antibiotic is switched based on sensitivity results
from the lab testing (Ref. 3, p.797 and Ref. 2, p.472). |
