Person with necrotizing fasciitis. The left leg shows extensive redness and tissue death.
Pronunciation
/ˈnɛkrəˌtaɪzɪŋˌfæʃiˈaɪtɪs/ or /ˌfæs-/
Specialty
Infectious disease
Symptoms
Severe pain, fever, purple colored skin in the affected area[3]
Usual onset
Sudden, spreads rapidly[3]
Causes
Multiple types of bacteria,[4] occasional fungus[5]
Risk factors
Poor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, peripheral artery disease[2][3]
Diagnostic method
Based on symptoms, medical imaging[4]
Differential diagnosis
Cellulitis, pyomyositis, gas gangrene[6]
Prevention
Wound care, handwashing[3]
Treatment
Surgery to remove the infected tissue, intravenous antibiotics[2][3]
Prognosis
~30% mortality[2]
Frequency
0.7 per 100,000 per year[4]
Necrotizing fasciitis (NF), also known as flesh-eating disease, is a bacterial infection that results in the death of parts of the body's soft tissue.[3] It is a severe disease of sudden onset that spreads rapidly.[3] Symptoms usually include red or purple skin in the affected area, severe pain, fever, and vomiting.[3] The most commonly affected areas are the limbs and perineum.[2]
Typically, the infection enters the body through a break in the skin such as a cut or burn.[3] Risk factors include poor immune function such as from diabetes or cancer, obesity, alcoholism, intravenous drug use, and peripheral artery disease.[2][3] It does not typically spread between people.[3] The disease is classified into four types, depending on the infecting organism.[4] Between 55 and 80% of cases involve more than one type of bacteria.[4] Methicillin-resistant Staphylococcus aureus (MRSA) is involved in up to a third of cases.[4] Medical imaging is often helpful to confirm the diagnosis.[4]
Necrotizing fasciitis may be prevented with proper wound care and handwashing.[3] It is usually treated with surgery to remove the infected tissue, and intravenous antibiotics.[2][3] Often, a combination of antibiotics is used, such as penicillin G, clindamycin, IV vancomycin, and gentamicin.[2] Delays in surgery are associated with a much higher risk of death.[4] Despite high-quality treatment, the risk of death is between 25 and 35%.[2]
Necrotizing fasciitis occurs in about 0.4 people per 100,000 per year in the U.S., and about 1 per 100,000 in Western Europe.[4] Both sexes are affected equally.[2] It becomes more common among older people and is rare in children.[4] It has been described at least since the time of Hippocrates.[2] The term "necrotizing fasciitis" first came into use in 1952.[4][7]
^Rakel, David; Rakel, Robert E. (2015). Textbook of Family Medicine. Elsevier Health Sciences. p. 193. ISBN 9780323313087. Archived from the original on 2017-09-08.
^ abcdefghijkHakkarainen, Timo W.; Kopari, Nicole M.; Pham, Tam N.; Evans, Heather L. (2014). "Necrotizing soft tissue infections: Review and current concepts in treatment, systems of care, and outcomes". Current Problems in Surgery. 51 (8): 344–62. doi:10.1067/j.cpsurg.2014.06.001. PMC 4199388. PMID 25069713.
^ abcdefghijklm"Necrotizing Fasciitis: A Rare Disease, Especially for the Healthy". CDC. June 15, 2016. Archived from the original on 9 August 2016. Retrieved 13 August 2016.
^Ralston, Stuart H.; Penman, Ian D.; Strachan, Mark W. J.; Hobson, Richard (2018). Davidson's Principles and Practice of Medicine E-Book. Elsevier Health Sciences. p. 227. ISBN 9780702070266.
^Ferri, Fred F. (2013). Ferri's Clinical Advisor 2014 E-Book: 5 Books in 1 . Elsevier Health Sciences. p. 767. ISBN 978-0323084314.
^Wilson, B (1952). "Necrotizing fasciitis". The American Surgeon. 18 (4): 416–31. PMID 14915014.
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