Necrotizing Fasciitis: Causes, Symptoms and Treatment

A small cut, a scrape, or even a bruise—what starts as a minor injury can turn deadly quickly. Necrotizing fasciitis is a fast-moving bacterial infection that destroys soft tissue, leading to severe complications or even death if not treated immediately.

Often called the flesh-eating disease, necrotizing fasciitis is rare but extremely dangerous. It spreads quickly, causing pain, swelling, and tissue death. Without rapid medical intervention, the infection can lead to organ failure and life-threatening complications.

This article covers the key facts about necrotizing fasciitis, including its warning signs, causes, medical treatments, and ways to lower your risk.

[signup]

What is Necrotizing Fasciitis?

Necrotizing fasciitis is a severe soft tissue infection that rapidly destroys fascia, subcutaneous tissue, and muscle. 

It spreads along connective tissue planes with poor blood supply, allowing the infection to advance quickly while the overlying skin may initially appear unaffected. This can delay diagnosis and surgical intervention, increasing the risk of complications. 

If left untreated, necrotizing fasciitis can lead to secondary infections in surrounding tissues, sepsis, organ failure, and death.

How the Infection Develops

Necrotizing fasciitis progresses rapidly, often within days. Initially, the skin may show minimal changes, but the infection spreads deep within the fascial planes. 

The skin becomes red, swollen, and tender within a few days before turning bluish-gray or purple. As the bacteria release toxins, they cause widespread tissue destruction, leading to fluid-filled blisters (bullae) and gangrene (tissue death).

The infection can spread through the bloodstream, leading to fever, tachycardia, and septic shock.

Causes and Risk Factors

Necrotizing fasciitis occurs when bacteria invade the body through wounds, cuts, surgical sites, or other skin injuries. The severity and progression of the infection depend on multiple factors, including bacterial strain and immune response. 

In 80% of cases, Staphylococcus aureus or Streptococcus bacteria are involved, though polymicrobial infections involving gram-negative and anaerobic bacteria can also occur. 

The most at-risk individuals include those with diabetes, alcoholism, or liver cirrhosis, as these conditions impair the immune system and increase susceptibility to severe infections.

Signs and Symptoms

Necrotizing fasciitis progresses quickly, with early symptoms that may initially be mistaken for a viral illness. As the infection spreads, severe complications develop.

Early Symptoms

• Fever, chills, and body aches
• Nausea and diarrhea
• Severe pain at the site of injury, often worse than expected

Progressive Symptoms

• Red or discolored skin
• Swelling and warmth around the affected area
• Fluid-filled blisters (may contain blood or yellowish fluid)
• Tissue death (necrosis)
• Low blood pressure and poor circulation
• Sepsis (a life-threatening infection response)

Diagnosis and Testing

Early and accurate diagnosis significantly improves treatment outcomes.

Doctors may use:

• Physical examination: Identifies areas of tenderness, swelling, and skin discoloration.
• Blood tests: Checks for infection and inflammation markers
• Tissue cultures and biopsy: Confirms bacterial infection and tissue death
• CT scan: Provides a detailed view of the affected tissues
• Surgical exploration: Helps assess the extent of damage and remove dead tissue

Potential Complications

Without immediate treatment, necrotizing fasciitis can lead to serious, often life-threatening complications:

• Permanent scarring and disfigurement
• Limb amputation due to extensive tissue destruction
• Toxic shock syndrome (a severe bacterial toxin reaction)
• Multi-organ failure as the infection spreads
• Sepsis, which can be fatal in severe cases

Up to one-third of people with necrotizing fasciitis do not survive, even with aggressive treatment. Rapid medical intervention with antibiotics, surgery, and intensive care is essential.

Medical Treatment

Necrotizing fasciitis requires immediate medical attention to prevent serious complications. 

The primary treatment involves intravenous (IV) antibiotics to fight the bacterial infection. However, if the infection has caused extensive tissue damage, antibiotics alone may not be sufficient. 

In such cases, surgical removal of dead and infected tissue (debridement) is necessary. In some cases, this procedure must be repeated multiple times to ensure all affected tissue is removed.

In severe cases with significant blood loss or shock, a blood transfusion may be needed to stabilize the patient. If the damage is extensive and cannot be controlled, amputation may be necessary to prevent further spread. 

Prompt and aggressive treatment is critical to improve survival rates and minimize long-term health complications.

Preventive Measures

Currently, there is no vaccine available to prevent necrotizing fasciitis.

Proper wound care is the best way to minimize the risk of infection. Keeping wounds clean and covered with a sterile dressing helps prevent bacteria from entering the body. 

Avoiding natural bodies of water, such as lakes and rivers, when you have an open wound can also reduce exposure to harmful bacteria.

Maintaining hygiene practices, including washing hands regularly and treating fungal infections promptly, can lower the risk of bacterial skin infections. 

Taking these precautions is essential to preventing necrotizing fasciitis and other serious infections.

[signup]

Key Takeaways

• Necrotizing fasciitis is a rapidly progressing bacterial infection that destroys soft tissue and can be fatal without immediate medical treatment.
• Early symptoms, such as severe pain, swelling, and skin discoloration, can escalate quickly, leading to tissue death, sepsis, and organ failure.
• Treatment involves intravenous antibiotics, surgical removal of dead tissue, and, in severe cases, blood transfusions or limb amputation to contain the infection.
• Preventive measures, including proper wound care, good hygiene practices, and avoiding exposure to contaminated water, can help minimize the risk of infection.