View source for Necrotizing fasciitis

{{Infobox_Disease |
  Name            = Necrotizing fasciitis |[[Image:''Example.jpg''"Quote from Belinda Collins": This is exactly what i had!!]]
  ICD10           = {{ICD10|M|72|6|m|70}} |
  ICD9            = {{ICD9|728.86}} |
  MedlinePlus     = 001443 |
  eMedicineSubj   = emerg |
  eMedicineTopic  = 332 |
  eMedicine_mult = {{eMedicine2|derm|743}} |
  MeshName        = Necrotizing+Fasciitis |
  MeshNumber      = C01.252.410.890.350 |
}}
{{SI}}
{{EH}}

__NOTOC__

{{CMG}}

'''Associate Editor-In-Chief:''' {{CZ}}

==Overview==

'''Necrotizing fasciitis''' or '''fasciitis necroticans''', commonly known as “flesh-eating bacteria,” is a [[Rare disease|rare]] [[infection]] of the deeper layers of [[skin]] and [[Subcutis|subcutaneous tissue]]s, easily spreading across the [[fascia]]l plane within the [[subcutaneous]] tissue. Many types of [[bacteria]] can cause necrotizing fasciitis (eg. [[Group A streptococcal infection|Group A streptococcus]], ''[[Vibrio vulnificus]]'', ''[[Clostridium perfringens]]'', ''[[Bacteroides fragilis]]''), of which [[Group A streptococcal infection|Group A streptococcus]] (also known as ''Streptococcus pyogenes'') is the most common cause.

==Symptoms==
The infection begins locally, at a site of [[Physical trauma|trauma]], which may be severe (such as the result of [[surgery]]), minor, or even non-apparent. The affected skin is classically, at first, very painful without any grossly visible change. With progression of the disease, tissue becomes swollen, often within hours. Diarrhea and vomiting are common symptoms as well. Inflammation does not show signs right away if the bacteria is deep within the tissue. If it is ''not'' deep, signs of inflammation such as redness and swollen or hot skin show very quickly. Skin color may progress to violet and blisters may form, with subsequent [[necrosis]] (death) of the subcutaneous tissues. Patients with necrotizing fasciitis typically have a [[fever]] and appear very ill. More severe cases progress within hours, and the [[mortality rate]] is high, about 30%. Even with medical assistance, antibiotics take a great deal of time to react to the bacteria, allowing the infection to progress to a more serious state.<ref>http://www.webmd.com/a-to-z-guides Necrotizing Fasciitis Flesh Eating Bacteria Overview</ref> <ref>Tiu,A et al, ANZ J Surg. 2005 Jan-Feb;75(1-2):32-4 </ref>

==Pathophysiology==
“Flesh-eating bacteria” is a misnomer, as the bacteria do not actually eat the tissue. They cause the destruction of skin and muscle by releasing [[toxin]]s (virulence factors). These include streptococcal pyogenic exotoxins and [[Streptococcus pyogenes|other virulence factors]]. ''S. pyogenes'' produces an exotoxin known as a [[superantigen]]. This toxin is capable of activating [[T-cell]]s non-specifically. This causes the over-production of [[cytokines]] that over-stimulate [[macrophage]]s. The macrophages cause the actual tissue damage by releasing oxygen [[free radicals]] that are normally intended to destroy bacteria but are capable of damaging nearly any macromolecule they contact in the body.

==Treatment==
The diagnosis is confirmed by either [[blood culture]]s or aspiration of [[pus]] from [[Biological tissue|tissue]], but early medical treatment is crucial and often presumptive; thus, antibiotics should be started as soon as this condition is suspected. Initial treatment often includes a combination of intravenous antibiotics including [[penicillin]], [[vancomycin]] and [[clindamycin]]. If necrotizing fasciitis is suspected, surgical exploration is always necessary, often resulting in aggressive [[debridement]] (removal of infected tissue). As in other maladies characterized by massive wounds or tissue destruction, hyperbaric oxygen treatment can be a valuable adjunctive therapy, but is not widely available. [[Amputation]] of the affected organ(s) may be necessary. Repeat explorations usually need to be done to remove additional necrotic tissue. Typically, this leaves a large open wound which often requires skin grafting. The associated systemic inflammatory response is usually profound, and most patients will require monitoring in an [[intensive care unit]].

==Prognosis==
This disease is one of the fastest-spreading infections known, as it spreads easily across the [[fascia]]l plane within the [[subcutaneous]] tissue. For this reason, it is popularly called the “flesh-eating disease,” and, although rare, it became well-known to the public in the 1990s. Even with today's modern medicine, the [[prognosis]] can be bleak, with a [[mortality rate]] of approximately 25% and severe disfigurement common in survivors.

==Other bacterial strains==
In February 2004, a rarer but even more serious form of the disease has been observed in increasing frequency, with several cases found specifically in California. In these cases, the bacterium causing it was a strain of ''[[Staphylococcus aureus]]'' (i.e. ''[[Staphylococcus]]'', not ''[[Streptococcus]]'' as stated above) which is [[Antibiotic resistance|resistant]] against [[methicillin]], the [[antibiotic]] usually used for treatment (see [[Methicillin-resistant Staphylococcus aureus|Methicillin-resistant ''Staphylococcus aureus'']] for details).

“Super Strep” appeared in Ohio and Texas in 1992 and 1993 and was contracted by approximately 140 people. It took under 12 hours to incapacitate most and caused 3 days of very high fevers. The death rate in 1993 was reported to be 10%, with a majority of the victims having mild to severe brain damage.

==See also==
* [[Mucormycosis]], a rare fungal infection which can present like necrotizing fasciitis
* [[Toxic shock syndrome]]

==References==
{{reflist|2}}

==External links==
*[http://www.nnff.org/ National Necrotizing Fasciitis Foundation official website]
*[http://www.flesheatingbacteria.net/ Flesh-Eating Bacteria]

{{Diseases of the musculoskeletal system and connective tissue}}
{{SIB}}

[[Category:Bacterial diseases]]
[[Category:Diseases involving the fasciae]]
[[Category:Dermatology]]
[[Category:Infectious skin diseases]]
[[Category:Rheumatology]]



[[de:Nekrotisierende Fasziitis]]
[[es:Fascitis necrotizante]]
[[fr:Fasciite nécrosante]]
[[nl:Necrotiserende fasciitis]]
[[tr:Nekrotizan fasiit]]

{{WikiDoc Help Menu}}
{{WikiDoc Sources}}