Necrotizing Fasciitis (Flesh-Eating Disease)

Necrotizing fasciitis is a severe bacterial infection in the tissue under your skin, the fascia. It spreads rapidly and can cause death.

Necrotizing fasciitis is a form of necrotizing soft tissue infection (NSTI). Some people call necrotizing fasciitis or any NSTI the “flesh-eating disease.” Necrotizing fasciitis is rare. It affects about 1 in every 250,000 people in the United States.

You may see symptoms of necrotizing fasciitis within 24 hours of getting scratched or bitten or cutting yourself. It gets worse quickly. Keep an eye out for areas that look swollen or discolored and grow larger.

This infection needs immediate medical treatment.

Types of this condition

There are two types of necrotizing fasciitis:

• Polymicrobial (Type I): More than one type of bacterium causes the infection.
• Monomicrobial (Type II): One type of bacterium causes this — usually group A Streptococcus or Staphylococcus aureus (staph).

Symptoms of necrotizing fasciitis

Early symptoms of necrotizing fasciitis resemble those of the flu. They typically start within 24 hours of a minor injury and include:

• Body aches
• Fever and chills
• Nausea and diarrhea
• Severe pain at the site of injury

Within hours to days, you develop symptoms like:

• Discolored skin
• Swelling of affected tissues
• Skin that’s warm to the touch
• Worsening pain and fever
• Blisters filled with bloody or yellowish fluid
• Low blood pressure, which can cause dizziness

Get medical care as soon as possible if you have these symptoms.

Necrotizing fasciitis causes

Bacteria that spread in the tissue under your skin (fascia) cause necrotizing fasciitis. Group A strep bacteria are the most common cause. But you can get it from many different types of bacteria, including bacteria that live in water.

Ways that bacteria can enter your fascia include:

• Cuts, scrapes or burns
• Insect bites
• From needles and other things that cause puncture wounds
• Surgery
• Injuries that don’t break your skin (less common)

Anybody can get this infection. But you’re at increased risk for it if you have a weakened immune system or diabetes.

Upon infection, the bacteria or bacterium spreads through your fascia. They produce toxins that limit blood flow to your fascia and the tissues around it. This leads to tissue death (necrosis). The toxins can also damage other parts of your body, like your organs.

Due to a lack of blood supply to the tissues, your body’s immune system can’t fight the infection. Antibiotics alone can’t fight it either. You need surgery to stop the spread of the infection and to remove dead tissue.

Is necrotizing fasciitis contagious?

Necrotizing fasciitis rarely spreads from one person to another. But rarely, in cases of severe infection, your provider might recommend that your close contacts take preventive antibiotics.

How to lower your risk

You can’t always prevent necrotizing fasciitis. But to reduce your risk of it, do the following:

• Clean wounds with soap and water. Cover them with a clean bandage until they heal.
• See your healthcare provider for any deep cuts or punctures.
• Don’t go into swimming pools, hot tubs or outside bodies of water if you have a break in your skin.

Complications of this condition

Many complications of necrotizing fasciitis are serious. They may include:

• Severe scarring
• Amputation
• Toxic shock syndrome
• Sepsis
• Multiple organ failure
• Death

How doctors diagnose this condition

If your healthcare provider thinks you have flesh-eating disease, they may do diagnostic tests, like:

• Blood tests, such as a complete blood count (CBC)
• Exploratory surgery
• Imaging tests, like a CT scan

Your provider may also send a tissue sample to a lab to find the bacteria that’s causing the infection.

How is it treated?

You need immediate treatment for necrotizing fasciitis. You’ll receive care in the intensive care unit (ICU) of a hospital.

Surgery is a must for this infection. It’s necessary to remove dead tissue (debridement) and stop the spread of the infection. You may need multiple surgeries.

Your provider will also likely prescribe antibiotics and IV fluids. After surgery, you may need skin grafts or plastic surgery to help the wounds close completely.

When should I see my healthcare provider?

You’ll likely need follow-up care to make sure you’re healing well. Ask your healthcare provider what typical healing looks like. Ask about signs to look for that may mean something is wrong.

What is the prognosis for someone with necrotizing fasciitis?

Your prognosis (outlook) for necrotizing fasciitis depends on many factors, like:

• How quickly you receive the diagnosis and treatment
• Your age and overall health
• The type of bacteria causing the infection

The odds of survival are best for people who get immediate debridement surgery, IV fluids and broad-spectrum antibiotics. Even with treatment, about 1 out of 3 people die from this condition.

What can I expect if I have this condition?

After initial treatment, it may take a while to feel healthy again. Necrotizing fasciitis can drastically change your body. You may benefit from physical therapy and other types of rehabilitation. It’s also important to get mental health help if the aftermath of necrotizing fasciitis is causing distress.