Friday, December 16, 2005
Synonyms and related keywords: Fournier's gangrene, Fournier gangrene, Meleney's ulcer, Meleney ulcer, postoperative progressive bacterial synergistic gangrene, flesh-eating bacteria, Cullen's ulcer, Cullen ulcer, hemolytic streptococcal gangrene, acute dermal gangrene, hospital gangrene, suppurative fascitis, synergistic necrotizing cellulitis, group A hemolytic streptococci, Staphylococcus aureus, Bacteroides fragilis, Escherichia coli, nonclostridial myonecrosis, Vibrio vulnificus, diabetes mellitus, fascial necrosis. (1)
Necrotizing fasciitis is a severe bacterial infection. It is most commonly caused by Group A Strep or a mixture of bacteria including anærobic bacteria. Anærobic bacteria thrive in environments that are poor in oxygen, like wounds. Rarely, bacteria get into the thin membranes called fascia that connect the skin and underlying muscle tissues. In this environment, the bacteria destroy surrounding tissues and can spread rapidly through the body. Such an infection can quickly become deadly.
Necrotizing fasciitis sometimes occurs in people who skin pop or muscle drugs and, more rarely, among intravenous users. The bacteria may come from contaminated dope, from using dirty injection equipment, or from bacteria on your skin. If the bacteria are in the drug itself, you can't depend on "cooking" to kill the bacteria.
This type of infection has been popularized in the press as "flesh-eating" bacteria. While cases are rare in King County, over the past couple years doctors at Harborview Medical Center report treating one to two cases at any given time. Most local cases happen among injection drug users.How to Protect Yourself
You can reduce your risk for bacterial infections and abscesses.
Use a brand new sterile syringe every time you inject or divide drugs.
Do not re-use syringes.
Do not share syringes, cookers, cottons, mixing or rinse water with anybody.
If you must re-use injecting equipment, clean it thoroughly with bleach. Click here to learn more about "How to Bleach Your Works in 3 Easy Steps."
Before you inject, clean the injection site with soap and hot water. Really scrub to remove harmful bacteria that may be hanging out on your skin.
If you can't use soap and hot water, clean the site with alcohol wipes before you inject.
What does Necrotising fasciitis look and feel like?
Typical signs of infection are redness, swelling, warmth and tenderness.
With necrotizing fasciitis, skin around an injection site may show redness and swelling OR it may look normal.
The underlying area will feel very tender.
You may have pain, chills, and fever.
At the beginning, it may look like a regular abscess, but it gets worse very quickly. It can cause serious damage under your skin in as little as 12 hours. Necrotizing fasciitis usually MOVES REALLY FAST.
If you have these signs of infection, or the redness or swelling around a wound gets bigger, go to an EMERGENCY ROOM for treatment. Don't try to treat this infection yourself. Bring a copy of this webpage with you.
If Necrotizing fasciitis is caught early, it can be successfully treated. But it is very important to catch it early and begin treatment immediately.
This infection is nothing to play around with. If you do not get medical care early, you run the risk of losing skin, losing an arm, or even death.
Necrotizing soft tissue infection
Necrotizing soft-tissue infection is a severe type of tissue infection that can involve the skin, subcutaneous fat, the muscle sheath (fascia), and the muscle. It causes gangrenous changes, tissue death, systemic disease, and frequently death.
Causes, incidence, and risk factors
Necrotizing subcutaneous infection or fasciitis can be caused by a variety of bacteria including oxygen-using bacteria (aerobic) or oxygen-avoiding bacteria (anaerobic). A very severe and usually fatal fasciitis is caused by a virulent species of streptococcus that is often referred to as the "flesh-eating bacteria" by the press.This type of infection develops when bacteria enter the body, usually through a minor skin injury or abrasion.
The bacteria begin to grow and release toxins that:
Directly kill tissue
Interfere with the blood flow to the tissue
Digest materials in the tissue which then allows the bacteria to spread rapidly
Cause widespread effects, such as shock
Infection may begin as a small reddish painful spot or bump on the skin. This quickly changes to a painful bronzed or purplish patch that expands rapidly. The center may become black and dead (necrotic). The skin may break open. Visible expansion of the infection may occur in less than an hour.
Symptoms may include fever, sweating, chills, nausea, dizziness, profound weakness, and finally shock. Without treatment death can occur rapidly.
Severe pain in the area
Swelling in the area
Discoloration in the area
May appear reddened, bronzed, bruised, or purple (purpuric)
Progresses to dusky, dark color
Bleeding into the skin
Visibly dead (necrotic) tissue
Patchy skin color
Skin breaks (open wound)
Skin around the wound feels hot and looks reddened, raised, or discolored (inflamed)
Oozing fluid ranging from yellowish clear or yellowish bloody to puslike in quality
General ill feeling
Signs and tests
The appearance of the skin and underlying tissues and presence of gangrenous changes (black or dead tissue) indicates a necrotizing soft tissue infection. Imaging tests, such as CT scans, are sometimes helpful.
Often a patient will need to go to the operating room so a surgeon can diagnose such an infection. A Gram stain and culture of drainage or tissue from the area may reveal the bacteria to blame.
Powerful, broad-spectrum antibiotics must be administered immediately. They are given in a vein to attain high blood levels of the antibiotic in an attempt to control the infection. Surgery is required to open and drain infected areas and remove dead tissue.
Skin grafts may be required after the infection is cleared. If the infection is in a limb and cannot be contained or controlled, amputation of the limb may be considered. Sometimes pooled immunoglobulins (antibodies) are given by vein to help fight the infection.If the organism is determined to be an oxygen-avoiding bacteria (anaerobe) the patient may be placed in a hyperbaric oxygen chamber, a device in which the patient is exposed to 100% oxygen at several atmospheres of pressure.
Outcomes are variable. The type of infecting organism, rate of spread, susceptibility to antibiotics, and how early the condition was diagnosed all contribute to the final outcome.
Scarring and deformity are common with this type of disease. Fatalities are high even with aggressive treatment and powerful antibiotics. Untreated, the infection invariably spreads and causes death.
Calling your health care provider
This disorder is severe and may be life-threatening, so consult your health care provider immediately.Call your health care provider if signs of infection occur around a skin injury: pain, swelling, redness, drainage of pus or blood, fever, or other similar symptoms.
Clean any skin injury thoroughly. Watch for signs of infection such as redness, pain, drainage, swelling around the wound, and consult the health care provider promptly if these occur.
Update Date: 1/16/2004