Today's condition is the rarest we’ve spotlighted to date: Necrotizing Fasciitis. This rare infection affects only about 4 in 1 million people in the US every year. Though mortality rates have improved since it was first identified in 1871, it still has a high rate of misdiagnosis. Since early treatment is essential for a positive outcome, it’s important to know the risk factors and early warning signs of infection.
What Is It?
Necrotizing fasciitis (NF) is a rare infection of the soft connective tissue (fascia) system. The infection is sudden and aggressive: attacking the skin, tissue just below the skin, and fascia. There are many types of bacteria that can cause NF, but group A strep is the most common cause. Bacteria enters the body mostly through breaks in the skin (cuts, scrapes, burns, insect bites or puncture wounds). It is also possible, though incredibly rare, for NF to result from blunt force trauma. The bacteria damage tissue by releasing toxins that restrict blood flow, preventing the body's immune response from reaching the infected areas.
Early symptoms are flu-like (fever, general body aches, etc), which contributes to its high rate of misdiagnosis (only 15-24% of patients with NF are admitted to the hospital with an accurate initial diagnosis). More easily identifiable symptoms include swelling, heat, and disproportionately painful spots on the body. The infection site is not always obvious, as the softer tissues tend to be affected before the skin starts showing any outward signs of infection. NF is fast-spreading, and the severe pain of infection can spread from the initial site as quickly as an inch an hour.
As the infection progresses, symptoms grow to include ulcers, blisters, or black spots on the skin; pus or oozing at the infection site; dizziness; fatigue; diarrhea; sore throat; and nausea. In the later stages, pain at the affected areas tends to suddenly improve as nerves begin to die and sensation is lost.
Anyone can get NF, however there are some conditions that make infection more likely. Diabetes is a major risk factor for NF, with one study showing that 70% of patients with NF also had diabetes. A history of alcoholism and liver cirrhosis are also major contributors. Other risk factors include: kidney disease, cancer, immunosuppressive drugs, malnutrition, age over 60 years, intravenous drug misuse, peripheral vascular disease, and obesity. NF is also a very rare complication of chickenpox in young children.
Luckily, NF is very rarely contagious. While people who’ve been exposed to NF should look out for early warning signs, the chance of becoming infected is very low and doesn’t require proactive antibiotic treatment.
Though many of the early symptoms mimic minor illness, it’s important to immediately seek medical attention if you suspect an NF infection. Patients who delay treatment are at major risk of developing sepsis or toxic shock syndrome, making them twice as likely to face multiple organ failure and death. The loss of limbs or severe scarring is also highly likely if the infection is allowed to spread due to delayed care. Without medical intervention, NF’s mortality rate is near 100%.
Hospital care is always required for NF, though most patients are admitted before receiving an accurate diagnosis. A hospital’s first choice for diagnosis is generally a CT scan, as it is the most readily available and effective non-invasive diagnostic tool for NF. The second option (and the unfortunate golden standard) is exploratory surgery.
Once a patient has been diagnosed with NF, treatment includes surgery and antibiotics. In most cases, surgeons will first remove dead tissue to prevent spread of the infection and allow the surrounding tissue to recover. On average, patients receive 3 surgeries spaced 12 – 36 hours apart to remove all infected tissue. Once the surgeries are complete, skin grafts and plastic surgery are used to fully close the wounds. Throughout this process, antibiotics are used to control sepsis and prevent further spread of the infection.
Preventative Care and the Rebuilder®
There are no vaccines to prevent the infections that cause NF. As such, other preventative measures are essential. The easiest way to prevent NF is to properly clean, treat, and bandage all open wounds. For more serious wounds, like punctures or deep cuts, make sure to seek medical attention immediately. If you have an open wound or skin infection, avoid hot tubs, swimming pools, and natural bodies of water. Making sure to properly wash your hands with soap and water is another quick and easy way to prevent all infections, including NF.
However, even with all the proper precautions, infection can still occur. In that case, as we’ve stated several times in this article, early diagnosis is essential. Unfortunately, that can be difficult if you suffer from neuropathy with loss of sensation. Since early signs of NF include pain and increased temperature at the infection site, loss of sensation can mask these symptoms and delay diagnosis. Especially since 50% of NF cases occur in the extremities where peripheral neuropathy tends to affect the body most.
This is where the ReBuilder® can help. By stimulating and retraining the nerves, the ReBuilder® can help you regain feeling in areas affected by neuropathy. With sensation back, it’s easier to identify when you’ve been injured and if those injuries have become infected. Though NF is the most extreme case, it’s best to catch even minor infections early. Returning feeling to the body is an important step toward this goal. To take the first steps toward a happier, healthier you with the ReBuilder®, click the button below to give us a call at 877-717-5487. Or check out our Find A Doctor page and we can help direct you to the nearest participating physician.
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