Necrotizing Fasciitis

Justina Du, Thao Nguyen,

Camille Thorsen

What is Necrotizing Fasciitis?

• life-threatening, progressive, rapidly spreading, inflammatory infection located in the deep fascia.

• infection rapidly destroy the skin and soft tissue beneath it

• Also known as: “flesh-eating” bacteria.

• Other names: β-hemolytic streptococcal gangrene, Meleney ulcer, acute dermal gangrene, hospital gangrene, and necrotizing cellulitis.

• 3 types of NF.

– Type I : a polymicrobial flora.

– Type II Group A β-Streptococcus bacteria (most common case)

– Type III : marine vibrio gram-negative rods.

How does one contract NF?

• exposed to an individual with an opening in their skin. – direct contact with someone carrying the bacteria – the bacterium being carried by the person itself.

• sight of entrance can be as minor as a paper cut or a pin prick.

• enter through weakened skin, as a contusion, a bruise, a blister, or even an abrasion.

• Can happen to anyone!!!!!!

Cofactors that Increase risks

• Diabetes

• Alcoholism

• Immuno-suppression

• Severe illnesses: heart, lung, or liver disease

• Obesity

What’s going on inside your body?

• Bacteria eat away at tissue between skin and muscle• Increase in sensitivity or anaesthetic feel to the skin itself• Inflammatory response by immune system• Bacterial toxins released • Cytokines impede function of phagocytic cells

– Anaerobes thrive speeding up necrotic process• Endothelial cells become damaged;

– Increased permeability of the lining of vessels in the body• Poor blood supply inhibit:

– Inflammatory response process– Ability for the immune system to properly work– Ability to transfer antibiotics to the affected fascial layer

• Vasoconstriction and thrombosis edema hypoxia necrosis of the fascia, skin, soft tissue, and muscles.

• Additional necrosis involving the subcutaneous nerves.

What are the early symptoms and signs of NF?

• Flu like symptoms that include fever, chills, nausea, weakness, dizziness, aches and a heat rate of more than 100 beats per minute.

• Skin becomes tender, warm, red in color, and will start to swell.

• Patients may experience pain greater than expected from the appearance of the wound.

• Subcutaneous tissue may also have a hard feel on palpation that goes past the visibly infected area.

• Clinically indistinguishable from other possible soft tissue infections with only the presentation of pain, tenderness, and warm skin.

Advanced symptoms…

• The advanced symptoms appear as the disease progresses

• The area of the body experiencing pain begins to swell excessively.

• Multiple discolored patches develop to produce a large area of gangrenous skin.

• Initial necrosis appears as a massive destruction of the skin and subcutaneous layer.

• The normal skin and subcutaneous tissue are loosened.

• Large, dark marks that become blisters filled with a yellow-green necrotic fluid appear.

Critical symptoms…• The critical symptoms form in the last stages of NF.

• 30% of patient’s develop hemorrhagic bullae which may cause them to become anemic.

• Vasculature of the skin becomes inflamed and thrombosed. Resulting in necrotic eschars that look like deep thermal burns.

• Without treatment, secondary involvement of deeper muscle layers may occur.

• Patients may become numb because of nerve damage and progressing gangrene in the infected area.

• Unconsciousness will occur as the body becomes too weak to fight off the infection along with a severe decrease in the patient’s blood pressure.

• As toxins are being released, the body’s organ may go into septic shock while contracting a high fever, high white blood count, and becoming disoriented. This may result into respiratory failure, heart failure and renal failure.

Exams and Laboratory Testing

• In order to get a definitive diagnosis of NF, physicians look for abnormalities in the test results that are characteristics of the disease.

• Some of these tests include:1. Blood samples2. Testing for elevated or lowered creatinine, glucose, CPK, bicarbonate, albumin, and calcium levels.3. X-ray4. CT, and MRI scanning5. And most importantly antibiotic culture and sensitivity tests

Treating NF

• Early diagnosis and treatment is vital

• Emergency debridement

• IV antibiotic treatment

• Hyperbaric oxygen therapy is recommended for anaerobic organisms

• Morphine drip and a patient-controlled analgesia pump to control pain

• Soft tissue reconstruction

• Monitor nutrition

• If sepsis has set in, vasoconstricting medications should be given.

• Education and counseling

PREVENTION!!!

• Most people are in good health before they become infected.

• Degrees to lessen your chances– basic hygienic practices (washing

hands),

– keep all wounds clean,

– watch for signs of infection (increase pain, swelling, pus, heat or fever),

– seek immediate medical attention if have symptoms of flesh-eating disease, and

– have precaution if in close contact

with someone with the bacteria.