NECROTIZING FASCIITIS

By: XXXXXXXXXXXBiology 1407April 23, 2010Houston Community College

What is Necrotizing Fasciitis? A progressive, rapidly spreading,

inflammatory infection located in the deep fascia, with secondary necrosis (death) of the subcutaneous tissues.

Commonly called flesh-eating bacteria 25% of people who contract Necrotizing

Fasciitis will die from it.

What Causes Necrotizing Fasciitis?

A group of bacteria called Group A Streptococcus cause NF (Necrotizing Fasciitis).

These bacteria also cause such diseases as strep throat, scarlet fever, and pneumonia.

Some of the bacteria from this group include Staphylococcus aureus, Vibrio vulnificus, and Clostridium perfringens.

Pathophysiology of Necrotizing Fasciitis

There is a misconception about this disease: the bacteria does not actually “eat” the skin or tissue.

The bacteria comes in through an opening in the skin, from the size of a paper cut or pin prick to a major trauma or surgery incision.

Pathophysiology of Necrotizing Fasciitis

The bacteria releases toxins (virulence factors), which activate T-cells nonspecifically, which stimulate the overproduction of cytokines.

This leads to inflammation, then leads to tissue death.

Where does the bacteria come from?

The bacteria comes from respiratory droplets Coughing Sneezing

Direct contact with secretions from someone carrying the bacteria. Body fluids

Who Can Get Necrotizing Fasciitis?

Anyone can have Necrotizing Fasciitis. It does matter if you are male or female,

old or young, or of a specific race. Also, the disease can be contracted

anywhere in the world. No one is immune to this ailment.

Higher Risk Groups to Contract NF

The higher risk groups to acquire Necrotizing Fasciitis include people with: Weak immune systems Chronic health problems, like diabetes,

cancer, liver or kidney diseases Cuts on skin, including surgical wounds

Higher Risk Groups to Contract NF

The higher risk groups to acquire Necrotizing Fasciitis include: People who recently had chickenpox or a

viral infection that causes a rash People that use steroid medications

Chicken Pox

Symptoms of NF

Early Stages (Within 24 hours) Minor trauma or other skin opening

(not necessarily infected) Some pain from wound Pain whole lot worse than wound

Symptoms of NF

Early Stages Flu-like symptoms- diarrhea, nausea,

fever, confusion, dizziness, weakness, and depression

Intense thirst

Symptoms of NF

Advanced Symptoms (within 3-4 days) Limb or area experiencing pain begins to

swell, and may turn purple May start to have large dark marks, might

turn into blisters filled with blackish fluid May start to appear necrotic with bluish,

white or dark, spotted, flaky appearance

Symptoms of NF

Critical Symptoms (usually within 4-5 days) Blood pressure drops severely Toxic shock Unconsciousness

How is NF Diagnosed?

CT scan - if diagnosis is uncertain or to show depth

X-rays Chest- to look for signs of lung damage

(respiratory distress syndrome) Others check for gas and fluid buildup at

site of infection

How is NF Diagnosed?

MRI - if diagnosis is uncertain or to show depth

Tissue cultures - for bacteria Blood Tests - CBC, blood chemistry,

creatine phosphokinase, C-reactive protein- shows whether infection present or muscles have been damaged

Misdiagnosis

Many times Necrotizing Fasciitis is misdiagnosed for a variety reasons: Early symptoms are the same as many

other illnesses. Rare disease

Treatment of NF

Usually starts with IV antibiotics: penicillin, vancomycin, and clindamycin

Aggressive debridement - removal of affected tissue by surgery

Skin grafting to cover large openings in the skin after debridement

Treatment of NF

Hyperbaric oxygen therapy - helps prevent tissue death and promote healing

Amputation Other medications to treat symptoms,

like blood pressure

Prevention of NF

Good Hygiene Anti-microbial soap Cover your mouth when you cough or

sneeze

Prevention of Necrotizing Fasciitis

Throw away tissues Wash hands frequently Avoid contact with persons showing sore

throat symptoms

Glossary

Autolytic - using your own body’s processes CT Scan - sometimes called CAT scan-

combines special x-ray equipment with sophisticated computers to produce multiple images or pictures of the inside of the body. CT scans provide greater clarity and reveal more details than regular x-ray exams.

Debridement - removal of unhealthy tissue from a wound to promote healing. It can be done by surgical, chemical, mechanical, or autolytic removal of the tissue.

Glossary

Fascia - strong connective tissue which envelops and isolates the muscles of the body, and provides structural support and protection.

MRI - Magnetic Resonance Imaging - uses a powerful magnetic field, radio frequency pulses and a computer to produce detailed pictures of organs, soft tissues, bone and virtually all other internal body structures.

Necrosis - death of body tissue, occurs when there is not enough blood flowing to the tissue, whether from injury, radiation, or chemicals. Necrosis is not reversible.

Glossary

Pneumonia - respiratory condition in which there is inflammation of the lung.

Scarlet fever - or scarlatina, is an illness that brings on a rash covering most of the body, a strawberry-like appearance of the tongue and usually a high fever.

Subcutaneous tissue - loose connective tissue under the dermal skin layer.

Bibliography

"CT - Body." RadiologyInfo.org. RadiologyInfo.org, 2010. Web. 25 Apr 2010. <http://www.radiologyinfo.org/en/ info.cfm?pg=bodyct>.

"Debridement of a Wound, Infection, or Burn." Your Health. Aurora Health Care, 2010. Web. 15 Apr 2010. <http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%2214803.html%22>.

"MRI of the Body (Chest, Abdomen, Pelvis)." RadiologyInfo.org. RadiologyInfo.org, 2010. Web. 22 Apr 2010. <http://www.radiologyinfo.org/en/info.cfm?pg= bodymr>.

Bibliography

"Necrosis." Medline Plus, 2010. Web. 24 Apr 2010. <http://www.nlm.nih.gov/medlineplus/ency/article/ 002266.htm>.

"Necrotizing Fasciitis." Medicine Net. Medicine Net, 2009. Web. 25 Apr 2010. <http://www.medicinenet.com/necrotizing_fasciitis/ page4.htm>

"Necrotizing Fasciitis." WrongDiagnosis.com. WrongDiagnosis.com, 2009. Web. 18 Apr 2010. <http://www.wrongdiagnosis.com/n/ necrotizing_fasciitis/intro.htm>

Bibliography

"Necrotizing fasciitis: an uncommon disease, frequently misdiagnosed." Access My Library. Access My Library, 2008. Web. 25 Apr 2010. <http://www.accessmylibrary.com/article-1G1-121416627/necrotizing-fasciitis-uncommon-disease.html>.

"NF Fact Sheet." National Necrotizing Fasciitis Foundation, 2009. Web. 25 Apr 2010. <http://www.nnff.org/nnff_factsheet.htm>.

"Pneumonia." Google Health. Google, 2010. Web. 25 Apr 2010. <https://health.google.com/health/ref/Pneumonia>.

Bibliography

"Scarlet Fever." Mayo Clinic. Mayo Clinic, 2010. Web. 25 Apr 2010. <http://www.mayoclinic.com/health/scarlet-fever/DS00917>.

"Subcutaneous Tissue." WrongDiagnosis.com. WrongDiagnosis.com, 2009. Web. 25 Apr 2010. <http://www.wrongdiagnosis.com/medical/ subcutaneous_tissue.htm>

"What is Fascia?." Wise Geek. Wise Geek, 2010. Web. 24 Apr 2010. <http://www.wisegeek.com/what-is-fascia.htm>.