Necrotizing fasciitis is a life-threatening bacterial infection that may follow trauma, but also can accompany mild scrapes and insect bites. This disease rapidly destroys muscle, fat and skin tissue. The cause of necrotizing fasciitis is most often strains of group A streptococcus bacteria, but other bacteria including Clostridium, Pseudomonas, and Escherichia can also cause this disease. The factors that predispose a person to necrotizing fasciitis are age, diabetes, recent surgery or trauma, alcoholism, intravenous drug use and a compromised immune system. However, a review article in the “Journal of the European Academy of Dermatology & Venereology” reported nearly 50 percent of infections occur in young healthy persons.
Symptoms
Necrotizing fasciitis is difficult to diagnose, but the early detection of the infection greatly enhances survival. The initial symptoms of necrotizing fasciitis are low blood pressure, systemic flu-like symptoms and severe pain that is out of proportion to the size of the wound. The most deadly manifestation of necrotizing fasciitis is streptococcal toxic shock syndrome, which has the symptoms of high fever, confusion, multi-organ failure and may rapidly progress to death.
Debridement
The removal of all damaged and infected tissue, also known as debridement is critical to prevent the spread of the necrotizing infection and toxic shock. The authors of the review article in the “Journal of the European Academy of Dermatology & Venereology” recommend daily evaluation of the wound with repeated debridement until all dead tissue is removed and new tissue growth is observed.
Antibiotics
Clindamycin is effective in treating infections caused by group A streptococcus and is often the initial antibiotic administered to patients with necrotizing fasciitis. Combinations of broad-spectrum antibiotics may likely be administered and could be changed after culturing has provided a more accurate description of the type of bacteria causing the infection.
Hyperbaric Oxygen Therapy
Hyperbaric oxygen therapy, in addition to debridement and antibiotics, may be used to treat necrotizing fasciitis. This type of therapy is conducted in a chamber that has higher oxygen levels then the surrounding atmosphere. It increases the level of oxygen in tissues and improves the immune response. A study in the March 2010 issue of “Undersea and Hyperbaric Medicine” notes that hyperbaric oxygen therapy did not improve the length of hospital stay or mortality incidence in patients with necrotizing fasciitis, but it did reduce the number of amputations in treated patients in comparison to those who did not receive this type of therapy.
Intravenous Immunoglobulin Therapy
Intravenous immunoglobulin therapy is the infusion of antibodies into a patient to increase their immune defenses. This treatment for necrotizing fasciitis is controversial and has not been adequately studied. A study in the journal “Current Opinion in Infectious Disease” states that intravenous immunoglobulin therapy has been shown to reduce mortality in patients that have necrotizing fasciitis that is accompanied by streptococcal toxic shock syndrome.
