Necrotizing fasciitis, or flesh-eating disease, is a rare, fast-moving bacterial infection that causes the fascia under the skin to break down and die. Because tissue is dying, this condition can turn into a life-threatening emergency quickly.
Any break in the skin, such as from injury, surgery, or IV drug use, can enable the condition. Necrotizing fasciitis must be treated as quickly as possible to avoid further damage or death. Doctors treat the condition with antibiotics, surgery, and blood transfusions.
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What Is Necrotizing Fasciitis?
Necrotizing fasciitis, or flesh-eating disease, is a rare, fast-moving bacterial infection that causes the fascia (soft connective tissue) under the skin to break down and die. The fascia surrounds and supports every part of your body, including organs, bones, muscles, blood vessels, and fat. When the infection spreads, tissue dies rapidly, turning this condition into a life-threatening emergency.
Any break in the skin — such as from injury, surgery, or IV drug use — can enable bacteria to enter and start the infection. The most common cause is Group A Streptococcus (strep), but other bacteria like Staphylococcus aureus, Escherichia coli (E. coli), and Klebsiella can also be responsible. Often, more than one type of bacteria is involved.
Necrotizing fasciitis is very rare, affecting about 4 in 1 million Americans each year. Most cases occur in people with other health problems, but anyone can be affected.
Necrotizing fasciitis risk factors
- Alcohol use disorder.
- Blunt trauma (even without broken skin).
- Cancer.
- Chronic kidney disease.
- Cirrhosis of the liver.
- Diabetes.
- Having an open wound.
- IV drug use.
- Obesity.
- Pregnancy.
- Weakened immune system.
Complications of necrotizing fasciitis
Because flesh-eating bacteria spread quickly, complications can be severe and include:
- Death.
- Loss of limbs.
- Organ failure.
- Severe scarring.
- Sepsis and septic shock.
- Toxic shock syndrome.
Necrotizing fasciitis prevention
Good hygiene and proper wound care are the best ways to prevent necrotizing fasciitis, including:
- Avoid swimming or using hot tubs if you have an open wound.
- Clean wounds with soap and water; cover with clean bandages or gauze.
- See a provider for deep wounds or punctures.
- Wash your hands often.
What Are the Signs and Symptoms of Necrotizing Fasciitis?
Flesh-eating disease forms quickly.
Early symptoms include:
- Fever.
- Intense pain around a wound, even after the initial injury pain subsides.
- Pain when touching nonswollen or red skin near the wound.
- Popping or cracking sounds under the skin (from gas produced by bacteria).
- Skin around a wound feels warm.
- Swelling and discoloration that spreads rapidly.
Later symptoms include:
- Blisters or sores.
- Bluish-gray or black areas on the skin.
- Diarrhea.
- Dizziness.
- Fast heartbeat.
- High fever.
- Reduced pain due to nerve damage.
- Necrosis (black spots), ulcers, or pus.
When should I seek help for necrotizing fasciitis?
Go to the emergency department immediately if you have swelling and red or discolored skin that spreads quickly from a wound, or any of the above symptoms after injury or surgery.
How Do You Diagnose Necrotizing Fasciitis?
Diagnosis can be challenging since early symptoms resemble other infections.
Doctors will:
- Ask about symptoms and medical history.
- Perform a physical exam.
- Order tests such as:
- Biopsy —Tissue sample for lab testing.
- Bloodwork to check for infection.
- Culture of wound fluid to identify bacteria
- Imaging — CT scan, MRI, or ultrasound.
How Do You Treat Necrotizing Fasciitis?
Prompt hospital treatment is essential. Necrotizing fasciitis is a medical emergency that requires rapid intervention to prevent severe complications or death.
Treatment options include:
Antibiotics
Doctors administer powerful antibiotics directly into a vein (IV) to halt the infection quickly. This method ensures the drugs reach the bloodstream rapidly and work faster against the bacteria. Multiple types of antibiotics may be used at once to cover all possible bacteria involved.
Surgery (debridement)
- Removal of dead and infected tissue — The main surgical procedure is called debridement, where surgeons open the skin around the wound and remove all dead, infected, or potentially infected tissue. Debridement is necessary because antibiotics alone cannot reach areas where the blood supply has been destroyed by the infection.
- Multiple surgeries — People with flesh-eating disease often require several surgeries to ensure all infected tissue is removed and to restore healthy blood flow. In severe cases, amputation of a limb may be necessary to stop the spread of infection.
- Plastic reconstructive surgery or skin grafts — After the infection is controlled, reconstructive procedures may be needed to close wounds and restore function or appearance to the affected area.
Blood transfusions
- Support after surgery — Blood transfusions may be required if there is significant blood loss during surgery or if your blood count drops due to infection or repeated procedures.
Other treatments
- Intravenous immune globulin (IVIG) — Human antibodies may be given to help fight the infection, especially if the bacteria produce toxins that damage tissue.
- Medicines to support organs — You might need medications to support vital organs, such as the heart, lungs, or kidneys, if the infection causes organ failure.
- Hyperbaric oxygen therapy — This therapy involves breathing pure oxygen in a pressurized chamber, which can help speed wound healing and fight infection. It is used when possible, but may not be suitable for very ill patients.
Monitoring and follow-up
- Close Monitoring — After initial treatment, your wound and overall health are closely monitored for signs of ongoing infection or complications. Additional surgeries or treatments may be needed if new areas of infection develop.
Prognosis
Even with aggressive treatment, necrotizing fasciitis can be fatal. About 1 in 5 people may die from it. Survivors often have reduced function in the affected area due to destroyed muscles, nerves, and blood vessels. Early treatment greatly improves chances of survival.
