“Flesh-eating bacteria” — just the facts

Unfortunately, “flesh-eating bacteria” (medical name: Necrotizing fasciitis) has been in the news again lately and fear of this frightening condition is spiking. A few important things to be aware of:

1. While usually devastating and often deadly, necrotizing fasciitis (NF) remains very rare. Despite high-profile cases, it is not believed to be on the increase.

2. It’s often caused by Group A strep bacteria (the same bacteria that causes “strep throat”), but MRSA (resistant staph aureus) has become a prominent cause in the last decade. Virtually any bacteria can cause NF and multiple bacteria may be involved simultaneously.

3. Those most susceptible are patients with underlying medical problems (eg diabetics, those with cancer, alcohol/drug abusers and others with chronic illnesses) unlike the previously healthy victims most commonly reported on by the media.

4. The bacteria is usually delivered to body tissue structures called “fascia” via a deep, penetrating wound, but even minor wounds such as a staple cut or sliver can produce the condition. Rarely, the bacteria can reach the fascia without apparent preceding trauma.

5. Fascia are thin sheets of connective tissue around and between muscles. They have no blood supply, which creates the following problems: The body’s natural defense against infection – an army of white blood cells – can’t reach the bacteria there; nor can antibiotics. Also, as the bacteria multiply, the infection spreads rapidly along the fascial planes of tissue. Finally, because the tissue is well below the skin, the signs of infection may be difficult to detect — especially early on.

6. One sign to be particularly on the lookout for is pain out of proportion to the apparent severity of the wound. This should prompt immediate evaluation with clear mention to your doctor that the pain is much worse than it looks. [Other worrisome signs to watch forgenerally include: redness/red streak going up the arm or leg, blistering, swelling, warmth, oozing or foul-smelling discharge. These signs suggest serious infection of skin or related soft tissues and should prompt a rapid evaluation by a doctor to rule out necrotizing fasciitis.

7. Non-specific symptoms like nausea, vomiting, and fever or even confusion may also occur as NF progresses.

8. Despite the lack of blood supply to the fascia, antibiotics are still part of the treatment plan to help protect adjacent tissues that do get a blood supply. Emergency surgical removal of the involved tissue is essential to halt continuing spread of the process.

9. The bacteria which cause NF aren’t truly “flesh-eating”. Rather, they release toxins, which cause destruction of the tissues.

10. The best protection against “flesh-eating” bacteria (as well as less ominous infections) is prompt, thorough cleansing of all skin wounds with soap and water followed by coverage with a clean bandage or bandaid. This should be followed by frequent monitoring for signs of infection which typically appear soon after the trauma (ie commonly within 24 hours). The first three early signs of skin infection are pain, redness and swelling at the site of the wound. Any of these should prompt a visit to your doctor for further evaluation and treatment.

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